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    Edward Teach MD - The Last Psychiatrist

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    Edward Teach MD - The Last Psychiatrist

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    Augie

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    © All Rights Reserved
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    of 3437

    The Last Psychiatrist

    Archives
    2005.07.05: Do Antidepressants Induce Mania?
    2005.10.21: If France Gets Its Way, 38 Million People
    Will Die
    2005.12.11: So Ends The Ochlocracy of Medicine: How
    To Fix Medicaid, Part 1
    2006.03.22: Is Schizophrenia Really Bipolar Disorder?
    2006.04.02: Deja Vu
    2006.04.03: Nature Weighs in On What Is True
    2006.04.04: Subtypes of OCD
    2006.04.06: Pedophilia Makes You Stupid
    2006.04.08: The Other Abortion Question
    2006.04.10: Who Died?
    2006.04.14: Clozaril: FDA Misses The Point, Again
    2006.04.16: CATIE: Sigh
    2006.04.16: CATIE: And Another Thing
    2006.04.17: CATIE Reloaded
    2006.04.19: Healthcare Savings Accounts: Emphasis on
    Savings, Not Healthcare
    2006.04.20: Why Are So Many Psychiatrists From India?
    2006.04.25: Missing The Point At The NY Times
    2006.04.26: Who Are Academics Writing For? (For
    Whom Are Academics Writing?)
    2006.05.03: Are Antipsychotics Overprescribed In Kids?
    2006.05.06: Provigil vs. Cocaine
    2006.05.07: Modafinil vs. Clozaril
    2006.05.10: Atypicals and Diabetes: Glucose Transport
    2006.05.10: How Do Antipsychotics Cause Weight Gain?
    2006.05.14: Zyprexa’s Weight Gain: Does What You Eat
    Matter More Than How Much?
    2006.05.20: Parenting and Personality Disorders
    2006.05.21: Parenting and Personality: MAO-A
    2006.05.24: Liver and Medications
    2006.05.25: Ritalin Causes Cancer?
    2006.06.11: What You Need To Know About The MAOI
    (Selegiline) Patch
    2006.06.17: Selegiline: Can I Still Smoke Crack?
    2006.06.17: Pseudoseizures vs. Seizures
    2006.06.24: Selegiline Again— Neuroprotective?
    2006.06.28: Antispychotics and Lawyers
    2006.07.07: Star-D Study Participants: What’s Wrong
    With These People?
    2006.07.09: STAR*D Augmentation Trial: WRONG!
    2006.08.10: Plan B Emergency Contraception: Doctors
    Out of Their League, Again
    2006.08.17: Vioxx
    2006.08.30: $51M Vioxx Verdict Overturned
    2006.09.05: Ritalin Doesn’t Cause Cancer(?)
    2006.09.07: Stopping Meds Does Not Cause Relapse
    2006.09.15: What is Off Label Usage?
    2006.09.17: Breast Implants and Suicide
    2006.09.25: How To Get Rich In Psychiatry Steps 1-5
    2006.09.27: How to Write A Suicide Note
    2006.10.03: The Most Prescribed Drugs
    2006.10.07: Psychology vs. Psychiatry
    2006.10.09: Psychiatrists On The Wrong Side of Civil
    Rights, Again
    2006.10.12: One Last Word on University Suicide
    2006.10.14: Sunshine and Suicide
    2006.10.17: Werther Effect: Copycat Suicides May Not
    Exist
    2006.10.20: What Political Propaganda Looks Like
    2006.10.23: How To Get Rich In Psychiatry (update on
    stocks)
    2006.10.24: There’s A Shortage of Psychiatrists
    Somewhere, We Just Have To Find It
    2006.10.31: Psychiatry Is Politics
    2006.11.03: The Charade is Revealed— We Are Doomed
    2006.11.06: Lunar Cycles and Psychiatry
    2006.11.09: Suicide Note Revisited: Formulation
    2006.11.09: Massacre of The Unicorns
    2006.11.14: “Because I Said So”
    2006.11.16: The Ten Biggest Mistakes Psychiatrists
    Make
    2006.11.21: What Percentage of Suicides Had
    Depression?
    2006.11.23: Why Do The Elderly Commit Suicide?
    2006.11.26: Imitrex (sumatriptan) Is Good For Many
    Headaches— And Therefore Dangerous
    2006.11.28: Is Obstetrics Worse Than Psychiatry?
    2006.12.02: Who Would Benefit?
    2006.12.05: If Bipolar is Kindled Than You’re In Trouble
    2006.12.05: Murder-Suicide
    2006.12.07: How To Get Rich In Psychiatry Steps 6-10
    2006.12.12: Mood Stabilizer + Antipsychotic for Bipolar
    2006.12.13: Violent Crime vs. Coffee vs. Wine
    2006.12.14: If You Are Surprised By Vioxx’s Risks,
    You’re Fired
    2006.12.15: Diana Chiafair ‘s Hot, but Is She Illegal?
    2006.12.17: Time’s Person of the Year Is Someone Who
    Doesn’t Actually Matter
    2006.12.22: Christmas Break
    2006.12.26: An Army of Narcissists? No Way
    2006.12.27: Comedians Tosh, Gaffigan and Hedberg for
    Narcisissm
    2006.12.28: I’m One of The Best Doctors In America.
    Seriously.
    2006.12.29: If This Is One of The Sexiest Things You’ve
    Ever Seen, You May Be a Narcissist
    2006.12.31: This Is Not A Narcissistic Injury
    2007.01.02: Xanax, Vicodin, Percocet, Ritalin and
    Valium
    2007.01.03: Vote
    2007.01.05: Borderline
    2007.01.09: Neither Is This Is A Narcissistic Injury
    2007.01.10: Not Competent To Make Medical Decisions?
    2007.01.12: More on Medical Competency
    2007.01.19: Competency To Commit Suicide?
    2007.01.21: Competency to Be Executed
    2007.01.26: Further Thoughts on Competency To Be
    Executed
    2007.01.27: Atkins v. Virgina and the Execution of the
    Mentally Retarded
    2007.01.31: When Your Patient’s Parent Is A Psychiatrist
    and A Patient and You Just Want To Go To Bed
    2007.02.02: What Goes Wrong In A Psychiatrist’s
    Family?
    2007.02.06: Geodon Is Not BID
    2007.02.11: What Is The Best and Healthiest Coffee To
    Drink?
    2007.02.15: Lost TV Series: Desmond’s Fear and
    Trembling
    2007.02.19: Pediatric Bipolar. Yeah. Okay.
    2007.02.20: Just How Many Drinks A Day Is Bad?
    2007.02.27: Clarification On What Goes Wrong In A
    Psychiatrist’s Family
    2007.02.28: This Is How I Know Society Is Collapsing
    2007.03.07: The Psychological Uncertainty Principle
    2007.03.09: Reciprocal Determinism And Why Punching
    People Out Is Way Cool
    2007.03.14: Sleep Loss And Moral Judgment
    2007.03.18: Pathological Liars
    2007.03.19: Here’s What Governor Spitzer Should Do
    With The Pedophiles: Send Them To Cuba
    2007.03.22: A Primer on Pedophilia
    2007.03.27: Not Yet Ready For Porn
    2007.03.31: Here’s What Happened When I Went To
    LAX With No ID: Nothing
    2007.04.02: Worse Than The Flu
    2007.04.04: Farewell, Depression
    2007.04.11: The Trouble With Psychiatry— “Not Even
    Wrong”
    2007.04.16: Atypicals for Maintenance Bipolar
    2007.04.18: The APA Says The Media Is Making Women
    Really Hot
    2007.04.18: Cho Seung-Hui is Ismail Ax
    2007.04.19: Cho Seung Hui: It’s The Movies, Stupid
    2007.04.19: Schizophrenia and Dry Cleaning?
    2007.04.23: A Final Thought On Cho’s Mental Illness
    2007.04.23: Desmond’s Teleological Suspension of The
    Ethical— Or My Novel?
    2007.04.25: Is Cho The Question?
    2007.04.26: “Inflammable Means Flammable? What A
    Country!”
    2007.04.27: A Quick Word on Porn’s Effect On Your
    Penis
    2007.04.30: Does Media Reporting Of Suicides and
    Homicides Promote Copycats?
    2007.05.05: University Suicides On Schedule
    2007.05.07: University Shootings: I’m Sure It’s All Just
    A Coincidence
    2007.05.08: Another Final Word On Cho’s Mental Illness
    2007.05.10: Why We Are So Obsessed With Culpability
    vs. Mental Illness
    2007.05.13: The Girls Of Pfizer
    2007.05.24: The Wrong Lessons Of Iraq
    2007.05.30: Why Fly When You Have Tuberculosis?
    2007.05.31: I Win Again
    2007.06.04: If These Guys Aren’t Invested, Then It’s
    Over
    2007.06.04: “The Copycat Effect:” Does Reporting
    Violence Lead To Violence?
    2007.06.10: Paris Hilton or Mary Winkler? Forensics
    Gone Awry
    2007.06.12: FTAC: Forensics Gone Awry, And I told You
    So
    2007.06.14: This Will Either Mean Something To You,
    Or It Won’t
    2007.06.15: The Sopranos Finale Explained
    2007.06.20: Dr. Nasrallah Asks Questions That No One,
    Including He, Wants Answered
    2007.06.22: So At Least Two People Agree With Me
    2007.06.27: Damned If You Do… No, That’s All.
    Damned If You Do.
    2007.07.03: When I Said Doctors Were Too Involved In
    Social Policy, This Isn’t Exactly What I Meant
    2007.07.10: The Most Important Article On Psychiatry
    You Will Ever Read
    2007.07.17: No, Not Effexor, Too!? The Most Important
    Article On Psychiatry You’ll Ever Read, Part II
    2007.07.27: Why I Am Against Mental Health Parity
    2007.08.02: Aren’t Two Antipsychotics Better Than One?
    The Most Important Article on Psychiatry, Part 3
    2007.08.06: How Do You Treat Atrial Fibrillation?
    2007.08.09: Lawsuit Funding
    2007.08.11: Are You Good At Reading Faces?
    2007.08.14: How To Take Ritalin Correctly
    2007.08.16: Hong Kong Suicides, Revisited
    2007.08.21: Interest Rates and The Moral Hazard: Why
    You Must Buy GOOG Now
    2007.08.22: The Moral Hazard
    2007.08.22: The Fed’s Dilemma: The Moral Hazard
    2007.08.24: Child Rapist-Murderer John Couey Loses By
    Eight
    2007.08.27: The Other Soprano Psychiatrist
    2007.09.04: Birth Order: Are First Borns Always Older
    Than Their Siblings?
    2007.09.05: Number Needed To Treat
    2007.09.06: How Doctors Don’t Think
    2007.09.07: Will Lilly’s New Glutamate Agonist
    Antipsychotic Be A Blockbuster?
    2007.09.10: Why Is This Funny?
    2007.09.13: The Scariest Thing I Have Ever Seen
    2007.09.15: This Needs To Be Explained
    2007.09.17: Youth Suicide Rates Up? Not So Fast
    2007.09.18: WOW
    2007.09.19: Beer Goggling Isn’t Natural and Being A
    Good Looking Girl Sucks From 9 To 5
    2007.09.20: Worried About What Kids Will See On The
    Internet?
    2007.09.21: Another School Shooting— Sort Of?
    2007.09.23: What The Hell Kind Of Suicide Assessment
    Is This?
    2007.09.27: An Unquiet Mind
    2007.09.28: So Doctors Are Allowed To Breast Feed
    2007.09.30: Ten Things Wrong With Medical Journals
    2007.10.03: An Addendum To “Ten Things Wrong With
    Medical Journals”
    2007.10.05: Kerouac’s On The Road: The 50th
    Anniversary Of A Book I Had Not Read
    2007.10.07: Holy Crap, I’m On Wikipedia
    2007.10.07: This Is What You Wanted, Right?
    2007.10.10: This Is Just a Joke, Really, No, Really, It’s
    Not Real, We’re Much More Rigorous Than This, I Said
    It’s A Joke, Okay? Let It Go!
    2007.10.12: What Hath Google Wrought
    2007.10.21: Upgrading Movable Type Is Like Getting Hit
    By A Bus While Watching An Airplane Crash
    2007.10.23: The Diagnosis of Borderline Personality
    Disorder: What Does It Really Mean?
    2007.10.25: Abusive Teens Force Their Girlfriends To
    Get Pregnant! (Don’t Let The Truth Get In The Way Of A
    Good Story)
    2007.10.26: If You’re Drinking Decaf, You’re Probably
    Too Tired To Read This
    2007.10.29: Presidential Anti-Pharma Rhetoric Heats Up
    2007.10.30: Pre-Fed Update
    2007.10.30: More On Medical Journals
    2007.11.01: Bipolar Rates Are Increasing As Long As
    You’re Willing To Call Everything Bipolar And Defy
    God’s Will
    2007.11.02: The Problem With One Specific Female
    Doctor
    2007.11.08: Jay-Z Calls The Next Market Move
    2007.11.09: Is Taking Nothing Legal?
    2007.11.13: If You Want The Closest Thing To A
    Financial Disaster, Look To Etrade: How To Be Up 50%
    And Still Lose Everything
    2007.11.14: The Extent Of Psychiatric Knowledge
    2007.11.17: Some Inspirational Words From My Friend
    In Colorado Springs
    2007.11.20: Moriarty
    2007.11.21: The Question Isn’t Why Do Babies Do It
    2007.11.26: “Pivotal Role That Psychiatry Has Come To
    Play”
    2007.11.27: Which Is Worse: An Altered Photo of
    Reality, Or A Photo That Alters Reality?
    2007.11.29: One Of These Things Is A Straw Man, And
    The Other Is On Fire
    2007.12.05: Everything Is A Teachable Moment When
    You Are A Piece Of Garbage
    2007.12.19: Deus Ex Homonymia
    2007.12.28: Paris Hilton Loses Inheritance
    2008.01.06: Hey! We Just Now Invented A Cocaine
    Vaccine 9 Years Ago
    2008.01.07: I Go To Germany For A Week, And The
    Country Implodes
    2008.01.14: Do Narcissists Get Abortions?
    2008.01.16: Raising Wine Prices Makes Wine Taste
    Better
    2008.01.17: Are Drug Companies Hiding Negative
    Studies?
    2008.01.21: A Study Finds Antidepressants Don’t Work,
    And Suddenly It’s October 25
    2008.01.23: Sometimes The Question Is Worse Than Any
    Answer
    2008.01.23: You Can Have Your License Revoked For
    That?
    2008.01.24: A Quick Word On Google
    2008.01.31: Three Vignettes You Won’t Understand Until
    I Explain Them, And Then It Will Be Too Late
    2008.02.04: Probably Not The Best Lesson, But One Of
    The Few I Know
    2008.02.05: FDA Discovers That Anticonvulsants Cause
    Suicide, Too
    2008.02.06: What Else Causes Suicide? You’ll Never
    Guess
    2008.02.26: ECT Deserves A Press Release
    2008.02.26: Yet Another Study On Antidepressants, And
    No One Notices The Timing
    2008.03.04: An Observation About The Current Election
    2008.03.05: USAToday Says Drug Ads Are Smarter Than
    Doctors
    2008.03.05: Pricing of Placebo Affects Efficacy
    2008.03.09: In My Language
    2008.03.11: Suicidal Patients’ Access To Their
    Psychiatrist
    2008.03.12: Accounting For Inflation It’s Closer to 40,
    But True Anyway
    2008.03.13: Economy: Where We Go From Here
    2008.03.23: Elizabeth Smart: Hey, You Brought It Up
    2008.03.25: Eliot Spitzer and Alexandra Dupre: Don’t
    Choose The Red Pill
    2008.03.27: “But I Wanna Kill Myself!”
    2008.03.29: Friday Diversion: Jonathan Coulton
    2008.04.03: Vytorin
    2008.04.07: The Pornography Of Medicine
    2008.04.09: Time Magazine Stays Out Of the Election
    2008.04.11: Nature Says Scientists Use Performance
    Enhancing Drugs
    2008.04.14: First Anniversary Of The Death Of
    Antidepressants
    2008.04.15: The Dead Sea Effect In Academia
    2008.04.16: The Sex-Starved Wife
    2008.04.17: British Medical Journal Sends Its
    Scienticians To The Internet
    2008.04.21: Who Are We?
    2008.04.23: Intrinsic Value of Money
    2008.04.24: Update on Schering Plough
    2008.04.24: The Real Mystery of ‘Lost’
    2008.04.28: Election 2008
    2008.04.29: Experts Weigh In On Bipolar Disorder
    2008.05.03: Oh, Please, What Do Europeans Know
    About Psychiatry?
    2008.05.07: First Person Account Of The Milgram
    Experiment
    2008.05.08: Cookie Monster Becomes Aware
    2008.05.12: “My daughter deserved to die for falling in
    love”
    2008.05.14: I DO NOT CENSOR COMMENTS, MY
    DAMN SPAM FILTER DOES
    2008.05.22: What’s Wrong With Research In Psychiatry?
    2008.05.29: Law Says To Science, “You’re Kidding Me,
    Right? “
    2008.05.29: The New Yorker Writes About Power
    2008.06.14: McCain, Obama Describe Tim Russert—
    And Themselves
    2008.06.19: Internet Addiction Belongs In The DSM-V
    2008.06.24: He’s Not Yelling At You Because He’s
    Angry
    2008.06.25: Acadia Gives Up On ADP-104— Maybe It
    Shouldn’t Have
    2008.07.01: Six Quick Changes That Will Lead To Better
    or More Cost Effective Hospital Care
    2008.07.03: The Boy Who Learned To Talk Too Late
    And Too Fast
    2008.07.03: Election 2008: “What Patriotism Means To
    Me”
    2008.07.07: Esmin Green Died Because Only Kings
    County Hospital Cared
    2008.07.08: What Did You (Not) Do In 2008?
    2008.07.09: Clinical Experience vs. Clinical Trials
    2008.07.11: What Are We Voting For?
    2008.07.14: Wine Is Healthy In A New (Or Old) Way
    2008.07.15: The FDA Says No Black Box Needed On
    Drugs That Increase Suicidality, But Still Needed For
    Those That Don’t
    2008.07.17: When CGI Porn Looks Real: Is Anyone
    Thinking About The Children?
    2008.07.20: Academics Hide Drug Company Payments
    2008.07.22: Being The Main Character In Your Own TV
    Show Is Sort Of A Delusion
    2008.07.23: Psychiatry is the pressure valve of society
    2008.07.28: Fifty Percent of Foster Kids Are On
    Psychiatric Medications
    2008.07.30: Social Welfare Is A Red Herring: The Return
    Of Feudalism
    2008.08.06: A Little Bird Told Me
    2008.08.08: Craig Ferguson, The Jonas Brothers, and
    Katy Perry
    2008.08.11: The Hidden Zero Effect
    2008.08.12: A Trip You May Have Taken
    2008.08.13: Drug Reps From Congress To Detail Doctors
    2008.08.14: Seroquel For Bipolar Maintenance
    2008.08.15: Ara Abrahamian Wins Award For Medal
    Toss, Saved By Passport
    2008.08.20: If You’re Watching, It’s For You
    2008.08.27: What Happens If Pharmaceutical Marketing
    Disappears? Part 1
    2008.08.29: A Solution To The Pharma Problem
    2008.09.02: Why Are Athletes Barely Better Than Their
    Competitors?
    2008.09.04: Doctors May Only Be Paid Once
    2008.09.05: Undue Influence On Psychiatrists, Or The
    Public?
    2008.09.08: David Duchovny Does Not Exist
    2008.09.08: Odd Finding of Gender Differences In
    Walking
    2008.09.10: Scientists Find Evidence For The
    Unconscious
    2008.09.15: Cut Rates Now
    2008.09.15: MMS Chicks: Oil, Sex, Drugs And Anything
    Else You Want To Imagine
    2008.09.17: The Process of Bringing New Drugs To
    Market
    2008.09.17: Market Capitulation
    2008.09.18: Recollections Of Your Parents Before And
    After You Have Children
    2008.09.22: Does CNBC Cause Market Volatility?
    2008.09.22: Advancing Paternal Age And Bipolar
    Disorder
    2008.09.23: Teenage Girls May Be Having Oral Sex, But
    The Problem Is You
    2008.09.24: My Fellow Americans: The Speech President
    Bush Should Give
    2008.09.26: Obama And McCain On Mental Health
    Coverage
    2008.09.27: The Women Of Lipstick Jungle Are The
    Same Age As Rachel From Friends
    2008.09.28: Either Conservatives Are Cowards Or
    Liberals Are…
    2008.09.29: We Are All Mercantilists Now
    2008.09.30: CNBC Ratings Seem Correlated To Future
    Market Volatility
    2008.10.01: What Design Flaws Need Fixing In This
    Blog?
    2008.10.01: Psychopathy, Antisocial Personality
    Disorder, and Narcissism
    2008.10.03: CNBC Ratings Predicts Bailout To Pass,
    VIX To Fall
    2008.10.03: What An Obama Presidency Means For
    Blacks
    2008.10.06: The Media Is The Message, And The
    Message Is You’re An Idiot
    2008.10.07: The World Is At A 52 Week Low, And The
    Past 10 Years Never Happened
    2008.10.08: 7 Things To Expect In Our Brave New
    World
    2008.10.09: This Shall Pass
    2008.10.09: The Next Step: Suspend The Capital Gains
    Tax, and The Market
    2008.10.10: CNBC Ratings And VIX Predict Rum Sales
    2008.10.10: Secretary Paulson Implements the
    Regulatory Act of 1773
    2008.10.13: Christopher Columbus Was Wrong
    2008.10.15: Wanted, Starring Angelina Jolie, Is The
    Greatest Movie Of Our Generation
    2008.10.16: You Always Know Less Than Your Source,
    Unless It’s Balenciaga
    2008.10.20: Those Five Days Matter More Than
    Anything, Except The Other Days
    2008.10.21: The Dumbest Generation Is Only The
    Second Dumbest Generation
    2008.10.23: The Graying Of Kindergarten: The Goal Is
    To Keep Them In Puberty, Part 1
    2008.10.24: This Week On Grey’s Anatomy The
    Preposterous Happens
    2008.10.27: Vanderbilt University: The Goal Is To Keep
    Them In Puberty, Part 2
    2008.10.29: Narcissism Up In College Students; The
    Goal Is To Keep Them In Puberty, Part 3
    2008.11.04: Celebrities and Narcissism
    2008.11.06: The CIA Has The Same Problem Medicine
    Does
    2008.11.10: Should Kids Go To College Early?
    2008.11.11: Forget Paypal- This Is What Blogging Is All
    About
    2008.11.11: The Supreme Court Hears Arguments That
    Warning Labels Should Include Things Done Correctly
    2008.11.17: Man Convicted Either For Child Porn Or
    Nothing
    2008.11.18: Where Does A Tree Get Its Mass?
    2008.11.24: The Communists Say James Bond Is Anti-
    Communist
    2008.11.24: Do We Want Neuroimaging In Court?
    2008.11.25: The Truman Show Delusion Is Not Real
    2008.11.26: Has Anyone Noticed That Price Of Gold
    And Platinum Is The Same?
    2008.11.27: How To Treat Vertigo
    2008.11.27: AM Radio Kids
    2008.12.01: Off Label Prescribing Turns Out To Be On
    Label
    2008.12.02: Psychopaths Are Charming?
    2008.12.04: The British Model Of Cost Effectiveness
    Fails On Philosophy
    2008.12.08: 1 In 5 Cars Has A Personality Disorder
    2008.12.09: If You’re Reading It, It’s For You?
    2008.12.10: Is An Hourglass Figure The Ideal? Only If
    You’re Weak And Stupid
    2008.12.15: Should Hubris Be In The DSM-V?
    2008.12.15: Self-Embedding Syndrome: What’s Going
    On In Ohio?
    2008.12.17: Is Internet Addiction Really An Addiction?
    2008.12.22: Major Depression is Major Depression, Until
    Proven Otherwise
    2008.12.24: The Writers of Fool’s Gold Get One Thing
    Right
    2008.12.29: Heidi’s Real Problem On The Hills: She’s In
    The Wrong Movie
    2008.12.30: What Happens To An Action Hero When We
    Grow Up?
    2009.01.01: Can A Patient Postpone Their Own Death?
    2009.01.06: The Ultimatum Game Is A Trap
    2009.01.08: The Enemies Of Promise Guard The Road
    To Success
    2009.01.09: The Chart Is Dead, Long Live The Chart
    2009.01.14: Treating Insomnia With Less
    2009.01.15: Another Round Of The Ultimatum Game
    2009.01.19: DSM-V Controversies
    2009.01.20: God’s Cheat Code For Accuracy
    2009.01.26: Can Narcissism Be Cured?
    2009.01.29: Wrong About Obama
    2009.02.03: Two Causes Of Autism
    2009.02.09: Autism and The MMR Vaccine
    2009.02.10: Federal Judges Order California To Release
    50,000 Inmates
    2009.02.12: Congress Has Its Say, And It Says, “Hey,
    Did You Cashew Shells Loan Out All The Money We
    Told You Not To Dare Lose Any Of?”
    2009.02.12: Judges Accused Of Supporting Social
    Change As Per Script
    2009.02.13: MMR Vaccine Finally Cleared Of Assault
    2009.02.13: The Boy Who Cried Wolf
    2009.02.16: The Bubble In Academic Research
    2009.02.17: Platinum vs. Gold
    2009.02.18: Guess What Isn’t The Cause Of Physician
    Suicide
    2009.02.19: The Biggest Dick Ever
    2009.02.19: Chicago Tea Party
    2009.02.23: Why No Progress Will Ever Be Made In
    Psychiatry
    2009.02.25: The Action Movie Fairy Tale
    2009.03.02: Good Game, America
    2009.03.04: Impulsivity In Kindergarten (Does Not)
    Predict Future Gambling
    2009.03.05: The Special Circumstance Which Causes
    The Wisdom Of Crowds To Fail
    2009.03.09: Biology Is Destiny
    2009.03.12: What Was The Matrix?
    2009.03.16: When Lilly Pays Out $800M, Where Does
    That Money Go?
    2009.03.18: Are Schools Breeding Narcissism?
    2009.03.19: Reality Responds To The Matrix
    2009.03.21: What Happens To Fake Studies?
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    Do Antidepressants Induce
    Mania?
    July 5, 2005

    No.
    This myth is the result of imprecise use of language. Many2 3 4
    5 6 have detected a temporal association between the use of

    tricyclic antidepressants and episodes of mania in patients with


    bipolar disorder, though no plausible mechanism has been
    suggested, much less found. It has been assumed that this
    association could be extended to all antidepressants despite
    their substantial chemical and pharmacological heterogeneity.
    However, such an association between mania and selective
    serotonin reuptake inhibitors has not been found. In fact, the
    studies 7 8 9 which have been done strongly indicate that the
    rate of mania with SSRIs is no different than the normal
    switch rate of bipolar disorder. A recent study10 11 of
    venlafaxine, sertraline and bupropion found a 13% 10 week
    switch rate into mania or hypomania (excludes symptoms
    lasting less than 7 days), and an 18% one year switch rate, but
    this study was confounded by the concomitant use of mood
    stabilizers of dubious efficacy (lamotrigine, gabapentin,
    topiramate) in 22% of the patients, and the lack of a placebo
    arm to establish the baseline switch rate. Because of the
    significant phenomenological heterogeneity of the patients
    with “bipolar disorder” in clinical trials, a placebo arm is vital
    in order to compare results in different studies.
    It must be reiterated that these are studies of temporal
    associations between mania and antidepressants, and no causal
    link can be inferred. Despite this, many continue to discuss the
    question in terms of the induction of mania by antidepressants.
    This betrays a bias that is supported neither by data nor logic.
    For example, studies of novel antidepressants cite rates of
    “induced” mania, while studies of antiepileptics discuss
    “breakthrough” manias, automatically presupposing a
    difference in the mechanism of mania. Similarly, it is
    popularly assumed that bupropion is less likely to induce
    mania than SSRIs. This assumption is formalized in the Expert
    Consensus Guidelines 200012, where bupropion “was clearly
    rated as the antidepressant least likely to precipitate an episode
    of mania.” It is not immediately obvious why this was so clear,
    as there is virtually no evidence indicating this. One single
    study13 (N=19) found bupropion to be less likely to induce a
    switch than desipramine. The final results of Post, above, are
    still pending, but it appears evident that if one has decided to
    accept the myth that antidepressants induce mania, there is no
    reason to believe bupropion is any less likely to do this.
    The accumulated data in the field strongly suggest that the real
    risk in the treatment of bipolar depression is ineffectiveness,
    not mania.
    ––––-
    2 Prien RF. Klett CJ. Caffey EM Jr. Lithium carbonate and
    imipramine in prevention of affective episodes. A comparison
    in recurrent affective illness. Arch Gen Psych 29(3):420-5,
    1973 Sep.
    3 Prien RF. Kupfer DJ. Mansky PA. Small JG. Tuason VB.
    Voss CB. Johnson WE. Drug therapy in the prevention of
    recurrences in unipolar and bipolar affective disorders. Report
    of the NIMH Collaborative Study Group comparing lithium
    carbonate, imipramine, and a lithium carbonate-imipramine
    combination. Arch Gen Psych 41(11):1096-104, 1984 Nov.
    4 Boerlin HL. Gitlin MJ. Zoellner LA. Hammen CL. Bipolar
    depression and antidepressant-induced mania: a naturalistic
    study. J Clinical Psychiatry. 59(7):374-9, 1998 Jul.
    5 Wehr TA. Goodwin FK. Rapid cycling in manic-depressives
    induced by tricyclic antidepressants. Arch Gen Psychiatry.
    36(5):555-9, 1979 May.
    6 Jann MW. Bitar AH. Rao A. Lithium prophylaxis of
    tricyclic-antidepressant-induced mania in bipolar patients. Am
    J Psychiatry. 139(5):683-4, 1982 May.
    7 Amsterdam JD. Garcia-Espana F. Fawcett J. Quitkin FM.
    Reimherr FW. Rosenbaum JF. Schweizer E. Beasley C.
    Efficacy and safety of fluoxetine in treating bipolar II major
    depressive episode. Journal of Clinical Psychopharmacology.
    18(6):435-40, 1998 Dec.
    8 Peet M. Induction of mania with selective serotonin re-
    uptake inhibitors and tricyclic antidepressants. British J
    Psychiatry. 164(4):549-50, 1994 Apr.
    9 Nemeroff CB, Evans DL, Gyulai L, Sachs GS, Bowden CL,
    Gergel IP et al. Double-blind, placebo-controlled comparison
    of imipramine and paroxetine in the treatment of bipolar
    depression. Am J Psychiatry 2001; 158:906-12.
    10 Post RM. Altshuler LL. Frye MA. Suppes T. Rush AJ.
    Keck PE Jr. McElroy SL. Denicoff KD. Leverich GS. Kupka
    R. Nolen WA. Rate of switch in bipolar patients prospectively
    treated with second-generation antidepressants as
    augmentation to mood stabilizers. [Clinical Trial. Journal
    Article. Randomized Controlled Trial] Bipolar Disorders.
    3(5):259-65, 2001 Oct.
    11 Post RM. Leverich GS. Altshuler LL. Frye MA. Suppes
    TM. Keck PE Jr. McElroy SL. Kupka R. Nolen WA. Grunze
    H. Walden J. An overview of recent findings of the Stanley
    Foundation Bipolar Network (Part I). [Journal Article. Review.
    Review, Tutorial] Bipolar Disorders. 5(5):310-9, 2003 Oct.
    12 Sachs GS. Printz DJ. Kahn DA. Carpenter D. Docherty JP.
    The Expert Consensus Guideline Series: Medication
    Treatment of Bipolar Disorder 2000. Postgraduate Medicine.
    Spec No:1-104, 2000 Apr.
    13 Sachs GS. Lafer B. Stoll AL. Banov M. Thibault AB.
    Tohen M. Rosenbaum JF. A double-blind trial of bupropion
    versus desipramine for bipolar depression. J Clin Psych
    55(9):391-3, 1994 Sep.
    If France Gets Its Way, 38
    Million People Will Die
    October 21, 2005

    “All of healthcare is in crisis.” Well, Chirac is not helping


    matters.Healthcare policy has two concurrent and dangerous
    trends developing. In the first trend, as detailed recently by Dr.
    Marcia Angell in the New York Review of Books (“The Truth
    [sic] About Drug Companies“) is the pervasive notion that
    pharmaceuticals are a need and a right, and cannot be left to
    the drug companies to disburse with an eye to profits. Leading
    us to the second trend, as evidenced by France’s recent swipe
    at the U.S. for not allowing poor countries to bypass patents
    and create cheap generic HIV drugs, which specifies that when
    medical need arises, government should be allowed to
    commandeer treatments and prices for the good of the people
    who need the drugs. Looks like the old argument: social
    justice vs. personal responsibility. Except the argument isn’t
    grounded in reality. Saying something vague like “people need
    these drugs,” misses the immediate point: which drugs? On
    what grounds is it even possible to say that people “need
    something” that didn’t exist until a company created it? Under
    what circumstances can we say people now need a drug that
    won’t be invented for another 10 years?

    The problem, in part, in this debate arises from scientists


    confusing discovery or research with invention. Looked at in
    terms of the production of novel material, certain distinctions
    can be made. Discovery and research are not creative acts.
    While they require creative thinking, they do not add anything
    materially new to the world. Alternatively, invention is the act
    of creating something that did not exist. There was no Prozac
    or Tylenol until someone invented it. You may think the
    rainforests have all the cures, but they don’t. As of right now
    (things could change) the law appreciates this, and only allows
    for the grant of the patent right when the invention in question
    is new, useful, and not obvious. However unfair this may
    seem, that is the system. Ordinarily, no one debates what is
    new or useful. Obvious, by contrast, is the source of much
    debate. Can something be not obvious if it was the logical next
    step? Or if someone else would have done it sooner or later?
    Many do not understand this debate, lamenting the unfairness
    of assigning property rights in science “when discoveries that
    depend on generations of prior science are patented by the
    person who made the last step.”
    This is the classic mistake. The last step is not obvious before
    it is taken. Perhaps there exists an example of a patent in
    which the inventive step was obvious to everyone before the
    inventor himself took that step? It seems obvious now for
    surgeons to wash their hands before operating, but tell me,
    why wasn’t it obvious to the doctors who performed surgery in
    the hundreds of years before the practice was conceived? It is
    common in many fields to look at patents and say “oh, I could
    have thought of that.” This is impermissible hindsight, because
    the determination of obviousness can’t be made after the fact.
    I suspect, however, that the current debate among politicos
    over drug patents has little to do with the assignment of
    property rights (which is best left to lawyers and judges skilled
    in the practice of assigning rights generally). Rather it is a land
    grab to curry favor with voters at the expense of the health of
    future voters. This is what is so damaging about the
    controversy over HIV drugs. The drugs exist, and they are
    needed now. But how to hand them out?
    Note that the debate is not about changing patent law with
    respect to future drug patents. Rather, the debate is over
    changing the laws on existing patents for successful and safe
    drugs that were developed under the assumption that the patent
    to them would last 20 years.
    This is “patently” unfair, because it amounts to changing the
    rules after the game has already been won. Drug companies
    invest hundreds of billions to create (not discover - create)
    these drugs. Scientists like to dismiss this part of the argument,
    because they feel that crass commercialism sullies the purity
    of science. This is as childish as it is preposterous. Scientific
    research is massively expensive. The investment is made by
    investors who don’t care about science, but do care about
    returns, based on the understanding that anything they invent
    they will be able to sell exclusively, at least for a while. To
    threaten abrogating the patent right for successful drugs, or
    artificially manipulate their prices will cause investors to pull
    out of drug companies now and into more predictable and less
    regulated industries. This will reduce the investment in future
    drugs. You don’t appreciate the strategic problem here,
    because the future drugs that will never get invented don’t
    exist, so it does not seem like you are losing anything.
    But you are.
    If you do not think that this is true, consider the fact that many
    of the newest drugs are cosmetic or lifestyle drugs, like Viagra
    et al, or are “me-too drugs” (other versions of the same kind of
    drug, i.e. 5 different Prozac like drugs.) Drugs which treat
    conditions that are not life-threatening and which are therefore
    not prone to federal or HMO price control. Compare this to the
    fact that drug companies invest comparatively little in new
    antibiotic research to combat the well-known problem of drug
    resistant bacterial strains. Public and social policy has
    distorted the market and predictability of patent rights, so drug
    companies stay away from research that is likely to become a
    political issue. Why bother investing to invent an antibiotic (or
    HIV drugs) when it could be commandeered by the
    government because it is “needed?” And the public suffers. It
    is convenient for France to demand the commandeering of the
    patent to HIV drugs to allow for cheaper generics. But current
    HIV drugs are not curative. Who, exactly, does France expect
    to invent the actual cure– that will then likewise be
    commandeered? In a flashback from the Fountainhead, France
    wants to take credit for charity that someone else will pay for.
    Would you rather have Viagra or a new HIV vaccine? Both are
    a question of money, but if you are going to place a value
    judgment on one over the other, then you have to incentivize
    the drug companies to do what you want. At the very least,
    you shouldn’t disincentivize them.
    Good drugs cost a lot, and we are going to have to pay it.
    Period. Because the alternatives are completely unfathomable:
    that good drugs are never invented; or, that they are invented
    but kept secret. Maybe they are used only to cure members of
    one’s family, or race, or class, or religion. That is perfectly
    legal, by the way. France should think about this before they
    sentence millions to death.
    So Ends The Ochlocracy of
    Medicine: How To Fix
    Medicaid, Part 1
    December 11, 2005

    Preferred Drug Lists are the bane of the practicing clinician.


    Instead of, for example, a psychiatrist being allowed to
    prescribe any antipsychotic they think appropriate, Medicaid
    requires them to pick from a list of only three, “on formulary”
    agents.
    Unfortunately for doctors, the logic is sound. Unless one can
    show that, for example, two antipsychotics do not have the
    same general efficacy or tolerability across a population, than
    an insurance company cannot be reasonably obligated to
    provide both, especially if one is cheaper.
    Psychiatrists complain that some patients respond better to one
    drug than another, but while this may be true, there is no way
    to predict this; try the formulary ones first. But this is just a
    red herring. What angers doctors is that these restrictions are
    an intrusion on their practice. Doctors are better able to decide
    risks and benefits of a medication; which drugs to prescribe,
    and when.
    This would be a great argument if it were true. It isn’t.
    The truth is that doctors are woefully ignorant of the available
    scientific data. As with literature and philosophy, most doctors
    read about the science, not the actual science itself. In general,
    doctors prescribe medicines not based on careful review of
    data, but impulse, habit, and the recommendations of “thought
    leaders.” (Seriously. They’re actually called that.) Prescribing
    medicines based on partial information or clinical soundbites
    may feel like “the art of medicine” but it is, in fact, a random
    process. It is certainly no better than having an insurance
    company that did review the data tell you what not to
    prescribe.
    They also tend to practice in a vacuum. A patient’s psychiatrist
    and cardiologist have no link. Are the treatments synergistic?
    Antagonistic? Neither fully know that the other is doing.
    And so, because doctors are not rigorous about their practice,
    someone else has to be. One of the most outrageous way
    psychiatrists, and possibly other physicians, waste money is to
    use multiple medications for a situation that could well have
    been handled by one. “Polypharmacy” is so common that it is
    actually codified in treatment guidelines, despite—and this is
    where insurance companies go insane—there being practically
    no evidence that this is ever appropriate. Why combine two
    antipsychotics when maybe more of one will do? It may seem
    plausible that two are better than one, but they aren’t. It may
    be true that a patient needs two drugs; but you can’t assume
    that. The default practice cannot be augmentation. That has to
    be the maneuver of last resort.
    Loose practice has caused the paradigm shift. It used to be that
    everyone deferred to the judgment of the wise physician. No
    more. Now, it’s incumbent upon us to show why we need to
    use a treatment, not for the insurance company to trust that we
    know best, that we made a careful analysis of the risks and
    benefits—because we didn’t. We complain that medicine is
    being assaulted in a million different ways—insurance
    companies, lawyers, alternative practitioners—but the reality
    is it is the exact same assault: we are no longer trusted to know
    best.
    So what to do? There is a solution. But you’re not going to
    like it.
    Link each Medicaid patient with a pharmacy budget per
    specialty—money controlled by the psychiatrist. A psychiatrist
    can use any drug, any dose, no restrictions, but only up to, say,
    $10 a day. Go.
    There are numerous advantages.
    First, there is cost control.
    Second, Pharma will inevitably cut prices in order to compete.
    Third, it gives doctors their autonomy.
    Fourth: it will force doctors to pay very close attention to what
    is, actually, best practice. They will have to be more attentive
    to outcome studies. They will have to predict side effects: if
    you’ll need to add a second drug to counteract the side effects
    of the first, it may be better to use a completely different drug.
    Fifth: They will use fewer medicines. Two is not always better
    than one; but it certainly is twice as expensive with twice as
    many side effects.
    Sixth: Pharma no longer has incentive to create “me too”
    drugs. They are incentivized to come up with novel, even
    niche, treatments.
    If you really want to tax the imagination of doctors, and force
    a level of rigor in medicine that has not been seen since, well,
    since never, create a global pharmacy budget per patient across
    all subspecialties. This way, if a psychiatrist wants to prescribe
    Zyprexa, he’s going to have to discuss with the cardiologist
    whether that is more cost effective than the Lipitor. Wow.
    The unexpected benefit is that the two doctors have to
    communicate. Maybe a switch from Zyprexa could preclude
    the need for Lipitor? Maybe? Hello? Let this communication
    be billable to Medicaid. $100 per “consultation” is more than
    offset by the pharmacy savings. There are going to be some
    patients who actually do require more money, more
    medications. In that case, the doctor can petition for increased
    benefits. Doctors hate doing this. Too bad. The problem was
    created by doctors, not by pharmacists.
    Finally, to bring Pharma into the game: the first 30 days of a
    prescription must be piad for by the Pharma company making
    the drug, i.e. samples or vouchers. This way, only the drug that
    actually works gets paid for by Medicaid. That’s gold.
    It’s worth stating, for the record, that I am opposed to
    government interference in my practice. I don’t particularly
    like lawyers, either. But the sad truth is that the state of
    psychiatry is the fault of psychiatrists, who have failed to take
    full responsibility for their own education and practice. To
    blame anyone else at this stage is totally disingenuous.
    Is Schizophrenia Really
    Bipolar Disorder?
    March 22, 2006

    The answer should be so obvious that there shouldn’t be an


    article on it. But there it is.
    Lake and Hurwitz, in Current Psychiatry, conclude that
    schizophrenia is really a subset of bipolar disorder.

    The author’s initial volley is (sentence 3):

    The literature, including recent genetic data (1-6)


    marshals a persuasive argument that patients diagnosed
    with schizophrenia usually suffer from a psychotic
    bipolar disorder.

    Well that’s a pretty powerful assertion, supported by 6


    different references. Except for one thing: none of the six
    references actually support that statement.

    1. Berrettini: finds that of the various regions of the genome


    connected to bipolar disorder in genome scans, two are
    also found in scans of schizophrenia. Regions that
    overlap— not genes, or collections of genes, but entire
    chunks of chromosomes. He says there are (perhaps)
    shared genetic susceptibilities, not that they are the same
    disease.
    2. Belmaker: A review article. No new data.
    3. Pope: specificity of the schizophrenic diagnosis— written
    in 1978.
    4. Lake and Hurwitz: says there’s no such thing as
    schizoaffective disorder, which would be groundbreaking
    stuff if it weren’t written by the same author as this
    article.
    5. Post: Review article talking about kindling in affective
    disorders. In 1992.
    6. DSM-IV. Seriously.

    I’m game if you are: find the “persuasive argument” that these
    references “marshal” and then we have something to talk
    about. What makes all this so hard to fathom is not the
    movement to lump the two disorders together, but rather to
    lump them together under the more arbitrary, heuristic
    diagnosis. It is schizophrenia, not bipolar, that actually has
    physical pathology. Let’s review:
    Brain anatomical findings:

    white-gray matter volumes decreased in caudate, putamen


    and nucleus accumbens. 1
    deficits in the left superior temporal gyrus and the left
    medial temporal lobe.2 3
    moderate volume reduction in the left mediodorsal
    thalamic nucleus (but total number of neurons and
    density of neurons is about the same) 4
    reduced gray matter volume, reduced frontotemporal
    volume, and increased volume of CSF in venticles 5 and
    1

    Physical features:

    Larger skull base and larger lower lip 1


    Velo-cardio-facial syndrome (22q11 deletion) 2
    vertical elongation of the face 3
    high arched palate 4

    Granted, these aren’t great; but try to find anything like this
    for bipolar.
    Clearly, the Kool-Aid is delicious because they want us to
    drink it, too.
    In the final section, magnificently entitled “What is standard
    of care?” the authors pronounce:
    Antidepressants appear to be contraindicated, even in
    psychotic bipolar depressed patients.14,15 We suggest that you
    taper and discontinue the initial antipsychotic when psychotic
    symptoms resolve.
    Which is great, except it’s not true. If the authors have some
    evidence that antidepressants actually increase the switch rate,
    I’d love to see it: but for sure references 14 and 15 aren’t it. At
    least, could “contraindicated” be a tad overstated?
    The last two sentences of the whole article:
    The idea that “symptoms should be treated, not the diagnosis”
    is inaccurate and provides substandard care. When psychotic
    symptoms overwhelm and obscure bipolar symptoms, giving
    only antipsychotics is beyond standard of care.
    No references given for these outrageous statements, but given
    the relevance of their previous references I guess it really
    doesn’t matter. “Substandard care?” “Beyond the standard of
    care?” Really? I’ll see you in court.
    Deja Vu
    April 2, 2006

    I had a patient with a chief complaint of deja vu, so I looked it


    up. (BTW: turned out to be undiagnosed dementia in my
    patient’s case.)
    Best article I found was Wild E. J Neurol. 2005 Jan;252(1):1-
    7. Summarized (and all below references come from Wild’s
    paper):
    Definition: “any subjectively inappropriate impression of
    familiarity of a present experience with an undefined past.”
    (Neppe, 1983)
    Wild explains that the definition here is importantly specific:
    “subjectively inappropriate” means that the patient
    understands the familiarity is impossible (i.e. this is not a
    delusion.) “Undefined past” is a non-existent past, and the
    patient never pinpoints it (because it never happened).
    Some theories:
    Wigan (1985), Jensen (1868) and Maudsley (1889): a “loss of
    synchronicity” between two hemispheres of brain, so that they
    are working “separately but synchronously.” Jensen also
    suggests it is familiarity of one part of the experience
    generalized to the whole.
    Gestalt psychology: object-affect entities. An experience
    causes an affect, which is identical to the affect assocaited
    with an unrelated event in the past. Your brain interprets it as a
    rememberance of the object (as opposed to the affect.)
    De Nayer:“tape recorder hypothesis:” you are remembering
    the event and recollecting the event at the extact same time.
    Freud: the situation is similar to a suppressed fantasy, so the
    fantasy activates as a wish to make improvements in the
    current situation, so in essence it is the wish to turn back time.
    Biology:
    Associations with temporal lobe epilepsy suggested that that
    was the relevant neuroanatomy, but some interesting
    experiments suggest that deja vu is associated with limbic
    structures (especially hippocampus and amygdala) and not the
    temporal neocortex itself. Bancaud (1994) tried to synthesize
    the available information and proposed that the perception is
    encoded in the temporal neocortex and remembered in the
    hippocampus; affective memory is supplied by the amygdala.
    Then, these relate back to the temporal neocortex as a daja vu.
    Thus, a situation, as it is experienced and “recorded” (see De
    Nayer) activates deeper memory structures.
    All of this appears to be lateralized to the to the temporal lobe
    ipsilateral to the dominant hand (which is really the non-
    dominant hemisphere— it crosses). In fact, the point of all this
    was to use the symptom of deja vu to predict where a seizure
    focus would be. (Unfortuantely, a PET scan study could not
    confirm this lateralization.)
    Because of the prominent association of deja vu with
    autosomal dominant “partial epilepsy with auditory features” a
    genetic contribution is suggested. This gene is the
    LGI1/epitempin gene (10q24).
    Assessment should rule out depersonalization or flashbacks. If
    deja vu is short or infrequent, it is probably normal; but if
    recurrent, prolonged, or associated with physical sensations,
    consider TLE. If associated with anxiety or depression,
    consider psychiatric causes.
    Other articles:
    A study of 24 epileptics receiving direct stereotactic electrical
    stimualtion of the brain found that stimualtion of the
    entorhinal cortex produced more deja vu than the amygdala or
    hippocampus, while the perirhinal cortex was associated with
    the recollection of memories.
    A prospective study of TLE patients and their “auras” (called
    simple partial seizures, i.e. seizures with no loss of
    consciousness, and include deja vu, weird tastes, etc)) found
    that the SPSs, deja vu, a warm sensation, a cephalic sensation,
    taste hallucination, and a “strange” sensation predicted an
    abnormal amygdala ipsliateral to the seizure focus. Though
    fear was the most common for all TLE patients, the single best
    predictor of an abnormal amygdala was… deja vu. As
    described by Wild, this occurred most commonly on the right
    (i.e. ipsilateral to handedness, or nondominant for language.)
    A study of 14 patients with varying frontal lobe damage were
    tested for a number of memopry parameters; those with
    incorrect “feeling-of-knowing” had damage in the right
    prefrontal cortex.
    Although deja vu is supposedly distinct from psychosis, and
    not related to dopamine, there’s a case report of a 39yo
    physician-patient who took amantadine and
    phenylpropanolamine to ward off the flu, and got intense deja
    vus. They stopped when he stopped the medications. The
    authors find other case reports finding the same.
    An interesting case report (two cases, actually) found that,
    contrary to the popular understanding that the deja vu shares
    some similarity to an actual past event, on formal testing these
    two patients had recollections which were unlikely related to
    previous familiarity (“incorrectly recognised low frequency
    words.”). They then created justifications, i.e. they
    confabulated the recollections.
    As an aside, there are 85 articles in Pubmed with the words
    “deja vu all over again” in the titles. Almost none actually had
    anything to do with deja vu. That’s creativity for you.
    Nature Weighs in On What
    Is True
    April 3, 2006

    and turn out to be wrong.


    There’s been something of a controversy raging over the best
    place to get accurate information.
    Specifically, there’s a free, user-written encyclopedia called
    wikipedia at http://www.wikipedia.org that competes with the
    Encyclopedia Britannica. The idea is that anyone who uses
    wikipedia can edit any story. So if you happen to be reading an
    article that has an error in it (for example, if it says the
    Constitution was ratified in 1798) you can correct it with a few
    clicks (e.g. you change it to 1789). Aside from controversial
    topics (where articles are edited constantly to favor one
    opinion or the other), the “hard facts” articles on science,
    culture or history are fairly decent. Or so they seem at first
    glance.
    The controversy is this: Britannica’s editor in chief went on
    record (in a newspaper article I can’t find) stating that
    Britannica is a better, more reliable source of “knowledge”
    because it’s a closed controlled editing environment, where
    articles are researched, edited, and reviewed internally by
    academics who are experts in their respective fields.
    Wikipedia responded saying it doesn’t need all that editorial
    oversight because any error in an article is corrected relatively
    quickly by an expert in the field.
    The essence of the argument is “top-down” (Britannica) vs.
    grass-roots/bottom-up (wikipedia), or, to put it more succintly,
    does the existence of a gatekeeper for knowledge improve the
    quality, accuracy, and veracity of knowledge?
    The debate matters for two reasons: (1) at some point people
    have to agree on the basic facts of whatever they are talking
    about, and (2) there needs to be a place where you can find the
    core true facts about any subject.
    So anyway, the medical journal Nature decided to compare the
    two sources of knowledge:
    http://www.nature.com/news/2005/051212/full/438900a.html
    Now you may ask what the hell business is it of Nature’s (a
    quasi-medical journal) to do this (review the accuracy of
    encyclopedias), but that’s my point and I’ll get to that in a
    second.
    Anyway, surprise surprise, Nature says that in the case of
    science articles, wikipedia is better. This was not unexpected -
    wikipedia claimed all along that it amounted to enabling peer-
    review of its articles by readers, and Nature, of course, is all
    about peer-review.
    Britannica responded, finding errors in Nature’s methodology
    (warning: pdf ahead, but it’s worth reading if you think for a
    second Nature should be trusted to do anything):
    http://corporate.britannica.com/britannica_nature_response.pdf
    concluding that the study was bogus, and that Britannica had
    far fewer errors and omissions than Nature claimed.
    What interests me here is not the accuracy of Wikipedia vs.
    Britannica, but why Nature feels it is in any position to
    examine this.
    Here is Nature’s response to Britannica’s criticisms:

    http://www.nature.com/nature/journal/v440/n7084/full/440582
    b.html
    Here’s the line to focus on:

    “Britannica complains that we did not check the errors


    that our reviewers identified…but there is a more
    important point to make. Our reviewers may have made
    some mistakes — we have been open about our
    methodology and never claimed otherwise — but the
    entries they reviewed were blinded: they did not know
    which entry came from Wikipedia and which from
    Britannica.”

    For the record, Nature says this is how the test was
    conducted:

    “Each pair of entries was sent to a relevant expert


    for peer review. The reviewers, who were not told
    which article came from which encyclopaedia, were
    asked to look for three types of inaccuracy: factual
    errors, critical omissions and misleading statements. 42
    useable reviews were returned.”

    And this, my scientician friends, is why medicine isn’t a


    science. Nature is saying that its methodology is sound
    because the entries they reviewed were blinded - BUT WHO
    ARE THE PEER REVIEWING EXPERTS, WHO
    SELECTED THE ENTRIES, AND ACCORDING TO WHAT
    CRITERIA?
    You cannot excerpt an article describing something and then
    test the excerpt for omissions. Furthermore, the excerpting is
    not blinded, and the person excerpting things may have a
    different opinion of what can be safely left out than the person
    doing the review.
    Nature’s mistake is assuming that the expert is always right. If
    the expert disagrees with Britannica, then Britannica is wrong.
    You should be able to test the accuracy of an entire
    encyclopedia article *by giving it to multiple experts*. Not the
    other way around, multiple articles to one expert. The
    hypothesis is “do experts think the article is correct”, and you
    test it by find the percentage of experts that think it is/isn’t.
    What is truly ironic is that while Nature likes to hold itself out
    as an open source for medical knowledge (and thus more like
    Wikipedia), it is in fact a gatekeeper of knowledge like
    Britannica. When Nature publishes an article, the belief of the
    scientific community is that the article is correct *because it’s
    in Nature*. But Nature is the journal of statistical regression
    sciences - medicine, global warming, etc., i.e. disciplines
    where there is no right answer or it’s impossible to know the
    right answer because you are observing only a small
    percentage of all the variables being affected. It tests
    associations, not causality.
    Keep this in mind when a journal like Nature also makes
    policy proclamations (“global warming needs to be stopped”)
    or creates artificial hierarchies by its coverage (substantially
    more articles on HIV than malaria, so HIV becomes more
    “important” than malaria, etc.)
    Subtypes of OCD
    April 4, 2006

    CNS Spectr. 2006 Mar;11(3):179-86.


    The authors examined the difference between two (theoretical)
    subtypes of OCD symptoms. Based on the earlier work of Lee
    and Kwon, obsessions can be divided into autogenous and
    reactive.
    Autogenous: occur without identifiable or likely stimuli;
    repetitive; disturbing;
    Examples: “sexual, aggressive, or immoral thoughts, images,
    or impulses.” The sudden obsession to rape; or seeing a red
    shirt, which signifies raping.
    Coping strategy: suppress these thoughts
    Reactive: caused by identifiable external stimuli, including
    thoughts of contamination, asymmetry, loss; are realistic;
    Coping strategy:reduce anxiety (e.g. wash hands.)
    They found some interesting differences:
    Autogenous obsessives were more likely to be male, and older
    (34) and have older ages of onset (27);
    Reactive obsessives were more likely female (60/40), younger
    (27) and younger age of onset (19).
    No difference in either group in education or marital status;
    nor were there any major psychiatric comorbidities.
    But autogenous obsessives rarely (1%) dissociated; reactives
    did dissociate (10%).
    A few points. That aggressive/sexual thoughts go with males
    is no surprise. But that they are found in the older people is
    interesting. If you can see how primitive thinking occurs in
    reactive OCD, it makes sense they would get their symptoms
    at a younger age. It is known that cleaning and checking
    obsessions are associated with an earlier age of onset.
    The prevalence of dissociation in reactive patients- or the
    absence of it in autogenous patients— had already been
    suspected. Checking and symmetry symptoms (associated here
    with reactive type) had already been found to be more
    commonly associated with dissociation. (Personal diversion:
    my own clinical experience with pedophiles supports this—
    that those with sexual obsessions are fully conscious of them;
    obsess over them, are familiar with every nuance. They know
    to molecular detail what the child looks like, how it moves;
    and are totally aware of their own behavior at every step of the
    molestation, even when they pretend a quasi-dissociative
    experience as a defense. They wouldn’t dissociate during the
    acts because, in effect, it defeats the purpose of committing the
    act.)
    Additionally, in other studies, Lee and partners (Telch, Kwon,
    etc) found that autogenous obsessions were more associated
    with schizotypal personality than to other OCD symptoms
    themselves (while reactive obsessions had no association with
    schizotypal.) 1 The authors use this finding to support the idea
    that autogenous obsessions represent cognitive issues, while
    reactive represent behavioral ones; autogenous obsessives
    obsess; reactive obsessives are compulsives. This is further
    supported another study finding that on Rorshach, autogenous
    obsessives, like schizophrenics, have severe thought disorder,
    while reactive obsessives do not.2 The belief that merely
    thinking a thought could make it true (formally called the
    likelihood bias of though-action fusion) sounds like the
    magical thinking in schizotypal, and in fact TAF is seen in
    schizotypals 4 1. It would be interesting if it could be
    investigated in autogenous obsessives versus reactive
    obsessives separately, the hypothesis being that autogenous
    obsessives display likelihood TAF, while reactives do not.
    Clinically, it may be fair to say that people with autogenous
    type obsessions share schizotypal features, and
    cognitive/perceptual distortions, while reactive obsessions go
    with OCPD features and compulsive behaviors. So, do
    antipsychotics help autogenous obsessives (and not (or better
    than) reactive obsessives?)
    In line with this, there is some evidence that schizophrenics
    and OCDs share some neurodevelopmental pathology. For
    example, using fractal dimension and CSF volume, one could
    accurately categorize schizophrenics or OCD patients, vs
    controls, with 90% accuracy.3 It would be interesting to see if
    these obsessives, based on brain pathology alone, could be
    distinguished between autogenous and reactive types. I suspect
    the answer will be yes.
    1. J Anxiety Disord. 2005;19(7):793-805. Epub 2005 Jan 5.
    2. J Clin Psychol. 2005 Apr;61(4):401-13.
    3. Neurosci Lett. 2005 Aug 12-19;384(1-2):172-6.
    4. Behav Res Ther. 2005 Jan;43(1):29-41.
    Pedophilia Makes You
    Stupid
    April 6, 2006

    Homeland Security Official Charged in Online Seduction


    The system has failed.
    Plot synopsis: DHS press secretary is caught in online sting, as
    he has sexual online chats to what he thinks is a 14yo girl but
    is really a cop.
    Seriously, what’s wrong with these people? Do you need a
    14yo so badly, at any cost, you’re willing to tell them you
    actually work for Homeland? Is that supposed to turn on 14
    year old girls?
    You would think the deputy press secretary of Homeland
    Security would know that he could be easily caught on the
    internet trying to solicit sex from a minor, or at least that the
    Department would know what he is doing on their computers.
    But he doesn’t, for two reasons: a) he’s stupid; b) in fact, the
    Department doesn’t know what he is doing, because the
    Department is stupid.
    I’ll do you one better: no one traffics kiddie porn on IRC if
    they have half a brain in their head. You want to traffic kiddie
    porn? Make your connections over online games like WoW,
    Everquest, or Halo. In the case of the former two, the chat
    conversation works as well as irc, and in the case of the latter,
    it’s voice traffic. In no case is the transcript or anything else
    logged. I bet there’s more weird crap happening in online
    games than you’d want to know.
    Add to that freenet, which is basicaly encrypted decentralized
    bittorrent with invite-only peers, and you’ve got a pretty
    robust digital underground.
    The Other Abortion
    Question
    April 8, 2006

    For those who live and breathe the abortion debate, it may be
    worthwhile to personalize the issue and see if anything
    changes. Certainly, Rick Santorum has done this.
    If you do not already know the story, Senator Santorum told it
    himself on Fresh Air in September 2004. Briefly, at
    approximately 20 weeks gestation, he and his wife learned the
    fetus had a terrible disorder that would likely result in the
    fetus’ demise. They had three choices: carry the fetus to term,
    when it would inevitably die; abort the fetus; or try a risky
    surgery on the fetus (which was still inside the womb) which
    had a low probability of success. The Santorums, true to their
    faith and their principles, reasoned thusly: if this was a five
    year old child, there would be no debate. They went with the
    surgery.
    As tragedies go, this was a big one, as the surgery failed, the
    fetus died, and the mother suffered complications. However,
    the story clearly indicates how one should reason if one
    believes life begins at conception. This is the point for the
    Senator; it is illogical to argue any differently. If we are
    debating the abortion issue, this is a hard argument to rebut.
    But I am not, here on this blog, interested in the abortion issue
    specifically; I am interested in another question. It is this:
    Who pays for this surgery?
    It is not an academic question. Senator Santorum has the
    benefit of almost infinite medical resources. If we are going to
    force Medicaid patients to make a similar choice, we have to
    ask this practical question.
    Many are not going to like having, depending on your
    perspective, a moral or privacy question reduced to money;
    but that is precisely the problem. Accountability. In the end,
    someone has to pay.
    Only the schizoid will argue that abortion should not be an
    option even when the mother’s life is in mortal danger; and
    only the amorally unrealistic will fail to realize that there is
    something psychologically wrong with a woman who has had
    three, four, five abortions. (This is not so unusual: it is 18% of
    all abortions.) You may think it is your right to have as many
    abortions as you need, and you may be right; but there is still
    something wrong with you.
    Not permitting abortions requires an explanation of how we’re
    going to pay for surgeries like the Santorums’s. And if you
    want to keep abortions legal, you have to tell me how we’re
    going to pay for them; or for any complications that result
    from them.
    Either healthcare is a right, like due process; or it isn’t, like
    driving. Either one you pick, you must be accountable for the
    consequences of your selection, for example, its effect on the
    abortion question; similarly, your stance on abortion must
    include an discussion of cost. Even if this is,a fter all, a moral
    question, someone still has to pay for it. I recognize this
    tarnishes the purity of the academic dialogue. It’s not pretty,
    it’s not clean, but it’s reality. And if you think that money is
    not a relevant factor here, then it almost certainly means you
    are not going to be the one who will have to pay.
    This applies to other questions beyond abortion, of course. If
    someone discovers a cure for AIDS, but it costs ten million
    dollars, does everyone get to have it?
    When the universal healthcare nuts draft a plan that includes
    how they are going to pay for the unintended consequences of
    an insufficiently reasoned abortion provision (or restriction),
    give me a call. Until then, wovon man nicht sprechen kann….
    Who Died?
    April 10, 2006

    Here is a suicide statistic:


    “Suicide is the eighth leading cause of death in men.”
    That’s useless, because there is no context. Other useless
    statements are: the risk is higher in psychiatric illness; the risk
    is higher the more previous attempts; men have higher rates of
    sucide than women, etc.
    Here are some statistics (1999, 2001 and 2003— they’re all
    the same) which may help you.
    In the US in 2001, 30,622 people died from suicide. Yes. That
    few.
    24,672 were men. 5950 were women. (That’s 80/20). In the
    whole world (WHO 2000), it was about 815,000.
    5395 were over 65. (85/15 males to females)
    3971 were 15-24. (85/15 males to females)
    So 70% of all suicides are adults.
    73% of all suicides are white males (20,000+). To put it in
    perspective, in 2003, the number of black women who
    suicided was 358.
    Guns were involved in 55% of all suicides; 60% of the men’s,
    and 73% of the elderly’s, and 54% of youth’s.
    In other words, mostly white adult males die.
    White men over 85 have the highest rate given their
    popualtion (54/100,000), vs. an overall rate of 10.7/100,000
    (.01%) But this number of suicides is so small that the statistic
    doesn’t help you.
    So the real risk factors are white males with a gun.
    I should also point out that 30,622 is a really small number of
    people— even though it is almost as many as homicides (20k)
    and AIDS deaths (14k) combined.
    How about suicide attempts that don’t result in death?
    Well, there are a lot: in 2002, 132,353 were hospitalized for a
    suicide attempt, and 116,639 were seen in an ER and released.
    But here’s the thing: they didn’t die.
    The problem with our suicide assessment is that it screens for
    attempts, not death. And while non-psychiatrists might be
    surprised to hear this, a whole lot of people commit impulsive
    suicidal acts with no or little interest in actually dying.
    Psychiatry cannot do much to stop these acts, nor should it be
    responsible to do so. A psychiatrist should be no more
    responsible to prevent these parasuicidal acts than an
    endocrinologist is to guarantee that the patient takes their
    insulin. If psychiatric illness— that’s major Axis I— so
    impairs their reason that they don’t know what they’re doing,
    can’t stop, etc— then it’s our responsibility, just like, given
    that same patient, it’s the endocrinologist’s. Otherwise, it is
    not.
    We spend a lot, a lot, of money and time hospitalizing people
    who are not going to die. A not insignificant portion are
    outright malingerers, and everyone knows it. The rest may be
    at risk, but they may not be best served in a hospital.
    So we can either spend our time and resources on preventing
    suicide attempts, or on preventing the 30k actual suicide
    deaths. It’s not the same thing.
    Clozaril: FDA Misses The
    Point, Again
    April 14, 2006

    As you may know, when prescribing Clozaril (clozapine), a


    complete blood count with differential (CBC w/ diff) has to be
    checked every two weeks, because of the risk of
    agranulocytosis.
    The FDA has relaxed these requirements: now, you have to
    check weekly for the first six months; then every two weeks
    for six months, then only monthly after that. You have to show
    WBC >3500/ml, and ANC>2000/ml. (That’s white blood
    count and absolute neutrophil count.)
    Don’t think for a millisecond this was done because the FDA
    did a rigorous re-evaluation of safety data. This is the FDA
    that black boxed antidepressants for suicide and antipsychotics
    — oh, sorry, only atypical antipsychotics, even though typicals
    are as bad, if not worse— for death in patients with dementia
    related psychosis.
    What’s stupid about this is that agranulocytosis is the least of
    anyone’s problems. In the Clozaril National Database (1990-
    1994) (1), there were 99,502 patients. 382 (0.4%) got
    agranulocytosis, and 12 died (that’s 0.001%). The number of
    clozaril related deaths (all kinds) was more than 400.
    In an Italian study, the rates of neutropenia are about 0.9%,
    and agranulocytosis 0.7% (2)
    They are, however, dying in not insignificant numbers by
    other things.
    Consider a Maryland finding: of the 2046 clozaril patients
    from 1990-2000, three died of new onset diabetic ketpacidosis.
    (0.15%) None had had diabetes. (3) Or the Israeli study (4)
    that found that 4/561 clozaril patients had sudden death— 10
    years younger, healthier, and 4 times the rate of non-clozaril
    treated sudden deaths. NB: no one died from agranulocytosis.
    How about myocarditis: 8000 patients over 6 years: 15
    myocarditis, 8 cardiomyopathy; 6 died. That’s 0.3% 5 of the 6
    deaths occurred in first month (that’s right: month). (2) Given
    the rapidity of death, the authors speculate it’s an acute
    hypersensitivity reaction (i.e. IgE/Type I).
    A review of Pubmed/MEDLINE from 1970-2004 found rates
    of fatal myocarditis/cardiomyopathy to be between 0.015%
    and 0.188%.
    An oft cited article by Walker examined 67072 clozapine
    patiens from 1991-1993, and found that of the 396 deaths, the
    most common cause was pulmonary embolism. (FYI:
    Zornberg found that exposure to low potency antipsychotics
    massively increases the PE risk to (OR 24 for low potency, 3
    for high potency; not dose related, usually occurred in first
    three months.)
    In contrast to Hagg’s finding of 12 cases of PE/DVT, and a
    frequency of about 0.03%, another study of 13000 inpatients
    over 6 years found 5 PEs, i.e. a rate of 0.038%; but this was no
    different than typical neuroleptics of non-treated.
    Look, I’m not saying to ignore agranulocytosis. I’m saying
    that when your patient’s heart explodes, you can’t say, “but the
    FDA only said CBCs!” You need to be checking EKGs. And
    when the lawyer asks you how most people die when on
    clozapine, it’ll look really bad when you give the wrong
    answer.
    CATIE: Sigh
    April 16, 2006

    1. You know, if you’re going to be rigorous about BID dosing


    schedules because the FDA requires it, why so liberal with
    total dosing for Zyprexa? A mean dose of Zyprexa is 20.8 is
    way (150%) above FDA guidelines. For comparison, that
    would have meant dosing Geodon at 240mg, Seroquel at
    1000mg, and Risperdal at 6mg. BTW: a mean of 20.8mg
    means that a lot of people were dosed with MORE than
    20.8mg (max=30mg).
    2. The miracle here isn’t that Zyprexa won, but that Zyprexa
    20mg barely won against Geodon 114mg.
    3. Why Trilafon (perphenazine)? Originally you thought all
    conventionals were the same; so why not Haldol? Or Mellaril?
    You say it’s because it had lower rates of EPS and TD, which
    is fine, but then why exclude TD patients from that arm?

    4. So you excluded patients with tardive dyskinesia from the


    perphenazine group (fine) but then had the nerve to say people
    tolerated it as well as other meds? Do you think maybe people
    who have TD may have different tolerances to meds?
    Different EPS? Different max doses? That they’re just
    different?

    5. You can’t generalize from an obviously slanted “typical”


    arm to all other typicals. If you chose Trilafon over Haldol
    because of better tolerability a priori, you can’t now say that
    “typicals” have equal tolerability to atypicals. Why not pick
    two typicals of differing potencies (like Mellaril and Haldol)
    and infer from there?

    6. Do you actually believe— does anyone believe— that any


    of these patients are compliant with BID regimens? Especially
    with sedating meds like Seroquel?

    The secret to understanding CATIE 2 is to understand that


    there are two CATIE 2s.

    CATIE2-Efficacy: People who dropped out of CATIE 1


    because their med didn’t work were randomized to Clozail,
    Zyprexa, Risperdal or Seroquel. On average, new Clozaril
    switches stayed on 10 months, everyone else only 3. 44% of
    Clozaril stayed on for the whole 18 month study; only 18% of
    the others completed the study.

    CATIE2-Tolerability: People who dropped out of CATIE 1


    because of side effects (not efficacy) were randomized to
    Zyprexza, Risperdal, Seroquel, and Geodon (not Clozaril.)
    Risperdal patients stayed on for 7 months, Zyprexa for 6,
    Seroquel for 4 and Geodon for 3.

    CATIE2-Efficacy is fair. If you fail a drug, you’re likely to do


    better on Clozaril than anything else.

    CATIE2-Tolerabilty makes no sense at all. The reason Geodon


    was used is because it has “very different” side effects. Hmm.
    How? “In particular, ziprasidone [Geodon] was known not to
    cause weight gain.” But this assumes that the intolerability of
    the first antipsychotic was its weight gain.

    Most importantly is this: if a patient couldn’t tolerate their first


    antipsychotic, how likely is it that it was effective? In other
    words, if it wasn’t tolerable, it wasn’t efficacious— these
    patients could have been in CATIE2-Effectiveness study. So
    how did they choose?

    Easy: they gave the patient the choice: Geodon or Clozaril?


    Out of 1052, half left altogether. 99 went into the Clozaril
    study (CATIE2-Effectiveness) and 444 went into Geodon
    (CATIE2-Tolerability.) Of the 444 in the Tolerability trial,
    41% were actually labeled first drug non-responders. 38%
    were labeled as not tolerating their first drug, but of those, who
    knows how many were also nonresponders?

    And 74% dropped out again.

    If you take the 444 in the Tolerability study and divide them
    into two groups:

    those who left CATIE1 because of lack of efficacy: then


    switching to Zyprexa or Risperdal kept them on their
    meds longer. (Which makes no sense again: this is the
    same thing as the CATIE2-Effectiveness, where (except
    for Clozaril) there was no difference between Seroquel,
    Zyprexa and Risperdal.)
    those who left CATIE 1 because of lack of tolerability,
    then it made no difference what you switched to.

    Sigh.
    And what’s with the blinding? In every other study with a
    clozapine arm, you equalize the weekly blood draws by
    making everyone have to submit to them. But in this case, they
    unblinded clozapine so as not to have to subject all these
    people to blood sticks. Except they were subjecting them
    already— they were checking blood levels.

    And where was perphenazine? “[CATIE1] did not anticipate


    this unexpected result [that perphenazine would be as
    efficacious] that challenged the widely accepted (but never
    proven) belief that the newer atypical antipsychotic
    medications are better than all older antipsychotic
    medications” and so was not considered for CATIE2. Apart
    from the fact that it is simply untrue that anyone thought the
    atypicals were more efficacious than the typicals, it is
    furthermore untrue that that the authors did not “anticipate this
    unexpected result.” In 2003, after basically doing Medline
    meta-analysis, they found that “not all of them were
    substantially different from conventionals such as
    perphenazine.”
    What’s funny about these guys is how they conveniently lump
    all typicals together but arguing for differential effects of
    individual atypicals; then argue typicals are different from
    each other to justify picking Trilafon; and then say atypicals
    are different from each other (“not all of them were different”)
    but typicals are all pretty much the same (“conventionals such
    as perphenazine.”)

    Bottom line:
    The stated purpose of CATIE2 was to help clinicians decide
    which drug to switch to if patients a) failed their first drug; b)
    couldn’t tolerate their first drug.
    The divorce rate in America is 40-50%. Say you get divorced,
    and a friend says, I have two women for you, Jane and Mary.
    If the problem with your first wife was that she didn’t turn you
    on, you should marry Jane. If the problem with your ex was
    that she was annoying, you should marry Mary.
    What’s going to happen here is that your second marriage, to
    either girl, is doomed. Certainly more than the national
    average of 50%. How long is it going to take before your
    second wife doesn’t turn you on either? How long before you
    find stuff intolerable about her? The answer is, more likely
    than your first marriage— say, 75%— because the problem
    isn’t your wives, it’s you. You’ve framed the question in an
    idiotic and arbitrary manner. You don’t get married to get
    turned on OR to be with someone who isn’t annoying. You
    want the marriage to have both simultaneously, and much
    more. These things are not separable. This is CATIE2. A
    meaningless dichotomy— efficacy and tolerability are not
    separate, let alone opposites— used to create a false paradigm
    of medication selection.
    CATIE: And Another Thing
    April 16, 2006

    if CATIE is so important, and was funded by the NIMH (i.e.


    taxpayer dollars), why isn’t it available free on the CATIE or
    NIMH websites? Or anywhere else? Snakes. All of you are
    snakes.
    CATIE Reloaded
    April 17, 2006

    And enough with the notion that medication compliance is a


    good proxy for overall efficacy.
    All of these horrible psychiatry studies— CATIE, Lamictal
    and Depakote maintenance trials, etc— keep telling us how
    long patients stay on medications, because they say this means
    the drugs are working. The authors think that if a drug is
    working, they patient will stay on it. But you would think this
    only if you didn’t actually treat many patients. I can make a
    similar argument that staying on a medication is inversely
    related to efficacy— because when a patient feels better, they
    simply stop taking their meds.
    Think about antibiotics. People don’t finish the full 14 day
    course, precisely because they feel well. If they felt sick, they
    would probably take them longer than 14 days. In fact, people
    overuse these antibiotics even when its a virus, despite the
    antibiotic having no efficacy at all. They will demand an
    antibiotic even though know that it shouldn’t be doing
    anything.
    Same with pain meds. Oh, that’s an acute problem? How about
    the chronic problems of diabetes and hypertension. People will
    skip/miss/forget doses when they feel asymptomatic, and will
    be more compliant when they have symptoms associated with
    these illnesses (e.g. headache, dizziness, etc.)
    Look, I’m not telling you that compliance and efficacy aren’t
    related. I am saying that if you want to measure efficacy, don’t
    use compliance as a proxy— go measure actual efficacy. And
    don’t tell me it’s too hard. You got $67 million for this study.
    Find a way.
    Healthcare Savings
    Accounts: Emphasis on
    Savings, Not Healthcare
    April 19, 2006

    A Healthcare Savings Account allows you to put aside


    $2700/yr, or $5040/yr/family, tax-free, for healthcare
    expenses. So what? So sit down.
    First, a primer on deductible medical expenses. The IRS
    allows you to deduct the amount you spent on approved
    healthcare, minus 7.5% of your gross adjusted income. In
    other words, take your gross adjusted income (i.e. how much
    you make minus deductions) and multiply by .075. Subtract
    this amount from your total medical expenses: that’s how
    much you can deduct.

    You make $100,000. You incurred $4000 in medical


    expenses.
    0.075 x 100000 = 7500. 7500-4000=3500. You can
    deduct 3500 from your taxes.

    In the above example, if you only incurred $2000 in medical


    expenses, you can’t deduct anything. Think of the 7.5% as a
    sort of— deductible.
    Healthcare Savings Accounts are different, and
    complementary. In the above example, the $4000 of medical
    expenses was (hopefully) made with money you earned and
    paid taxes on. If you’re in a 35% tax bracket, you actually had
    to make $5400 to come up with that $4000. So you had to pay
    $1900 in taxes; and another $500 is a wash (7.5% deductible).
    So your illness cost you $1900 in addition to whatever the
    actual medical care cost.
    But in George Bush’s America, not only can you deduct
    medical expenses, but you can also put away money tax free
    for use in healthcare.
    Many progressive types will complain that this doesn’t solve
    the healthcare crisis, and they are right. But that’s because
    HSA aren’t about healthcare, they are about savings; they are
    another way of sheltering income from taxes. What they are,
    in effect, is 401(k)s.
    Say you retire. You’ll draw on your 401(k), which was funded
    by $14000/yr contributions, to pay for food, vacations, cable,
    whatever— and healthcare. With an HSA, you can save
    $14000 AND $2700 a year, and use it as necessary when you
    retire. If you have medical expenses, you can just use the HSA
    money; the 401(k) money is for everything else.
    So you can now save $16700 a year. AND you can deduct
    your medical expenses (above 7.5%)
    And by the way, money in an HSA is fully investible, like a
    401(k).
    But what happens if you get hit by a truck (i.e. you have
    catastrophic medical expenses?)
    Each HSA is linked with a “High Deductible Health Plan”
    (HDHP). They have high yearly deductibles of $1k-$2k,
    depending on the plan (which you can use saved HSA money
    to pay) but have maximum deductibles of about $5000 (or
    $10,000 per family.) In other words, you always have to pay at
    least $1000, but not ever more than $5000.
    Each plan also has a monthly premium you have to pay
    (around $90) but about 60% is placed into your HSA (called
    “Premium Pass Through”— you are in essence paying money
    to yourself, and the rest to the plan.) Each plan has different
    premiums, minimum and maximum deductibles, and
    penalties/enticements to use network services. These are
    summarized here, and in slightly more detail here.
    Look, you can argue the social policy ramifications of this all
    day. But don’t look a gift horse in the mouth.
    By the way, you may be fascinated to know what is an
    allowable medical deduction.

    Abortions
    Acupuncture
    Home improvements for health reasons (elevators,
    widening a doorway,“lowering” kitchen cabinets)
    Fertility enhancement
    Lead paint removal
    Legal fees to get healthcare
    Medical conferences and transportation (if the conference
    is about your/your family’s illness)
    Psychoanalysis
    Transportation to healthcare services (gas, bus, etc)
    Weight loss programs
    Wigs
    Vasectomies
    Why Are So Many
    Psychiatrists From India?
    April 20, 2006

    Because they’re not.


    Odd article in Clinical Psychiatry News about the Match.
    Although it doesn’t come out and say it, it basically laments
    the fact that there are so many foreign medical graduates in
    psychiatry. Which is weird, because there aren’t.
    As the article correctly indicates, there were 1037 slots
    available. 983 (95%) were filled. U.S. med school graduates
    comprised 62%.
    The article says:

    Another issue that concerns some psychiatrists is “a


    continued and sustained reliance” on international
    medical graduates to fill residency slots.

    What’s so wrong about this perspective is that it misses how


    slots get filled. The slots don’t “exist” and need filling. Slots
    exist because there’s a demand for them. And they get filled
    by FMGs because they had been filled by FMGs the year
    before. For example: in 2005, U.S. grads filled 63.6% of the
    slots. In 2006, it is 62%.
    So the question isn’t why so many FMGs go into psychiatry. It
    is a) what is it about U.S. medical education that doesn’t
    prompt U.S. grads to go into psychiatry; and b) do we really
    need this many psychiatrists?
    What we should be thankful for, and Dr. Weissman indicates
    this, is that by taking in FMGs to residency slots, we don’t
    have to pay to educate them in U.S. medical schools.
    Basically, it’s free money: some other country paid to educate
    them, and now they work here. Good for us.
    But this should lead us to the next question: why send them to
    medical school at all? Many argue that foreign medical
    schools are not as good as U.S. ones. Fine— then why are they
    allowed in residencies? And if they are, then you can’t say you
    need a U.S. “level” of education, either. And if an NP can
    prescribe, and a psychologist can prescribe, you similarly can’t
    obligate we all go to medical school.
    So either we need U.S. med schools, or we don’t. There are
    ramifications to either choice. Choose.
    You can find the distribution of residency matches here.
    Missing The Point At The
    NY Times
    April 25, 2006

    This time by one of our own (academic psychologist, Harvard)


    in an Op-Ed, entitled, “I’m Ok, You’re Biased.”
    The premise is summarized here:

    Doctors scoff at the notion that gifts from a


    pharmaceutical company could motivate them to
    prescribe that company’s drugs, and Supreme Court
    justices are confident that their legal opinions are not
    influenced by their financial stake in a defendant’s
    business, or by their child’s employment at a petitioner’s
    firm. Vice President Dick Cheney is famously
    contemptuous of those who suggest that his former
    company received special consideration for government
    contracts.

    Which would be an ok, if not tired, set up, except for the very
    next sentence:

    Voters, citizens, patients and taxpayers can barely keep a


    straight face.

    It’s the populism of the message that is laughable. So doctors,


    lawyers, Supreme Court Justices and others have no idea that
    they’re biased, but the average joe does? Seems pretty
    unlikely. But— maybe they are biased and it’s okay.
    And the proposed solution, of course, is the same knee jerk
    ineffectual nonsense proposed before:

    In short, doctors, judges, consultants and vice presidents


    strive for truth more often than we realize, and miss that
    mark more often than they realize. Because the brain
    cannot see itself fooling itself, the only reliable method
    for avoiding bias is to avoid the situations that produce it.

    There’s that determinism so popular among those who feel


    powerless.
    I hope that the irony of the NY Times, through a psychologist,
    preaching about objectivity is not lost on anyone. It is so bad
    at that paper that both the right and the left simultaneously
    blast it for overt bias. No wonder that the NY Times stock has
    lost 50% of its value in two years.
    Why not discuss the bias of journalists? Or, more importantly,
    why are they assumed immune from it? This isn’t an idle
    political question, it is the very essence of this debate.
    I’ll state it explicitly: first, the reason it doesn’t matter if
    doctors are biased (and why it matters very much if journalists
    are) is because medicine is supposed to be a science. If it is a
    science— receptors and all— then it shouldn’t matter what I
    think, it should matter what is true. I can delude myself and
    say that seizure drugs are mood stabilizers for the long term;
    but that doesn’t make it true. But if you want to actually see if
    it is true, you have to look it up. And don’t come back with
    “one negative study doesn’t disprove its efficacy.” This is
    science again: it’s not up to me to disprove its efficacy, it’s up
    to you to prove it has any.
    So the real question isn’t bias, it’s whether medicine in general
    is paying attention to its own data. Do we read our own
    studies, or hope the “thought leaders” will, and then write us a
    synopsis? Do we believe it because Harvard said so? Is this
    science, or a cult of personality?
    Second, when discussing medicine, the question of bias is not
    the important one. Yyou have to ask what the harm is. Thie
    bias isn’t harmful to science because science should be able to
    stand on its own. The bias is only harmful to patients— so the
    real question we should be asking is not if there is bias, but if
    it harms patients. Ready: pretend a family doc gets paid
    $800,000 by Pfizer to prescribe only Lipitor, no Zocor,
    Mevacor, etc. What, exactly, is the harm? It’s not snake oil: in
    all the anti-pharma controversy, no one is accusing them of
    selling a product that doesn’t do what they say it does. So
    unless you can tell me which patient shouldn’t get Lipitor, but
    should get Zocor, then you can’t argue this hurts the patient.
    I’m not saying it isn’t sneaky, or unethical. But unless you can
    show the harm, you can’t say it’s harmful. That’s what’s
    relevant.
    But we’re not really worried about patients, are we? That’s a
    screen. What this is all about is our own impotence; anger
    against people who are perceived to have power. We don’t
    even actually believe our own nonsense. This is the same
    argument against Vice President Cheney. If everyone is so sure
    that the Iraq war was about oil and Halliburton, why didn’t
    everyone buy Exxon and Halliburton stock back in 2002? It’s
    fun to criticise, I know. But belief without follow through is
    pointless. If you’re not willing to act on your own beliefs, why
    should anyone else even listen to your crazy beliefs?
    I’m not saying doctors and politicians aren’t biased. I’m
    saying we should worry about the things that actually matter.
    Want to start somewhere, Daniel Gilbert? Academic medicine,
    and the journals that are their propaganda arms. These people
    aren’t scientists, they are science journalists. And they are very
    much biased. Don’t believe me? Call me when you look up
    everyone’s supporting references.
    Who Are Academics Writing
    For? (For Whom Are
    Academics Writing?)
    April 26, 2006

    Interesting study from Princeton psychologist Daniel


    Oppenheimer, called “Consequences of Erudite Vernacular
    Utilized Irrespective of Necessity:Problems With Using Long
    Words Needlessly.” (I should mention I have not read, and
    can’t find, an actual copy of this study.)
    Took a selection of writing samples (grad school applications,
    sociology dissertations etc), and changed each of the words to
    more complex/longer synonyms. Then he gave these samples
    to 71 students and asked them to judge the intelligence of the
    authors. The more complex and flowery the language, the
    dumber the author was assumed to be.
    Think about it…
    From collision detection
    Are Antipsychotics
    Overprescribed In Kids?
    May 3, 2006

    According to USA Today, 2.5 million antipsychotic


    prescriptions a year are written for kids under 18. The rate for
    privately insured kids is 6.5 in 1000— it has to be easily ten
    times that for Medicaid kids.

    The FDA database has 45 deaths; 6 from diabetes, the rest


    from CV disease, liver failure, suicide, etc. There were 41
    pediatric NMS cases.

    According to the article, 13% of antipsychotic prescriptions


    are for bipolar disorder.

    So are antipsychotics being overprescribed? The answer is yes,


    but not for the reasons cited in the article.

    The article, indeed, all articles about pediatric psychiatry,


    make a special point about how these medicines are not FDA
    approved for kids. This is absolutely meaningless. FDA
    approval requires two double blind, placebo controlled studies.
    These studies are universally taken on by the drug companies.
    No drug company would ever assume the massive risk of such
    a study— let a lone two— in kids. How do you recruit the
    study subjects? What parent is going to allow it? Rich parents?
    No chance. So it will have to be Medicaid parents— and thus
    will come the Tuskegee-like charges, dripping with the
    obvious social and racial implications of pharma testing on
    poor minorities. Pharma is already loathed; they’re not going
    to take any risks for the sake of a medal from the FDA. So
    there will not be any new pediatric indications for psych meds.
    Not in this climate. Think this hurts Pharma? It’s your kids
    that suffer.
    But don’t be confused by crypto-socialist hysterics who say
    that Pharma will do anything for a profit, including peddle
    drugs to kids. Drug companies do not market these
    antipsychotics for kids. They are paranoid to a fault about
    doing this; they know everyone is scrutinizing them, especially
    lawyers. If you are a child psychiatrist who sees no adults, reps
    cannot even call on you. And if they call on you for other
    things, they cannot mention the use in kids. In the past five
    years, it has never— never— happened that a rep detailed me
    about their use in kids.

    The only two reasons these drugs are used in kids is because
    psychiatrists give them, and parents demand them.

    First, the parents. They don’t come looking for antipsychotics,


    specifically. But my experience is that they are unrealistic
    about what is going on with their kids; in near denial about the
    family dynamics impacting on the kid’s behavior; and virtually
    devoid of insight into relatively obvious, though procedurally
    difficult, maneuvers that could improve the situation. If your
    kid doesn’t sleep enough, and consistently— if your five year
    old doesn’t nap— you cannot tell me your kid has ADHD.
    Period. Parents demand a diagnosis of bipolar disorder for
    their kids because it means the divorce had nothing to do with
    it. They demand another medication when the first one fails to
    get the kid to do math homework instead of playing Xbox all
    day. And their kids’ marijuana and alcohol abuse can’t
    possibly have anything to do with their own marijuana and
    alcohol abuse. Parents: don’t flame me. Your situation is
    different, I know. I know.

    Second, psychiatrists prescribe them because of the pressure to


    do something, in the face of consistent failure. They don’t start
    with antispychotics— they end up with them. They prescribe
    them out of desperation. This is why, in every story about a
    child getting sick from one of these medicines, they are, in
    fact, on several medicines. First they start with Ritalin. If
    Ritalin doesn’t help, or there is a side effect, or they can’t
    sleep— then a second drug is added. Maybe this helps, but
    after a while something else happens— and another drug is
    added to this. That’s why psychiatry’s current obssession with
    the detection of underdiagnosed “bipolar disorder” is so
    important. This diagnosis justifies, and encourages,
    polypharmacy.

    It is psychiatry’s ridiculously dangerous, and ultimately


    doomed, paradigm: if you are not doing well on a medication,
    you must be so sick that you require two medications. It seems
    to have occurred to no one in psychiatry that failure on a
    medication could mean that it was the wrong medication.

    The reason this polypharmacy madness is even possible is


    psychiatry’s obsession with diagnosis, labels— with semiotics.

    What makes a drug an antipsychotic? Well, it treats psychosis.


    Fine— but does that exclude its efficacy for something else? If
    it is later found to be efficacious in, say, depression, then what
    do you call it? Is the drug an antipsychotic that’s also good for
    depression, or an antidepressant that’s also good for
    psychosis?

    There’s no value in the label “antipsychotic” or


    “antidepressant” except what we give it. It’s a drug that treats
    psychosis and depression, not an antipsychotic that treats
    depression (or the other way around). If you can’t see the
    difference, stop reading now and go back to watching
    American Idol.

    For example, why are antipsychotics viewed as “off label” for


    kids? The word “antipsychotic” is meaningless.
    Antipsychotics are tested against a scale, like the Brief
    Psychatric Rating Scale. But these scales measure a lot of
    things, like depression, and not just psychosis.

    And at what point did we start making a distinction between


    psychosis and “dementia related psychosis?” Or bipolar
    depression and regular depression? Why do we need separate
    FDA approvals? Does someone know something about the
    physiology of these disorders that I don’t? Do we need to start
    approvals for “diabetes related depression?”

    Saying an antipsychotic is worse than an antidepressant for


    depression is a valueless statement, especially in the absence
    of data on this question. You are actually better off asking,
    “which is better for depression, blocking the serotonin
    transporter or blocking 5HT2a receptors?” See? Put this way
    the distinction seems less obvious. And even that question is
    valueless, as there is nothing (that we know of at this time)
    that allows us to say what effect either pharmacologic
    maneuver actually has. 5HT2A blockade does what again?
    Really? Do you have any evidence for that at all? And no
    more post hoc ergo propter hoc nonsense. David Hume laughs
    at you.

    A Simpson’s reference is helpful here:

    Homer: Not a bear in sight. The Bear Patrol must be


    working like a
    charm.
    Lisa: That’s spacious reasoning, Dad.
    Homer: Thank you, dear.
    Lisa: By your logic I could claim that this rock keeps
    tigers away.
    Homer: Oh, how does it work?
    Lisa: It doesn’t work.
    Homer: Uh-huh.
    Lisa: It’s just a stupid rock.
    Homer: Uh-huh.
    Lisa: But I don’t see any tigers around, do you?
    [Homer thinks of this, then pulls out some money]
    Homer: Lisa, I want to buy your rock.

    I know. The FDA, the Scientologists, socialists, the parents at


    the end of their ropes- the easy thing to do is blame Pharma.
    I’m in the strange position of having to be a Pharma apologist,
    to be the only doctor willing to defend Pharma. There are
    plenty things I don’t like about the way Pharma conducts
    business, but I can’t voice these complaints because I have to
    use the time countering these inane attacks. I know what will
    happen if the Pharma critics get their way.

    You think Pharma should have no sales contact with


    physicians? Fine. Now deal with the consequences.
    Provigil vs. Cocaine
    May 6, 2006

    In an attempt to see if there is an interaction between cocaine


    and Provigil, 20mg or 40mg IV cocaine was given pre and
    post Provigil (400mg or 800mg) for 7 days. There was an
    interaction, but it turned out to be positive: Provigil reduced
    systemic cocaine exposure.
    A safety study investigated (in 7 people) the interaction
    between cocaine (30mg IV) and Provigil (modafinil) 200mg or
    400mg, or placebo, and found no synergistic effect on vital
    signs (T, BP, HR) or EKG. Not only did it not augment
    cocaine euphoria, it blunted it in one person.
    In another study, 62 (mostly black) males addicted to cocaine
    were randomized to placebo, CBT, or Provigil 400mg.
    Abstinence, the primary outcome, was measured by
    benzoylecgonine in the urine. Patients on Provigil were
    abstinent longer, and produced fewer positive urines (i.e.
    fewer relapses.) Importantly, no one got addicted to Provigil.

    Unlike cocaine and Ritalin (methylphenidate) Provigil did not


    produce “cocaine like discriminitive stimulus” (i.e. didn’t feel
    like cocaine; Ritalin and cocaine do feel like cocaine.)
    That’s all we know about Provigil vs. cocaine so far, which is
    pitiful but not inconsequential. Given Provigil’s near absence
    of terrible side effects, I say it’s worth a try.
    In the interest of completeness (and correctness) I have to
    correct the major paper, above (the 62 people with the urine
    tests) . The authors of that paper propose the following
    potential mechanism:

    Its glutamate-enhancing action (Ferraro et al, 1998; 1999)


    might be clinically advantageous in cocaine dependence
    because the repeated administration of cocaine depletes
    extracellular glutamate levels

    Except that the Ferraro paper doesn’t actually say that. What it
    says is that it inhibits striatal and globus pallidus GABA, but
    doesn’t directly affect glutamate. In order for it to have any
    effect on striatal glutamate, you needed 300mg/kg (i.e.
    21,000mg. See you on the other side.) Given that GABA and
    glutamate are opposites (i.e. glutamate goes up because
    GABA goes down), it’s probably a small point, but not an
    insignificant one: if it directly increases glutamate, it could
    antagonize Lamictal or even potentially cause seizures (and it
    does neither.)
    The second Ferraro reference finds essentially the same thing:
    inhibition of medial preoptic area and posterior hypothalamus
    GABA, and consequently glutamate increases. And again, all
    of this occurs at preposterously high doses (100-300mg/kg.)
    In interesting side finding of Ferraro’s study is that the medial
    preoptic area and posterior hypothalamus are primarily
    controlled by tonic GABA inhibition; consequently
    modafinil’s (or any drug’s) effect of increasing glutamate in
    these areas can be blocked by giving a GABA-A antagonist.
    So Provigil operates by (probably) by antagonizing GABA,
    not specifically by enhancing glutamate (neither synthesis of
    or transport of).
    To further complicate this picture, it may be that the effects on
    GABA and glutamate are both indirect, and really the result of
    serotonin agonism. In an earlier study by the same guy, the
    decreases in GABA were partially prevented by a 5HT3
    blocker (think Zofran, Remeron). Does Provigil work through
    serotonin? In a later study, the same guy finds that at
    100mg/kg, Provigil does, after all, increase serotonin in the
    medial preoptic area and posterior hypothalamus. (At lower
    doses, 10-100mg/kg, it increases serotonin in the cortex, dorsal
    raphe and the amygdala.) (And in another study, (yes, by that
    same guy again,) 3mg/kg Provigil, which in itself has no effect
    on serotonin, synergistically augmented serotonin increase to
    fluoxetine and imipramine.)
    We already know that Provigil can reduce the sedation that
    comes from varying drugs, like SSRIs, general anesthesia,
    haloperidol, and chlorpromazine. It would be interesting to see
    if Provigil was unable to improve sedation on Remeron,
    supporting the 5HT3 hypothesis.
    Good luck out there.
    Modafinil vs. Clozaril
    May 7, 2006

    I’m researching modafinil for my last post, and bam— I see


    this thing. How is no one talking about this article? Does no
    one read anymore?

    A short intro to EEGs and antipsychotics.

    Generally, antipsychotics increase power across all


    frequencies, but each drug (or receptor system) is associated
    with a specific frequency’s power increase. Additionally,
    antipsychotics’ effects are region specific: here, the prefrontal
    cortex gets the majority of the effect.

    Effects of haloperidol 0.5 mg kg-1 s.c. (A) and 1 mg kg-1 s.c. (B);
    chlorpromazine 0.5 mg kg-1 i.p. (C) and quetiapine 2.5 mg kg-1 s.c. (D) on
    EEG spectral power in rats. Panels on the left show data from prefrontal
    cortex, panels on the right show data from sensorimotor cortex.
    Everything is higher (i.e. above the line), but see how each
    drug or dose changes which frequency sees the most increase
    in power? So now you can make a comparison table:

    Summarizing:

    D2 blockers (haldol, racloperide): increase in 10-15Hz power


    band (lesser in 15-20Hz)
    Pure 5HT2A blockers (MDL100907): increases 2 Hz power
    band
    High 5HT2/D2 ratios (Risperdal, sertindole): peak
    synchronization at 7-10 Hz.

    In other words, mixing receptors gets you a mixed effect on


    EEG.

    Additionally, drugs with high alpha-1 blockade (Clozapine,


    chlorpromazine, quetiapine) increase in 8-10 Hz power band.
    You would guess that mixing an antipsychotic with
    apomorphine (a dopamine agonist) might decrease these
    effects, and mostly this would be right. There seems to be
    more effect on the sensorimotor cortex, but this isn’t today’s
    message.
    What do you think would happen if you mixed Provigil and
    racloperide (D2 blocker) or clozapine? With racloperide,
    Provigil increased the power in the 10Hz band in both
    prefrontal and sensorimotor cortex— a lot.
    But apomorphine added to clozapine had no effect— and
    Provigil added to clozapine decreased— and at high doses
    almost totally extinguished— the effect. This is the opposite of
    what happens in a pure D2 blocker!

    Effects of the co-administration of clozapine (CLZ, A) 0.2 mg kg-1 s.c. and


    modafinil (MOD) 62.5 mg kg-1 i.p. (B), 125 mg kg-1 i.p. (C) or 250 mg kg-1 i.p.
    (D) in rats. The ordinate represents the percentage change in EEG power.
    Vertical bars for each Hz show 95% confidence intervals. Panels on the left
    show data from prefrontal cortex, panels on the right show data from
    sensorimotor cortex.
    The likely explanation is alpha-1 blockade. Clozapine is a
    potent alpha-1 blocker. The wakefulness promoting, and EEG,
    effects of Provigil, which has no affinity for adrenergic
    receptors, are strangely blocked by prazosin (an alpha-1
    blocker.) Thus, the specific effects of clozapine on EEG
    synchronization must be through alpha-1, not dopamine (i.e.
    the opposite of racloperide), as evidenced by the fact that they
    can be negated by Provigil, but not by apomorphine (again, the
    opposite of racloperide.)
    In other words, alpha-1 blockade is integral, not incidental, to
    the antipsychotic efficacy of clozaril. It’s not just orthostasis.
    This bodes well for Seroquel as well. But the reason why
    alpha-1 blockade is important is not clear. More on this when I
    figure it out.
    Atypicals and Diabetes:
    Glucose Transport
    May 10, 2006

    Glucose is absorbed through the small intestine into the blood.

    All glucose is taken into cells via hexose transporters: this is


    facilitated diffusion (no ATP). Facilitated diffusion is passive
    diffusion through a channel made by a transmembrane protein;
    the proteins are able to open and close this channel. There are
    many ways channels can be opened/closed: ligand gated (i.e.
    neurotransmitter receptors), voltage gated (neurons), or, in the
    case of hydrophilic molecules such as glucose, mechanically
    gated: the channel is shaped like a closed “V”. Glucose goes to
    the bottom of the V, causes a conformational change and the
    “V” opens, but closes at the top (makes an upside down “V”.)
    Glucose can pass, and the V recloses. All diffusion is down a
    concentration gradient.

    The hexose transporters are called, randomly, “Glucose


    transporters 1-5” (GLUT1-5).

    GLUT4 is the main transporter in muscle, fat, and the heart.


    GLUT4 is insulin-sensitive (though it can also be activated by
    muscle contraction— go figure.) In the absence of insulin,
    GLUT4s are stored in cytomplasmic vesicles floating around
    in the cytosol. If insulin binds to the insulin receptor (an ATP
    dependent tyrosine kinase receptor— NOT the GLUT4), a
    signal cascade is activated that causes the cytpolasmic vesicle
    to go to and bind to the plasma membrane and lodge the
    GLUT4 there. The GLUT4 then allows glucose to diffuse
    through. When insulin disappears, the insulin receptor
    reconforms, the signal cascade stops, and the GLUT4 pinches
    off (by clathrin and other contracting proteins in the cell
    membrane) into a vesicle again (pinocytosis).

    Thus, if there is no insulin: even if there is much glucose, there


    is no signal for the vesicle to go to the plasma membrane and
    lodge the GLUT4, so there will be no transport of glucose into
    the cell; so glucose stays high in the blood. Thus we have Type
    1 diabetes.

    Insulin also stimulates the creation of glycogen in the liver and


    muscle. [Insulin activates hexokinase (1st enzyme in
    glycolysis) as well as phosphofructokinase and glycogen
    synthase) and inhibits glucose-6-phosphatase ((opposite
    direction of hexokinase, same reaction) gluconeogenesis).]

    Insulin promotes fatty acid synthesis.


    Once glycogen synthesis has maxed out (i.e. about 30g, about
    20% of the carbohydrate part of a studied meal, max in 4-
    6hrs,) then fatty acid synthesis IN THE LIVER takes over.
    Glucose is converted to free fatty acids (FFAs) and dumped
    back into the blood as lipoproteins— which are then broken up
    into FFAs.

    FFAs go into the adipose cells of the body. Glucose also goes
    into adipose cells— via GLUT— and are converted into
    glycerols. Glycerol+FFAs= triglycerides.

    Thus, insulin’s role is to store fat and/or oxidize glucose. Too


    little insulin will also trigger protein catabolism.

    GLUT1 and GLUT3 account for 95% of the glucose transport


    to the brain. GLUT1 is for the blood brain barrier (the tight
    junctuions of the BBB are what require these channels), and
    GLUT3 is in the neurons. (pic here) GLUT1 is also found in
    muscle.

    These are not insulin dependent (like GLUT4 is) so the brain
    can continue to get its energy. Not only does the distribution of
    GLUT 1 and 3 mirror capillary density and areas of relative
    glucose utilization, the GLUT1/3 densities can change
    depending on chronically increased (or decreased) need for
    glucose. Interestingly, nicotine, which increases brain glucose
    utilization, increases GLUT1/3 but not capillary density.

    GLUT2 and 7 are in the liver. GLUT2 can also carry D-


    fructose.

    GLUT5 is in the intestine, and some glial cells of the brain.

    Type II diabetes is insulin resistance, not lack of insulin. There


    is not, at least initially, a problem with the pancreas’s secretion
    of insulin in response to high glucose. The problem is at the
    level of the insulin receptor and/or GLUT, which become
    insensitive to the effects of insulin— because there has been
    so much of it for so long. (For more info, see: News Physiol
    Sci. 2001 Apr;16:71-6.
    Next up: how do antipsychotics affect
    glucose/insulin/transporters?
    (For a review: What We Know About Facilitative Glucose
    Transporters )
    How Do Antipsychotics
    Cause Weight Gain?
    May 10, 2006

    In order for this post— and any discussion on antipsychotic


    induced weight gain— to make sense, you have to understand
    one thing: each antipsychotic seems to cause weight gain by a
    different mechanism, not varying degrees of the same
    mechanism. Because let me tell you right off the bat:
    researchers here are far from agreed.
    A review of some articles:
    In rat pancreatic beta cells, neither clozapine nor haloperidol
    had any effect on basal insulin release. In the presence of high
    glucose, haloperidol had no effect on the normal insulin surge,
    but clozapine inhibited this effect by 40%. How it did this is
    not clear, as clozapine, in the presence of glucose, completely
    suppressed electrical activity by hyperpolarizing the
    membrane potential (i.e. increased K+ conductance.)
    Haloperidol depolarized (inhibited K+ conductance). Thus, by
    completely suppressing electrical activity, it should have
    completely suppressed insulin release— but it only inhibited
    40%. Similarly, haloperidol should have increased insulin
    release (via depolarization) but it didn’t have any effect. We
    don’t know what would have happened if the study had been
    continued for a year; but note here that the effect on insulin is
    dependent on the presence or absence of glucose, not the other
    way around.

    Most studies focus on the changes in serum parameters


    (triglyceride, cholesterol, insulin, etc) and not the mechanism
    for these changes.
    For example, in 112 schizophrenics on meds for 8 weeks,
    Zyprexa, clozapine, Risperdal, sulpiride all increased insulin
    and C reactive peptide, as well as insulin resistance; but only
    clozapine and Zyprexa increased triglycerides and cholesterol,
    and had a greater impact on insulin, insulin resistance, and C-
    peptide. What you can’t tell is when this happened and what
    came first: did the insulin go up as a direct effect of the med,
    and consequently so did cholesterol, or did insulin resistance
    happen first, etc?
    In the first study looking at the drugs’ effects on GLUT1-5
    mRNA, it was found that Remeron (mirtazapine) increases
    GLUT4 (muscle/fat) and 5(intestine) mRNA, and Haldol and
    Zyprexa increase GLUT5. No effect on GLUT1-3. (Contrast
    with Clozaril and Risperdal, below.)
    The authors propose something interesting about Remeron:
    “Therefore, the increasing effects of mirtazapine on GLUT4
    mRNA levels in our study might lead to a decrease in blood
    glucose levels and to an increase in cellular fat deposition,
    leading to intermittent or continuous lowering of blood
    glucose levels with a subsequent increased uptake of
    carbohydrates and other types of nutrients.” In other words,
    better glucose uptake into cells means more fat inside cells,
    and less glucose outside cells (hypoglycemia)— which is a
    stimulus to eat more.
    This is important, so I’ll repeat it: the hyperglycemia seen with
    Zyprexa and Remeron is here proposed to be due to the acute
    lowering of blood glucose (because of increased transport),
    and thus an increase in eating and fat deposition, and
    consequently insulin resistance and hyperglycemia; not a
    direct affect on glucose metabolism.
    (Consistent with Zyprexa’s effect on GLUT5 (and not on
    carbohydrate metabolism, per se), metformin did not prevent
    weight gain in 40 people on 10mg Zyprexa (all gained 5-6kg
    in 14 weeks.)

    In (male C57) mice, over a 6 month period, clozapine,


    chlorpromazine and quetiapine induced hyperglycemia via
    effects on glucose transport. Haldol and amisulpiride have
    little effect on GLUT, and were found not to induce
    hyperglycemia. Risperdal had a medium effect on
    hyperglycemia, but at the lower doses.

    Using rat pheochromocytoma cells, clozapine and Risperdal


    both inhibited glucose transport (i.e. GLUT3).
    Desmethylclozapine (a metabolite) was an even more potent
    inhibitor, while clozapine-N-oxide, the other metabolite, had
    no effect on glucose transport. Clozapine and fluphenazine
    also inhibited glucose transport in (rat) muscle cells. The drugs
    block glucose transport in a non-competitive (i.e. allosteric)
    manner (and tricyclics appear to work in the same way.) What
    is interesting about this is that different people metabolize
    clozapine differently, and perhaps those who create more
    desmethylclozapine get more hyperglycemia than those who
    make less (and/or more clozapine-N-oxide.
    A follow-up study tried to correlate the toxicity of these drugs
    to cells to their inhibition of glucose transport.
    They found that clozapine, desmethylclozapine, Seroquel and
    fluphenazine were toxic to cells; Risperdal was minimally
    toxic; and Zyprexa actually promoted cell growth.
    Seroquel, Zyprexa and clozapine all inhibited glucose
    transport about the same amount, and in a dose dependent
    manner. (Remember: Haldol and sulpiride don’t.)
    However, if the cells were exposed to drug for a longer time,
    fluphenazine greatly inhibited glucose uptake, clozapine had
    no effect, and Zyprexa increased glucose uptake. In other
    words, the toxic typicals only need a sort exposure to kill a
    cell, while less toxic atypicals need prolonged exposure. Also,
    fluphenazine increased GLUT3, and the atypicals had little or
    no effect (as found above.)
    Zyprexa was found not to affect either the basal or the insulin
    stimulated glucose transport via GLUT1 or 4. (Fun fact:
    bovine serum albumin (or impurities therein), used to replicate
    the fact that olanzapine is highly (93%) protein bound,
    actually increased basal glucose transport, making suspicious
    all studies previosuly done with BSA.) This contradicts the
    findins of the Dwyer articles, above, where antipsychotics had
    inhibitory effects on glucose transport. A possible explanation
    could be dosing: this study used doses comparable to 20mg,
    while others used 20x that amount.
    Another study, in humans, found that neither Zyprexa nor
    Risperdal affected acute (3 week) insulin sensitivity. Again,
    what happens after you get heavy is up for debate.
    So what we have here is confusion, but:
    1. acute, high dose in vitro studies indicate that
    typicals>atypicals inhibit glucose transport, but Haldol does
    not.
    1b. Typicals are toxic to cells, atypicals less so, and Zyprexa
    promotes cell proliferation.
    2. Normal dose and human studies show no effect on insulin
    dependent glucose transport (i.e. GLUT4) but there are effects
    on small intestine absorption (GLUT5) with Zyprexa and
    Remeron.
    3. Clozapine inhibits insulin release in the presence of glucose,
    but Haldol doesn’t.
    4. Acute effects may be different than chronic. i.e. even though
    antipsychotics may not directly affect insluin resistance or
    glucose transport, if they make you hungry or increase fat over
    time, this could result in later insulin resistance,
    hyperglycemia, etc.
    Zyprexa’s Weight Gain: Does
    What You Eat Matter More
    Than How Much?
    May 14, 2006

    The authors of this article have an interesting hypothesis, upon


    which I speculate wildly. But it is fascinating:
    GLUT5, is found primarily in the small intestine (though also
    in muscle and kidneys.) What’s interesting about it is that it
    transports fructose, which in turn directly stimulates additional
    GLUT5 mRNA expression. You eat fructose, this increases the
    expression of GLUT5 in the intestinal villi, which increases
    the transport of fructose. So the more fructose you eat, the
    more readily you can absorb it.
    Now fructose doesn’t stimulate insulin secretion. Since insulin
    regulates leptin, fructose actually reduces leptin. Fructose
    increases ghrelin. So you get hungry. Fructose goes to the liver
    and is metabilized to acyl glycerols, and consequently result in
    increased triglycerides.
    So you have a situation in which Remeron and Zyprexa (and
    high dose Haldol) cause an increase in GLUT5 expression; if
    they are also eating fructose (read: high fructose corn syrup)
    this is causing an additional expression in GLUT5, and
    hunger, and increased triglycerides… if one wants to conduct a
    useful experiment, find out if the people who gain the most
    weight on Zyprexa are those who consume the most high
    fructose corn syrup (and not just those who eat the most.) In
    other words, can you gain weight on Zyprexa if you are eating
    Atkins?
    (NB: there are many who want to believe that Zyprexa causes
    weight gain by increasing leptin; and so fructose and GLUT5
    lowering leptin seems confusing. Zyprexa, as shown above,
    actually decreases leptin, acutely. (And clozaril has either no
    effect, or minimal lowering.) Letpin only increases with
    increased fat— i.e. as a consequence of fat, not as the cause of
    fat. Those who have found increases in serum leptin do so
    only after chronic administration, and resultant weight gain
    (for example, in a study of 13 schizophrenics on Zyprexa who
    showed a small increase in leptin after 4 weeks— and after a 2
    kg weight gain; or 6 week animal study finding increased fat
    and leptin. The question, as noted by the authors, is whether
    the acute hypoleptinemia and hypoglycemia is what triggers
    hunger and an ultimate increase in fat, leptin, glucose and
    insulin. )
    Parenting and Personality
    Disorders
    May 20, 2006

    A fascinating article that no one will ever actually read:


    Parenting Behaviors Associated With Risk For Offspring
    Personality Disorder During Adulthood.
    The authors made a (startling) discovery: there are types of
    parenting behaviors which predispose your kid to growing up
    personality disordered.
    This was a longitudinal study of 592 families, first assessed
    when the kids were about 5, and then again when they were in
    their 30s. (More info at their website
    http://nyspi.org/childcom/)
    The results are pretty much what you’d expect:

    The more of these behaviors the parents exhibited, the more


    the risk of PD increased. What is interesting is which PD was
    increased given the number of parental behaviors:
    First, overall number of bad parental behaviors:
    (antisocial=criminal; avoidant=shy; narcissistic=self-absorbed)

    You’ll notice that antisocial PD is essentially zero at baseline,


    and is dramatically sensitive to bad parenting. Contrast this
    with avoidant PD, which, while also sensitive to the parenting,
    starts out higher at baseline. In other words, you may be born
    shy, but not antisocial.
    Looking at specific types of bad parenting:
    What you’ll see in the top figure is that being an aversive
    parent is a great way of making someone borderline or
    passive-aggressive, not to mention paranoid. But it doesn’t
    make them antisocial. Hmm.
    Meanwhile, having low affection or low nurturing scores
    increased the risk for antisocial, as well as everything else (but
    especially avoidant, paranoid, depressive, borderline).
    Some covariate caveats: even when parental psychaitric
    disorders and offspring behavioral problems at age 6 were
    controlled, bad parenting was still associatd with increased
    risk of their kids’ PD.
    Furthermore, the usual association of parental psychiatric
    disorder leading to child PD could be explained, in fact, 95%
    due to the bad parenting. Another way of saying this is that
    95% of the effect that a parental psychiatric disorder has on
    causing their kids’ personality disorder can be obviated by
    better parenting. In a similar vein, 35% of the effect of
    childhood behavioral problems leading to later PD can be
    similarly reduced by better parenting. In other words, even if
    you or your kids have a “biological” psychiatric disorder,
    better parenting skills can darmiatically affect the outcome.
    It is not an insignificant fact that only one of the 5 authors was
    an MD (oddly, he is also a PhD but does not list this in the
    authorship line.). The nature vs. nurture debate in psychiatry is
    all but dead.
    The longer we delude ourselves that biology controls behavior,
    and not the other way around, the longer we’ll have to live
    with the same behaviors.
    Parenting and Personality:
    MAO-A
    May 21, 2006

    Continuing the series:


    The authors investigate the interaction between child abuse
    and MAOA (gene) activity on future antisocial behavior.
    FYI: MAOA is a gene on the X chromosome— so males only
    have one copy. It makes MAO-A enzyme, which metabolizes
    serotonin, dopamine, and norepinephrine, so having low
    MAOA gene activity probably means less MAO-A, and thus
    more serotonin, norepinephrine, and dopamine. MAO-A is in
    CNS, liver, and GI tract; MAO-B (metabolizes mostly
    dopamine and phenethylamines (e.g. amphetamines)) is in
    CNS and platelets.
    Importantly, having been maltreated in childhood predisposed
    you to becoming antisocial; having the MAO-A deficiency, by
    itself, did not. This is important: MAO activity has no effect in
    the absence of child abuse. Having low MAOA activity does
    not predisose you to violence. The abuse is the primary
    determinant.
    What about the interaction between the environment (abuse)
    and biology (MAOA)? This interaction is very significant, but
    how you explain this interaction makes all the difference.
    Here’s the figure:
    The easy (and wrong) explanation, the one that jumps out at
    you, is this: if you were maltreated, having low MAO-A
    predisposes you to becoming antisocial.
    But that’s not what the figure shows. What it shows is that
    having high MAOA mitigated, i.e. lessened, the effect of being
    abused on future criminality.
    What you see is that when MAO-A is high, you are protected
    against the effects of abuse. When it is low, abuse matters.
    It may seem like the distinction between MAO being
    protective vs. being a risk factor is only semantics, but it isn’t.
    How we define the problem actually generates different
    problems. “Having low MAOA increases your risk of being
    antisocial” is a very different social problem than “having high
    MAOA lessens the effect of child abuse.” So if you’re a
    lawyer, don’t go concocting a “low MAOA made me do it”
    defense.
    As an aside, it might be helpful if someone could explain how
    having low MAOA is a risk factor for agression and violence,
    but taking antidepressants (and MAO inhibitors especially) are
    supposed to make you less violent?
    Liver and Medications
    May 24, 2006

    Here’s how to think about the effect of the liver on drugs:


    When you eat a drug, some of it gets bound to protein
    (albumin) and some circulates freely. Your body uses free,
    non-protein bound drug.

    Most drugs are mostly protein bound— notable exceptions are


    lithium, Ritalin, Lexapro (40%) and Effexor (40%). Low
    albumin— as could occur in cirrhosis, severe malnutrition, etc
    — increase the availability of the free form of the drugs. So
    low albumin + valium = more valium for you.

    Next is volume of distribution (Vd)— drugs with high Vd will


    diffuse into fluid spaces. So patients with a lot of edema will
    end up with lower useful drug (because it diffused into third
    spaces.) Be aware that diuresis may consequently increase the
    dose as it returns to circulation.

    First pass metabolism is also important. First pass metabolism


    means that a substantial portion of the drug is metabolized
    quickly— or, conversely, won’t be metabolized if your liver is
    damaged. The appropriate doses of medications are based on
    functioning livers. For example, tricyclics are metabolized by
    50% on first pass; which means, in the absence of a liver, you
    are actually giving twice as much drug as what you think you
    are prescribing. Zyprexa has 40% first pass. Dilantin, by
    contrast, has low first pass metabolism, so the dose is about
    the same.

    There are two phases of liver metabolism.


    Phase 1 occurs in smooth endoplasmic reticulum: reduction,
    oxidation, and hydrolysis. All the cytochrome P450 happens in
    Phase 1.
    Phase 2 occurs in periportal region of portal triad:
    glucoronidation, acetylation, sulfation.

    The trick of this is to understand that liver damage (cirrhosis,


    etc) affects Phase 1, not Phase 2.

    This is why Ativan (lorazepam), Serax (oxazepam) and


    Restoril (temazepam)— all metabolized primarily by Phase 2
    — are favored in drinkers or cirrhotics. Also, renally
    metabolized or cleared drugs will not be as much affected (for
    example, Neurontin.)
    I hope this was helpful. Please drink responsibly.
    Ritalin Causes Cancer?
    May 25, 2006

    An eye-opening study from some Texans.


    18 kids, newly diagnosed with ADHD, started the study, only
    12 finished. They showed up on day 1, and blood was taken.
    The kids were then given Ritalin (methylphenidate) 20-
    54mg/d, as part of ordinary treatment, for three weeks. At the
    end of three weeks, another blood sample was taken. The
    bloods were evaluated for cytogenetic abnormalities.
    In every single case, the frequency of chromosomal
    aberrations, sister chromatid exchanges (SCE), micronuclei,
    and nucleoplasmic bridges were all dramatically higher than at
    baseline. Not a little higher— massively higher.

    The authors had, in their introduction, summarized the absence


    of substantial evidence (or actually even studies) for
    carcinogenicity or mutagenicity, except one long term (2 year)
    high dose study in rodents— it gave them hepatocellular
    carcinoma. But there has been nothing done in humans.
    There are some problems with the study, beyond the obvious
    small sample size.
    First, there’s no control group. The assumption is that the only
    new factor over the three months of the study was the taking
    of Ritalin, so that is the likely culprit. Of course, it is certainly
    possible that something else occurred during those three
    months that could have caused this effect, such as a new
    illness, new meds, taking up smoking, etc. In all twelve
    people. At the same time. Sure, it’s possible.
    Second, the pretreatment group actually had less sister
    chromatid exhcanges than are expected on average. In a
    follow-up letter letter , the authors indicate that the known
    average frequencies of SCE are actually based on adults, not
    kids. Do kids have lower frequencies in general? Maybe.
    The authors in that same letter also observe that despite the
    perception that there has not yet been on observed link
    between Ritalin and carcinogenicity, in fact

    “the national toxicology program (NTP)—CERHR expert


    panel report on the reproductive and developmental
    toxicity of methylphenidate, indicate that only one study
    addressed the carcinogenic risk of methylphenidate
    treatment in humans… conducted by screening pharmacy
    and medical records, indicated that there was no increase
    in reports of cancer in a small number of patients taking
    methylphenidate (only 529 patients).”

    I looked up the cytogenetic effects of amphetamines.


    One study found methamphetamine exposure correlated to
    frequency of micronuclei and SCEs in humans (though, in
    hamsters, this effect was due exclusively to methamphetamine
    itself, and not its metabolites; and free radical scavengers also
    reduced this effect).
    An old 2 year rodent study found decreases in number of
    neoplasms when given dl-amphetamine. Another study found
    a similar reduction, especially in pheochromocytomas,
    pituitary adenomas, and breast adenomas.
    But again, these are rare studies, and this one here is the first
    done, prospectively, in humans.
    What is astounding to me, apart from the obvious, is that no
    one knows this article. It has not been referenced in any
    subsequent articles. I can’t find one psychiatrist, academic or
    otherwise, who has even heard this. They all look at me
    blankly: “Really?”
    Yet, simultaneously, psychiatrists live with complete
    confidence that Ritalin is safe. They’ve never checked the
    known information before, of course, so what allows them to
    be so confident I have no idea; and they certainly don’t run
    Medline once a month “just to keep up with all of science”—
    but they’re sure of what they know. Not even an empty
    patronizing nod to “but of course, our knowledge base is
    expanding…”
    The point is not that Ritalin is unsafe. This study could be a
    load of crap, for all we know. But shouldn’t psychiatry have at
    least heard of this study? What is the mechanism to
    disseminate this kind of information? How long does it take
    for something like this to hit the psychiatric press? In other
    words, given psychiatrists’ arrogant confidence, how do they
    believe they would be informed of new developments? They
    don’t really read psychiatry journals. They certainly aren’t
    going to read cancer journals.
    9/5/06 Update Further info suggests this may be a fluke.
    What You Need To Know About
    The MAOI (Selegiline) Patch
    June 11, 2006

    You’ve probably already read quite a bit about the selegiline (L-
    deprenyl) patch (right?), but these four (five) points may frame the
    information more usefully.

    1a. All the oral MAOIs you are used to (phenelzine, moclobemide,
    trancylpromine, etc) are either nonselective (both MAO-A and
    MAO-B inhibitors) or are selective MAO-A inhibitors.

    1b. MAO-A inhibition is needed for antidepressant effect.

    2. MAO-A metabolizes serotonin, norepinephrine, dopamine, and


    tyramine.

    3. MAO-A in the gut is what metabolizes tyramine. Inhibition of the


    gut MAO-A allows tyramine to enter the circulation unmetabolized
    — thus releasing norepinephrine and causing hypertensive crises.

    4. Oral selegiline (pill) is an MAO-B inhibitor at doses less than


    10mg/d.

    In other words, a) selegiline requires no dietary restriction below


    10mg/d (because it doesn’t affect MAO-A in the gut) and b) it
    doesn’t work below 10mg/d (for depression; MAO-B metabolizes
    dopmaine, so selegiline will still be good for Parkinson’s at small
    doses.)

    5. Above 10mg/d, selegiline is nonselective (thus MAO-A and B


    inhibition). Thus, a) it should work; b) it will require dietary
    restrictions.

    One interesting point: selegiline is rapidly metabolized (first pass) to


    desmethylselegiline, l-amphetamine, and l-methamphetamine. (1)

    The point of the patch is that it bypasses the first pass metabolism
    (you don’t eat it) so you get much higher concentrations of drug into
    the CNS and few metabolites. Also, much less goes to the intestinal
    MAOs, so you get both MAO-A and B inhibition in the brain, but
    less of the MAO-A in the intestine. So even if you use doses greater
    than 10mg/d, you (probably) don’t need dietary restrictions. (NB:
    even though I can’t find any studies clearly linking the risk (most
    find it safe up to 20mg) the PI still says to avoid tyamine foods
    above 9mg/d.)

    Part 2: Efficacy

    Above, I made the outrageous statement, “it doesn’t work below


    10mg/d.” What’s really outrageous is that I couldn’t find any
    evidence that it worked above 10mg/d, either.

    Here’s a typical example: a 2003 study of 289 patients, double


    blinded, placebo controlled, of selegiline patch 20mg/d (keep in
    mind, the starting dose is 6mg/d) vs. placebo patch. Though the
    paper finds “statistical superiority” of the patch over placebo, it took
    8 weeks to get a 2-3 point difference on the MADRS or HAMD-28.
    (For context: the HAMD-28 has 28 questions with ratings from 0-4.
    So three points difference could be three points on one question, or
    one point on three questions…) It never beat placebo on the HAMD-
    17. (To the author’s credit, he does not hide this and is upfront that
    these were “modest” differences.)

    Contrast that with the first clinical trial of the selegiline patch (done,
    astonishingly, by the same author): superior efficacy on all three
    scales. But, of course, even at 20mg/d, it’s really not that superior:
    Maybe 2-4 points, max? I grant more people responded to the patch
    (as defined by reduction of 50% on the HAM score)— but it was
    15% more people, and, well, come on on…
    Just to make the point, a 67 person, multicenter, double blind,
    placebo controlled study tested oral selegiline’s efficacy in
    schizophrenics, and found improvement vs. placebo in “negative
    symptoms,” as defined by the Scale for the Assessment of Negative
    Symptoms (SANS). Troublingly, “improvement” means one point
    difference:

    And not much happened for depression (HAM-D) either.


    Someone, somewhere is going to accuse me of only showing weak
    studies and omitting all the studies that showed it worked well.
    Okay. Here is the last known study:
    The only other patch study was a 321 person, 1 year long placebo
    controlled study, found that while twice as many people dropped out
    for side effects (13.2% vs. 6.7%), twice as many on placebo relapsed
    at 6 months (16.8% selegiline relapse vs. 29.4% placebo).
    Interestingly, at one year the relapse rates for both drug and placebo
    were identical— in other words, all relapses occurred in the first 6
    months, none in the second 6 months.
    That’s it.
    Selegiline: Can I Still Smoke
    Crack?
    June 17, 2006

    Ironically, while selegiline can’t be mixed with cheese or


    Prozac, it can be mixed with methamphetamine and cocaine. A
    small placebo controlled study found that concomittant
    administration of methamphetamine (15 or 30mg) with
    selegiline (oral) caused no EKG, lab, or vital sign changes.
    The clearance and half-life of methamphetamine was also
    unchanged. Similarly, 10mg PO can be safely mixed with up
    to 40mg cocaine, should you be into that. An earlier study
    found that 10mg/d could reduce the high of cocaine and
    reduced the activity of the amygdala (as defined as glucose
    utilization on PET scan) and not caus any negative
    interactions.
    If that’s not good enough for you, a study using the selegiline
    patch 20mg/d in 12 cocaine addicts found that heart rate and
    blood pressure were lower on selegiline at baseline, and were
    increased less after 40mg cocaine IV. It caused a slightly less
    subjective feeling of highness. In case this is not amazing to
    you, let me point out that as an MAO-B inhibitor, selegiline
    should increase dopamine levels— and you should feel more
    high. But the opposite happened. (Why? Because selegiline
    already raises dopamine, so the effect of cocaine is less
    (because there’s less dopamine left to increase) and so it feels
    less fun?)
    It had no effect on cocaine pharmcokinetics or dynamics, and
    did not alter cocaine’s effect on prolactin (suppression) or
    growth hormone (increase.)
    A larger, 300 person double blind trial of patch versus placebo
    (done by the same authors) found no difference for the
    treatment of cocaine dependence— but, importantly, there
    weren’t any adverse effects of mixing the two, either.
    While not recommended, it appears the patch is at least safe
    with your addict populations.
    Pseudoseizures vs. Seizures
    June 17, 2006

    The title says it all: Ictal eye closure is a reliable indicator for
    psychogenic nonepileptic seizures.
    First, the bottom line:
    50/52 patients with pseudoseizures closed their eyes during
    their “seizure,” while 152/156 of actual epileptics opened their
    eyes during their seizures. That’s a sensitivity of 96% and a
    specificity of 98%. That’s gold.
    Now, the details:
    The authors took 234 consecutive “seizure” patients, hooked
    them up to video EEGs and stopped their medications. There
    were 938 total ictal events in 221 patients. 52 (23%) had
    pseudoseizures, and 156 (70%) had eplieptic seizures. There
    was a 3:1 female predominance in the pseudoseizures, no
    difference in epileptics.
    In the epileptics, there was rhythmic eye blinking during tonic-
    clonic activity, and the eyes closed after theseizure was
    finished.
    An interesting corollary to this is when pseudoseizures occur
    in an actual epileptic: quoting the authors, “the simple
    question of eye opening or closure can help differentiate
    between the two types of events. One previous study found
    that patients with both types of events tended to have their
    eyes closed during PNES and open during ES.(6)”
    Outstanding.
    Of course, this is isn’t going to mean much to psychiatrists,
    apparently.
    A questionnaire was put to neurologists (N=39) and
    psychiatrists (N=75) about the utility of video EEG in
    diagnosing pseudoseizures. 70% of the neurologists, but only
    18% of the psychiatrists, thought that video-EEG was accurate
    “most of the time” in diagnosing pseudoseizures. 12% of the
    psychiatrists (no neurologists) said it is accurate “almost
    never.” (3% of the psychiatrists gave no clear response. Why
    doesn’t that surprise me?)
    So here are some other differentiating symptoms:
    In seizure patients, there is a crescendo-decrescendo quality to
    the spike-wave frequencies on EEG. In pseudoseizure patients,
    however, the frequency is the same from beginning to end, and
    it comes on suddenly as if a switch was flicked. The spike-
    wave on EEG is actually motion artifact, and typically runs
    around 4 Hz, while epileptics have frequencies that vary
    between 4-25 Hz.

    In a study of 40 pseudoseizure vs. 40 matched normal


    controls, the pseudoseizure group had more left handers,
    reduced strength and speed in both dominant and non-
    dominant hands, and reduction in the dominant hand
    advantage in strength and speed (i.e. both hands performed
    equally badly— the dominant hand wasn’t a little better.)
    Interestingly and importantly, the authors did not think this
    was due to faking or psychological factors, but felt that it was
    due to actual neurologic impariment in bilateral pathways:
    65% had had a closed head injury, 27% had had physical
    abuse, and 17% had had a history of substance abuse. 40% had
    an IQ less than 90!
    A study in epileptics vs. pseudoseizure patients trying to
    determine how long after admission to a video EEG unit it
    takes for patients to have events (answer: 88% had it on day 1)
    also found that urinary incontinence, focal neurologic exams,
    and tongue biting were about the same in both groups. But
    more epileptics had events less than one minute, and more
    pseudoseizures lasted > 5 minutes (and very few (13%) lasted
    less than one minute.)
    Slightly different results were found in another study: 11/28
    pseudoseizure patients had them on day 1, but 9/28 needed an
    average of 5 days. 19/28 had an induced pseudoseizure to IV
    saline challenge within 3-7 minutes. But still— 3 days should
    be enough for most patients.
    And alexithymia is of no value. It is found more often in
    epileptics and pseudoseizure patients equally, though still
    more than expected in the community. A larger, controlled trial
    had found a similar inability for alexithymia to differentiate:
    alexithymia was very common in epileptics (76%) and
    pseudoseizures (90%). Thus, it is likely that alexithymia is a
    coping strategy, and not an independent trait.
    Addendum 11/5/06: I did find an interesting (Greek) study
    finding an excess of seizures on full moons (34% vs. about
    21% for the other phases.) Importantly (and in contrast to
    suggestions by other studies) these were not pseudoseizures,
    because all patients were monitored. The authors speculate
    either electromagnetic/gravitational effects (hey, it could
    happen) or an interaction between the intrinsic seizure
    threshold and the environment (i.e. you can change you rown
    threshold.)
    Selegiline Again—
    Neuroprotective?
    June 24, 2006

    As a final point on selegiline, it has long been thought that its


    efficacy in Parkinson’s is due to the inhibition of the
    metabolism of dopamine. Which is true, but there may be
    more to it than that.
    A summary of this fascinating article:
    Apoptosis is different from necrosis in a fundamental way: it
    is signaled, rather than directly caused. In necrosis, the cell
    rapidly dies, the plasma membrane ruptures (with resultant
    irreversible ion shifts), but DNA stays intact. In apoptosis, the
    plasma membrane stays intact, but the cell shrinks, chromatin
    condenses and the DNA fragments.
    Signaling is important: the genes p53, bad and bax induce
    apoptosis, while the Bcl family of genes promotes survival. It
    is now thought that apoptosis mediates substantia nigra
    neuronal death.
    So anything that delays or stops apoptosis could be
    neuroprotective.
    Selegiline seems to be such a drug. Since it inhibits the
    metabolism of dopamine, it will also prevent the formation of
    free radicals associated with this metabolism. But, through a
    mechanism totally independent of MAO-B inhibition, it
    protects dopamine neurons from MPTP and its metabolite
    MPP+. (This is a double effect: MAO-B inhibition prevents
    the metabolism of MPTP to the toxic MPP+; and then
    selegiline’s other unexplained mechanism protects neurons
    from MPP+.) Its metabolite desmethylselegiline is actually a
    more potent neuroprotector; and P450 inhibitors which block
    the metabolism of selegiline to desmethylselegiline, also
    inhibit the overall neuroprotection.
    The anti-apoptotic mechanism of selegiline (and the even
    more powerful irreversible MAO-B inhibitor rasagiline) is via
    glyceraldehyde-3-phosphate dehydrogenase (GAPDH).
    GAPDH is usually in a dimer with a stem-loop of RNA in the
    cytoplasm. In mitochondrial oxidation, NAD+ levels rise and
    then knock off the GAPDH, which then floats to the nucleus.
    There, GAPDH inhibits the formation of of anti-apoptotic
    molecules, and thus causes apoptosis. Propargylamines insert
    themselves into the RNA dimer and obstruct GAPDH from
    dislocating— thus it cannot go to the nucleus and cause
    apoptosis.
    Additionally, rasagiline upregulates Bcl-2 and Bcl-xl, among
    other anti-apoptotic molecules.
    The study goes on to describe some clincial trials. Indeed, the
    entire May 2006 supplement in Neurology is about
    neuroprotection in Parkinson’s— definitely worth the read.
    We’ll have more on this topic after some research.
    Antispychotics and Lawyers
    June 28, 2006

    You may have seen the advertisements on TV: “if you’ve


    taken Zyprexa and have diabetes, call us, the legal team at…”
    Before you take your patients off of Zyprexa in a misguided
    attempt at warding off litigation, consider the following:
    1. You can’t be sued if there’s no damage. In other words, you
    can’t be sued because of the risk of diabetes, you can only be
    sued for diabetes. No damage, no lawsuit. If a patient gets
    diabetes, you catch it and act appropriately, you can’t be sued.
    If you take reasonable care (note the weight every, say, 6
    months; follow blood sugars every, say, year— more
    frequently if there is weight gain), not only have you shown
    above standard-of-care practice, but you’re going to catch the
    problem and fix it— so no lawsuit.
    2. The lawyers in these ads are trying for a class action—
    against the company. Class actions are not about the severity
    of drug side effects. The class action requires that the company
    (Lilly) knew about the risks, but purposefully hid these risks
    from doctors and the public. (This is why there are no class
    actions against chemotherapy makers.) But if the company hid
    the info, then the doctor couldn’t be responsible for the
    diabetes, because the risk was hidden. So the class action
    actually protects the doctor, in a sense.
    3. Here’s a puzzler: consider the following by-product of these
    advertisements. By soliciting patients who have taken Zyprexa
    and gotten diabetes, they are, essentially, telling people about
    the risk. So a patient who develops diabetes sometime in the
    future may not be able to claim he didn’t know about the risk,
    as the risks have now entered the public discourse.
    Stop worrying about lawyers. Worry about loose practice.
    Star-D Study Participants:
    What’s Wrong With These
    People?
    July 7, 2006

    I don’t even know what to make of this:

    4041 patients show up and consent to be in a massive


    antidepressant trial, and almost 25% can’t even score a HAM-
    D of 14? (7=complete cure.) Who are these people? What
    were they thinking?
    And then of the ones who actually stay to participate
    (N=2876), their average HAM-D is 21? For two years?
    And Celexa cures a third of these patients? Half of them in
    less than 6 weeks? After two years walking around HAM-D
    =21? Cures? Celexa? 40mg? Hello?
    Remember, this is open label. These people, who presumably
    have been in psychiatric treatment for a long time (mean
    length of illness 15 years), know that they are taking 40mg of
    Celexa. Not a new experimental drug with a new mechanism
    of action. Celexa. 1/3rd get cured. After all this time.
    BTW, the people who failed this Celexa study get moved into
    Star-D II. What is the relevance of this? Well, in this study
    63% were female, 75% were white, 40% were married, 87%
    were high school grads or greater, 56% had jobs. It is the
    opposite of this demographic that is most likely not to have
    gotten better.

    Evaluation of Outcomes with Citalopram for Depression


    Using Measurement-Based Care in STAR*D.
    STAR*D Augmentation
    Trial: WRONG!
    July 9, 2006

    This is what a $150 subscription to the NEJM gets you:


    From the abstract:

    Conclusions Augmentation of citalopram with either


    sustained-release bupropion or buspirone appears to be
    useful in actual clinical settings.

    I can’t be the only person who actually reads the articles and
    not just the titles, can I? There has to be at least one other
    person?
    565 Celexa failures (i.e. did not achieve remission) from the
    previous STAR*D trial were then randomized to Celexa (avg
    dose 54mg) + Wellbutrin or Celexa + Buspar. 30 percent of the
    augmented patients (either Wellbutrin or Buspar) achieved
    remission.
    From this it is concluded “These findings show that
    augmentation of SSRIs with either agent will result in
    symptom remission.”
    How the hell do you conclude that? Is it a mere coincidence
    that the remission rates of Celexa+Wellbutrin in this group
    were the same as Celexa alone in the other study (30%)— and
    the same as almost every other monotherapy trial for every
    other antidepressant?
    In other words, how can you be sure it was the combination of
    Celexa+Wellbutrin that got the patients better, and not the
    Wellbutrin alone? What would have happened if you had
    given these patients Wellbutrin but taken them off Celexa?
    They would have done half as well? Are you sure?
    I’m not saying that it might not be true that two drugs are
    better than one, I’m saying that this study doesn’t show that. If
    anything, this study actually supports switching as a strategy
    (i.e. fail Celexa, so switch to Wellbutrin)— because two drugs
    are not proven here to be twice as good as one alone, but I can
    certainly prove they carry twice as many side effects and are
    twice as expensive.
    Here we have a massive expenditure of tax dollars that will
    undoubtedly lead to treatment guidelines that will be clinically
    misleading and economically wasteful. How much did the
    NIMH pay for this? And for CATIE? I’m not a Pharma
    apologist, but what was wrong with forcing Pharma to pay for
    their own studies which we get to pick apart? These
    government sponsored studies are no better. Gee— the generic
    came out on top?
    Plan B Emergency
    Contraception: Doctors Out
    of Their League, Again
    August 10, 2006

    “In a long overdue concession to science, the Food and Drug


    Administration could finally, grudgingly, be ready to allow an
    emergency contraceptive to be sold without a doctor’s
    prescription.” (USA Today Opinion 8/2/06)

    “Concession to science?” Wow!

    I have admittedly almost zero interest in the way Plan B has


    become a proxy war for anti/pro abortion armies. But when
    doctors become social policy analysts I take note.

    Why are “scientists” saying that this drug should be sold


    without prescription? Why should oral contraceptives require
    prescription, but this should not? Or, to reverse it, if this
    doesn’t need a prescription, then what does? How do we
    decide what needs a script and what doesn’t? Expediency?
    Political advantage?

    The argument that this is an important option in the event of a


    pregnancy scare is premised on the notion that Plan B will be
    rarely used. This is false. It overlooks a very key point: every
    unprotected sexual intercourse is a pregnancy scare. And
    people usually have a lot of sex.

    Look at it this way:

    Before Plan B: you’re a woman, you have sex. You’re worried


    — not really worried, it’s not the “right time of the month,” he
    pulled out, etc, etc, but it’s in the back of your mind. But
    there’s nothing you can do, too late now, so you just wait it
    out.

    After Plan B: you’re a woman, you have sex, etc, etc, but now
    exists a safe, non-prescription way to ensure you don’t get
    pregnant. Why wouldn’t you take it, just in case? Even if the
    chances you are pregnant are really small— Why not? What
    does it hurt? It’s safe, the FDA said so, and even put it over the
    counter. A little nasuea to guarantee you don’t get pregnant?

    See? It’s a no-brainer.

    But what about the next night? And the next? What if you
    have sex— 10 times a month? It’s not frequent enough to
    embark on the oral contraceptive— after all, you don’t have
    that much sex, you can’t afford to go to the doctor, you don’t
    have the time, etc— but you know, Plan B is available in
    seconds… Why not?

    I know men who take Viagra “just in case.” (And that requires
    a prescription.) You think this will be different?

    Look, Plan B might actually be safe, even if taken every day.


    But isn’t every-day-Plan B chemically identical to an oral
    contraceptive— which requires a prescription? And if it isn’t
    safe taken daily, why wouldn’t a prescription be required? I
    should point out that Plan B actually has three times more
    hormone in it than an oral contraceptive. Hmm. Is taking three
    birth control pills a day safe? Anyone?

    Again, this isn’t about whether Plan B is moral or a social


    necessity— something on which doctors are no better
    equipped than lumberjacks to pass judgment. This is about
    whether Plan B should need a prescription, based on the drug’s
    safety.

    This isn’t about women’s rights or abortion or anything else.


    It’s about “scientists” picking and choosing what they want to
    believe; about becoming intoxicated with the power to drive
    social policy, and manipulating the infrastructure of the
    discipline to generate a smokescreen of science to support
    them.

    Remember: these are the same people who discovered (read:


    decided) Vioxx causes heart attacks and Zoloft drives people
    insane— years after their release— but Plan B is so safe it
    doesn’t need a prescription.

    If I were a class action lawyer, I’d start clearing my desk…

    ––––––

    Levonorgestrel: WHO recommends 1.5mg as a single dose;


    “Plan B” is .75mg in two doses (12hrs apart.)

    Assume the average OCP has 0.25mg of levonorgestrol. (a


    levonorgestrol-only OCP, called Microval, has only .03mg).
    Addendum 11/24/06: Turns out that Plan B emergency
    contraception does not reduce pregnancy rates. Big surprise.
    But the one difference was that those with easy access took it
    more often. (News article here.) My post about this here.
    Vioxx
    August 17, 2006

    Merck’s previous win in the Vioxx suit gets thrown out


    because the judge was concerned about the new criticism of
    the NEJM study.
    What happened is an idiot’s guide to forensic computing. Greg
    Curfman, executive editor of NEJM, was going to give a
    deposition in the trial of Frederick Humeston, an Idaho postal
    worker (or he was just curious about the data after Vioxx was
    pulled— depends on which story you read) and so pulled the
    manuscript. Back in 2000 you’d submit a paper copy and a
    disk; NEJM says they worked off paper, so the first time they
    looked at the disk was Oct 5, 2004 (days after Vioxx was
    withdrawn.)
    Here’s the fishy part: on the disk was a table called “CV
    events,” which was blank.

    Time stamps in the software indicated that the table was


    deleted two days before the manuscript was submitted to
    The New England Journal on May 18, 2000. “When you
    hover the cursor over the editing changes, the identity of
    the editor pops up, and it just says ‘Merck,’” Curfman
    says.

    What’s so terribly misleading about this and NEJM’s


    “Expression of Concern” is this statement:

    We determined from a computer diskette that some of


    these data were deleted from the VIGOR manuscript two
    days before it was initially submitted to the Journal on
    May 18, 2000.

    This isn’t true. First, the missing MIs were never in the table
    to begin with. Second, the table was deleted, but the data itself
    was still in the paper.
    Now it is obvious the study attempts to minmize the
    thromboembolic risks. What do you expect from an academic
    study? Let me assure you— if you think drug reps are biased,
    go find yourself a professor. So I acknowledge the criticism
    that the study is misleading. But.
    But it’s the social policy angle that gets me, the moralistic high
    ground of journal editors who are far worse than study authors.
    The gateway to hell is peer reviewed.
    The article says Curfman was deposed by plaintiff’s lawyers.
    Was Curfman paid by them? It doesn’t mean he’s biased, but if
    you have to disclose Pharma sponsorship, don’t you think you
    should disclose lawyer sponsorship? (and I am looking to find
    out if he was indeed paid.)
    As I have absolutely no interest whatsoever in the actual
    outcome of these trials— my interest is really about how
    doctors butcher science and promote themselves to senators—
    but, we should take a look at what this revelatory missing data
    says.
    What they found was that with the inclusion of the missing
    data, the rate of heart attacks would have been 5 times greater
    than naproxen, not 4 times. 0.5% vs. 0.1%.
    Just to put this in perspective, of course, you should know that
    the missing data was three more heart attacks, raising the
    number of patients with MI from 17 to 20 (out of 4000+
    patients), vs. 4 in tha naproxen group.
    BTW, “five times” and “four times” may sound like big
    differences, but they do not even approach statistical
    significance in this study.
    BTW, strokes were the same in both groups. Not that anyone
    cares, of course.
    $51M Vioxx Verdict
    Overturned
    August 30, 2006

    Judge Fallon decides that the jury’s $50M award is a bit much
    for a heart attack in which the guy is still alive and well. He
    leaves in place $1M punitive damage award. (The $50M was
    compensatory damage.)
    I also refer you to the PointofLaw blog, in which is observed
    the inconsistency of the jury’s verdict: no, they aren’t strictly
    liable for failing to warn about and causing the MI; and yes,
    they were negligent in failing to warn and causing the MI.
    How can you be negligent if you weren’t liable?
    Liable=responsible
    negligent= “careless in not fulfilling responsibility” (from
    law.com). There was a duty toward the person AND you didn’t
    do what a reasonable person would have done AND what you
    did actually caused the damage
    Ritalin Doesn’t Cause
    Cancer(?)
    September 5, 2006

    Supplement to this earlier post: Ritalin Causes Cancer?


    Follow-up study from a different group finds no clastogenic
    effect of Ritalin:

    In summary, MPH was found to be non-genotoxic in all


    bacterial assays reported [5] and [8], in all in vitro
    mammalian assays conducted in compliance with current
    guidelines (5, present study) and in two in vivo bone-
    marrow micronucleus studies (5, present study).

    It sounds like the El Zein study was a fluke (and thank God,
    too.)
    But it doesn’t resolve my main point: how is the average
    psychiatrist going to know about these findings? Is there a
    mechanism for new information? Is there somewhere, hell,
    even a blog or listserv, where psychiatrists can at least get the
    headlines of important articles? But that requires someone to
    write this all up, and I don’t know anyone who has that
    amount of funding or time to spend on such an endeavor.
    Stopping Meds Does Not
    Cause Relapse
    September 7, 2006

    Glick and friends did a small study finding— big surprise—


    stopping some of the medications when a schizophrenic is
    stable does not drive them into a horrible suicidal relapse.
    Some even got better.
    Naturalistic study: 53 stable schizophrenics on antipsychotics
    were tapered off of antidepressants or mood stabilizers and
    followed for up to two years, using CGI as the measure (sigh.)
    20/21 patients tapered off antidepressants were unchanged or
    (n=3) better; the one who did worse was an 18 yo WM on
    300mg Wellbutrin.
    9/12 tapered off mood stabilizers were unchanged; the three
    who did worse were all WM (actually, they were all white) on
    Lithium 600, Tegretol 1200, or Neurontin 1200.
    So while that is very encouraging though only preliminary,
    what got me about the paper was this sentence:

    “There are definitivew data in general medicine showing


    that combintations are much more effective than
    monotherapy, supported by many randomized blinded
    studies with a good understanding of mechanism—”

    Seriously? Does he have access to some other internet than I


    have? What are the references?

    “— in chronic pain, for example.16”

    Oh, chronic pain. I see.


    FYI: Glick also did a study on suicidality, finding that the
    study that showed Clozaril’s anti-suicide property (InterSePT)
    had nothing to do with the concomitant medications (mood
    stabilziers, antidepressants or benzos).
    (16) references a morphine +/- neurontin for pain paper.
    What is Off Label Usage?
    September 15, 2006

    Some guys in Georgia do a massive study and discover that


    doctors use medications off label. They also determine that
    that’s bad.
    The real question is not why we use them off label, but why
    we persist in thinking that means anything.
    First, the core problem with the paper, and the entire thesis of
    the validity of indications, is that the definition is recursive. A
    drug has an indication because it was found effective for a
    cluster of symptoms that we have defined as a disorder. This
    does not necessarily make the disorder valid, and it does not
    preclude the drug’s efficacy elsewhere.
    In other words, it tells you what it is good for, but not what it
    isn’t good for.
    So what is the value of an indication?
    Can someone clarify the basis for the arbitrary distinction
    between “dementia related psychosis” and any other kind of
    psychosis? Is there new PET data that I missed that
    distinguishes the two?
    Similarly, to say a drug “is” an antidepressant doesn’t mean it
    isn’t actually an antipsychotic. For example, what is it,
    exactly, about Prozac that makes it not an antipsychotic? The
    only legitimate answer is that when tested, Prozac didn’t work
    in psychosis—not that an antidepressant can’t be an
    antipsychotic. It is an artificial hierarchy that puts
    “antidepressant” below/weaker than “antipsychotic.” Try the
    reverse: can an antipsychotic be an antidepressant? Why is that
    easier to believe?
    Thus, categorizing a medication based on an arbitrary
    selection of invented indications to pursue—and then
    restricting its use elsewhere—may not only be bad practice, it
    may be outright immoral.
    I do not make the accusation lightly. Consider the problem of
    antipsychotics for children. It is an indisputable fact that some
    kids respond to antipsychotics. They are not indicated in kids.
    But don’t think for a minute there will be any new
    antipsychotics indicated for kids. Who, exactly, will pursue the
    two double blind, placebo controlled studies necessary to get
    the indication? No drug company would ever assume the
    massive risk of such a study— let alone two— in kids.
    And which parents will permit their child in an experimental
    protocol of a “toxic” antipsychotic? Rich parents? No way.
    The burden of testing will be undoubtedly born by the poor—
    and thus will come the social and racial implications of testing
    on poor minorities. Pharma is loathed by the public and
    doctors alike, and the market for the drugs in kids is (let’s face
    it) is effectively already penetrated. There will not be any new
    pediatric indications for psych meds. Not in this climate.
    Think this hurts Pharma? It’s the kids that suffer.
    Lastly, the likely most common laments to this paper will be
    that it will be used by insurance companies to further restrict
    the practice of psychiatrists. Too bad. If psychiatrists cannot be
    bothered to learn how medications work and their appropriate
    usage, then unfortunately the State must intervene. It is, after
    all, their money, and it is not infinite. But restricting
    formularies based on “approved indications” (read: nothing) is
    not the solution. If the problem is economic (and it is) then
    you need an economic solution. And you’re not going to like
    it.
    –––—
    Off-Label Use of Antidepressant, Anticonvulsant, and
    Antipsychotic Medications Among Georgia Medicaid
    Enrollees in 2001.” Hua Chen, Jaxk H. Reeves, Jack E.
    Fincham, William K. Kennedy, Jeffrey H. Dorfman, and
    Bradley C. Martin 67:6 2006.
    Breast Implants and Suicide
    September 17, 2006

    I’ll give you the punch line first: In each of the Danish,
    Swedish, Finnish, American, and Canadian studies, appx.
    0.4% of breast implant patients killed themselves, representing
    a two to threefold higher risk than the general population. In
    some studies, the risk of suicide was increased to 1.5 times for
    any type of plastic surgery. Getting implants over 40 may also
    be a risk for suicide.
    2761 Danish women who got breast implants from 1973-1995
    were compared to 7071 women who got breast reduction, and
    11736 who were considered controls. Median age was about
    31.

    14 (0.5%) breast implants committed suicide, 3 times more


    than expected (i.e. standardized mortality ratio=3). 7 of them
    had been previously psychiatrically hospitalized. 220 (8%) of
    all implants were psychiatrically hospitalized.

    22 (0.3%) breast reduction committed suicide, 1.6 times more


    than expected. 6 of them had been previously psychiatriically
    hospitalized. 329 (4.7%) of all reductions were previously
    psych hospitalized.

    0 controls committed suicide. 96 (5.5%) were previously


    psychiatrically hospitalized.

    A U.S. study followed 12144 implant patients (mean age 31)


    and 3614 other plastics patients (mean age 40) from 1970-
    2002. 29 (0.24%) implant patients suicided vs. 4 (0.1%) other
    plastics patients. Thus, the 29 suicides were 1.6 times more
    than expected (SMR=1.6).
    Interestingly, the risk of suicide was increased only after ten
    years; 22/29 died after 10 years. And while the majority killed
    themselves before 35 (16/29, SMR=1.4), the biggest risk was
    for >40 year olds. (SMR=3.4)

    Really interestingly, the authors found that for breast implants


    there was no excess risk for any kinds of accidents— why
    should there be, they were accidents— except car accidents.
    Hmmm. 10 MVA deaths (occurring 15 years post implant) vs.
    0 for other plastic surgery. The authors speculate these may
    not have been accidents.
    Swedish study, prospective but no comparator group, of 3521
    women (mean age 31) found 15 (0.4%) suicides, SMR 2.9.
    Finnish study of 2166 breast implant women from 1970-2000
    were studied (retrospectively) until 2001; there were 10 (0.4%)
    suicides, SMR 3. 6/10 happened in the first five years (in
    contrast to the U.S. study.) (Accidents here were 14, SMR 2.1.
    No explanation given for this.)
    Canadian study: 24558 women with breast implants vs. 15893
    women with other plastic surgery from 1974-1989, studied
    through 1997. Mean age 32. Once again, overall all-cause
    mortality was lower for breast implant women, except in
    suicide: 58 (0.24% SMR 1.73) ) suicides vs. 33 (.20%, SMR
    1.55) for other plastic surgery. Like the U.S. study, women
    over 40 with implants carried the greatest risk of suicide (SMR
    2.3), but no relationship to how far after surgery suicides
    occurred.
    So in these studies, appx. 0.4% of breast implant patients
    killed themselves, representing a threefold higher risk than the
    general population. In some studies, the risk of suicide was
    increased to 1.5 times for any type of plastic surgery. At least
    in North America, getting implants over 40 is a risk for
    suicide. It goes without saying that the number of actual
    suicides was very small, and this could all be bunk.
    All studies excluded implants for breast cancer surgery.
    You may be interested in knowing that suicide is the only
    serious risk that has been regularly associated with breast
    implants— silicone included— and supported by real
    evidence, so far. Everything else is either no greater risk, or
    less risk. For example, there is a higher risk of lung cancer, but
    it most likely is related to smoking, not the implant.
    The obvious next step is to see if there is a causative link
    between implants and suicide (likely impossible) or the
    implant is a clue to something else (poor self image,
    depression, drinking, etc.)
    Something else: the stereotypical breast implant recipient (e.g.
    20 year old coed in Playboy) is not really the typical recipient.
    The average recipient is older (mean age 34,); is more affluent;
    is married (75%) and has two kids; had kids at younger ages;
    has had abortions; and smokes. I mention this so that you have
    the right person in mind when you go looking for risks.
    Other fun facts:
    80% are cosmetic, 20% are breast cancer surgery
    reconstructions.
    290,000+ breast implant surgeries done last year (compared to
    130,000 in 1998). 25% are replacement surgeries for ruptures,
    pain, etc. Compare to 324k liposuction and 300k nose jobs.
    10% of US women have implants. (This seems wrong.) 95%
    are white.
    10% did it in California.
    Since we’re on the subject of implants and suicide, it seems to
    me an easy maneuver to fill breast implants with liquid
    explosives, puncture and mix. I am not sure why no one has
    tried this, actually— or, more specifically, why no one at the
    TSA is looking for this as they stop to search my stupid tube
    of toothpaste. Not that there’s any good way of checking, of
    course.
    How To Get Rich In
    Psychiatry Steps 1-5
    September 25, 2006

    No one ever tells you this stuff in residency. So I’m going to


    give you ten steps towards wealth. This isn’t about being a
    better doctor, okay? That’s what all the other posts are for.
    This is simply about making money.

    1. Roth IRA
    The Roth allows you to put away $4000 a year. It is after tax
    income. But anything that happens in that Roth account is
    never taxed. If you buy the next Google and it quintiples— no
    tax. When you withdraw it, no tax.

    Contrast that with regular IRAs: whatever you withdraw is


    taxed as income. So if you withdraw $10,000, you pay income
    tax on that. The logic is that when you retire and stop earning
    income your tax rate will be less than it is now that you work.
    Great. Do you know any doctors who retire? And do you
    believe taxes are going to go lower as the years go on?
    The reason the Roth is #1 on my list is a) it is powerful; b) you
    must do it immediately, in residency. Once your income
    exceeds $100,000/yr, the rules prohibit additional
    contributions. You have four years. Go.
    If you are an intern, you make $38,000/yr. Therefore, you can
    save $4000— it should all go into the Roth. Skip meals out,
    moonlight, whatever. You must do this. The only reason not to
    put $4000 is credit card debt, which must be paid off.
    You say, “I can’t afford $4000 a year.” False. Would you be an
    intern if it only paid $32,000/yr? Of course. You’d find a way.
    Therefore, you can save $6000/yr. All I’m asking is $4000. No
    buts. Just do it.
    Why is it so important? Because when you save is even more
    important than how much you save. At 10% growth per year,
    money doubles every seven years. (Take 72 and divide by the
    interest rate, that’s how many years it takes to double your
    money.) So if you put away $12,000 in residency, then have a
    kid, by the time he’s ready for college you have $85,000. Tax
    free.
    Unlike IRAs, which must be used after retirement, Roth IRAs
    can be passed on as gifts. So if you get rich and don’t need this
    money, you can just give it away. It is the financial equivalent
    of hiding money under your mattress with a rod of plutonium
    and and waiting to see what happens.
    Where do you get a Roth? Anywhere. All banks offer them.
    All brokerage houses offer them. Etrade, Vanguard, Fidelity,
    everybody. Also, you can invest the Roth money in anything
    you want. You can put it into a mutual fund, or all into Apple
    stock, or divide it among 90 stocks and mutual funds, etc. You
    can daytrade your Roth IRA money. The only thing you can’t
    do is withdraw it before you are 59 1/2.
    Sort of. Actually, you can withdraw from your Roth anytime
    you want— which you will never, ever, do— if you are going
    to use it for “qualified first-time homebuyer expenses.” And,
    (unlike every other kind of IRA) you can withdraw the
    original contribution amount anytime, without penalty.
    Example: you contribute $4000. It grows to $11M. You can
    withdraw $4000 without penalty, because technically you
    already paid taxes on the income that generated the $4000.
    (None of this matters, because you will never, ever, withdraw
    that Roth money.)
    2010: Something wonderful will happen
    In 2010, any money you have in a regular, traditional IRA can
    be converted into a Roth. (Right now, anyone who makes over
    $100,000 can’t do this.) After you convert, the money is
    forever immune from taxation. You can even pass it on as
    inheritance (a traditional IRA must be used starting at age
    70.5).
    I can make a prediction: you will absolutely not become rich if
    you do not open a Roth. The Roth is a test of self-discipline, of
    delaying gratification, of the ability to see the future as reality
    and not as potentials, fantasies. If you fail this test, it predicts
    you will live the rest of your life always trying to “make it,” to
    get by. You will worry about your salary, about the mortgage,
    about the electric bill. You’ll be doing accounting maneuvers
    in your head while on vacation. In short, you will become your
    parents.
    2. Don’t do a fellowship.
    Every year I tell psychiatry residents not to do a fellowship,
    and every year no one listens to me, and every year people
    from previous years come and tell me they wish they had
    listened to me.
    Unless the fellowship gives you credentialling to do something
    that no one else can do, it is worthless. So doing a cardiology
    fellowship is valuable. Doing a bipolar fellowship is not. What
    does a fellowship get you? Nothing. Are you telling me that a
    person who did a Bipolar Fellowship at Harvard is any better
    able to treat bipolar than someone who reads on his own and
    sees patients? I need an extra year of residency to learn how to
    use Lamictal?
    Similarly, forensics, psychosomatics, pain. I do a lot of
    forensic work. It has never once come up, in court, with
    lawyers, no one, if I had done a fellowship or if I had taken the
    Forensics Boards. Why? Because no one wants an expert in
    forensics. They want an expert in psychiatry.
    And patients certainly have no clue that you are or are not
    subspecialty certified.
    But what about the knowledge, the training? Psychosomatics
    (consultation/liaison psychiatry) offers a good example. When
    you’re not the person who is really responsible, you’re only
    partly learning. Doing a fellowship in Psychosomatics may
    expose you to more patients (and even that’s debatable) but
    you don’t really, really learn how to handle them because you
    are not really, really responsible for them. You get much better
    “training” if you actually get hired as a consult psychiatrist.
    See? After a year of fellowship vs. a year of actually doing the
    job, who do you think is more qualified?

    I know, you’re thinking, “why would they hire me with no


    training?” Answer: because they have no choice: most places
    cannot get enough good people. (Are you good? If not,
    consider law.)
    There is one thing a fellowship does get you: $50,000 less
    money then if you just went out and worked. Doing an
    Addiction Psychiatry Fellowship does not get you better
    training— and gets you less experience and less money— than
    simply working in a drug and alcohol program or even in a
    community mental health clinic.
    $50,000 less for one year isn’t a lot? Hmm. Assume you clear
    $30,000 after taxes. In 14 years, at 10%, that $30,000 is now
    $120,000. Congratulations: you can now take a year off and go
    back and do a fellowship.
    3. Declare yourself an expert.
    Declare: not just become, but declare.
    Certainly you need to become an expert if you’re going to
    succeed. But you also have to announce it to everyone who
    will listen. You need to be the person everyone reflexively
    thinks of when a certain situation arises. For example, if you
    like OCD, then as soon as possible— in residency— tell
    everyone you know you are (say this exactly) “interested in
    OCD.” So that every time a resident or attending in any
    specialty meets an OCD patient, they immediately think of
    you.
    The referrers actually have no way of telling whether you
    really are an expert or not; that’s not the point. You simply
    want to create an immediate association between “OCD” and
    you. This way, you get all of the referrals. Most likely, they
    don’t know anyone else to refer OCD patients to, so why not
    you? This is also why your expertise can’t be in something
    common. There’s no room for any more bipolar experts. But
    OCD, forensics, “medically unexplained physical
    symptoms”/somatoform disorders; use of
    ECT/MAOI/Clozaril; student issues; gay and lesbian issues;
    personality disorders, etc— all these things are sufficiently
    niche but sufficiently in demand that you establish a name and
    thus career. You doubt this? Observe:

    “Oh crap, I have another borderline patient.”


    “Oh yeah? Just refer them to X, he sees all borderlines.”
    “Really? Ok…”

    It goes without saying: once you declare yourself an expert,


    you better fast become one. Experience AND reading.
    Reading all the time. I said all the time.
    4. Learn Spanish or Russian. Or Chinese or Vietnamese.
    If I have to explain this, it’s not for you. Partial proficiency in
    Spanish guarantees you a 30 hr week at a salary of
    $150,000/yr.
    5. Invest in stocks. Under no circumstances invest in
    pharmaceutical companies.
    When doctors buy drug company stocks, it is a disaster.
    Doctors think they have some better knowledge of drug
    stocks, but their information is always flawed. Always. In fact,
    if a doctor tells me he is thinking of buying Pfizer, I know
    Pfizer is going to implode. Doctors think that because they see
    Geodon being used a lot that Pfizer is going to go up. Wrong,
    for two reasons: first, people already bet that this would
    happen, probably even before you knew there was a drug
    coming out called Geodon, so the run up has already
    happened. Secondly, the stock price reflects growth, not
    earnings. If the company made a billion dollars this year,
    great. But if it doesn’t make more than a billion next year, the
    stock is dead. So Amazon, Microsoft, Intel, Dell, etc— all
    great companies, all making money hand over fist— but no
    significant prospects for growth. So too Big Pharma. Unless
    there’s a great new drug in the pipeline, forget it. And by the
    way, if the new drug already has a name (as opposed to a
    numeric code) then it’s too late.
    If you have no stomach for this investing stuff, buy the
    following stocks and go back to bed: BRK.B, SHLD, GOOG,
    USO, COP, AAPL. (I own them all.) Call me in 20 years.
    Update on these stocks here.
    How to Write A Suicide Note
    September 27, 2006

    I’ll write this for the ER psychiatrist seeing acute cases, but
    the strategy applies to all types of psychiatry. Always keep in
    mind what is the purpose of the note, and who will actually be
    reading it.

    1. Write so the reader doesn’t have to guess what you were


    thinking.
    The overall biggest mistake in medical note writing is
    spending too much time/too many words on the “Objective” or
    narrative portion of the note, and not enough on the
    “Assessement.”
    Who is going to read this note? Insurance companies read the
    objective and bill based on it. But no one else will care about
    this. The only part that other doctors, lawyers, and juries care
    about is the assessment and plan (assuming its more than two
    lines.)
    And so you must write your assessment and plan in a way that
    makes it completely obvious why you did what you did.
    For example, a common error is trying to convince the reader
    that the person was not suicidal by listing occurrences or
    patient statements. “Patient was denying suicidal ideations…
    had good affect and was joking with staff… etc etc.” You are
    forcing the reader to make an inference, to have to connect the
    dots himself. This is bad, because what if they come up with a
    different conclusion? Make the train of thought obvious. “I
    was able to conclude that he wasn’t suicidal because not only
    was he denying suicidality, but his good affect and joking with
    staff indicated to me he felt better.”
    Did the person shave himself this morning, with attention to
    detail? If yes, that’s a good clue he wants to live. But write it
    down in the note. Don’t write it as, “Appearance: clean”
    because it’s more important than that. Put it in sentence form
    in the body of the note. Here’s an example of a suicidal
    surgical patient I was saw in consultation. “I noted that he was
    cleanly shaved with attention to the margins along his goatee;
    I asked him if he had done it (or a nurse) and he said he did it,
    he was trying to look good.” That’s gold. He may be suicidal,
    but he was hopeful enough to want to look good. Now link it
    explicitly: “This supported my assessment that he was still
    interested in life, and that he wanted to live.”
    2. Prime real estate should be valued.
    The maxim “if it wasn’t written, it wasn’t done” is idiotic, and
    false. But if it is written, it shows it carried more importance to
    you relative to other parts of the note. Writing about a patient’s
    future plans in the objective shows it mattered more to you
    than did, say, checking a box near “Appearance: Clean.” Or,
    the reverse: not writing about his future plans makes it look
    like it mattered LESS to you than his appearance.
    Don’t waste space with SIGECAPS and the like; no one cares.
    I know this contradicts everything you’ve been taught, but it’s
    true. It’s important in making the diagnosis of depression, but
    the actual readers of the note (other doctors, lawyers, and
    juries) only care what your diagnosis was, and what you did
    about it.
    3. Your note should be timeless.
    Certainly you need to assess suicidality, and explain why you
    think he isn’t right now. But keep in mind that your assessment
    will last more than 24 hours. If he kills himself next week,
    lawyers are still going to come looking for you— and
    documenting that he wasn’t suicidal at that precise instant isn’t
    necessarily going to be enough. You need to evaluate his
    future and what should be done about it. For example, you
    have a person who has had multiple suicide attempts (but is
    not malingering) in the ER. You’re convinced he’s not suicidal
    now. But what about next week?

    “Currently he is not suicidal, feels fairly hopeful about


    the future and has made some specific future plans like
    XXX…” [list them!]

    Note that hopelessness/pessimism about future— not


    depression, psychosis, etc,— is the best predictor of suicide.
    So note it explicitly.
    Okay, in the near term he is not likely to be suicidal. Or is he?
    He’s had nine attempts before, after all. What about that?

    “…However, given his history of [impulsiveness/poor


    judgment/poor frustration tolerance/drugs], it is probable
    that he will attempt suicide again at some point in his life.
    Unfortunately, this is a function of his future acute
    stressors— over which I have no current control— not
    how he feels right now. He feels fine now, but on the
    drive home something bad could happen (e.g. girlfriend
    leaves him, loses his job, etc) which will activate his
    suicidal impulses…”

    That’s key, because it sets up the problem: he is going to


    attempt it again— let’s just get that out into the open— but
    that has nothing to do with how he feels today. And it explains
    how you can’t be held responsible now for it then. So now you
    explain why you didn’t do the “obvious” thing, which is
    hospitalize:

    Hospitalization and/or medication now is not going to


    alter that future eventuality, and thus are not indicated
    today. In fact, hospitalization may be detrimental because
    it sets up a pattern of dependency. Rather than finding
    better ways to deal with distress, he learns to run to the
    hospital whenever he is faced with frustration. He does
    not learn how to cope with stress. The main risk is thus
    that if he can’t get to an ER, or the distress is particularly
    severe, he will not be able to cope and will have an even
    greater risk of suicide. In essence, hospitalizing him now
    puts him at greater risk for suicide later…”

    But what makes you a good doctor (and saves you from the
    charge of negligence) is the next two sentences:
    “Given the chronicity of his suicidality, I have to do
    something that will actually help him long-term. I believe
    he is not suicidal now, so my responsibility is to help
    decrease his suicide risk, as best I can, forever. The best
    way to help him is to refer him for [intensive therapy/day
    program/psychiatric visit, etc] for long term follow-up, so
    that he can have somewhere to go and someone to
    manage him as symptoms and stressors develop. This is
    the best way to keep him alive. So, we discussed a crisis
    plan for future suicidality: at the first sign of distress he
    will call X; if this is not sufficient he will Y, then Z;
    ultimately he will come to ER…”

    That’s what the note should say, in your own style and with the
    contents of your interview. So that when the lawyer asks,
    “why the hell didn’t you hospitalize him?” he and the jury
    already know the answer.
    4. The note is a not a newspaper article, it is an op-ed.
    Also note the way I wrote my sentences. They are personal
    and informal. “Best way to keep him alive.” “…over which I
    have no control.” Etc. The note is your educated opinion, not a
    scientific article. You have to explain— pretend it is to a jury,
    if that will help— not just what you did, but why you did it—
    and why not something else. “His affect changed when I left
    the room and he was noted to be joking” does not powerfully
    (enough) convey what you saw and what it meant to you.
    “With me, he was crying, but when I left the room and he
    thought the evaluation was over, I watched him joking and
    laughing with one of the nursing assistants.” See how that
    changes things?
    5. You can be wrong, but you cannot be negligent.
    It should be obvious from the note exactly what you were
    thinking— and, importantly, that you were thinking. That you
    took time to ask questions, observe, assess, draw conclusions
    that were reasonable. You might have been wrong, but you did
    a thorough job. That’s why the assessment matters. Simply
    having volume to the Assessment shows that you gave due
    consideration to the case.
    In other words: the note isn’t written to help you win a lawsuit,
    it’s to prevent one from being filed. You want a potential
    plaintiff’s attorney to look at your notes and say, “forget it, it’s
    not worth it— it’s obvious he isn’t negligent.”
    6. Call someone.
    Very important: get someone else’s opinion, and document it.
    It’s one thing for you to say he is not suicidal; but it’s
    tremendously helpful to have a family member tell you he
    isn’t, or that this situation is common, or that this happens
    whenever he gets upset, etc. If his girlfriend, etc, seems to
    think it is ok for him to come home, write that down!
    “Spoke with his wife, who expressed no reluctance in taking
    him home despite everything he had been saying.”
    or, better:
    “Spoke with his wife who was happy to take him home, and
    did not think he needed to be hospitalized.”
    See how telling that sentence is? Sure, by itself it is
    meaningless, and the wife is no psychiatrist, etc. But in
    combination with the other things you (will) write, it details
    what’s going on and why you did what you did.
    (In the converse, you should be hesitant to go against a family
    member, because they know them better than you. If the mom
    says he needs inpatient, you have to have a really good set of
    reasons why he doesn’t. If you can’t convince mom, you’ll
    never be able to convince a jury after they die.)
    If family and friends are not available (document that you tried
    — that also shows effort and is above standard of care!) then
    get a second doctor, or nurse. I don’t mean atttending phone
    back-up, which is useless. I mean another resident, or an ER
    doc, anyone, so that you can write this next sentence:
    “Discussed the situation with X who also evaluated the
    patient, and X agreed with me that…”
    Apart from giving you a valuable second opinion, it also helps
    establish “standard of care,” loosely defined as how a
    “respectable minority” of docs in your situation would have
    proceeded. Two docs is pretty much a respectable minority, as
    far as I’m concerned (and have testified to such.)
    7. If you discharge a suicidal patient, you must show that
    this is a better treatment than admssion.
    You read all this and say, “well what if they say they’re still
    suicidal?” Let’s assume they are not malingering. (I’ll get to
    that later.) And let us assume you don’t actually think they
    need hospitalization and should be better served somehow
    else.
    What’s the key? To explain to the reader why you kicked them
    out of the ER despite actually believing their suicidality. (I say
    “kicked out” because that’s how the lawyers are going to
    phrase it.)
    First thing is to explain why you felt he would be alive next
    week despite his suicidality now. What’s keeping him alive for
    later until Thursday, when is he has his outpatient
    appointment? Explicitly list all the reasons for hope for the
    future and his future plans.
    Second thing is to explain why hospitalizing him isn’t going to
    help him. Essentially, it’s the same note as in #3.
    “Given his history of multiple suicide attempts, what needs to
    be done is to get him through this acute situation, and then
    prepare him for the future. Hospitalizing him will have no
    impact on his future suicidaliity as it is stressor dependent.
    Obviously, his history of other hospitalizations, medications,
    and ER visits have done little to prevent him from being at this
    point again and in this ER now. Thus, hospitalizing him will
    only “ensure” his safety for the few days he is inpatient, and
    do nothing to keep him alive long term. It delays, not treats his
    suicidality, and when another stressor comes this
    hospitalization will have done nothing to help keep him alive.
    Given this, the best way to help him is to refer him for… [as
    above].

    As for his suicidality now, the plan is to let him decompress


    and reorganize for an hour or two here in the ER. We will give
    him some Ativan (etc) to help him. I’ll give him supportive
    therapy as well as try to give him some better coping
    techniques for the future, and have RN do the same, to
    reinforce it. I was upfront with my opinion that hospitalization
    was not helpful here, and I explained my reasons, and while he
    was not happy with this and did not agree—he wanted to be
    inpatient— he at least understood my perspective and was
    satisfied I was trying to help him. Of course [note word choice
    “of course”], I called his family/friend/etc who agreed to come
    pick him up and stay with him continuously, and would not let
    him out of their sight, and would bring him back if things
    worsened, etc. I told them how and when to give ativan. etc.
    This is tricky, so let me be clear: this note isn’t to convince you
    he’s not going to die. You have to already be convinced, for
    yourself, that despite his suicidality he will be alive tomorrow.
    Then, and only then, should you be writing a note supporting
    your decision.
    8. Plan should match Assessment; You can be wrong, but
    not negligent.
    This again? Here I refer specifically to diagnosis and plan. If
    the diagnosis is malingering, and you kick him out of the ER,
    don’t write “Psychosis NOS; Plan: discharge.” Because the
    plan is not obvious for the diagnosis. The diagnosis should be,
    “Malingering; Plan: discharge.” Because that fits. To the
    reader, it’s obvious.
    You may be wrong. You need to work on not being wrong. But
    for the purposes of negligence, an incorrect diagnosis with a
    reasonable plan for that diagnosis is better than the correct
    diagnosis with an unreasonable plan.
    The note should convey an obvious train of thought. Obvious
    means that the person could guess what your plan will be
    based on the diagnosis, and vise versa. A person comes in
    suicidal because they broke up with their boyfriend yesterday
    should not have a note that says, “Depression: discharge.” It
    should say, “Adjustment disorder: discharge.” Because that
    plan seems more obvious for that diagnosis to a reader.
    If you diagnose “depression” you are implying a longstanding
    problem that may exist in the absence of actual stressors. You
    might not want to be implying this, but it does. All you meant
    was that the guy was sad, but now you have to write a more
    detailed note explaining the future course or treatment.
    This applies to personality disorder. If a borderline has another
    self-cutting event, the diagnosis is not depression; it’s
    borderline. Writing, “Axis I: Depression; Axis II: Borderline”
    means, “oh my God, she was acutely depressed on top of an
    underlying borderline personality disorder!” Which is worse.
    9. Write the note as if the patient died, but you have a
    chance to change your note.
    First, an amusing anecdote about why doctors are idiots. I did
    a malpractice case where the doctor received a subpoena for
    records, and sent them in. Great. Except the plaintiff’s attorney
    already had a copy of the records, which he used to show that
    doctor had altered his copy after receiving the subpoena.
    Game over. You lose. I am told this is a common maneuver.
    So don’t change your note. But imagine the patient kills
    himself— and you have the ability to change your note. What
    would you change? If the guy shot himself, maybe you’ll have
    wanted to write he had denied having a gun, or that you
    discussed removing the gun with the family. Or if he was on
    drugs, you’ll have wanted to document discussing abstinence,
    protecting against withdrawal, or at least noted there were no
    signs of intoxication. Etc. Well, write this all in the note now.
    Pretend they’re dead, and write the note from that perspective,
    in other words justifying how you could not have predicted
    this— any reasonable person would have concluded they
    would live, not die— and how extensively you attempted to
    prevent it.
    And this is purusant to #2. If the patient suicided, your
    magnificent documentation of SIGECAPS and his Family
    Psychiatric History isn’t going to be worth squat. It may even
    hurt you without a rigorous Assessment (#3). This is a real
    quote: “Doc, you’ve documented pretty clearly the guy was
    depressed: low energy, poor appetite, poor sleep, lack of
    pleasure, lack of interest in sex, chronic lower back pain—
    how the hell could you let this guy out of the ER? Did it not
    occur to you he was going to hang himself? Or did you think
    he was just going to catch a movie to cheer himself up?”
    Obviously, you’re not supposed to lie in the note. I’m trying to
    get you to think proactively, to start asking the right questions
    (SIGECAPS is the wrong question) and assessing the right
    things. And then documenting them.
    Write what you will someday desperately wish you would
    have written. Make the Assessment and Plan strong.
    The Most Prescribed Drugs
    October 3, 2006

    You may as well find out what you’re up to.


    Top 20 Psychiatric Prescriptions in 2005
    Xanax and Zoloft win. (Zoloft went generic in 2006. Current
    reduction in cost: zero.)
    But, a little perspective:
    Most Prescribed Drugs of all classes 2005
    Percocet is prescribed 3 times more than Xanax. Lipitor twice
    as often. Of course, the cost of percocet and Xanax are
    negligible relative to Lipitor.
    Note also that the majority of “most prescribed” are generics.
    So where does the money go? Take Lipitor, which retails
    $800/yr for 10mg, $1300/yr for 20mg. Generic lovastatin
    20mg costs $450. For that savings, you can slap on a Toprol
    XL 50mg (branded!) and a metformin, for good measure.
    So wait a second, should we force all generics? No. Some
    don’t have generics. So how do you reduce costs? Price caps?
    Useless. Then what? Not this fake, bureaucratic, pharmacy
    “formulary” with “negotiated” prices that are really extortion
    of Pharma by Medicaid and Medicare providers at patients’
    expense. Socialism isn’t working in Venezuela, it isn’t going
    to work here. To really reduce costs, you have to strike where
    it counts. And you’re not going to like it.
    Psychology vs. Psychiatry
    October 7, 2006

    I was sent a question from a recent college grad about whether


    to go into psychology or psychiatry. I don’t know which is
    better; you should decide which you like yourself. But I can
    help you succeed in either one.
    Since I graduated residency, I have never— never— had a
    patient ask me where I went to college, medical school, or
    residency. Whether I went to Harvard or Guatemala, no one
    would know.
    It’s true that people assume I’m good because I work in an
    academic institution, so it lends me credibility. And it helps in
    court, tremendously, to say I work at said academic institution.
    But if you are thinking of being a private practice clinician, it
    matters not a lick where you went to school— or fellowship
    (so don’t go.)
    What matters is how you set up your practice.
    Following the logic above— and you will initially doubt this,
    but bear with me— it doesn’t matter, financially, whether you
    go into psychiatry or psychology. What matters is how you go
    into the practice of either.
    I’ll just refer to psychology right now. And I’m going to talk
    about money only, not personal fulfillment or career
    advancement or awards— all that is your business, and there
    are plenty of resources to help you. I’m trying to tell you about
    the money side, which no one else seems ever to want to talk
    about.
    The key difference in the need for psychiatrists and
    psychologists is the duration of follow-up. The shortage for
    psychiatrists exists for long term follow-up in
    Medicaid/Medicare patients. The shortage for psychologists is
    for short term and CBT for private insurance patients.
    To get rich in psychology, it is not necessary to have the best
    paying patients, but rather to have a steady stream of patients,
    whether they pay well or not. If you have a waiting list, you
    win. How to get such a stream?
    If I was a good clinical psychologist— PhD helpful but not
    necessary, master’s is fine— I would find two or three good
    psychiatrists and set up a group. Every patient that comes
    through them has to have at least an initial eval with you, and
    vise versa. This guarantees you volume, which is great, and
    many of the patients will continue on with you. But even those
    that don’t are still a win, because that first session can be
    billed at a higher rate.
    I would find the nearest academic institution with a “residents’
    clinic.” That’s a gold mine. There are a lot of private insurance
    patients there, who need short term therapy. These academic
    clinics almost never have enough therapists, because the ones
    that are on staff are not really incentivized to see extra
    patients; they’re on salary. So there is a massive number of
    patients who could benefit from therapy, but are on a waiting
    list, etc, etc. It seems unbelievable, so I’ll say it again:
    university clinics need to refer out. If you can get that
    overflow, if you can get one or two docs there to vouch for
    you and tell everyone to refer to you, you win. How do you get
    them to vouch for you? Well, go back to my Steps: you need a
    specialty. Do you do CBT? Supportive therapy? Grief
    counseling? You can do everything if you want, but it is vital
    that you be known for regular therapy AND something
    specific. You business card should read, “Grief Counseling
    and General Therapy” or something like that.
    That makes you different and better than other therapists, even
    if you’re not. And makes it ok for you to approach a
    psychiatrist to get referrals. “Hi, I’m a therapist, send me
    patients” is very different than, “Hi, I specialize in Grief
    Counseling, short and long term, so if you have any
    patients…” Again, the unbelievable truth about referrals: the
    referrer doesn’t actually have to be certain you are an expert—
    hell, they don’t even have to know you are legitimate. If your
    niche is sufficiently small, they simply won’t have any other
    names available when they get cornered by a patient. And if
    they have no other such “expert” in their minds, you will get
    the referrals. And if just one patient reports back to the
    psychiatrist that you’re good, you win.
    Try to meet psychiatrists wherever you can, but the best place
    I know is through drug reps. Go to one of the “drug dinners”
    and meet the psychiatrists who attend. Find a psychiatrist-
    parent— hell, any kind of doctor— in your kid’s school, meet
    them, let them know you’re open for business. Meet the
    guidance counselor, tell them you specialize in adolescent
    issues. (Obviously, make sure you actually do specialize in
    adolescent issues.) Or Family Systems model. Or divorcing
    parents. Etc.
    Remember: it’s not “why refer to me?” It’s, “who else are they
    going to refer to?” A doctor who has any sort of emotional
    connection to you (i.e. met you once) will more likely refer to
    you than anyone else.
    If you want to work the “best paying patients” angle, then you
    are looking to work with cash only, reasonably affluent
    patients. Ok— why would they pick you? Because you went to
    Harvard? Because you have a PhD.? No. Either a) you in their
    insurance network so they can get reimbursed; b) they were
    referred to you. And so we are back to the beginning: you need
    a niche, an area of expertise. I am sure there are patients who
    would prefer to go to someone who did “Psychodynamic
    Therapy and General Psychotherapy” even if they simply
    needed grief counseling, because they’ll assume you’re better.
    I’ll write more about this later.
    Psychiatrists On The Wrong
    Side of Civil Rights, Again
    October 9, 2006

    Hunter college caves to lawyers.


    A student takes a bunch of Tylenol in an OD attempt, and after
    4 days inpatient returns to her dorm to find she has been
    evicted.
    The article makes it sound as if Hunter College kicks you out
    of school if you attempt suicide, which wouldn’t necessarily
    be improper, but it’s also not true. Hunter College’s housing
    contract says you can’t live in the dorms if you have a suicide
    attempt. That’s a little different.
    So the student sues, and Hunter decides to settle. Her lawyer
    gloats:

    “We’re pleased that Jane has been compensated for the


    college’s discriminatory treatment based on the stigma
    attached to a mental illness,” said David Goldfarb, one of
    the law firm’s attorneys representing her. “If Jane had
    been hospitalized for mononucleosis or pneumonia, I am
    confident that she would have been welcomed back to her
    dorm,” he added.

    Well, gee, maybe a suicide attempt made volitionally, with a


    good chance of happening again, is a little different than
    pneumonia? Stigma of mental illness? So she was evicted for
    being on Zoloft?
    The lawyer for the Bazelon Center for Mental Health Law ,
    who should know better, says,

    “Schools that exclude students who seek help discourage


    them from getting the help they need, isolate the students
    from friends and support at a time when support is most
    needed, and send students the message that they have
    done something wrong.”

    Hmm. I thought Hunter was a college, not a daycare? Since


    when is it a school’s responsibility to ensure adequate access
    to friends? Is it responsible for finding them mates as well?
    The problem with this statement is its logical conclusion:
    when can a school exclude students who seek help? Never?
    Let’s say the next time she tries suicide by turning the gas on,
    and she blows the dorm up. Oops?
    The most dangerous quote of all is from someone who really,
    really should know better, but obviously doesn’t:

    [Rachel] Glick, who is also associate chair for clinical


    and administrative affairs and a clinical associate
    professor in the Department of Psychiatry at the
    University of Michigan, emphasized that “universities
    should be open to being informed by psychiatrists and
    other mental health professionals about what to do to
    enhance the care of the students, rather than just thinking
    about protecting themselves from lawsuits.”

    So let me get this straight: the university should ask the


    psychiatrist about whether the person could stay on campus or
    not? Any psychiatrist out there who wants that liability
    football?

    College: So now that you’ve evaluated her, should she be


    allowed to return to the dorm?
    Psychiatrist: Huh?
    College: Is she going to kill herself again?
    Psychiatrist: How the hell would I know that? I can’t
    predict the future.
    College: But you all told us we needed to seek your
    advice.
    Psychiatrist: Hey man, don’t try to pin this on me. I’m
    going to lunch.
    Interestingly, the Psychiatric News article doesn’t mention last
    month’s case where the parents of Charles Mahoney sued
    Allegheny University because Charles was not put on
    mandatory leave of absence while he battled depression for
    two and a half years.
    Everyone wants it their way; sue when you don’t get your way,
    logical consistency be damned. Has it now become outrageous
    to say that the liability for a suicide attempt and its prevention
    lies entirely with the person attempting it?
    (Addendum: many angry at my post, so I refer to the specifics
    of the case itself.)
    One Last Word on University
    Suicide
    October 12, 2006

    Good debate going on over at Shrink Rap.


    I’ve posted a few comments there, but in summary:
    Hunter College didn’t expel her for being suicidal; they
    EVICTED her from her DORM for ATTEMPTING suicide.
    They wouldn’t be allowed to do the former; they are obligated
    to do the latter, for public safety.
    People want to refer to the George Washington University
    case. Ok, but let’s get our facts straight, from the Superior
    Court:
    Jordan Nott’s roommate jumped out the window OF HIS
    DORM in April 2004, while Jordan and a friend were trying to
    break in to save him. In October 2004, thinking about this,
    Jordan himself became suicidal but went to the ER instead.
    The University suspended him. Well, not exactly:

    in order to be “cleared” to return to the residence hall, the


    UCC and Community Living and Learning Center
    (“CLLC”) had to assess Jordan’s “ability to obtain
    recommended treatment” and ability to “live
    independently and responsibly.” In order to obtain
    clearance, Jordan had to set up an appointment with UCC
    within 48 hours, and develop an agreed-upon treatment
    plan.”

    That’s not GWU’s defense— that’s Jordan’s complaint. That


    he had to go through that. Is that so unreasonable?
    Living in the dorm is a privilege, not a right. If the University
    thinks you are a risk AND it doesn’t violate constitutional
    rights, you’re gone. It’s not up to them to prove you are a risk;
    it’s up to you to show you aren’t.
    And people are angry about GWU and Hunter because it
    seems that they’re just out to minimze their liability? Yeah, so
    what? And it’s not just the liability of student who kills
    himself. It’s about his effect on public safety. People say that
    an OD or jumping out a window doesn’t put other students at
    risk. Well, clearly Jordan’s roommate’s suicide had an effect
    on Jordan— he admits this himself. So there’s the copycat
    risk. And what if Jordan had decided to blow himself up? Why
    should anyone in the dorm have to live with that risk?
    Again, it’s not up to the school to show she’s dangerous; it’s
    up to her to show she’s not.
    The best line is this one:

    If he had known [about the evictions, etc], he said, he


    never would have gone to the hospital.

    So what are you saying? That he would have simply killed


    himself?
    Sunshine and Suicide
    October 14, 2006

    Would you predict suicides increase in the sunshine/summer or


    darkness/winter?
    Obviously, if I’m asking…
    A Greek study— and Greece has one of the lowest suicide
    rates in the world, about 5/100,000 (U.S. is about 17) with two
    major findings:
    1. Suicides in the northern hemisphere, across 18 very diverse
    countries (Europe, Eastern Europe, Japan, North America,)
    peak in May/June, with a relative risk 1.08-1.5.
    2. This peak is actually due to the amount of sunshine. More
    sun=more death.
    #2 seems a stretch to me, so I looked it up further. Wow.
    Same guys, find that there was no relationship between suicide
    and that day’s sunlight; but there was a strong correlation with
    the past days sunlight. There were several specific sun/day-
    suicide interactions, but in general for males that past 8 days
    and the day before, and for females that past 4 days (but not he
    day before) were correlated to increased risk.
    If you consider that the solar radiance in June is 26 MW/m2,
    and December is 6 MW/m2, then the risk of suicide increases
    3% for every 1 MW/m2.
    Others have found the same. An illustrative example is the
    Chile study finding the springtime peak of suicides, but this
    effect was absent in the north, which is closest to the equator
    and thus has the least seasonal variability (Chile is a strip that
    runs up and down the western part of South America.)
    Interestingly, other equatorial regions have failed to find
    seasonal suicide links (e.g. Singapore); some have even
    identified a reverse pattern in the southern hemisphere. And
    urban areas seem to have a less pronounced or absent effect.
    This is all quite interesting, but in order for it to be useful we
    have to show that there isn’t another obvious explanation.
    Here’s one: people kill themselves in June because there are
    more available tools. Jumping off a building, outdoor hanging,
    drowning, all prefer better weather. For example, you don’t
    mull jumping off a building during a week of rain.
    Now you could counter that such a suicidal person would
    simply come up with something else (e.g. OD) but that’s not
    what happens; suicides are very specific and personal acts.
    The jumper doesn’t instead use a gun. (Consider that people
    with multiple suicide attempts use the same one or two
    methods each time.) If two methods are similar, however, then
    I think such a move could happen. But if the person is
    considering drowning, then an OD is probably not an option,
    because drowning means something, it ihas unconscious
    significance, and that can’t be ignored.
    I might even propose that non-OD and non-self-cutting
    suicides are just as much about the act as about the desire to
    die. When you get drunk and then stab yourself in the
    abdomen 45 times, you’re communicating something as well
    as trying to die.
    Following from this, it has been observed that there is no
    seasonal pattern to non-weather related methods: cutting, OD,
    gassing, (i.e. non-violent methods). There’s no seasonality
    (skew towards winter) to jumping in front of a German
    subway, which is thankfully free of sunlight’s evil effects.
    So if it rains for a week, instead of moving to another
    completely different suicide method, I believe they would
    simply postpone (i.e. continue to ruminate about it) their
    attempt, unless a similar method is available.
    BTW, this is about completed suicide, not suicidality or
    suicide attempts, for which I have no idea about the
    seasonality.
    I bring this up because of the discussions I’ve had, especially
    with the residents at my hospital, on the extent of volitional
    control in suicide. I say it is a cognitive process and not
    necessary outcome of a disorder, and the idea that sunlight or
    weather can influence the timing or method of a suicide goes
    along with that.
    Werther Effect: Copycat
    Suicides May Not Exist
    October 17, 2006

    Goethe’s popular comic book, Sorrows of Young Werther,


    published in 1774, allegedly inspired two imitations; many
    young men decided to kill themselves, and many, many young
    men decided to dress in yellow pants and blue jackets.
    Well, that’s all great, but I decded to investigate whether
    suicide rates really do increase after one is popularized— a
    propos of the previous post’s discussion about whether Lott’s
    roommate’s suicide pushed Lott towards it as well. I was
    pretty sure it existed, but I may have been wrong.
    Preliminarily, here’s what I found, through 4 examples:
    A study in Austria found that gun suicides increased in the
    three weeks following a famous gun suicide (as compared to
    the three weeks preceding). There are lots of this kind of study,
    which are correlations based on statistical anomalies.
    A better kind of study actually interviewed the suicide
    attempters to see what had affected them. For example, a U.S.
    study found that exposure to parental suicide was not
    associated with suicide; exposure to a friend or acquaintance’s
    suicide was mildly protective, and media accounts were
    strongly protective. However, this study wasn’t about the
    immediate risk (e.g. in the following month), and the authors
    did note that this protective effect was only if the friend’s
    suicide or media report was greater than a year in the past. It is
    easy to speculate that the longer you have to think about what
    they did, the more likely you are to think it wasn’t the best
    option.
    A 1993 study in adolescents found that within one month of
    the suicide of a friend, depression and suicidal ideation
    increased; but actual suicide attempts did not.
    Most of the studies finding no correlation are done using the
    general population; how would it be different if we looked
    only at people with established mental illnesses? A 2005 study
    found that suicides in mental illness patients were clustered in
    terms of place, time, and method. Unfortunately, this study
    looked at the clusters and did not identify whether or not the
    victims were actually even known— or whether the patients
    had even heard about the suicides. (For example, they might
    happen at the same clinic, but that doesn’t mean they
    knewabout each other.)
    Etc, etc. So clustering, at least in terms of lethal attempts,
    appears not to happen much, (and if it does it is primarily in
    teens.)
    As an observation, most of the articles finding Werther effects
    were written pre 1980, while most finding no relationship
    were written post 2000. One explanation is that we are more
    rigorous now (HA!); the other explanation being that there is
    considerably less idealization of suicide now. In fact, suicide
    now is unremarkable. Consider the “medicalization” of
    depression and suicide, as biological diseases rather than
    character pathology or expressions of emotion, a
    communication of sorts. Suicides then “meant” something—
    something more than “I’m depressed,” while suicides now are
    simply symptoms. Suicide= more Wellbutrin.
    I still think they “mean” something, and I try to interpret it, but
    the focus nowadays is certainly not to interpret suicide as an
    expression of anything. Too bad.
    What Political Propaganda
    Looks Like
    October 20, 2006

    This is what a subscription to JAMA gets you:


    from the abstract:

    RESULTS: Among the 201 women in the sample, 86


    (43%) experienced a relapse of major depression during
    pregnancy. Among the 82 women who maintained their
    medication throughout their pregnancy, 21 (26%)
    relapsed compared with 44 (68%) of the 65 women who
    discontinued medication. Women who discontinued
    medication relapsed significantly more frequently over
    the course of their pregnancy compared with women who
    maintained their medication (hazard ratio, 5.0; 95%
    confidence interval, 2.8-9.1; P<.001). CONCLUSIONS:
    Pregnancy is not “protective” with respect to risk of
    relapse of major depression. Women with histories of
    depression who are euthymic in the context of ongoing
    antidepressant therapy should be aware of the
    association of depressive relapse during pregnancy
    with antidepressant discontinuation.

    Read it again. What’s the message they are trying to


    communicate?
    The study found that pregnancy is not protective, and stopping
    your meds during pregnancy raises the risk of relapse. Any
    other way to interpret this abstract? Am I putting words in
    their mouths?
    I read the entire article, with familiar horror. This was a
    naturalistic study that followed 201 women with MDD and
    their medication dosages and saw what happened. That this
    study had nothing to do with the “protective effect of
    pregnancy” is right now a secondary issue. The real problem is
    that the actual study says something very different than the
    Conclusions:
    The study did find that more people relapsed if they stopped
    their medications. But it also found that more people relapsed
    if they increased their medications.
    Exactly how were you to know this if you only read the
    abstract?
    Don’t you think that might have been important? Tthe
    medication changes themselves are not the cause of the relapse
    — how could both stopping them and raising them both be
    bad?— but are logically explained as representing something
    else.
    The Conclusions should have read:

    Conclusions: Taken together, these findings suggest that


    pregnant women who are stable (on medication) tend not
    to relapse, but those who are unstable (and need med
    changes or who go off them) relapse at higher rates.

    The authors do address, slightly, this odd finding— on the last


    page. But so what? Only liars read the last page. What makes
    this misrepresentation so egregious that it is near unforgivable
    in a journal of JAMA’s arbitrary status is that they and we
    know doctors are not reading these studies from start to finish;
    for the most part, we skim over the abstracts. So we’re going
    to skim over this abstract, it supports our existing prejudices so
    we don’t give it a second thought, and go on with our deluded
    lives.
    So to write the abstract this way is absolutely volitional, and
    absolutely misleading. The problem is not with the study,
    which was excellent, but with the presentation of the findings,
    which is psychiatric propaganda.
    I would demand my subscription to JAMA be cancelled
    immediately if I had one in the first place.
    –
    But this isn’t really the disturbing part.
    What’s really sad is that I am, apparently, the only one who
    noticed this. None of the three Letters To The Editor about this
    article complained. One of the three letters did complain, but
    not about the article— rather about the authors’ ties to drug
    companies. Yes, that again. That’s what passes for ccritical
    thought nowadays. That’s now the default moral high ground
    soundbite of bitter doctors, akin to “the war is just about
    Halliburton” or some other half-thought deduced from two
    hours of the Colbert Report and the table of contents of the
    New York Review of Books.
    That’s the problem. We’re not critical of our fundamental
    principles. So we attack windmills. We doctors are conditioned
    (yes, conditioned) to find Pharma bias everywhere, and never
    to see— so that we don’t have to see— the real bias in the way
    we have set up psychiatry. It’s the same reason we spend so
    much time on statistics. Pharma and statistics are witches in
    The Crucible.
    The bias isn’t Pharma related. It’s much more fundamental.
    What’s at issue here is the approach, the worldview of the
    authors and psychiatrists everywhere. They are seeking to
    support the notion that antidepressants work and prevent
    relapse— not even because that’s what they believe, but
    because that’s what psychiatry is. They are not asking a
    theoretical question and impartially looking for the truth;
    they’re unconsciously trying to validate their existence. So
    they see what they want to see, and anything that isn’t
    obviously in support of these postulates, this paradigm, is
    cursorily dismissed— or is altered to mean something else.
    This is important: they’re not hiding data, they just interpret it
    with the only paradigm they have.
    Blaming Pharma is easy because it seems obvious— money
    buys truth— but also protects the blamer from needing to
    perform any actual critical thought, any internal audits of their
    prejudices. So what if Pharma bought those doctors start to
    finish? You still need to read the study and figure out how the
    buying altered the data, if it did. But that would be work.
    10/30/06 Addendum: I sent a modified (i.e. nicer) version of
    this as a Letter to JAMA. It was rejected in less than a day.
    How To Get Rich In
    Psychiatry (update on stocks)
    October 23, 2006

    Hi. On 9/25 I recommended 5 stocks. Here’s where we stand


    one month later:
    BRK.B 3123 3333 +210 (7%)
    SHLD 160 180 +20 (13%)
    GOOG 404 480 +76 (19%)
    USO 56 52 -4 (-7%)
    COP 57 61 +4 (7%)
    AAPL 76 81 +5 (7%)
    For comparison, the S&P rose 4% during this month.
    So there you go. And, for the record, I now own only GOOG
    and BRK. USO should continue to fall (and so should
    consequently, COP) until either it gets really, really cold
    outside, or until April (it is cyclical, after all.) But when USO
    goes up, GOOG should go down.
    And USO is a winning play over the next decade. I can only
    be sure of that with SHLD and BRK.
    In case anyone cares at all, I also own AKAM; I’ll be buying
    back AAPL this week; and I’m looking at ATI. These should
    be solid plays until Christmas, though I’m expecting some sort
    of massive retracement this week.
    There’s A Shortage of
    Psychiatrists Somewhere, We
    Just Have To Find It
    October 24, 2006

    I was emailed a link to a 2003 article in the Psychiatric Times,


    which describes a maddening report out of California is so
    blatantly politicized that Arnold himself is embarrassed.

    The report says, insanely, that there are not, and will not be in
    the future, enough psychiatrists to meet the needs of
    California. (Actual report PDF here.)

    Well, not exactly true, is it?


    When you say shortage, what do you mean— 5000
    psychiatrists for one state isn’t enough? Oh, you mean that for
    some inexplicable reason, 63% of the entire state of
    California’s psychiatrists work in the Bay Area or LA? Sounds
    like you have plenty of shrinks, they’re just not distributed
    very evenly. Why would that be?

    48% of all psychiatrists in California are in a solo or 2


    physician practice. Hmm. 75% were male, 65% white. Hmm.
    Perhaps the problem is that your solo psychiatrists want to
    work in a nice area with good pay, and not in an inner city
    where— ironically or tragically, your choice— the need is
    greatest but the pay is least?

    The nuts filing the report continue to lament that there aren’t
    enough child and geriatric psychiatrists. Enough for what? Oh
    — enough for Medicaid and Medicare. What did you expect?
    After suffering through a Child psych fellowship, why would
    go work for peanuts in a community mental health clinic,
    where you have a better chance of getting stabbed than getting
    rich?

    Their complaints are misplaced and deluded. They do not


    reflect reality. Let me give you reality: the shortage exists in
    community (read: Medicaid) mental health, primarily because
    the pay sucks. But even there, the problem is not as dire as
    they make it sound.

    First, even if there are numerically more psychiatrists seeing


    private patients, the community mental health psychiatrists see
    many, many more patients in a day. I’m going to guess the
    ratio is five to one. (Oh, you’re upset they see them in ten
    minute intervals? When you give them a case load of 3000,
    what did you expect them to do? Psychoanalysis?)

    Second, psychiatrists aren’t the only ones providing


    “community mental health.” Advance practice nurses (APN)
    and nurse practitioners (NP) also prescribe medications; in
    some states physician assistants can prescibe; and very soon
    psychologists will be able to prescribe, as they already can in
    New Mexico (and I think Louisiana.). (Care to retract your
    asinine prophecy, “the center predicts that there may actually
    be too many psychologists in the future.”)

    Third, primary care docs handle far more psychiatry than we


    can imagine. They just can’t bill for it. (And so how good a
    job are they incentivized to do?)

    The shortage is for “psychiatrists” proper (i.e. MD/DOs), not


    “providers of psychiatric medications.”
    The question then, uniquely, is whether we need psychiatrists
    proper at all to do community mental health. Are community
    mental health psychiatrists, as a group, better at diagnosing
    and treating than anyone else, for example an NP? Sadly, the
    answer is currently undeniably no. No one reads anymore, no
    one studies, and worse, the half-learned information that still
    lingers is so incomplete as to be misleading. Post residency,
    we get our info exclusively from drug reps and throwaway
    journals. Ergo, most residents are better psychiatrists than
    someone in practice ten years.
    Woah— be careful. Think long and hard before you hurl
    “clinical experience is more important” at me. Make sure you
    want to go down this road.
    I am certain that I can take anyone with a college degree in
    any science, and in four months make them better than an
    above average psychiatrist. This is an open challenge to the
    APA. I’ll repeat it: I’ll take any person with a B.S. and in four
    months make them an academic psychiatrist.
    But back to our “shortage” problem, or more accurately our
    distribution problem. The solution to this is elementary, but
    bitter. Either raise the standards necessary to be a practicing
    psychiatrist— more audits and tests, greater documentation in
    notes, recertification exams with consequences to failing, and
    outcome/performance evaluations graded against other
    psychiatrists— but also raise the pay, dramatically— you can
    use the prescription drug savings when you implement my
    other plan— so as not to lose the smart people to internal med
    or neurology; or lower the requirements so that more people
    can be prescribers, and lower the pay so that you can afford
    more of them. Either of these two will satisfy the growing
    “need.” Which is better for the patient is up to California to
    figure out.
    Psychiatry Is Politics
    October 31, 2006

    Psychiatry is politics, it is politics in the way that running for


    office is politics. It is not a science, it is not even close to
    science, it is much closer to politics.

    A doctor makes a diagnosis of a patient and writes it down on


    the chart. If it were science, then I should be able to evaluate
    the patient myself and come up with the same diagnosis. If it is
    a science but not an exact science, I should be able to come up
    with the same diagnosis most of the time, and the other times
    where I disagree I should be able to see why the other person
    thought what he thought.

    But if I can guess the diagnosis without actually seeing the


    patient at all—but by knowing the doctor—then we do not
    have science, we have politics.

    If you are watching the TV news with the sound turned down,
    and a Republican senator is talking, and the caption reads,
    “Tax Breaks for the Rich?” you can guess his position. In fact,
    the actual issue doesn’t matter—what matters is his party
    affiliation. Everything follows from there. Not always,
    certainly, but enough times that you don’t bother to turn the
    sound back up on the TV.

    Psychiatry is the same way. It is very easy to determine who is


    considered a “great” psychiatrist, or a “thought leader in
    psychiatry” based on who is making the evaluation, and not on
    any merits of the psychiatrist himself. Down one hallway
    Freud is lauded; down the other he is villified; Kay Redfield
    Jameson is the hero. But their value, of course, is not at all
    dependent on what they did—it is dependent on who you are.
    Ronald Reagan was either a god or a devil depending on who
    you are, not who he was. It doesn’t seem to matter that most
    people can’t name one specific thing he did in office, what
    wars and battles he presided over, what he did or did not do to
    taxes. Ronald Reagan isn’t a person, he is a sign.

    It’s even possible for me to guess the medications a patient is


    taking based solely on who prescribed them, and not on the
    symptoms of the patient. Importantly, the possible medications
    vary widely from doctor to doctor; it is wrong to think my
    predictive accuracy is based on any fundamental logic or
    science to medication selection that should be true across all
    psychiatrists. It’s just his regular, unthinking, habit. “I like
    Risperdal.” Are you an idiot? Are there internists saying, “I
    like insulin?”

    Let me be clear: I’m not talking about doctors having unique


    insights into which medication might benefit a certain patient.
    (“I think Geodon could work really well here.”) I’m talking
    about each doctor having a set of drugs he prescribes with
    such regularity that I can guess them.
    –

    It stems from a lack of appreciation that mental illness is not a


    genetic disease, or even primarily a biological one, or even,
    surprisingly, a psychological one. It is a social disruption. On a
    desert island, no one can tell you are insane.

    The key evidence against my position is that biology is so


    obviously relevant. There is a hereditary component to many
    mental illnesses; twins raised apart still often have higher
    concordance rates than non-twins. But this misses the point of
    the problem entirely. Consider diabetes: it is obviously a
    biological disease, with a heritable component. Much more
    biological than any mental disorder, because you can point to
    the dysfunctional biology in diabetes, but you can’t do that in
    bipolar disorder. But despite this biology, the environment is
    so massively important as to often overwhelm this biological
    component.

    We can consider even further the actual relevance of genetics.


    Things that we assume are simple genetic outcomes are often
    more complicated than they seem. Eye color is every 7th
    grader’s primer for Mendelian genetics. But—surprise—there
    is no gene for eye color. There are in fact three genes for eye
    color, and the color is determined by the interplay of all three.
    So while you can guess eye color based on the parents, you are
    not always right—because each parent is giving three different
    genes.

    It may be, in fact, true, that bipolar disorder is genetic. Perhaps


    overwhelmingly genetic, let’s say 40%. We go wrong because
    we consider genetics a “fixed variable”—we think we can only
    affect the other 60% of the factors. Right? Wrong; genetics is
    not fixed. Having a gene may be a fixed, but whether you
    express this gene or not is most certainly under outside
    control. Consider gender; absolutely genetic, correct? Not
    much one can do about it? But lizards can alter the sex of the
    progeny by changing the incubation temperature of the egg.
    Think about this. Now, is it not probable that the expression of
    the genes for bipolar have a lot to do with how you are raised?
    And we already know that environment affects gene
    expression, so I’m not speculating here.
    The Charade is Revealed—
    We Are Doomed
    November 3, 2006

    Here’s a question: can an antipsychotic be an antidepressant?


    Why, or why not?
    The correct answer is that the question is invalid, because
    there is no such thing as an “antipsychotic” or an
    “antidepressant.” We (should) define them based on what they
    do, not what they are. Therefore, Wellbutrin and Effexor are
    both antidepressants if and only if they both treat depression—
    not because of some element of their pharmacologies, which
    are anyway different. Strattera, on the other hand— which has
    a pharmacology (in some ways) similar to Effexor— is not an
    antidepressant, only because it doesn’t treat depression.
    Following, just because something is called an antidepressant,
    or antihypertensive, it doesn’t necessarily take on all the other
    properties or side effects of the others in its “class.” Not all
    “antidepressants” have withdrawal syndromes (only SSRIs
    do). Not all antihypertensives cause urination (only diuretics
    do.) You wouldn’t dare put a “class labeling” on
    “antihypertensives” of “diuresis.”
    So you see where I’m going with this— except you don’t.
    I’ve previously yelled about the inanity of “antipsychotic
    induced diabetes” or “antidepressant induced mania” when
    they ignore pharmacologies, doses, and, of course, actual data.
    But today I saw something that I now understand to be one of
    the signs of the Apocalypse. It is the new package insert of
    Seroquel, which just got a new indication for the treatment of
    bipolar depression. The new PI reads:

    Suicidality in children and adolescents -


    antidepressants increased the risk of suicidal thinking
    and behavior (4% vs 2% for placebo) in short-term
    studies of 9 antidepressant drugs in children and
    adolescents with major depressive disorder and other
    psychiatric disorders. Patients started on therapy
    should be observed closely for clinical worsening,
    suicidality, or unusual changes in behavior. Families
    and caregivers should be advised of the need for close
    observation and communication with the prescriber.
    SEROQUEL® is not approved for use in pediatric
    patients. (see Boxed Warning)

    Stating the obvious: in none of these 9 studies was any patient


    actually ever on Seroquel; Seroquel itself is not associated
    with a risk of suicide; it’s not even been tested for major
    depressive disorder; and, well, this isn’t very rigorous science,
    is it?
    Just because a is now called an antidepressant, it carries the
    same risk as the SSRIs? (Whether even SSRIs have this risk is
    besides the point.) Isn’t that, well, racist?
    This is not really about preventing suicide. If we were worried
    about suicide, really, then why 24 hours before the FDA
    posted this warning, no one cared about Seroquel’s doubling
    of the suicide rate? Oh, because it doesn’t actually double the
    suicide rate? Die.
    So the game is clearly not about science, it’s about politics, it’s
    about liability, it’s about money.
    If this was honestly about about protecting children from
    suicide, we’d shrug our shoulders and say, “well, they’re just
    very, very cautious, so we’ll be careful and keep going.” But
    that’s not what this is. What this is factually inaccurate,
    misleading, and therefore more dangerous, more harmful. In a
    simple example, this warning protects no one for a risk of
    suicide— no potentially suicidal patient is going to look at this
    and say, “well, crap, I’m not taking this.” But it may prevent
    someone from taking it when they could actually benefit. See?
    This is Structuralism gone very badly awry, Saussure just
    bought a pick axe and he’s come looking for us all.
    Lunar Cycles and Psychiatry
    November 6, 2006

    Addendum 11/15/06: Fair is fair. I found an even better


    review by one Eric Chudler, PhD at Univ. of Washington,
    called Neuroscience for Kids. (don’t laugh). I didn’t review
    all the links, but it is certainly more comprehensive than
    what I have here.

    You know how everyone says that people go insane when


    there’s a full moon? Well, I looked it up.
    Most studies finding a link vbetween violence and the moon
    were done in the 1970s. For example, a 1978 study found a
    lunar relationhsip to everything— suicides, asssaults, MVAs,
    and psych ER presentations, with both homicides and assaults
    both occurring more often around the full moon. Then again,
    you have to be suspicious of any study that actually tells you
    they actually used a computer.
    But by the 1990s, this lunar relationship was on the way out.
    Consider a 1997 study in Italy found no relationship between
    community psych contacts and the moon phases. A 1998
    Australian study found no relationship between violent
    episodes in inpatient psychiatric patients and the moon phases.
    A Spanish 2002 study found no link between ER presentations
    for violence and the moon’s luminosity. A German 2005 study
    found only the weakest link between completed suicide and
    the moon (the new moon, mostly.) A 1992 Canadian study
    reviewed 20 studies covering 30 years and found no link to
    attempts or completed suicides and lunar phases. And, to
    prove a point, a gigantic Austrian study in 2003 found no
    relationship between lunar parameters (phases or sideric) and
    any ER presentations.
    Which brings me to one point— do Americans do anything
    other than drug studies? Well, one non-clinical study was done
    in Texas and found no link between prisoner violence and
    lunar phases.
    –
    So it is with violence and suicide. But what about other
    behaviors? I haven’t had time to investigate the question, but
    two studies are suggestive. One (British) 2000 study found a
    slight increase in presentation to family practice clinics during
    full moons that was not due to psychiatric symptoms. An
    Austrian 2003 study found a strong relationship between
    thyroid clinic appointments and dates around the full moon.
    And a strange (British) 2003 study finding that women called
    a crisis center more frequently on the new moon.
    I did find an interesting (Greek) study finding an excess of
    seizures on full moons (34% vs. about 21% for the other
    phases.) Importantly (and in contrast to suggestions by other
    studies) these were not pseudoseizures, because all patients
    were monitored. The authors speculate either
    electromagnetic/gravitational effects (hey, it could happen) or
    an interaction between the intrinsic seizure threshold and the
    environment (i.e. you can change your own threshold.)
    My interpretation of this is that the moon can’t affect your
    behavior directly (duh), but one’s relationship to lunar cycles
    could influence your behavior. Take the classic wolf and full
    moon relationship. Prey animals, such as rats, generally reduce
    their activity during the full moon (don’t want to get caught, I
    guess.) Wild maned wolves (which eat rats) travelled
    significantly less during the full moon. The authors’
    explanation was that prey is less available, so wolves would
    want to conserve energy. Additionally, maybe one reason why
    so few studies are American is that we have a lot of artificial
    night light, so the moon has less or no influence, while
    elsewhere there is less artificial light? Who knows. I’m going
    to bed.
    Suicide Note Revisited:
    Formulation
    November 9, 2006

    Previously, I had written an (what I thought to be outstanding)


    article about suicide documentation. The main point was a
    refocusing of the note away from Objective and towards
    Assessment. It now occurs to me that what I was really trying
    to get at is the lost art of writing a psychiatric formualtion of a
    patient.
    The reason we don’t do formulations anymore— they’re not
    even taught in most residencies, certainly not in mine or now
    to the residents I supervise— is because it’s not clear what the
    formulation is supposed to do. Doctors get overwhelmed by
    the psychodynamics of it and can’t seethe practical utility.
    Someone brought them twenty ingredients but didn’t tell them
    what they were cooking.
    A formulation is different than a diagnosis or description of
    the patient. The formulation seeks to convey the relevant parts
    of a patient so that you can predict how a patient might behave
    in future circumstances. By way of example, a formulation is
    similar to a “profile” in crime movies. When they say things
    like, “he’s going to want to tie the women with piano wires,
    because he’s a schizophrenic who was forced to sleep in a
    tuba…” that’s a formulation (sort of— you get the idea.)
    The formulation helps prediction by linking the various
    aspects— seemingly unrelated, perhaps— of a patient’s
    existence. It’s the stuff you know is relevant, but DSM and
    standard psychiatry have no room for. What does it mean if I
    tell you an inpatient brought with her fuzzy bunny slippers?
    That’s goes in the formulation. A statement such as, “the
    strong family history of bipolar disorder, along with his
    chronic alcohol abuse and prior suicide attempts, and the
    pending divorce and custody battle, and his recent apostasis
    from Catholicism put him at higher risk for suicide” is the type
    of sentence I want in the Assessment— and it is precisely a
    short example of a “biopsychosocial” formulation.
    Note the importance of having all factors together, as opposed
    to individually. It sets up the logic; it lets the reader know,
    immediately and obviously, what you were thinking. This is
    very different than writing in one part of the note, “Fam Hx:
    strong bipolar;” and in another part of the note, “Chronic
    alcohol abuse; history of multiple suicide attempts;” and in
    another place, “patient divorcing, and custody trial is next
    month.” Putting it that way, in the classic H&P format, forces
    the reader to have to infer. Put in a biopsychosocial
    formulation, and the reader gets it instantly without even
    reading the rest of the H&P. That’s what you want.
    Interestingly, the term “biopsychosocial” was coined by
    George Engel, psychoanalyst(?), who in 1977 made the
    startling observation, “The dominant model of disease today is
    biomedical, and it leaves no room within its framework for the
    social, psychological, and behavioral dimensions of illness.”

    [It] would seem that psychiatry would do well to emulate


    its sister medical disciplines by finally embracing once
    and for all the medical model of disease. But I do not
    accept such a premise. Rather, I contend that all medicine
    is in crisis, and, further, that medicine’s crisis derives
    from the same basic fault as psychiatry’s, namely,
    adherence to a model of disease no longer adequate for
    the scientific tasks and social responsibilities of either
    medicine or psychiatry.

    Plus ca change…
    Engel, like others, had understood that somatic symptoms such
    as pain, weakness, etc, and autonomic symptoms such as
    reflux, tachycardia, etc could be symbolic expressions of
    emotion or conflict. How could the Objective portion of a note
    ever explain why you discharged a person with acute bilateral
    leg paralysis? It can’t— but a biopsychosocial formualtion
    can.
    As per Engel, the main question such a biopsychosocial model
    seeks to answer is why some patients experience an “illness”
    while others experience a “problem of living.” Importantly, the
    patient himself doesn’t often know: the patient defines it as an
    illness recursively by whether or not he “needs” a doctor, and
    not by an actual understanding of what’s wrong with him. It’s
    the doctor’s job to decide whether it is actually an illness or a
    life problem, and then properly re-educate and re-train the
    patient.
    Note that in my post about suicide documentation, the
    hypothetical patient was not malingering. He believed he
    needed to be hospitalized because he was suicidal. But when
    you discharge such a patient from the ER, you are thinking
    that the person will not die— the suicidality is an expression
    of something else. This is Engel’s dichotomy. The patient
    thinks one thing, you think another— it’s your job to explain
    to the patient what’s really going on, AND explain to the
    reader why you did what you did.
    Typically, formulations are taught, in my opinion, backwards,
    so students “don’t get it.” You’re taught to start with what’s
    going on now, then describe what historical factors that made
    the patient who he is (including genetics, upbringing, social
    stressors, meds, etc),; then psychodynamic explanations, and
    then your proposed treatment and how you predict the patient
    will respond. I think it is easier to go backwards. First, decide
    what you think is going to happen in the future (will commit
    suicide, won’t relapse, is a mania risk, etc) and then explain
    what it is about his past and present that makes you think this.
    In this way, you’re writing the formulation with a purpose.

    “Joe came to the ER for suicidality after he got drunk


    after getting divorce papers.
    Joe takes rejection very hard, and characteristically when
    the rejection is new, he doesn’t spend time to think things
    through. He exhibits poor judgment (give examples here
    or in Objective), is impulsive (examples), and also does
    things which further reduce his judgment and raise his
    impulsivity (like get drunk.)
    Joe has several narcisissitic features . For example,
    importantly, his suicidality is directed at his ex-wife. The
    point of the attempt is that she find out, that she know he
    is feeling hurt. If it was guaranteed that she would never
    find out, he would not attempt suicide because it would
    have lost its meaning. He needs her, or at least someone,
    to acknowledge his pain, and see him as the person he is
    trying to portray. As we talked, I made it clear that I did
    see he was hurt, and I understood the rejection—how it
    not only was a loss of a wife, but also a hint that he
    himself was unworthy of her. We discussed that she was
    entitled to leave him, but that she could not deterine his
    value.”

    etc, etc. You see how even without an Objective portion, the
    narrative in the Assessment is quite clear. The reader
    understands what you were seeing and thinking.
    Massacre of The Unicorns
    November 9, 2006

    The real problem of a critique of our own cultural models


    is to ask, when we see a unicorn, if by any chance it is not
    a rhinoceros.

    It’s a convenient fiction that the difficulties with psychiatric


    diagnosis and treatment are due to incomplete knowledge- if
    we just knew more about dopamine!—but the real source of
    the failings is inherent in its structure. Psychiatry fails because
    it is designed to fail. (continued below…)

    Massacre of the Unicorns


    The real problem of a critique of our own cultural models is to
    ask, when we see a unicorn, if by any chance it is not a
    rhinoceros.[i]
    It’s a convenient fiction that the difficulties with psychiatric
    diagnosis and treatment are due to incomplete knowledge- if
    we just knew more about dopamine!—but the real source of
    the failings is inherent in its structure. Psychiatry fails because
    it is designed to fail.
    Semiotics and Psychiatry
    The problem is with the signs of psychiatry. Signs are vehicles
    for conveying information. For example, the term
    “antidepressant” is a sign conveying the idea of a “drug which
    treats depression.” While tricyclics and SSRIs are both called
    “antidepressants” because they treat depression, the term
    otherwise carries no necessary value except that. Signs can be
    misused if they are expanded to take on new meaning in an
    inconsistent fashion. Consider the controversy over
    “antidepressant induced mania.” Tricyclics have been shown
    to be associated with higher manic rates, but SSRIs haven’t.
    So does that mean that most textbooks and articles are wrong
    —that antidepessants don’t cause mania? Actually, the
    problem is worse than that. It’s not that antidepressants don’t
    cause mania—it is that there cannot be any such notion as
    antidepressant induced mania.
    Hydrochlorothiazide (a diuretic) and propanolol (a beta
    blocker) are both “antihypertensives,” but otherwise are very
    different drugs with very different side effects; only one makes
    you pee. There’s no such thing as “antihypertensive induced
    peeing.”
    But this error is itself based on an earlier semiotic error, with
    the sign of “bipolar disorder,” and its implicit idea of two
    opposing poles. Depakote will cure and prevent mania; and
    Zoloft will cure and prevent depression. The treatment of one
    pole should surely move the patient closer to the next pole;
    hence, psychiatrists talk about “antidepressant induced mania”
    but “Depakote breakthrough mania.” See the difference? No?
    That’s because, in reality, there is no difference in the two
    manias, and absolutely no reason one should believe one is
    “induced” and the other “breakthrough,” except that the
    problem has arbitrarily been defined in this manner, i.e. a)
    mood stabilizers are a priori preventative, and b) Depakote is a
    mood stabilizer. But a) is a postulate and b) is an optimistic
    assumption.
    A similar example is the often cited myth that diagnosis of
    bipolar disorder is frequently missed. A survey[ii] found that
    69% of patients were actually misdiagnosed, most often as
    having regular depression. An average of 4 physicians were
    consulted “prior to receiving the correct diagnosis.” But who
    is to say what is the correct diagnosis, when the diagnosis is
    based on vague and overlapping descriptions (and not on
    objective pathology?) You can look at this the other way, and
    say only 1 out of 5 psychiatrists felt it was bipolar disorder,
    while the other 80% thought it was depression. So it pays to
    have the last word. Bipolar disorder is “frequently missed” not
    because it exists and doctors miss it, but because it is defined
    in a way which allows it, by 80% of doctors, to be legitimately
    called something else. The only way to say the diagnosis was
    correct or incorrect, in the absence of objective pathology, is to
    say that the treatment they received for “bipolar disorder”
    from the fifth doctor was better (read: safer or more
    efficacious) than the treatment they received from the first
    four. This is not evident.
    Marco Polo’s Dilemma
    The problem in psychiatry is the problem in the epigraph at the
    beginning of the paper. When Marco Polo saw the exotic one
    horned quadruped, his frame of reference required that it could
    be none other than a unicorn, even though it did not conform
    exactly to his prior conception of it. Marco Polo made his
    observation fit his existing paradigm of zoology. While
    superficially (and in retrospect) this may seem silly and
    arbitrary, it is in fact the opposite, Marco Polo believed the
    only thing he could believe—because the alternative was to
    believe he had discovered an entirely new, unheard of,
    creature. This is the semiotic problem in psychiatry, wherein
    we are forced to interpret clinical signs with our available
    “encyclopedia,” because we lack both the newer encyclopedia,
    and its accompanying language, to interpret the signs
    differently. But here’s the extra credit question: is it really a
    rhinoceros or a unicorn?
    Psychiatry is trying to move away from a symptom based field
    to a disease (or at least disorder) based science. We are
    deciding (note word choice) that a psychiatric disease exists a
    priori, and can present with different symptoms, the way
    cancer could present as the flu, but really is cancer. The
    diagnosis (or sign) becomes more important than the
    individual symptoms, because it demands a specific treatment.
    But if the paradigm is faulty, what of the treatment?
    An example is the association of bipolar disorder with mood
    stabilizer. Through a series of laughable twists, psychiatrists
    came to believe that antiepileptics had special properties in
    bipolar because they could quell the chaos in the brain in the
    same way that they calmed seizure activity there. It is now
    common practice, as defined in numerous “Expert” guidelines
    and consensuses, that patients with bipolar disorder need to be
    on a mood stabilizer, specifically lithium or the antiepileptic
    Depakote. The problem with this is that there has never been a
    study that found that Depakote is a mood stabilizer. In fact,
    there is no evidence that any antiepileptics are mood
    stabilizers. What few studies have been done show no benefit
    over placebo for this purpose. Remarkably, very few
    psychiatrists know this. But worse, even when you show them
    data, they refuse to accept it.
    I know, it seems—well, crazy—that psychiatrists would
    blatantly ignore the absence of data—the opposite of data. Ask
    your psychiatrist the following question: A patient with a
    history of bipolar disorder presents depressed. There are only
    two medications available: Prozac or a new antiepileptic for
    which no efficacy or safety data yet exist. Which do you use?
    That the mystery antiepileptic is even considered shows the
    power of the association, because I haven’t actually told you
    anything about the antiepileptic. Nothing about efficacy,
    safety, anything. And a doctor would consider it? It’s
    considered because it is assumed that it will share the same
    properties as other antiepileptics, i.e. that it is a mood
    stabilizer. But no other antiepileptics are mood stabilizers, so
    why the assumption? And even if one seizure drug was, in
    fact, a mood stabilizer, why would another one be? If
    antiepileptics have totally different efficacies with respect to
    seizure treatment, why should it be any different for bipolar
    treatment? The power of the paradigm compels us.
    Can an antipsychotic be an antidepressant? Sure. Can an
    antidepressant be an antipsychotic? See? You’re hesitating. It
    is harder to imagine that an antidepressant can be an
    antipsychotic—as if there is anything in either term that allows
    us to predict other actions—because the paradigm has given
    value to terms that they don’t have.
    There’s an analogy in the social sciences: racism.
    The Knowledge Trap
    But psychiatry is an applied discipline. What’s the harm if
    assumptions lead to efficacious treatments? This is a trap.
    Psychiatry has convinced itself that it needs to focus on
    expanding its knowledge (i.e. data) rather than re-evaluating
    its postulates and paradigms. New discoveries or information
    are used to build on a paradigm, not to test it. But now
    psychiatry is looking to see what it expects to find. And if a
    discovery flatly contradicts the tradition, then it is ignored or
    rationalized. How else to explain the comparative absence of
    articles critically discussing the placebo response? And the
    even fewer whose proposed solution is not the abandonment of
    the placebo arm, in favour of “active controls.” Active as
    defined by whom? Is Depakote an active control?
    What Is Modern Psychiatry Seeking?
    The fiction is that psychiatry is looking for more efficacious
    treatments. It is not. It is looking for different treatments; the
    paradigm does not allow for the creation of better treatments.
    For example, psychiatry can applaud itself from moving from
    a “noradrenergic hypothesis” to a “serotonin hypothesis” of
    depression, but it’s still the same paradigm. While first line
    medications have changed, they have not changed because of
    improved efficacy. Nothing has ever found anything to be
    more efficacious than the previous standard (SSRIs. vs.
    tricyclics, atypical antipsychotics vs. chlorpromazine, etc.) nor
    has any “model” been more or less correct than any other. That
    some medications have less side effects and greater versatility
    is useful, but a) this is almost never the result of intentional
    scientific discovery but rather the fortunate by-product of the
    invention of (yet another) efficacious treatment; b) this greater
    tolerability in no way reflects the accuracy or inaccuracy of an
    existing model. That Zoloft is more tolerable than imipramine
    has nothing to do with the viability of the “serotonin
    hypothesis.” And yet how many times have I heard that
    antipsychotics treat depression with no more rigorous
    explanation than because of their “activity” (note the vague
    term) on serotonin?
    Psychiatry, which seeks to be like physics, becomes instead a
    caricature of it. It, too, tries to focus on expanding knowledge
    and not re-evaluating its principles. But unlike physics,
    psychiatry has no formal principles. They are made up. It is,
    strictly speaking, not a science but a paradigm, no different
    than psychoanalysis. It may seem as though Freud concocted
    the notion of the unconscious out of thin air and developed an
    entire field around it, but modern psychiatry has done nothing
    different in concocting the notions of kindling or
    “upregulation of receptors” as first principles and then
    constructing an equally arbitrary field around them. That
    medications help patients has everything to do with the
    medications and nothing to do with the incense and liturgy that
    surround them.
    Paradigm shifts do not occur in physics because the principles
    do not change. Newtonian mechanics will always be useful for
    prediction because it is correct for the cases in which it is
    applicable (i.e. for measurable bodies.) It is furthermore not
    susceptible to political influence. Psychiatry is the opposite.
    The decision to accept or reject the paradigms in psychiatry
    are very clearly political, not evidentiary. We as individuals
    accept the idea that antiepileptics are mood stabilizers because
    psychiatry has decided to adopt this position, not because the
    evidence requires us to accept it (in fact, the evidence should
    require us not to accept it, or at least seriously question it.) No
    physicist could hope to “practice” physics without having read
    and understood what came before, without having worked the
    “block on an incline” problem. But there is no theoretical nor
    practical requirement to practice psychiatry of reading the
    papers on, for example, mood stabilization, let alone what
    came before. All that is required is to know what the current
    practice is (“Guidelines recommend prescribe antiepileptics.”)
    This may seem like science, i.e. “scientists have determined
    that antiepileptics are mood stabilizers, so we will trust their
    word and prescribe them,” but it is very clearly politics.
    The current problem of psychiatry is that it seeks to be
    something that it is not: science. It may be, at some future
    date, readily described by scientific principles, but this is
    assuredly not the case now. It is most certainly a sociological
    construct, a paradigm, with a shared educational system,
    shared assumptions, and a mechanism to communicate
    discoveries (i.e. journals, meetings.) It also has a common
    language. But it lacks the predictive ability common to other
    disciplines.
    An argument against the notion that psychiatry is an arbitrary
    paradigm is that it is a reflection of what actually occurs in the
    brain. This is sophistry. For example, saying the “serotonin
    system is relevant in mood disorders” is empty because it
    lacks context. Does it mean that no other system is relevant?
    Or that it is the most relevant? Or even necessary? Sufficient?
    What about Wellbutrin? Are you saying psychotherapy alters
    serotonin? (And not dopamine? Etc)
    Why There Can Be No Progress in Biological Psychiatry
    Using The Current Paradigm
    While there is a science of the brain, there is no science of
    thought. Another way to think of the problem is to question
    the nominalism of the field. Psychiatry talks about things like
    mood, emotion, depression. But are those actually real and
    distinct things? Is there some signal pattern in the brain that is
    mood that is wholly unrelated to the signal pattern for a
    thought? Just because something has a name, that does not
    mean that the thing exists in fact. These may be simply
    convenient fictions.
    To say that because it is known that chemicals can alter what
    is called mood therefore proves the existence of mood is not
    satisfactory. The death of a loved one will alter mood as well,
    often dramatically and to an extreme. How is this possible, if
    no chemicals are introduced into the system? In fact, nothing
    new is introduced into the brain except, depending on the
    paradigm, a) information or b) energy (i.e. converted sound
    waves.) How does the introduction of a new piece of
    information trigger an alteration of mood? Why would one
    thought “My family is dead” trigger the release of some
    chemicals, but another thought “My family is alive” not
    trigger that same release? And how does a non-physical entity
    like a thought trigger a physical reaction? Are thoughts even
    discrete? Or does the brain operate on a flow of thoughts?
    Digital or analog?
    Linear regression and statistics cannot address all of the
    problems of chemistry and mood; for one reason because it
    does not account for thoughts that a patient cannot have while
    on the drug— but it is reasonable to think there are some. In
    other words, if there is some set of thoughts A, a subset B of
    which are negative and a subset C of which are positive, then
    is the introduction of a chemical in the brain able to block only
    subset C, or does it simply block set A? The reverse is
    potentially applicable: that there are certain thoughts that can
    be had only when on a drug. (This is obviously evident in the
    case of perceptions that can be had only on a drug.)
    The simple analogy to computer hardware and software
    illustrates the difficulty in psychiatry. One can understand all
    of the hardware of a computer system, but this will not explain
    if or how the computer can run word processing software,
    video games, instant message or be susceptible to a virus, or
    make any predictions about the behavior of this software in the
    real world (for example, no computer technician could predict
    the writing of this paper, nor, by changing the hardware, alter
    the content of this paper.) Hardware is finite, but software is
    infinite, or as infinite as is thought. Without understanding the
    mechanism of thought, or at least how thoughts or states can
    affect mood, then a pharmacology of the brain will simply
    tread water with no progress towards either treatment or
    diagnosis. One cannot permanently alter mood without at least
    simultaneously altering thought. In a sense, there is more logic
    to the psychological approach, or at least in conjunction with
    medications, because if software (thought) is the problem,
    more software is the cure. While the applicability of “therapy”
    in schizophrenia may be debatable, there is no reason as yet to
    decide that any other approach is applicable to mood disorders
    such as depression or anxiety, and absolutely no evidentiary
    reason to assume that pharmacology is the superior approach.
    It is not necessarily faster nor more consistently reliable.
    Myths of psychiatry such as those described above are not
    isolated examples of poor practice or lack of knowledge, but
    are the unavoidable manifestations of an artificial paradigm
    which is arbitrarily derived from unproven assumptions,
    justified by inappropriate logic. They often lead to ineffective,
    dangerous, and very expensive treatment. Psychiatry must be
    more vigilant about its own data. It is necessary to avoid
    laziness in our education and understand from where comes
    our knowledge. There are daily diatribes against the influence
    of pharmaceutical companies; but the effect of pens and
    detailing is surely much smaller than the effect of
    misunderstood data, poorly researched axioms, and signs run
    amok. Psychiatry will not survive as a medical subspecialty if
    it continues along this path. It will lose its dignity, and worse,
    it will become irrelevant.
    “It would be good to conclude by recommending a short book,
    What Is Science?, that does things the right way. It takes a
    robustly objective view of the relation of evidence to
    conclusion, explains what laws of nature are, briefly shows
    how measurement, data, statistics, and mathematical models
    work in science, states which parts of science are well-
    established and which not, illustrates with engaging episodes
    in the history of science, and ends with some colorful
    rudenesses on postmodernist solecisms concerning science.
    Unfortunately, it does not exist.”[iii]

    [i] Eco, Umberto (1998). Serendipities: Language and lunacy


    (William Weaver, Trans.). New York, NY: Harvest.
    [ii] Hirschfeld RM, Lewis L, Vornik LA. Perceptions and
    impact of bipolar disorder: how far have we really come?
    Results of the national depressive and manic-depressive
    association 2000 survey of individuals with bipolar disorder. J
    Clin Psychiatry. 2003 Feb;64(2):161-74.
    [iii] Franklin, James. Thomas Kuhn’s irrationalism. The New
    Criterion Vol. 18, No. 10, June 2000
    “Because I Said So”
    November 14, 2006

    I have written endlessly about how language controls


    psychiatric thought, and that it will be impossible for
    psychiatry to progress while semiotics trumps science. Here is
    a recent example:

    In the Oct 2006 JCP, there is an article about the efficacy of


    Depakote ER for acute mania.

    As I read the introduction to this useless paper, I get kicked in


    the throat by this:

    “Currently approved treatments of the acute manic phase


    of bipolar disorder can be categorized primarily as mood
    stabilizers (e.g. divalproex sodium, lithium, and
    carbamazepine) or as atypical antipsychotics (i.e.
    aripiprazole, olanzapine, quetiapine, risperidone, and
    ziprasidone.(5)”

    Note carefully that the authors have taken a set of medications


    and artificially divided them into “mood stabilizers” OR
    “antipsychotics.” Ok, well, wouldn’t it be great if reference 5
    actually justified this? Using data or logic? Well, it doesn’t.
    But the damage has been done. Unless you have a computer
    with FIOS and three monitors and are reading every reference,
    a quick skim registers that there is a reference, which you
    assume has been checked, and move on. In fact, the authors
    here don’t even feel that a reference is necessary— everyone
    knows what a mood stabilizer is. It’s too basic to even
    reference.
    So, is there any reason that seizure drugs are “mood
    stabilizers” (read: prophylactic) while antipsychotics are not?
    For antipsychotics, is there anything about their pharmacology,
    half-life, color, or pill size that a priori exclude them from the
    “mood stabilizer” category while including the seizure meds?

    The artificiality of the terminology is confirmed when you


    actually look at the data: the only drugs listed here which
    actually are “mood stabilizers” are lithium, olanzapine and
    aripirazole (over 6 months).

    A study may eventually show Depakote is a mood stabilizer


    after all, but that’s not my point. My issue is that in the
    absence of data or logical necessity, how can we take an
    arbitrary set of names and make unjustified deductions?
    This is the semiotic trap of psychiatry. It doesn’t actually
    matter what the data says (e.g. Depakote is not a mood
    stabilizer, Zypexa is), what matters is the language, the
    categories. This isn’t science. Just because there are graphs
    and chi-squareds, doesn’t make it science. There’s no science
    here at all. At best it is linguisitics. At worst, propaganda.
    I’m not saying they are lying. It’s worse than that. It’s the
    structure of psychiatry. It’s a subtle manipulation of reality to
    make people believe what you “already know” to be true.
    They are trying to convey a perspective, not report a finding.
    For example, later on the authors try to make the point that
    higher levels correlate with efficacy, but go too high and you
    get toxicity:

    One analysis noted that serum valproate concentrations


    between 45-125 ug/ml were associated with efficacy,
    while serum valproate concentrations > 125 ug/ml were
    associated with an increased frequency of adverse effects.
    19

    This isn’t what reference 19 says, exactly. What it says is that


    45 is a pivot point; below it is not as good as above it. But it
    doesn’t say that higher and higher levels give you better and
    better efficacy. What makes the omission of this rather
    important clarification all the more perplexing is that reference
    19 was written by the same authors as this article.
    But the damage has been done, again. Now you think you have
    read a statement in support of what you already assumed to be
    true. So you push the level.
    You may argue that I am misinterpreting the author’s words,
    that he never implied that efficacy had a linear relationship
    with level. Ok: prior to reading this blog, did you think that
    there was? Where did you learn that? Did you pull it out of the
    ether? No— you skimmed articles like these that left you with
    half-truths, and never questioned it because everyone knows
    this already.
    Let me show you what I mean. Here’s the relationship of the
    Depakote level to maintenance treatment:

    Higher serum levels were modestly but significantly


    correlated with less effective control of manic symptoms
    in a maintenance study (26). The study therefore supports
    a somewhat lower serum level range for maintenance
    treatment than for treatment of mania.

    Did you know that? That the efficacy decreases as the level
    increases? I’m not asking if you believe it, I’m asking if you
    had ever heard it. Because if the answer is no, then there is
    something very, very wrong with the way we convey our
    knowledge. *
    ––––––-
    *Contrary to the opinions of former girlfriends, I am not an
    idiot. I can plausibly explain this odd finding: the most manic
    patients got higher and higher doses, so the least responsive
    ended up getting the highest doses and levels. So it looks like
    higher levels were associated with decreased efficacy, when
    really the highest doses went to the sickest people. Ok, good
    explanation. But this supports my earlier point: you can’t take
    something which requires a post hoc justification and use it to
    make a leap in logic to conclude something else.
    The Ten Biggest Mistakes
    Psychiatrists Make
    November 16, 2006

    Long but necessary.


    1. Talk too much

    It’s not a conversation, and it’s not a debate. You are either
    treating their symptoms with medication, or guiding them to
    “treat” their own symptoms. Neither requires much talking.
    If the psychiatrist says more words than the patient, then the
    psychiatrist is the patient.
    Many psychiatrists talk because they feel powerless. The
    patient is in distress. How can the session be worth the money
    unless they get some thing? A prescription is good, but what
    else—what now? So the psychiatrist thinks they need to say
    something, to appear as though you are giving something to
    the patient. The worse the situation is, the more the
    psychiatrist talks. You’re talking to make yourself feel better,
    to justify your value as a psychiatrist. Don’t do this. It’s not
    help.
    And empathize, don’t sympathize. I cringe whenever I see a
    psychiatrist on the first visit try to sound genuine while they
    affect a sad and shocked voice, lean forward, grab a box of
    tissues, “oh my God, I’m so sorry, that’s terrible!” It’s fake,
    which makes it annoying, but it’s patronizing, which makes it
    countertherapeutic. A psychiatrist cannot sympathize—did the
    same thing happen to you?. What they need to do is
    empathize, to understand the feelings, to appreciate them—not
    to share them. Plus, you don’t know what the situation means
    to the patient. Maybe they’re secretly happy (and guilty about
    it), and now that you’ve confirmed that it’s “terrible,” they’ll
    never admit to you or themselves they’re happy about it.
    Simply saying, “I’m sorry. Can you tell me more about…” is
    all that’s necessary.
    And enough with the tissues. If you stalled the interview to go
    get them a box of tissues, you have failed, you changed the
    energy of a key moment. And you did this—let’s be honest—
    not because they needed tissues, but because it took some
    pressure off the moment and allowed you to give them
    something. Leave tissues by the patient chair from the
    beginning, and focus on what you’re doing.
    I had a great mentor who taught me to begin the first session
    with the words, “Where would you like to begin?” And then to
    shut up. Great advice.

    2. Take too much history


    This is going to be controversial. I can hear academics seizing.
    I know psychiatrists are taught that careful, meticulous history
    taking is the cornerstone of good care. Well, it’s not.
    Every session should be about the patient, not about you.
    You’re supposed to help them, not understand them. The two
    may go together, but they might not. It is possible for you to
    help without understanding, but it is not acceptable for you to
    understand without helping. You’re not CSI, you’re not
    Batman, you’re not trying to solve a mystery or make some
    aha! discovery. They’re telling you what’s wrong. Just listen.
    Taking a detailed history may seem like a good idea, but many
    times it is masturbation, it contributes nothing to the patient’s
    well being, it only makes us feel thorough. As in: well, I can’t
    do much for him, but I got a really good history. Remember,
    it’s not about you, it’s about them. It may seem as if a strong
    family history of bipolar disorder is important information, but
    it isn’t. I know, bipolar runs in families and blah blah blah.
    You couldn’t tell they were bipolar before you learned their
    family history? And how do you know the family’s diagnosis
    was correct, so that you can rely on it to make your diagnosis?
    I’m not saying don’t get the information. I am saying devoting
    the first one or two sessions exclusively to this gains the
    patient nothing. Everything from the moment they walk
    through the door should be about their service. Forget about
    the notes, especially outpatient notes. Worry about the patient,
    the notes should come second.
    Are you proud of your notes because they contain so much
    detailed patient information? You need to think about this. Did
    you break eye contact to write, “sad over husband’s loss?”
    Then you missed the moment. Just listen—write your notes
    after the session. And if I see one more psychiatrist with a note
    pad playing stenographer I am going to punch him in the neck.

    3. Ignore smoking cessation


    or at least make it a secondary outcome. Also applies to
    soda/juice/calorie reduction.
    This may seem trivial. It’s not—after the treatment of the
    initial presenting acute symptoms and treating drug and
    alcohol abuse, this is more important than almost anything in
    psychiatry. The logic is as follows:
    1. Smoking is obviously and severely detrimental to one’s
    health, arguably more damaging than hypertension and
    depression combined. Its effect on life expectancy rivals, well,
    arsenic.
    2. It is an addiction, so it is psychiatry’s business.
    3. It is highly comorbid with psychiatric disorders, and may be
    a relative symptom of them. (For example: half of all people
    who commit suicide smoke.)
    4. Smoking itself has a significant impact on other medications
    (e.g. did you know it reduces Haldol by half?)
    5. What the hell else are you doing with the session?
    Especially in the “maintenance” phase of psychiatric treatment
    (where symptoms are relatively controlled, etc).
    All of this applies equally to soda consumption or even diet in
    general. Drinking 2 liters of soda a day may not seem like a
    psychiatric issue, but most of the medications used have the
    propensity to increase appetite, and excess eating, smoking,
    soda drinking are hardly psychologically meaningless
    behaviors. If your psychiatrist asks you to keep a mood chart
    or teaches you about “serotonin dysfunction,” but doesn’t tell
    you to quit smoking, run. He has missed the forest for the
    trees.
    4. Blame lawyers/insurance companies/Big Pharma

    In order to understand why this is such a popular mistake


    among psychiatrists (all doctors, actually) it’s useful to
    identify when psychiatrists do this. There are two specific
    times. The first is when psychiatrists seek to justify doing, or
    not doing, some clinical maneuver, as in, “I can’t discharge
    him from the emergency room, even though I don’t really
    believe he is suicidal, I think he is lying simply to get
    hospitalized— but I don’t want to get sued.” The second time
    is when psychiatrists seek to explain a reduction in income, as
    in, “The insurance company only pays so much for a visit, so
    now I do only med checks.”
    What is striking about these justifications is that they almost
    never relate to the specific problem at hand, they are
    scapegoats for some general anger about the difficulty of
    practice. For example, in the example of the malingering
    emergency room patient, discharging him has no increased
    risk of legal liability because if the patient is, in fact,
    malingering, then he will not kill himself. The operational
    issue here is not one of increased legal liability, but whether a
    physician can detect malingering. This has nothing to do with
    lawyers.
    In the second example, while it is certainly true that the
    insurance company has set reimbursement rates, psychiatrists
    have not explored their responsibility in this. They have not, in
    any scientific, economic, and most importantly policy way,
    justified the necessity for a different (read: higher)
    reimbursement scheme. Consider psychiatrists’ attitudes
    towards psychologists acquiring prescribing privileges. It
    seems obvious that psychologists shouldn’t prescribe
    medications, but why not, exactly? To say that psychiatrists are
    trained in medicine and better understand drug-drug
    interactions, dosing, and toxicities presupposes that the
    average psychiatrist actually does know about drug-drug
    interactions, dosing and toxicities. Really? What’s the
    interaction between Prozac and hydralazine? Don’t know?
    Then why should psychologists know? And if you can look it
    up, so can they, etc, etc. Also, using this reasoning could
    backfire, as it can justify an insurance company refusing to
    pay for a psychiatric med check since the service could be
    performed by a primary care doctor (who will also handle
    everything else for the same low price.) Again, it is easy to
    complain, but it is on psychiatrists to explain, rationally, why it
    should not be.
    Consider the common complaint that each insurance company
    has its own formulary, requiring doctors to prescribe
    alternatives, generics, or submit prior authorization requests.
    This is taken as bureaucratic interference of patient care.
    However, in the majority of the cases these restrictions are
    economically and clinically valid. No logic, let alone evidence,
    exists for prescribing two antipsychotics simultaneously. So
    why should the insurance allow it? Similarly, an insurance
    company should be allowed to approve drugs based on cost,
    because unless one can show that, for example, two SSRIs do
    not have the same general efficacy or tolerability across a
    population, than an insurance company cannot be reasonably
    obligated to provide both, especially if it can contract to
    receive one of the SSRIs at a cheaper cost. To be clear: it may,
    in fact, be true that (for example) two antipsychotics are better
    than one. But the burden of responsibility is on psychiatrists to
    show that this (or any clinical) maneuver is necessary, and not
    on the insurance companies to simply trust that doctors know
    best, because they have shown repeatedly that they do not.
    Blaming lawyers has almost become a sport. It is certainly true
    that uncapped awards for damages hurts everyone (except
    lawyers.) However, lawyers are good at picking malpractice
    cases, not at inventing them. Consider informed consent: if
    one prescribes valproate for maintenance, one must not only
    discuss the side effects, but also the alternatives to treatment—
    especially when the alternatives to Depakote (a drug which has
    neither approval for maintenance nor rigorous data backing it)
    do have such approval and data (consider lithium, Zyprexa,
    Lamictal, etc.) To prescribe Depakote because it is at the top
    of an algorithm or in the “guidelines”, or because “that is my
    practice” and not because of a reasoned analysis of the
    individual merits of the case, is at minimum not thoughtful
    practice. A similar example is psychiatry’s current obsession
    with antipsychotic induced diabetes. Assume that Geodon
    does indeed have a much lower risk of diabetes than Zyprexa;
    is a psychiatrist any less liable if the diabetes is induced by
    Geodon and not Zyprexa? No. You don’t get sued for using
    Zyprexa. You get sued for causing diabetes and never picking
    it up.
    To state explicitly what seems the most obvious point of all: if
    a medication causes a side effect, and you catch it, there’s no
    lawsuit, because there’s no damage.
    The above examples come from misunderstanding the
    available scientific literature, or not knowing it at all. Oddly, if
    a lawyer does not research the current state of case law and
    statutes before answering any legal question, it is legal
    malpractice. But doctors practicing medicine are not required
    to review current journal articles on any medical condition.
    Pharma is the most maligned of all. On the one hand doctors
    resent the intrusion of the industry on their practice; on the
    other hand, industry is the primary—often only— ongoing
    educational source for doctors, whether they believe this or
    not. Drug reps, throwaway journals and supplements, “drug
    dinners” and almost all CMEs (yes, CMEs too, stop lying) are
    all industry sponsored educational processes which are the de
    facto continuing education of most psychiatrists. Oh, right,
    right— doctors learn by regularly reading numerous journals
    carefully and thoroughly. Ok—ask them to name one article in
    the most recent issue of the American Journal of Psychiatry.
    Not the results of the study; just the title.
    One may want to ask why the FDA feels it necessary to hold
    pharmaceutical reps to extremely strict standards: they cannot
    mislead, they cannot speak off label, they must discuss side
    effects and toxicities, and they cannot use any promotional
    material that was not reviewed by the FDA. Used car salesmen
    are not held to any standards, and they sell to idiots. No one
    needs to tell you the rate of blowouts on a Firestone tire. Why
    would doctors—the most educated consumer group in
    existence—need protection from salespeople? Shouldn’t
    doctors, ultimately, know more about the medications than the
    sales reps do? Unless…

    The sad truth is that the state of psychiatry is the fault of


    psychiatrists, who have failed to take full responsibility for
    their own education and practice. To blame anyone else at this
    stage is remarkably disingenuous.
    5. Become social policy analysts

    Remember how in May, 2005, the American Psychiatric


    Association endorsed same sex marriage? And you applauded
    the moral fortitude and progressive instinct of this august
    body? Well, instead of debating whether there should or
    should not be same-sex marriage, perhaps we should ask what
    modern psychiatry could possibly contribute to this discussion.
    The answer is nothing.
    You can’t get away with pat answers, such as psychiatrists see
    the psychiatric ramifications of discrimination or being unable
    to marry. There are psychiatric ramifications of bankruptcy,
    and war, but no one felt compelled to write a policy statement
    on it (and thank God.)
    And no, there isn’t a difference between bankruptcy and gay
    marriage— not to psychiatry. That’s the point. These are social
    problems about which modern psychiatry is definitionally
    ignorant. The APA did not endorse polygamy. What’s the
    difference? If homosexuality is not a psychiatric disorder, than
    there is no more reason to be more for or against it than there
    is for any other kind of marriage. The APA is no better suited
    to answering these questions than, say, the NFL.
    What if the NFL came out against antidepressants in children?
    This is a perfectly valid analogy, because neither the NFL nor
    psychiatry have special knowledge that make their statements
    anything more than opinions. What do psychiatrists know
    about same-sex marriage that the quarterback for the Patriots
    doesn’t? Don’t laugh—I’m serious. What’s the answer?
    Medicine, or the APA, can legitimately express a policy only if
    the policy was grounded in science or logic. Perhaps the APA
    cares to release this intriguing scientific data? (While it is at it,
    perhaps it can also release the data supporting the use of half
    of the medications currently favored by APA Guidelines?) But
    this seems pretty much business as usual for the APA. Rather
    than work on its own serious failings, it involves itself in
    social policy.
    “Modern” (read: pharmacological) psychiatry is obsessed with
    reinventing itself as a biological and scientific discipline. Well,
    if it wants to be a science, it better start acting like one.
    The FDA effectively killed Vioxx, and not a peep was heard
    from the APA about the dangers of letting the government
    regulate their practice. You can say Vioxx has little to do with
    psychiatry, but it’s still a lot more than gay marriage.
    Determining what is true and what is not, through serious and
    often disconcerting scientific enquiry, is very difficult. It is
    much easier to involve oneself in matters of opinion and
    debate, in activism, because it is both immediately rewarding
    and it is easy. It’s hard to measure things in psychiatry, and
    when it is possible the results are often disappointing. So it
    busies itself with matters of conviction because it feels some
    responsibility to have convictions. It doesn’t. It has a
    responsibility to the truth, and if it doesn’t want to invest any
    energy in that pursuit, it is on them. But don’t mask it with
    whimsy and dilettantism.
    I should point out that gays, far from being pleased with the
    APA’s stand, should actually be horrified. Do you— does
    anyone— want social policy suggested by psychiatrists? Think
    long and hard.
    Imagine the outrage if the APA had come out against gay
    marriage, or for the war in Iraq. There would be battalions of
    people saying, “well, what the hell do psychiatrists know
    about war in Iraq? Who the hell do they think they are telling
    gays not to get married?” There is no protection in being
    confident of the rightness of your current position, as history is
    loaded with examples of how terribly bad doctors are at
    determining what is right and what is wrong. Not long ago
    homosexuality was considered a disease. See? The Tuskegee
    experiments were endorsed by the AMA, and the AMA gave
    its endorsement, after ethics concerns were raised by Peter
    Buxtun. Remember that? How about the speech to the1941
    APA meeting, and the 1942 issue of the American Journal of
    Psychiatry in which euthanizing the “feebleminded” (IQ<65)
    sounded like a good idea?
    Psychiatry would do well to remember Wittgenstein TLP 7:
    Whereof one cannot speak, thereof one must be silent.
    6. Don’t refer to therapy.
    Psychopharmacology without therapy is treating an infection
    with Tylenol.
    Medications do not cure a psychiatric disease; we’re not even
    sure what the disease actually is. What they can do is reduce
    symptoms, give you strength—so that you can learn new
    behaviors. That’s the point of medications. Treating depression
    with an antidepressant is not the solution; it’s the preliminary
    step in allowing you to figure out how to handle depression
    later on. The adaptation, the adjustment, the physical altering
    of brain functioning is done by new learning, often this is
    therapy (though it doesn’t have to be.) I’m not saying therapy
    is that great, or necessary, either. I’m simply saying that trying
    to improve a person’s long term status using medications alone
    without some sort of education and training is a waste of time.
    It is maybe the most profound disservice of all to tell a patient
    that their depressive or bipolar symptoms are the result of
    biology or chemical imbalances and thus absolve them of the
    responsibility of learning new ways of interpreting and coping
    with their environment.
    7. Don’t think strategically.
    Psychiatry is fun, I’m sure, but it doesn’t help anybody when
    the patient refuses to play. Psychiatry telling us opiate abuse is
    a heritable disorder related to polymorphisms in dopamine
    receptors doesn’t stop your kid from stealing your money to
    buy smack. See? Sometimes you have to hide your wallet.
    What is the goal? What do you have to do to achieve that
    goal? Sometimes you have to look beyond the DSM.
    Do what you have to do. When a person needs treatment but is
    refusing it, neither the law nor psychiatry can help them. I
    can’t force someone into treatment. But you can. Take drug
    abuse: in my experience, the only way to get someone to
    (albeit reluctantly) accept treatment is a large scale
    intervention. 10 people, minimum, in a cramped room with the
    future patient trapped as far form the door as possible, all ten
    in energetic agreement that the person needs to get help—
    now. Not tomorrow morning. Immediately. You’ve already
    packed his bags. This isn’t a five minute pep-talk—take the
    whole day off, you’re going to be there a while. Also, a
    psychiatrist cannot do this for you, he shouldn’t even be there,
    because no one ever listens to neutral third parties, much less
    psychiatrists. (And I’ll just say it: you probably don’t want a
    psychiatrist there in case you…have to take things… to the
    next level…) It has to be ten highly motivated, concerned
    people. If you are not motivated enough to stage this
    uncomfortable intervention, I assure you he won’t be
    motivated to go. This is the kind of thing a psychiatrist should
    be telling you, not trying to sell you on Suboxone. Nobody
    likes confrontation or to be confronted. Ten people. Minimum.
    Sure, you are partly guilting them into treatment, partly
    coercing. But getting them into treatment in this way is better
    than not getting them into treatment in a nicer way. Psychiatry
    is war.

    Sometimes people don’t need to know. If a person’s life is


    changed on medication, it may be okay not to tell them all the
    side effects. I know, lawyers are standing by (see # (blame
    lawyers), but again, it’s strategy, and I think reasonable people
    (i.e. juries) will understand what you were doing. If lithium
    keeps the person from slitting their own throat, it’s okay to
    skip the part about how it can hurt your thyroid. It doesn’t
    exempt the doctor from checking for it, mind you. In these
    tricky situations, a) you have to be sure this medication is
    absolutely vital; b) recruit as many people as possible into the
    therapeutic umbrella. Tell the wife about the side effect; tell
    family what to watch out for. And monitor. There’s even a
    technical term for this therapeutic privilege, but I can’t
    remember what it was.

    Save the environment. Here’s an all too common scenario


    involving no strategic thinking: Your adult child is living at
    home, no job, sporadic drug use, involved in an abusive
    relationship, frequent quasi-suicidal acts, etc. You’ve tried
    everything, nothing has worked. You don’t know what to do.
    You’re afraid to kick them out because they can’t manage on
    their own, you’re afraid they’d sink deeper into
    drugs/depression/etc; but on the other hand you have other
    kids you have to worry about, a finite supply of money, etc,
    etc. You’re paralyzed.
    Here’s a question you might not have thought about: what
    happens to the kid when you die? They are suddenly going to
    be without support, suddenly without money, suddenly without
    resources. Will they simply manipulate your spouse into
    getting their needs met? Or worse, go somewhere else? Is that
    what you want? Plan today, now, for this eventuality. Maybe
    that means setting up a trust with a finite monthly payout only
    if they are living on their own and have a paycheck. Or only if
    they are seeing a therapist once a week. Or give clean urines.
    “What is this, probation?” Actually, that’s exactly what it is.
    You have to save the environment you are in before you can
    help the other person. That means protecting your wife and
    other kids, and their physical assets. It means protecting your
    marriage. It may seem cold to worry about money when your
    kid’s on heroin, but I assure you that this is the most important
    thing you can do if the kid won’t get help. Ripping apart your
    marriage over this benefits no one, absolutely no one. So yes,
    it may mean kicking them out of the house, cutting them off. It
    also means doing an intervention. It means holding your
    breath that that phone is going to ring in the middle of the
    night and it’s going to be the police. But letting them eat,
    sleep, and watch TV in your house while their chaos continues
    does not lessen the risk of receiving that phone call.
    It’s called enabling. Don’t do it. And a psychiatrist should be
    telling you this, not trying to give you Celexa to help you cope
    with it.
    8. Polypharmacy
    Polypharmacy isn’t just common— it’s the codified standard.
    When two psychiatrists discuss a patient, inevitably one of
    them will say these four words: “You should consider
    adding…”

    The paradigm is that if you fail a medication, you must be so


    sick that you need a second medication.

    It’s a useful paradigm; and by useful, of course, I mean wrong.


    Here’s an alternative paradigm: maybe if the medication didn’t
    work, you should try a different one?

    Polypharmacy would be ok if there was at least some data


    justifying it. But there isn’t. I know, controversial. Look it up.

    Consider antipsychotics: if anyone can provide the logic— not


    data, simply the logic— for using two simultaneously, I’d love
    to hear it. Antipsychotics work by blocking dopamine
    receptors, of which there are supposedly a finite number. If
    one antipsychotic blocks most of them, where is the other
    supposed to go? Why couldn’t you simply increase the dose of
    the first? And if side effects prevent this increase, why
    wouldn’t you just switch to the second medication?

    Same with antidepressants: Zoloft and Prozac are SSRIs, they


    target the exact same molecule, which is again finite in
    number. If most are blocked by one drug, where does the
    second go? Why are you offended that Medicaid doesn’t let
    you prescribe two at the same time?

    So you say: well, what about mixing two drugs of differing


    pharmacologies, like Zoloft (serotonin) and Wellbutrin
    (dopamine/norepinephrine)? At least there is logic to this one,
    but—surprise- no evidence. It may seem as though Zoloft +
    Wellbutrin, or Depakote + an antipsychotic, etc is better than
    one alone, but they’re not. But here’s the point: even if it were
    true, so what? How do you know it’s necessary? Shouldn’t
    prudence and common sense and fiscal responsibility and the
    cramp in your writing hand require you to at least try
    monotherapy a few times? Twice, at least? Because I can’t
    prove two drugs are better than one, but I can prove they are
    twice as toxic and twice as expensive.

    Polypharmacy is bastard child of the theory of maintenance


    treatment. If it took three medications to get you feeling better,
    then you need to continue these three medications in order to
    stay stable. Going off your medications results in disaster.

    First of all, no. Secondly, take the example of mania. If you’re


    manic, and it took three medications to bring the mania down,
    does that mean you need those three for the rest of your life?
    Because if so, what do you do the next time you get manic?
    Add a fourth? Don’t you get used to medications? Does
    tolerance not occur? Upregulation and all that? You see the
    problem— maintenance begats polypharmacy. Also,
    medications have side effects, and so medications are given for
    the side effects of the other
    medications, ad nauseum. At some point (four medications?)
    the symptoms you are seeing cannot be reliably ascribed to the
    disorder rather than the medications themselves. The patient is
    buried. The treatment now becomes getting them off these
    medications.

    Again: it may be true that an individual person needs several


    medications. But you can’t make polypharmacy a generalized
    treatment standard. It’s too expensive and has too many side
    effects for a theoretical benefit. And what kind of message
    does it send to the patient? If you’re on four medications, how
    can you be anything but severely ill, all the time? How can
    you be responsible for any of your feelings, or for controlling
    them?
    9. Diagnose everything
    The layman’s argument is that psychiatry pathologizes
    everything: “well, anyone would be depressed in those
    circumstances. How is that an illness? And why can you get
    SSI for it?”
    But the truth is in the nuances. When psychiatrists ask you to
    keep a mood chart, and you report that on these two days your
    “depression was worse,” what allows the psychiatrist to know
    that wasn’t normal sadness? Can a bipolar ever be sad for a
    month and not be depressed?
    If a person beats his girlfriends, kills cats, and gets brought by
    the police because he set fire to a rival’s car, is it possible that
    his Axis I diagnosis is—nothing? Ok—how many times have
    you actually written that down? How many times have you
    terminated the “treatment,” or refused to uphold an
    involuntary commitment order, because the case was not
    psychiatric? I know, the system does not have a good
    mechanism for doing this. I feel your pain. But every time we
    give some vague “Not Otherwise Specified” diagnosis or pass
    them along to the inpatient services, we are creating a social
    policy disaster. We are confirming to the laymen that we think
    these behaviors are psychiatric, that they are rightfully our
    purview, and ensuring that a) we will be held responsible for
    dealing with them; b) we will be held responsible for the
    outcome.
    What Percentage of Suicides
    Had Depression?
    November 21, 2006

    In the same JCP issue in which atrocities were committed,


    McGirr and friends looked at 351 Canadian consecutive
    suicides, and then performed a psychological autopsy to find
    out what had been wrong with them.
    Almost all of the women killed themselves with two methods:
    overdose (46%); surprisingly, hanging (38%). For men, it was
    hanging (53%) or firearm a distant second (16%). I don’t
    know what’s going on in Montreal, but it’s different than LA.
    (Less guns? More trees?)
    In comparison to men, women were more likely to be college
    grads and have jobs, to have a lifetime history of depression or
    anxiety, but less likely to have ever abused alcohol (26%
    females vs 44% males).
    In the six months prior to the suicide,
    Depression: males 52%; females 56%
    Anxiety: males 10%; females 15%
    Alcohol: males 31%; females 18%.
    So there it is, more than half of suicides were depressed at the
    time of the hanging/shooting/OD.
    Which is fine, but there is one statistic the authors neglected to
    report:
    Number of patients who had been in psychiatric treatment at
    the time of death: 10.
    The number 10 doesn’t appear in the study, and repeated
    attempts to get the actual number from the authors were
    failures: “we don’t have systematic data.” Ok: the same group
    put out another study: out of 422 suicides, 28% had been to
    psychiatry in the past year. Let me translate: 70% had not.
    If a tree falls in the forest, and no one hears it fall, shouldn’t
    we get some guys out to the forest?
    –
    Addendum: in the Oct 2006 Am J Pub Health, the authors find
    that suicide rates have been decreasing— dramatically—
    especially for the elderly since 1985 (from 21/100k to
    16/100k) and youth since 1995 (14/100k to 10/100k). But it’s
    worth repeating that the number of actual suicides is still very
    small.
    Why Do The Elderly Commit
    Suicide?
    November 23, 2006

    A thought provoking article. I have to admit this never


    occurred to me, and that’s exactly the problem.
    First, a question, and you must commit to an answer: why do
    the elderly suicide at higher rates? Write in your answer here:
    _________________________. No, don’t read on without
    answering.
    General theory is that they are hopeless, pessimistic, and their
    intent to die is high. That’s what you wrote, right? Me, too.
    But what if they died at higher rates not because they wanted
    to die, but because they were more susceptible to dying, even
    by a half-hearted, low-lethality attempt?
    Using Sri Lanka’s most common poisoning, yellow oleander
    overdose (= cholinergic toxicity), 94/1900 suicde attempters
    studied died. Elderly were 13 times more likely to die than
    those under 25— even when the number of seeds was
    controlled. And the number of seeds was often low (median
    was 3). In other words, the elderly were not dying at higher
    rates because they ingested more seeds; they were dying
    because they couldn’t survive even a few seeds.
    Wow. Ok, my previous bias had been to worry most about the
    intent in the elderly, not so much the means; once they decided
    to die, they’d find any way they could. Whereas in, say, teens,
    the bias was to worry about the means, because (often) their
    intent to die was low, but they might take something that was
    much more lethal than they thought it would be. A common
    question I ask is, “which is more lethal, an OD of Zoloft or
    Tylenol?” Because many believe psych meds are lethal, while
    Tylenol, an OTC, shouldn’t be.
    But it may be that I was wrong, and that the elderly have
    vague attempts just as frequently as others, but actually die
    from them. Maybe I need to be more careful about prescribing
    them meds that even in mild overdose could result in their
    death (Elavil, Tylenol, narcotics, etc)?
    What’s against this is that 60% of people under 65 use a gun to
    kill themselves, while 73% of those over 65 use a gun—
    suggesting that intent is pretty high after all. But that’s not my
    point here.
    What’s interesting is why this all never occurred to me. Where
    did I get the idea that the elderly were more intent on death
    than the younger people? Certainly, the popular psychiatric
    literature constantly reminds us the elderly have higher risk;
    but perhaps a culture which places so much value on youth,
    and which is incessantly and publicly debating doctor assisted
    suicide (always for the elderly), the right of family to
    withdraw care, etc— maybe all those notions recursively
    reinforce the premise on which they are based: that old people
    want to die? Of course a 20 year old doesn’t really want to die
    because he doesn’t “understand” death, he has his whole life
    ahead of him, hasn’t learned impulse control, etc. But the old
    guy “knows” there’s nothing to live for…(?)
    Yet another reason why doctors should not become social
    policy analysts. We are too much in the thick of it, and never
    question our assumptions because we believe them to be
    axioms.
    Imitrex (sumatriptan) Is
    Good For Many Headaches
    — And Therefore Dangerous
    November 26, 2006

    In researching something else, I learned that Imitrex may


    actually treat the headache associated with subarachnoid
    hemorrhage— which is a bad thing, because you’re still going
    to die.
    Subarachnoid hemorrhage, the “worst headache of your
    life”— comes on suddenly, lasts for hours (even days, yes,
    days), worse in light or with sounds, but not affected by
    movement— is the result of an aneurysm (usually middle
    cerebral artery) popping. CT is positive in 95% of cases if
    taken early— the longer time passes, the less sensitive CT
    becomes.
    A case report of a woman whose headache improved with
    Imitrex (6mg SQ) but still ultimately died. The authors said
    this was the only case report they found, but in the same issue
    is another such case report (improved after 6mg SQ and died
    later that day) , and a year later some British guys reported
    three other migraine patients who came in with undiagnosed
    SAH and their headache got better after getting Imitrex. (Two
    got 6mg, the other got 3x100mg). They were correctly
    diagnosed only after they came back with headache and
    meningeal signs, and got CTs.
    The editor of the first journal notes that sumatriptan is not
    “migraine-specific” and is effective in treating other head
    pains (such as viral meningitis, and, I discovered, orgasm
    headaches *.) The authors of the earlier SAH report
    hypothesize that since triptans block transmission at the
    trigeminal nucleus caudalis, any pain from the meninges
    should be blocked. (In bacterial meningitis, the pain relief may
    also be augmented by the 5HT1D and B agonism, which (in
    mice) reduces inflammation, decreases intracranial pressure,
    and reduces white blood cells in the CSF(!)) This may be only
    true in acute meningitis, as failure in two meningitis patients
    may have been the result of sensitization of the caudalis
    neurons (where triptans are supopsed to block input) and
    spontanueous activity. (So get your triptans early.)
    The obvious message here, given the efficacy iin SAH with
    such low doses of Imitrex, is that one should not assume
    efficacy is diagnostic of a migraine. Triptans seem to be
    efficacious across a variety of trigeminal neuropathies; which,
    like everything else in medicine, is good and bad.
    –-
    * Orgasm headache: apparently triptans can treat or prevent
    “orgasmic headaches.” The funniest line is in the abstract of
    that paper: “In patients who chose to predict their sexual
    activity, short-term prophylaxis with oral triptans 30 min
    before sexual activity might be a therapeutic option..”
    Is Obstetrics Worse Than
    Psychiatry?
    November 28, 2006

    Turns out that Plan B emergency contraception does not


    reduce pregnancy rates. Big surprise. But the one difference
    was that those with easy access took it more often. (News
    article here.) So I stand behind my earlier question: why do
    oral contraceptives require a prescription, but this doesn’t?
    Coupled with the fact that 50% of abortions are done by
    women who have already had one abortion at least, and 18%
    are on their third or greater, and you have a social policy
    problem on your hands. While everyone is busy with political
    nonsense, we are missing an important segment of the
    population that is simply not taking responsibility for their
    behavior. Having three or more abortions in the United States
    has exactly nothing to do with abortion rights or women’s
    health issues or access to contraception.
    Oh, but it will be okay, won’t it? OB/GYN will lead the
    charge? Sure. Context is everything: in the same issue of
    Obstetrics and Gynecology from which the above study came
    is an editorial by Douglas Laube, MD, President of ACOG. He
    suggests that OB/GYN has lost its way: med schools are not
    attentive to “differences in gender biology” (seriously.) And he
    suggests doing something about it:

    I will create a task force to assess whether our specialty


    should adapt behavioral assessment techniques to
    evaluate candidates’ suitability as women’s health care
    providers.

    I wonder if “suitability” will include social/political beliefs?


    Well, he does quote Isaiah Berlin, who
    “set in motion a vast and unparalleled revolution in
    humanity’s view of itself.”

    Unparalleled?

    “His lectures helped to destroy the traditional notions of


    objective truth and validity of ethics…”

    So, even if true (it’s not,) is that supposed to be a good thing?


    He’s also upset that America doesn’t pay its elementary school
    teachers enough.
    Oh, and he closes his editorial with a quote “by the prophet
    Muhammed.” Outstanding.
    ––-
    Addendum: Let me explain what I mean by that last sentence,
    again, it’s context: he’s not a Muslim. He is (was) a Lt.
    Commander in the Naval Reserve. Are you telling me that in
    all of literature, the only quotation he could find to express his
    point is that one? Does he have a copy of the Hadith handy?
    What would you say if Mubarak (Pres. of Egypt) closed a
    speech with a quote from Augustine’s Confessions? This is
    obviously a ploy, a pretense, he wants to show he transcends
    the childishness of politics and religion, he’s about humanity.

    That’s where it all falls apart, that’s where it stops being


    science and starts being dangerous.
    I looked through six other articles/addresses by him; he seems
    to be a rigorous and thoughtful clinician and educator— but—
    and this is the but that is killing medicine and society— he,
    like so many other doctors, wants to be a social policy analyst.
    No, no, for the love of God, no.
    Who Would Benefit?
    December 2, 2006

    Note the caption at the bottom. This is an interesting cover. No


    one would ever have thought to create a similar warning about
    the disastrous consequences of a poor fit for, say, Depakote.
    We know it has side effects, but using it would never be
    disastrous, right?
    But why would bad therapy be disastrous? If psychiatry is so
    biologically based that the a bad environment is not the main
    cause of illness, why should bad therapy be so powerful? If
    bad parenting can’t cause ADHD, how could bad therapy
    make it worse?
    “The Art of Psychotherapy”. Ok. But why the “science of
    pharmacology?” Because we sling “5HT2A” around like we
    know what we’re talking about?
    The sentence following that says, “Selecting patients for
    psychodynamic psychotherapy.” Young, attractive, white
    females, perhaps? But they didn’t mean that, of course. It’s
    just a picture.
    Almost no one appreciates— and no one at all verbalizes—
    how deeply the bias in psychiatry penetrates. It is no
    coincidence that psychiatry has been mixed up with SSI,
    welfare, criminal responsibility, etc. The “nature vs. nurture”
    debate is a red herring, a magician’s distraction. It allows us
    never to have to say the following:
    If they’re rich and intelligent, and can understand how their
    behaviors impact their moods, we can help them to help
    themselves. And they won’t want to take meds that cause side
    effects anyway.
    But if they’re poor or unintelligent, we will never be able to
    alter their chaotic environment, increase their insight or
    improve their judgment. However, such massive societal
    failure can not be confronted head on; we must leave them
    with the illusion that behavior is not entirely under volitional
    control; that their circumstances are independent of their
    activity; that all men are not created equal. Because without
    the buffer psychiatry offers, they will demand communism.”
    If Bipolar is Kindled Than
    You’re In Trouble
    December 5, 2006

    Tolerance develops to benzodiazepines— and every other


    antieplieptic, according to the new Epilepsia article.
    In general, efficacy to all AEDs decreases with long term
    exposure. That’s tolerance. If being on an AED reduces
    seizures by 50%, then tolerance is defined as occuring when
    you return to less than 50% reduction of symptoms. Thus
    defined, tolerance (of such severity that increased doses do not
    help) occurs in 10-50%.
    Worse, there appears to be cross tolerance. For example, and
    likely most significant for psychiatric patients, Depakote “lost
    >50% of its anticonvulsant efficacy in mice pretreated twice
    daily for only 3 days with [benzos].”
    Why does tolerance occur? On the one hand is the obvious
    metabolic concern— autoinduction of hepatic enzymes— but
    this is really only relevant with the first generation drugs (and
    especially CBZ and phenobarbital (these are such powerful
    inducers of cytochrome enzymes that they actually induce
    their own metabolism)— while Depakote is the opposite
    (inhibitor of cytochromes— which is why you must reduce the
    initial doses of Lamictal when given with Depakote, so as not
    to “overdose” and increase the risk of rash)). On the other
    hand are pharmacodynamic effects, which are of three types:
    downregulation of binding sites; functional uncoupling (on the
    GABA-A receptor, benzo binding has less of a positive
    allosteric effect on GABA binding); downregulation of or
    decreased sensitivity of ion channels (for example Neurontin
    downregulates Ca+ channels, benzos reduce Cl- channels, etc.)
    Activity on the ion channels (as opposed to receptors) would
    partially explain cross tolerance since these ion channels are
    the downstream target of many drugs.
    No, wait, there’s a fourth reason for “tolerance:” maybe the
    seizure disorder itself changes over time, so it looks like you
    became tolerant, but really you have a “new” seizure disorder.
    This is analogous to bipolar disorder, which evolves over time
    — how you present at 25 may be different than 35; your
    manias are different, etc.
    So now we have a problem: is there any reason to think that
    tolerance to the antimanic/antidepressive effects of AEDs
    wouldn’t occur? If seizures, why not mania? If mania is a
    strictly biochemical dysfunction in the brain, shouldn’t
    tolerance to its treatment occur? Do we make patients worse
    by keeping them on the meds? Or at least harder to treat? And
    if mania isn’t strictly biochemical— if we’re allowing that life
    happens— do we really believe that a fixed dose of an anti-
    epileptic administered over years is going to prevent a
    negative response to a life event? And wait a second— doesn’t
    mania spontaneously remit even without medication?
    Shouldn’t we just, sort of, help nature along, or even get out of
    its way?
    I’m not saying not to treat— I’m saying not to overtreat,
    A guy is on 1500mg Depakote today. What do you do when
    the patient relapses? Increase to 2000mg? Then what? When
    does it stop? When does this practice not ultimately result in
    polypharmacy?
    Any reason— biochemical or epidemiological, I’ll take any
    offer— why we should not be treating symptomatically rather
    than prophylactically? Antimanics when you’re manic, then
    stop them when you’re better?
    I know everyone thinks Osler helped write the DSM after
    finding the gene for psychiatry and Hippocrates is jealous
    because he’s balding junior faculty , but perhaps we should go
    reread The Epidemics and rethink our principles.
    Murder-Suicide
    December 5, 2006

    Just thought you should know:


    There are about 1200 murder-suicides per year (i.e. 500-600
    suicides by the person who just killed someone else).
    75% involve the boyfriend/girlfriend or spouse; 96% of the
    murderers are males (duh)
    92% involve guns
    92% occur in the house of the victim
    There is an average 6 year age difference between the
    murderer and his victim. Risk increases with widening age
    difference.
    23% of murder-suicides (say, about 130), the murderer is 55 or
    older. Contrast this with the general homicide rate by 55 year
    olds: 5%
    Contrast this with the suicide statistics in the general
    population, and I think you’ll agree that there are an amazingly
    high number of people dying at the hands of their idiot
    boyfriends/husbands. “You don’t understand, I loved her, I’d
    do anything for her, and she lied, slept around— all that time
    meant nothing to her— she wouldn’t listen! How can she just
    take what we had and just throw it away? It doesn’t make any
    sense!”
    The societal question is what has happened to many men that
    they are unable to define themselves, or affirm their value,
    except through another person. And “love”— or its distortion
    — and aggression are closely linked in such people. But that’s
    narcissism, and it’s the disease of our times.
    How To Get Rich In
    Psychiatry Steps 6-10
    December 7, 2006

    These are five more steps. This is tentative; what I plan to do


    is consolidate and reorganize the 10 steps into one post. But I
    think there is still value in this draft.
    6. Get Life Insurance, a 529, and another Roth.
    If you have a child, you need this. Immediately. Shut up. I said
    immediately.
    Term Life Insurance
    e.g. “If you die within 20 years (the term), we will pay your
    spouse $2M. For this coverage, you will pay us a monthly
    premium of $300, which will rise after ten years.”
    Term insurance is for a set period of time. If you live past the
    term, the insurance expires. Examples are 5 year, 20 year,
    “until age 90,” etc. For a healthy mid thirties person who
    neither smokes, drinks, nor takes medication, you can get a
    $2M 20 year term policy for about $100-300/month. However,
    if you are eligible (military=USAA; medical or
    teachers=TIAA/CREF) you can get it for much less. Premiums
    increase over time.
    Permanent Life Insurance (also known as whole life
    insurance)
    “Whenever you die, no matter when you die, we will pay your
    spouse $2M, plus any interest that has accrued from a portion
    of each month’s premium. For this, you will pay us a monthly
    premium of $800, which will never change.”
    Whole life insurance is forever. Additionally, after the first
    year, part of your premium goes into the insurance as a “cash
    value” on which you earn interest, all tax deferred. Think of
    this like buying a mutual fund within an IRA, and contributing
    a little every month. This is because when buying whole
    insurance, you are basically buying insurance AND shares in
    the insurance company. Certain kinds of life insurance
    (“Mutuals”) also pay you dividends based on surplus in the
    whole insurance fund.
    You can also use the cash value at any time to buy a home, pay
    for college or your retirement. And the premiums never
    increase.
    I favor term insurance; I need another investment that pays
    only 4% like I need syphilis.
    529 plan: I am amazed at how many people I have to kick in
    the teeth over this. Assume that your kid’s 4 years of college
    will cost you $110k. At a doctor’s tax rate, you’ll need to have
    earned $180k. A 529 plan is like an IRA, but instead of being
    allowed to use it for retirement, you can (only) use it for
    “qualified education expenses:” tuition, books, travel to the
    college, room, food, etc, etc. Anything at all that can be
    associated with education.
    It doesn’t have to be college. It can be medical school, vo-
    tech; You specify each account for a specific child; but any
    money that isn’t used you get to keep (though those
    withdrawals are taxed.) Or you can transfer the money to
    another kid, or your kid’s kids.
    The advantage of the 529 is that any growth of that money is
    never taxed, even on withdrawal (assuming it is for education.)
    Following this logic, in order to save $110k for college, you
    only need to invest $27k at the child’s birth (assume 8%
    growth.) Think about this.
    The beauty of the 529 plan is that it is essentially a legal tax
    dodge. You can save much more than would ever be needed
    for the kid’s education, tax free, and keep the money after they
    graduate. And the money cannot be taken in a bankruptcy. Is
    anyone listening to me?
    Roth for Kids: Did your lazy, pot smoking, iPod wearing (“it
    has to be white!”) MySpacer make some money from that one
    summer he pulled it together enough to work? Declare that
    money, pay his taxes (i.e. $0), and put it in a Roth in his name.
    Maybe your kid is an industrious 9 year old who washes cars
    when not at Mandarin class? Declare it, pay the taxes, and put
    it into a Roth. Oh my God— if you put $4000/yr into his Roth
    for ten years, he will have 11 billion dollars by the time he
    graduates. You’d be crazy not to!
    7. Open a clinic and form an LLC
    If you do solo private practice, you will make a comfortable
    living. You will not become rich. This article is not called,
    “How To Rot In Your Own Self-Satisfaction.”
    You need a clinic: one or two psychiatrists, one or two
    therapists, one or two NPs (these can overlap.) It is not
    necessary to share the same office, but you need to be in the
    same building. I’d argue NPs are more valuable than
    psychiatrists (less knowledge at the beginning but more
    motivated), but that’s for another day.
    Refer to each other. If the patient comes only for therapy, have
    yearly psychiatric checkups with the MD. If one of the
    clinicians is an expert in something but the patient is being
    treated by someone else, refer for a consultation.
    As I said before, your clinic should advertise as specializing in
    some things: Treatment Resistant Depression; OCD;
    Adolescents; Borderline Personality Disorder; Independent
    Medical Examinations (IMEs= disability evaluations; you are
    not the treating psychiatrist, and you get a flat fee per eval;)
    “treatment of impaired physicians” (a gold mine— contact the
    local medical society chapters and let them know you exist);
    Clozaril/lithium/meds that need regular blood work. (For
    example, have a Clozaril Clinic: all Clozaril patients come at
    the same time and get their blood drawn (by the RN) and
    clozaril (and other meds) dispensed (by the pharmacist of your
    local pharmacy, who will make money on the pills)— and you
    can bill each patient’s insurance for the service.) And hook up
    with the local schools, colleges, and area internists— get their
    referrals. (The best way to do this is to go there, (unannounced
    or by intro through a drug rep) and meet them— it takes 8
    seconds for the deal to be solidified because why not refer to
    you?
    This will work precisely because you are a clinic and not a
    solo psychiatrist . Somehow, being part of a group conveys the
    impression of expertise, professionalism. It’s like a mini-
    medical society. And people refer to them.
    The NPs can prescribe, and there is no reason why they cannot
    be as skilled (or unskilled) as any psychaitrist)— but they can
    also do nursing maneuvers: EKGs (bill for them,) labs (bill for
    them,) and preventative screenings/counselings (diabetes,
    smoking, etc (bill for them— yes, you can get money for it.))
    Limited Liability Company: In the past, the only way to shield
    yourself from liability was to incorporate your practice, “Joe’s
    Medical Practice, Inc.” (Usually an S corporation or PC.) The
    corporation is a separate legal entity (that has assets, like
    furniture and computers; and liabilities, like you). Any
    lawsuits would be against the corporation, and thus your
    personal assets can’t be taken in the settlement. If the
    corporation gets bankrupted, your IRAs are still safe. (But if
    your car is a business asset, it can be taken.) On the flip side,
    however, you have to pay corporate taxes on the revenue and
    then personal income taxes on what you take home, i.e. 30%
    corporate + 35% personal= death. Also, you have to have
    recorded meetings, bylaws, paperwork, etc.
    An LLC is a company, not a corporation; no corporate taxes,
    no double taxation, no meetings. But, it is a seaprate legal
    entity, so you have liability protection.
    Be careful to keep the assets separate. If you use your car for
    work and soccer games, it is up for grabs. If you buy groceries
    on the business credit card, you are destroying the distinction
    between you and the company.
    There may be some instances where an S corporation is better
    for your clinic. For example, LLC members (i.e. you) have to
    pay Medicare and Social Security taxes on all of the business’
    profits. S corporation members are actually shareholders—
    and get paid partly through a salary (so you have to pay
    Medicare and SS taxes) but partly through dividends (no
    Medicare/SS taxes.)
    Consult your local attorney for more info, I’m just a
    psychiatrist.
    8. Save money.
    I know, this one sounds stupid because it is “easy.” But no one
    does it. Listen to me, fools, listen to a story my Dad used to
    tell me, which I paraphrase here: Pretend you are a resident,
    and you “only” make $39k/year. Would you have taken the job
    if they only paid $35k/yr? Of course you would. Then you can
    put away $4000 per year— in a Roth. Don’t laugh— do it.
    Maybe you make more than $100k? Open a Roth for your kid.
    Now. A Roth AND a 529.
    Consolidate your loans: doing this lowers your monthly
    payments but extends the life of the loan (so you’d end up
    paying more.) However, take the money that you now save
    from this and fund your Roth because after you make >$100k,
    you can’t do this. After you start making big money, you can
    pay off your consolidated loans as fast as you want. The point
    is to get extra money now that you can save in a Roth.
    Because the max interest rate on federal loans is 8.25%— you
    can make more than this in a Roth.
    Credit cards should be paid off immediately, then burned—
    even GOOG can’t compete with 18% interest. And if you tell
    me you need credit cards to survive I am going to subpoena
    the bills and If I see anything from Nordstrom’s, I’m going to
    burn your shoes.
    Private Mortgage Insurance: If you did not put down at least
    20% of the appraised value of your house, you are paying an
    extra 0.5%-1%. For a $400k house that’s an extra $150/month.
    If you bought your house in the past year or two, more than
    likely it appraised less than you paid— check this. If you
    cannot afford to put down 20% (I should ask why you are
    buying such a house), pay extra principal in the early months,
    and get the loan down to 80%— and then call your lender to
    cancel the PMI, because they won’t do it automatically until
    78% (snakes.)
    Sell stuff: More than likely you have old technology, clothes,
    furniture, etc that you could sell on Ebay. But who needs that
    headache? i-soldit.com is a national chain of stores that sells
    your stuff on ebay (and charges 30%). But who cares? The
    sooner you sell that old cell phone, the more you’ll get for it.
    Put this money into a Roth.
    9. Connect with drug companies.
    Let me introduce myself to the room, I am the large elephant.
    This advice is like telling people to trade stock options. It’s
    almost guaranteed not to work except for a handful of very
    savvy people; but everyone else not doing it assumes those
    who do are making a fortune. And there’s resentment all
    around.
    At the risk of blowing the lid off the muddled symbiosis that
    exists between Pharma and psychiatry, let me give you the
    reality.
    First and foremost, Pharma does not hire shills. They simply
    cannot. First, shills are illegal. Secondly, all of those
    physician-speakers are hired not by the company, but by the
    rep. Pharma does not pay doctors to write scripts, for the
    simple reason that the people paying (the reps) would lose
    their jobs instantly.
    Let me explain:
    Doctors can get money from two sources: the corporate level
    and the rep level.
    The corporate level: Pharma decides who are the “thought
    leaders” in psychiatry, and gives grants to them or their
    university to write review articles, give Grand Rounds or
    CMEs, etc. In this way, the money is indirect. The doctor is
    doing something else (like giving a Grand Rounds) that has
    “nothing” to do with the drug company or the drug, per se. For
    example, right before Strattera came out, there were a billion
    articles written about the pharmacology of ADHD, behavioral
    phenotypes of ADHD, etc. Strattera was never mentioned (it
    hadn’t come out yet), but you see the move. The doctor gets to
    write his “scientific article” and Pharma gets a market readied.
    Corporate also gives grants to do research (“An open label
    study of Prozac in…”) The doctor doesn’t get the money
    directly, it is used to pay a portion of his salary. For example,
    if he makes $100k/yr (yes, that’s all,) and he has grants
    totalling $10k, he gets 10% fewer clinical duties.
    Importantly, these big name psychiatrists can be very haughty,
    holier-than-thou, because they don’t “get paid to write the
    drug.” This is disingeuous because they don’t write any drugs;
    they don’t even see patients (except in research studies.) So
    they really should just shut the hell up, if that’s okay with
    everyone.
    The rep level, things are different. Reps get paid by market
    share growth; so they target the “high prescribers.” They don’t
    call on the thought leaders, because they don’t generate any
    scripts. They call on local, clinic, hospital and private practice
    people. Reps are not allowed to pay doctors to write scripts—
    they will get fired. Here is the part of this you must
    understand, that no wants to: the drug company could not care
    less about an individual doctor’s prescribing. It doesn’t matter
    AT ALL to the drug company if an individual rep has grown
    his territory’s market share by ten billion percent— it is
    numerically insignificant relative to the liability if the rep did
    something sneaky. So if they paid the doctor to do it, that rep
    is GONE. (Caveat: anything can happen. I’m sure there’s a rep
    out there trading heroin for scripts. But mostly, no.)
    Reps do control a speaking/education budget. Selected doctors
    go through a training on a set slide deck (clinical data, rates of
    response/side effects, etc— slides according to FDA
    specifications, and there are many) and then get paid to give
    lunch or dinner programs to other doctors. Only clinicians can
    attend— no spouses. And the speaker must use the slide deck,
    because it limits liability to the company because it has been
    okayed by the FDA. I mention this because if you think you
    can go up there and blather about your version of the treatment
    of bipolar, forget it. Slide deck or nothing. Again, the drug
    company doesn’t care if you douse yourself with kerosene,
    they just don’t want trouble. Slide deck or nothing.
    For this, you can get anywhere from $500 (guy with
    considerable experience using the drug) to $2000 (academic
    types, clinicians who have written papers, etc.) And there’s a
    max per year (e.g. Glaxo=$35k, Wyeth =$50k) which almost
    no one ever hits. (Caveat: these are speaker honoraria, and
    wouldn’t include grant money and other corporate payments
    as detailed above.)
    But you have to be willing to travel. There’s only so many
    times doctors in your area will listen to your lecture before
    they want to stab you in the eye. Remember, it’s a set slide
    deck: the program is the same each time.
    Here’s the other important part of this you must understand:
    the rep doesn’t care about the company— he cares about his
    own market share. It doesn’t matter how great a speaker you
    are— if you aren’t writing the drug in his territory, you are
    nothing to them— unless he thinks your program would
    motivate other doctors to use the drug.
    Every year, 1st and 2nd year residents collectively decide such
    speakers are drug company shills and have no respect for them
    or their information. And 60% of them return in their 4th year
    and privately ask me how to start doing it. I’ll save you the
    trouble: either write some papers or otherwise develop a
    specialty; and prescribe the drug. If you like Risperdal and use
    it a lot, and hate Zyprexa and don’t use it, the Risperdal rep
    will eventually ask you to speak. That’s easy. Here’s the tricky
    part: the Zyprexa rep IS NOT going to say, “if you write
    Zyprexa I’ll let you speak for us” because they have a limited
    budget and you are simply not worth the risk. First, they don’t
    know if you will ever use Zypexa; second, they don’t know if
    your Zyprexa progam will be good enough to convince other
    doctors to write Zyprexa; and if you are good, then the
    Risperdal rep has already come to you— and no rep will use
    you if you already speak for someone else because you won’t
    be believable to the audience and thus will be useless to the
    rep. This part is hard for people to understand; they think that
    “the drug company” wants to “pay doctors to write the drug,”
    and reps thus contribute to company profits. The reps are
    individuals; they compete against each other in their own
    company. In fact, they’d rather no one prescribe the drug
    except their own doctors. Their budget goes towards building
    their market share; but again, no nonsense, the company
    doesn’t want the risk.
    This is sales, not a cabal. The reps are interested in exceeding
    their quota and making a bonus; not in global hegemony.
    So being a thought leader can get you pretty good money
    (which is helpful as academia pays nothing.) But being an
    ordinary speaker will not make you rich. But it does give you a
    not insignificant amount of money you didn’t have before—
    which, if you have any brains in your head at all, you will put
    in your 529 or ROTH and buy COP, BRK, GOOG, etc. (And I
    like ATI. (I own all of these.))
    10. Write a blog; ask for donations.
    Ok, maybe not rich. But every little bit helps.
    Mood Stabilizer +
    Antipsychotic for Bipolar
    December 12, 2006

    This slide-, taken from a drug company program- like many


    others— shows that using a mood stabilizer + antipsychotic is
    better than mood stabilizer alone.
    Look carefully. This is what is wrong with psychiatry.

    As you can see, Risperdal + Depakote (orange) is better than


    Depakote alone (blue.)
    This is not a finding unique to Risperdal. Every antipsychotic
    has virtually identical data for adjunctive treatment, which is
    good, because they shouldn’t have different efficacies.
    So given that 8 other drugs have identical findings, these data
    suggest that, essentially, two drugs are better than one.
    That’s obvious, right? That’s what the picture shows? Well,
    here’s what’s wrong with psychiatry: without looking at the
    slide, tell me what the y-axis was. Write it
    here:______________
    The problem in psychiatry is that no one ever looks at the y-
    axis. We assume that the y-axis is a good one, that whatever
    measure used is worthwhile. We assume that the y-axis has
    been vetted: by the authors of the study, by the reviewers of
    the article, by the editors of the journal, and by at least some of
    the readers. So we focus instead on statistical significance,
    study design, etc. Well, I’m here to tell you: don’t trust that
    anyone has vetted at anything.
    The y-axis here is “% of patients with a YMRS <12.” What’s a
    YMRS? A mania scale. But what is a 12? Is it high? Low?
    What’s the maximum score? What counts as manic? What
    questions does the YMRS ask, how does it measure the
    answers? You don’t know? Again— we figure someone else
    vetted it. The YMRS is a good scale because that’s what scale
    we use.
    Forget about the YMRS— what does “% of patients” mean? If
    this is an efficacy in adjunct treatment study, why not have the
    y-axis be just the YMRS, to show how much it went down
    with one or two drugs?
    Because that’s the trick. This y-axis doesn’t say “people got
    more better on two drugs.” It says, “more people on two drugs
    got better.”
    Pretend you have a room with 100 manics. You give them all
    Depakote, and 30% get better. Now add Risperdal— another
    30% get better. But that doesn’t mean the Depakote responders
    needed Risperdal, or the Risperdal responders needed
    Depakote— or the other 40% got anything out of either drug.
    It could be true that the effects are additive— but this study
    doesn’t show that. No study using “% of patients” can speak to
    synergistic effects. In other words, these studies do not say, “if
    you don’t respond to one drug, add the second.” They say, “if
    you don’t respond to one drug, switch to another drug.” They
    don’t justify polypharmacy. They require trials at
    monotherapy.
    So you may ask, well, do two drugs lower mania better than
    one drug, or not?
    Depending what week you look at, MS alone reduces the score
    by 13; two drugs gives you another 3-6 points. On an 11
    question scale, rated 0-4. So no, it’s not better.
    I have yet to meet someone who doesn’t interpret these studies
    as supportive of polypharmacy, and it’s not because they aren’t
    critical. The reason for the blindness is the paradigm: they
    think— want— the treatment of bipolar to be the same as the
    treatment of HIV, or cancer, or pregnancy. The important
    difference is that these other diseases are binary: once you get
    them, nothing you do makes it worse. Take pregnancy. If two
    chemicals combined lower the rate of pregnancy, it is clearly
    worth it to take both. One chemical might have been enough,
    but who wants to find out? So you take the risk, and you eat
    both. This is also my argument against making Plan B OTC.
    Bipolar is not like this: if one or two drugs in succession fail,
    or things get bad, you can always resort to polypharmacy later.
    Again, it may be true that polypharmacy is necessary. Maybe
    3-6 points are needed. Maybe two drugs gets you better faster.
    But it can’t be the default, it can’t be your opening volley.
    Because I can’t prove two drugs are better than one, but I can
    prove they have twice as many side effects, and are twice as
    expensive.
    At minimum, if polypharmacy is successfully used to break an
    acute episode, you should then try to reduce the dose and/or
    number of drugs.
    Now, here’s the homework question: if all these antimanics
    have about the same efficacy, and polypharmacy should be
    third or fourth line, why do we start with Depakote? Is it
    better? Safer? Cheaper? What are the reasons behind our
    practice?
    Violent Crime vs. Coffee vs.
    Wine
    December 13, 2006

    Draw your own conclusions.

    Violent crime range: 1.2-2.0 million


    coffee: 20.2-27.5 gallons
    Wine range: 1.7-2.3 gallons
    From http://www.swivel.com/graphs/show/1163271
    If You Are Surprised By
    Vioxx’s Risks, You’re Fired
    December 14, 2006

    This was an op-ed I had written two years ago. In light of the
    12th trial win for Merck (they chose to fight each suit
    individually, rather than settle a class action), I’m reposting it
    here.
    In the current politically polarized climate it is no surprise that
    yet another story of the evils of Big Pharma should surface.
    And why not? When everyone else abdicates responsibility,
    the easiest maneuver is to scapegoat the ones who actually
    create anything.
    Consider the Vioxx debacle. By now, everyone knows that it
    was recently discovered that taking Vioxx is associated with
    an increased risk of heart attacks and strokes. What is not
    obvious from the news is that the data used to make this
    discovery has been in the public domain for years. I even
    found it in a Yahoo! News article from 1999.
    Merck halted a recent trial because it detected this increased
    risk; but other studies had already found this same risk even
    four years ago. So why now? And why are any doctors
    surprised? Were they not reading the journals all along? Were
    they simply accepting the word of the drug companies? But a
    recent New England Journal editorial goes further, blaming the
    Merck and the FDA for failing to protect the public. You’re
    blaming the FDA? Is the FDA prescribing the drug? Again,
    the data was already available to anyone with internet access.
    The fact is that any doctor who is surprised by the “new” data
    on Vioxx’s cardiovascular risk should never have been
    prescribing it in the first place.
    The Journal goes on to say that Merck tried to minimize the
    significance of the risk. Even if true, it is irrelevant. The data
    was available. It doesn’t matter how marketing spins the data,
    because doctors, as medical scientists, are supposed to be able
    to ignore marketing and focus on the data. Doctors are
    supposed to know the data before they prescribe a medicine.
    Quoth the Journal:“If Merck would not initiate an appropriate
    trial (to formally asses cardiovascular risk) and the FDA did
    not ask them to do so, how would the truth ever be known?”
    This is a joke, right? Is he seriously suggesting that it is the
    government’s responsibility to evaluate existing data? Yes: “I
    believe that there should be a full Congressional review of this
    case.”
    The author fails to separate the responsibility of Merck with
    the responsibility of the physicians. Understand that I am not
    trying to absolve drug companies of their responsibility; I am
    trying to differentiate their responsibility from doctors’
    responsibility. Published data becomes the responsibility of the
    doctor. They are practitioners; their role is to determine,
    specifically, if the risks of a treatment outweigh the benefits
    (and vise versa.) If they choose not to read everything
    available on their own, and to rely on the words of the FDA, or
    the drug companies, or anyone else—then the fault is the
    theirs, the liability is the theirs. Ask any lawyer. The data is the
    data. It doesn’t matter what the drug companies say, or the
    FDA says, or even what another doctor says, because this is
    science. it has hard facts I can check, I don’t actually have to
    trust anyone’s word. Medicine is still a science, right? We’re
    still sticking with that story?
    But this almost never happens in actual practice, hence
    surprise at the “discovery” that Vioxx has cardiac effects. If
    doctors had done their jobs and understood, from the
    beginning, that Vioxx had a minor but still real increased
    cardiac risk, and modified their use of it (i.e. not hadning it out
    like water) then Vioxx would still be on the market and this
    controversy would never exist.
    Drug companies are an easy target, because they are large,
    impersonal, and very, very rich. The zeal which doctors now
    attack drug companies as “commercial” (seriously?) and
    “biased” borders on oedipal. This is because doctors do not
    create anything new. They are not inventors. When the TV
    tells you that “doctors have discovered a new cure for X” what
    they really mean is that a drug company has made this
    invention, and your doctor is using it. But to believe that
    doctors are making treatment discoveries during the course of
    ordinary practice completely misses how progress in medicine
    is made.
    This is not to minimize their role; obviously, they are the ones
    who are doing the treating. But by consistently framing the
    issue for the public, politicians, and other doctors, as one of
    doctors against the pharmaceutical industry, or Pharma against
    the weak and the oppressed, we are grinding progress to a
    slow and purposeful halt.
    Vioxx is an easy target because we don’t “need” it. But how
    do we know that someday they wouldn’t discover it cured, for
    example, cancer? Don’t laugh: the trial Merck interrupted to
    pull Vioxx was for the prevention of colonic polyps. Is that
    worth the very small (1%) risk of a heart attack? Now we’ll
    never know. That would have been a decision for doctors to
    make with their patients. This is the point, the only point. But
    now, because doctors were not rigorous about their own
    practice or education, no one gets to try it. Who suffers?
    Answer: you. And this barely accounts for the massive
    strategic harm this does to Merck, in lost revenue as well as
    increased paranoia, risk aversion, etc. It is unlikely that Merck
    will be as aggressive or spend as much to find the cure for, say,
    AIDS, tuberculosis, or cancer. Everyone happy with this
    outcome?
    Diana Chiafair ‘s Hot, but Is
    She Illegal?
    December 15, 2006

    from Pharmagossip, but also Dr. Peter Rost’s site, edrugsearch


    (which actually has several rep-models), etc, etc. She’s a rep
    from Miami (where else) who won Miss FHM 2006.
    Meanwhile, Sunderland at the NIH plead guilty to “conflict of
    interest” charges— he had received about $300k over 5 years
    from Pfizer while he was a director at NIH, but never
    disclosed the money.
    All of medicine has rules about disclosing financial
    relationships. Any academic center, for example, requires you
    to list all financial entaglements that could be perceived as
    conflicts of interest, including grants, honoraria, stock
    holdings, etc. The idea, of course, is that money can exert
    undue influence, and at the very least the people around you
    should be aware of any potential conflicts of interest.
    This includes conflicts of family members. If you are giving a
    Grand Rounds about how Zoloft is better than Lexapro, but
    your wife is a Zoloft rep, you could be benefiting financially
    by getting people to write more Zoloft which gets her bigger
    bonuses, so you have to disclose this relationship.
    But if you are dating a Zoloft rep, you don’t have to. There
    would be no way you could be profiting financially from her
    increased sales, and thus no need to disclose that relationship.
    But there’s the cryptosocialist hypocrisy. If it was really about
    protecting the public from conflicts of interest, we’d have to
    disclose dating reps as well. History is full of examples of
    people behaving unethically for the sole purpose of bedding a
    woman. Want examples? They all come from politics. Still
    want examples?
    So why aren’t we worried that I’m praising Zoloft because my
    rep is hot? Perhaps we should mandate all reps be ugly? You
    know, to protect society?
    This sounds silly not because hot reps don’t have influence,
    but because we’re lying: it’s not the influence that actually
    bothers us. It is specifically the money. “It’s not fair that a
    doctor gets all that money from…”
    So let’s stop kidding ourselves, it’s not about protecting the
    public after all; it’s really about resentment that the doctor
    makes so much money off the people; that they get sent on
    trips first class while others can’t afford healthcare; about the
    rich getting richer at the expense of the poor. &c., &c. Pick up
    any copy of the New York Review Of Books for further
    examples.
    Taking the convenient moral high ground just because it has
    better soundbites (“the public has the right to know!”) and
    saves us from having to perform any critical thought is lazy
    and unproductive. If you want to argue that doctors make too
    much money or Pharma’s profits are excessive, we can go
    down that road and try for an honest and productive debate.
    But let’s stop pretending these disclosure rules have anything
    to do with protecting the public from bias. They have
    everything to do with the current zeitgeist of income
    redistribution and class warfare.
    –
    As an cultural observation, look for the drug rep to become the
    next fetishized job, like cheerleader and nurse. A profession
    becomes sexualized not because the members are themselves
    hypersexual, but because they represent a particular balance of
    the “unattainable slut:” “sleeps with everyone but me.” “e.g.
    the only reason that bitch (nurse or rep) isn’t sleeping with me
    is that I’m not a doctor.” In this way suppressed misogyny is
    given a cover story to make it acceptable. It’s narcissism
    protected by an “if only” delusion. Violence is never far
    behind.
    – And there’s your free association bringing me back to what I
    was really thinking when I saw Diana Chiafair’s photo:
    marxism and healthcare reform. Hot rep—> fetishized—>
    commodity fetishism. Because we never see the labor that
    went into the objects, we never see that social relation; the
    laborer disappears, all that is left is the commodity to which
    we ascribe value— fetishize it.
    Time’s Person of the Year Is
    Someone Who Doesn’t
    Actually Matter
    December 17, 2006

    That would be you.

    The short version of the Time article is that we as individuals


    have formed a community on the internet (YouTube,
    MySpace, Wikipedia, etc), and this community is starting to
    “build a new kind of international understanding, not politician
    to politician… but person to person.”
    Ok, no. Wrong, wrong, wrong all over the place.
    The author of this piece is Lev Grossman. Grossman is fairly
    famous book critic, one of the better ones. He also wrote a
    novel that’s a nod to Borges. This isn’t bad, it’s just context.

    The entire problem with Grossman’s premise is exemplified


    by his first paragraph:
    The “Great Man” theory of history is usually attributed to
    the Scottish philosopher Thomas Carlyle, who wrote that
    “the history of the world is but the biography of great
    men.” He believed that it is the few, the powerful and the
    famous who shape our collective destiny as a species.
    That theory took a serious beating this year.

    Well, not exactly. Grossman’s thesis is that we matter, we can


    shape our destinies; he puts that in contrast to Carlyle’s
    premise that great men help shape destiny. But that’s not what
    Carlyle actually says. Here’s the actual quote:

    In all epochs of the world’s history, we shall find the


    Great Man to have been the indispensable savior of his
    epoch;—the lightning, without which the fuel would
    never have burnt. The History of the world, I said already,
    was the biography of Great Men.

    Carlyle doesn’t say great men shape destiny; he says great


    men, and only great men, cause history. These great men
    should be given power to run society because only they can be
    trusted to do it. Great men actually drive history, not shape it.
    Democracy can’t be trusted. Paternalistic socialism, or at least
    a non-hereditary, anti-capitalist, aristocracy is all that can keep
    us from the dark of ochlocracy. Individuals trump ideology—
    which sounds like a good motto, except when individuals
    means Stalin and ideology means liberalism. Oh, and the last
    book Hitler read was Carlyle’s History of Friedrich of Prussia.
    So Grossman is not really paraphrasing Carlyle correctly. This
    is important because Grossman is a book critic with a PhD
    from Harvard in comparative literature. Either he simply did
    not know this about Carlyle, which I have to assume is
    impossible, or it didn’t matter: he commandeered the quote,
    stripped it of the meaning Carlyle intended and used it the way
    he needed to use it. And that exactly describes the problem:
    truth and reality aren’t important, what’s important is you.
    Because “You” as Person of the Year is actually quite
    portentuous. It’s is both representative and symptomatic of the
    problem of our times: narcissism. Nowadays we are so
    alienated and matter so very little to larger society that the
    only thing that inflames any passion is to be reminded of this.
    Consider Bush and Cheney. Put aside politics for a moment, it
    is clear that their single-mindedness of purpose ignores each of
    us as individuals. Give them the benefit of the doubt, that they
    are doing what they think is best. But it’s best for society, for
    America: what we hate is that it isn’t for us, for you, for me.
    That’s what people hate about them, the seeming indifference
    to our individual worth, to our sense of importance. Our votes
    don’t count; everything is about religion; “Global War On
    Terror.” Where in all that is the individual? We are tools to
    their “higher cause.” I know people say that they are angry at
    the cause; but I think it’s really anger that we’re being used for
    anything.
    Being on YouTube, having a blog, having an iPod, being on
    MySpace— all of these things are self-validating, they allow
    that illusion that is so important to narcissists: that we are the
    main characters in a movie. Not that we’re the best, or the
    good guys, but the main characters. That everyone around us
    is supporting cast; the funny friend, the crazy ex, the neurotic
    mother, the egotistical date, etc. That makes reminders of our
    insignificance even more infuriating.
    Take a look at the photos in the Time article: a DJ, a punk
    rocker, a guy in dredlocks, a kid dancing with headphones, a
    guy singing into a mic, a hot chick taking a photo of herself—
    none of these people could ever be “Person of the Year.” They
    barely have identities outside of their image. (And observe
    how so many are defined through music they listen to.) They
    must be defined by something from without, like a tattoo. But
    they deserve everything anyone else can have. It’s their right.
    I’m not saying each of us as individuals is insignificant. We
    should, could, matter. But to protect ourselves from an
    existential implosion, we decide to define ourselves through
    images and signs, rather than behaviors; lacking an identity
    founded in anything real makes us vulnerable to anger,
    resentment. But no guilt, ever. The narcissist never feels guilt.
    He feels shame.
    It can’t last. If society chooses to make narcissism the default,
    it’s going to have to deal with society-wide narcissistic injuries
    — when we suddenly realize that it isn’t solely our movie and
    we’re really not the main character. And no one wants to see
    this stupid movie anyway. This inevitably leads to violence:
    the school shooting, inexplicable knifing over Play Station 3,
    Andrea Yates, beating the wife because she wore the wrong
    shoes type of violence. Oh, they weren’t white high heeled
    pumps? That bitch! She used to wear them for her old
    boyfriend.
    I’m not sure anyone in psychiatry sees this— they are too busy
    documenting Pharma excesses and Lamictal outcomes— but it
    is the problem of our times. The only ones who seem to notice
    are advertisers, marketers— they see it. They don’t judge it,
    they simply profit from it.
    Grossman could morph Carlyle into what he wanted because
    Carlyle doesn’t matter, what matters is what Grossman
    wanted, what Grossman needed. Carlyle doesn’t exist, or he
    only exists as we need to use him. He becomes a tool, another
    supporting character. Anyone actually read anything by
    Carlyle anymore? Why bother? We only need a few
    soundbites for our own use. Grossman is a clearly a good
    writer and hardly the problem here. But picking “You” as
    Person of the Year only reinforces the collective delusion that
    our individual selves matter more than other person, or a
    collective good, an ideology, truth, or right and wrong. It’s
    relativism with a cherry twist.
    It won’t last. It absolutely can’t.
    Christmas Break
    December 22, 2006

    I’m off for two weeks, taking the opportunity to upgrade the
    computers/monitors and plan my next move. I will also be
    starting another blog under another alias. I’ll reveal it as mine
    if it takes off.
    Also, to all those who emailed me about the Time Person of
    the Year post: thanks; it wasn’t Photoshop but MS Paint; I
    have nothing against Grossman at all, I loved his King piece,
    the piece wasn’t about Grossman, it was about us, society, our
    purposeful alienation from each other; I changed the screen to
    blue to reference the Blue Screen of Death; no, “Go Fuck
    Yourself” wasn’t supposed to be (only) mean, it was a double
    entendre: narcissism—> self love—> “Go Fuck Yourself.”
    An Army of Narcissists? No
    Way
    December 26, 2006

    A tremendous example of the societal narcissism I wrote about


    in my Time article with the funny cover. If there was any one
    organization that I would have thought was in direct
    opposition to narcissism it would be the military, yet here it is,
    being specifically promoted.
    I understand the practical necessity of this approach, of course;
    trying to tap into a listless and apathetic populace who get
    their current events from clips of the Colbert Report on
    YouTube— they can’t even be bothered to find Iraq or
    Afghanistan on a map, let alone enlist. But mark my words,
    when a military cannot effectively appeal to any higher beliefs
    at all, and must resort to patronizing illusions of self-
    fulfillment only, then this society cannot last.
    Look at the evolution of the slogans, and tell me I am
    exaggerating (from Army Times:)

    “Today’s Army wants to join you”: 1971-73.


    “Join the people who’ve joined the Army”: 1973-1979.
    “This is the Army”: 1979-1981.
    “Be all you can be”: 1981-2001.
    “An Army of one”: 2001-2006.

    Look at the grammar, the semiotic connotations. A question


    for the historians would be whether or not a civilization in
    decline was aware that it was declining; and if not, what did
    they think was going on?
    But perhaps all is not lost. The Army just announced their new
    recruiting motto, which has apparently tested quite well:
    “Army Strong.”
    –—
    As an aside, the “Army Strong” campaign was created by the
    Army’s new advertising firm, McCann Erikson. They’re
    responsible for the MasterCard “priceless/there are some
    things money can’t buy” campaign. Of course, this cost the
    Army one billion dollars.
    I’ll go back to psychiatry now.
    Comedians Tosh, Gaffigan
    and Hedberg for Narcisissm
    December 27, 2006

    I know, I said I was going on Christmas break. But what better


    time than the holidays to focus on narcissism?
    After thinking about how marketers target our narcissistic
    leanings, I wondered if other groups did the same. Stand up
    comedy seems also to have followed this path. Most of today’s
    main comics do what I call meta-comedy; they tell jokes, but
    then also deconstruct the process of joke telling, right there,
    during the act. They comment on the act. Here are some
    examples:
    Jim Gaffigan (outstandingly funny) has two parallel joke
    streams in his act: in the primary stream he makes jokes, and
    in the secondary stream he affects the voice of an uptight,
    perplexed female audience member and comments on the
    jokes he just made:

    You can’t have cake for breakfast. Unless it’s a pancake.


    How’d that slide through? Young man, you’re not having
    cake for breakfast, you’re having fried cake with syrup
    for breakfast. Now load up on that and try not to nap.
    Pancakes definitely make you lower your expectations.
    Well, look’s like I’m not showering today. (pause) This
    guy talks a lot about cake. [Then on to jokes about
    birthday cake.] If he does another cake joke, I’m going to
    kill him.

    [finishing a joke about Hot Pockets and Nascar]… hey,I


    like Nascar. He’s a jerk.

    [a series of jokes on holiday traditions, then finishing


    with a joke about Mr. Rogers:] Remember that from Mr.
    Roger’s? And they wonder why we do drugs. Oh, that
    was negative. How about those traditions, fellow. Why
    don’t you go back to that? [and so he jokes about
    Valentine’s Day and about eating something from the
    heart-shaped “gamble chocolates:”] Oh, that was really
    nasty— I’m going to have to eat nine more to get rid of
    the taste. (pause) That joke didn’t even make any sense.

    If you hear his act (not just read it) you’ll hear how the
    sidebars of the “commenting woman” are as funny as the main
    jokes, and are not incidental— they form a necessary part of
    the routine. They function as brief pauses of concentration to
    relax the audience, and relieve some of the pressure off the
    main jokes— even if the main jokes are not that funny, the
    sidebar can give them meaning as something to be commented
    upon. Thus, even jokes that are not funny can be made funny
    by commenting about them. (But NB: they’re all pretty funny.)
    Some comedians explicitly state that they are doing an act;
    there is no suspension of disbelief that the entertainer is telling
    a “true” story. The comedian lets you know this is fake,
    constructed, but still funny:
    Daniel Tosh (hilarious) on Tourette’s:

    Do you think there’s one case of polite Tourette’s in the


    world? One person, who yells out random compliments
    for no reason at all? Nice smile! I’m sorry ma’am, I have
    a disease.… Lovely hat! I think two examples is enough
    — next joke.

    And on changing Daylight Savings Time:


    I’d like to change Daylight Savings Time— are you ready for
    this? Hold on Irvine—(pause)— I put whatever city I’m in
    right there so it feels more local… (etc)
    …[it’s not fair, especially to] the people who work at night—
    1/3 of this country according to a survey I just made up for this
    joke…
    The main joke is funny, but it’s funnier because he has allowed
    the audience into the process.
    Another example is the terrifically funny Mitch Hedberg, who
    does a Steven Wright-esque routine of short, independent
    jokes (“Every book is a children’s book if the kid can read.”)
    But different than Wright, he also references himself as a
    comic, and tells you how he feels the set is going:
    Mitch Hedberg
    I think a gift certificate is a bad gift. What’s a gift certificate?
    You take money that was good everywhere…(a lot of
    laughter/cheering from the audience; he, too, starts laughing)
    You took a little long on that clap. I had some extra lines, but
    now I can’t do them.
    On writing jokes in his hotel:
    I got to write these jokes. So I sit at the hotel at night, I think
    of something that’s funny and then I get a pen and I write it
    down. Or, if the pen’s too far away, I have to convince myself
    that what I thought of ain’t funny.
    It is common for Hedberg to judge his own jokes (“that joke
    was dumb, I’m aware of that”) or talk about how he tells jokes
    (“I have monitors [today], thank God, because last night I
    didn’t have them and I was telling jokes, and I had no idea
    what joke I was telling. So I told jokes twice. I even told that
    joke twice”) or accept joke requests from the audience
    (“cherries joke? Wait, you mean the cherry—? Ok— I heard a
    guy tell me he liked cherries. I waited to hear if he was going
    to say, “tomatoes,” then I realized he just liked cherries… that
    joke is ridiculous.” He also jokes about taking the laughs he
    gets from one joke and using them on the CD for jokes that
    didn’t work.
    The comedians themselves aren’t narcissists; they are tapping
    into the narcissism of the audience. The audience is attracted
    to these comedians because they get brought in, they get to
    feel like they are part of the comedy, part of the process, part
    of the act— they are behind the curtain, behind the scenes.
    They’re not the performers, but they could be; and at least
    their close confidants, and that’s a start.
    This meta-comedy is appealing because by being brought into
    the process, audience members are permitted to believe that
    what separates them from being the main act isn’t hard work,
    or talent, but being noticed, being selected, getting a break. I
    could so do Mitch’s act. Howard Stern is also like this. Few
    people think they could be disk jockeys, but almost everyone
    thinks they can do a 4 hour morning show. And they think this
    because Howard has brought them into the process of a
    morning show. So you feel like you’ve already done it, you
    know the tricks of the trade and you’re good enough. But
    you’re not— you’re just narcissistic.
    To follow the evolution of this process, go back to the
    previous leader of comedy: Jerry Seinfeld. Certainly, his show
    “about nothing” was about himself, his (feigned) narcissism. It
    was the unimportant minutiae of his life blown out of
    proportion: he was the main character in his own show. But
    today’s comics play on our desire to be main characters, first
    in their shows, but of course ultimately in our own.

    I used to hear people repeat Seinfeld’s jokes, but it was funny


    precisely because we all had a shared experience of them. But
    nowadays I hear people use a Hedberg joke as if they came up
    with it— because they could have written it. They could be
    comics, too, if it wasn’t for the wife and kids. Mitch wouldn’t
    mind, anyway; he’s a friend.
    I’m One of The Best Doctors
    In America. Seriously.
    December 28, 2006

    Continuing my week long celebration of narcissism, let me


    jump on the wagon: I got an email informing me I was
    selected as one of the “Best Doctors in America.” (5% of
    doctors, selected by peers; and no, I didn’t pay them.) Yay!!
    Me!! Now…
    If This Is One of The Sexiest
    Things You’ve Ever Seen,
    You May Be a Narcissist
    December 29, 2006

    A quick primer on the new Narcissism.

    I don’t mean the traditional Kernberg, Kohut, or even Freudian


    descriptions. In the modern times, I think narcissism has
    evolved.

    A narcissist isn’t necessarily an egotist, someone who thinks


    they are the best. A quick screen is an inability to appreciate
    that other people exist, and have thoughts, feelings, and
    actions unrelated to the narcissist. These thoughts don’t have
    to be good ones, but they have to be linked to the narcissist.
    (“I’m going to get some gas— because that jerk never fills the
    car.”)

    The narcissist believes he is the main character in his own


    movie. Everyone else has a supporting role— everyone around
    him becomes a “type.” You know how in every romantic
    comedy, there’s always the funny friend who helpes the main
    character figure out her relationship? In the movie, her whole
    existence is to be there fore the main character. But in real life,
    that funny friend has her own life; she might even be the main
    character in her own movie, right? Well the narcissist wouldn’t
    be able to grasp that. Her friends are always supporting
    characters, that can be called at any hour of the night, that will
    always be interested in what she is wearing, or what she did.
    That funny friend isn’t just being kind, she doesn’t just want to
    help— she’s personally interested in the narcissist’s life. Of
    course she is.

    A comedian I can’t remember made a joke about actors in LA,


    but it’s applicable to narcissists: when two narcissists go out,
    they just wait for the other person’s mouth to stop moving so
    they can talk about themselves.

    So on the one hand, the narcissist reduces everyone else to a


    type, as it relates to himself; on the other hand, the narcissist,
    as the main character in his movie, has an identity that he
    wants (i.e. he made it up) and requires all others to supplement
    that identity.

    A narcissist looks the same every day; he has a “look” with a


    defining characteristic: a certain haircut; a mustache; a type of
    clothing, a tatoo. He used these to create an identity in his
    mind that he will spend a lot of energy keeping up.

    Consider the narcissist who wants his wife to wear only white,
    high heeled pumps. The narcissist wants this not because he
    himself likes white high heel pumps— which he might— but
    because the type of person he thinks he is would only be with
    the type of woman who wears white high heeled pumps. Or, in
    other terms, other people would expect someone like himself
    to be with a woman who wears those shoes. What he likes
    isn’t the relevant factor, and certainly what she likes is
    irrelevant. What matters is that she (and her shoes) are
    accessories to him.

    Never mind that the woman is obese, or 65, or the shoes out of
    style, or impractical— the shoes represent something to him,
    and he is trying to reinforce his identity through that object.

    Narcissists typically focus on specific things as proxies for


    their identity. As in the example above, that the woman might
    be obese or a paraplegic could be ignored if the footwear was
    the proxy for identity. These proxies are also easy to describe
    but loaded with implication: “I’m married to a blonde.” Saying
    “blonde” implies something— e.g. she’s hot— that might not
    be true. But the narcissist has so fetishized “blondeness” that it
    is disconnected from reality. The connotations, not the reality,
    are what matters (especially if other people can’t check.)

    This explains why narcissists feel personally sleighted when


    the fetishized object disappears. “My wife stopped dying her
    hair blonde; but when she used to date her other boyfriends,
    she was in the salon every month. Bitch.” He doesn’t see the
    obvious passage of time, what he sees is part of his identity
    being taken from him, on purpose. Here’s the final insult: “she
    obviously doesn’t care about me as much as her old
    boyfriends.”

    As a paradigm, the narcissist is the first born (or only) child,


    aged 2-3. Everything is about him, and everything is binary.
    His, or not his. Satisfied, or not satisfied. Hungry, or not
    hungry. Mom and Dad are talking to each other and not me?
    “Hello! Focus on me!” Youngest children don’t typicaly
    become narcissists because from the moment of their birth,
    they know there are other characters in the movie. (Youngest
    more easily becomes borderline.) Control, of course, is
    important to a narcissist. If you can imagine a 40 year old man
    with the ego of a 2 year old, you’ve got a narcissist.

    Obviously, not all first borns go on to be narcissists. Part of


    their development comes from not learning that there is a right
    and wrong that exists outside them. This may come from
    inconsistent parenting:

    Dad says, “you stupid kid, don’t watch TV, TV is bad,


    it’ll make you stupid!” Ok. Lesson learned. But then one
    day Dad has to do some work: “stop making so much
    noise! Here, sit down and watch TV.” What’s the learned
    message? It isn’t that TV is sometimes good and
    sometimes bad. It’s that good and bad are decided by the
    person with the most power.

    So the goal in development is to become the one with the most


    power. Hence, narcissists can be dogmatic (“adultery is
    immoral!”) and hypocrites (“well, she came on to me, and you
    were ignoring me at home”) at the same time. There is no right
    and wrong— only right and wrong for them. He’s an
    exaggerated example: if they have to kill someone to get what
    they want, then so be it. But when they murder, they don’t
    actually think what they’re doing is wrong—they’re saying, “I
    know it’s illegal, but if you understood the whole situation,
    you’d understand…”
    Narcissists never feel guilt. Only shame.
    This Is Not A Narcissistic
    Injury
    December 31, 2006

    I know it looks like one, but it’s not. And why it’s not makes
    every difference in predicting what will happen next.
    My previous post described the modern narcissist, which is
    slightly different than the kind described by Kohut and others.
    In short, the narcissist is the main character in his own movie.
    Not necessarily the best, or strongest, but the main character.
    A narcissistic injury occurs when the narcissist is confronted
    with the reality that he is not the main character in his movie;
    the movie isn’t his, and he’s just one of 6 billion characters.

    The worst thing that could happen to a narcissist is not that his
    wife cheats on him and leaves him for another man. He’ll get
    angry, scream, stalk, etc, but this doesn’t qualify as a narcissist
    injury because the narcissist still maintains a relationship with
    the woman. That it is a bad relationship is besides the point—
    the point is that he and she are still linked: they are linked
    through arguing, restraining orders, and lawyers, but linked
    they are. He’s still the main character in his movie; it was a
    romantic comedy but now it’s a break-up film. But all that
    matters to the narcissist is that he is still the main character.

    No, that’s not the worst thing that can happen. The worst thing
    that could happen to a narcissist is that his wife cheats on him
    secretly and never tells him, and she doesn’t act any differently
    towards him, so that he couldn’t even tell. If she can do all
    that, that means she exists independently of him. He is not the
    main character in the movie. She has her own movie and he’s
    not even in it. That’s a narcissistic injury. That is the worst
    calamity that can befall the narcissist.
    Any other kind of injury can produce different emotions;
    maybe sadness, or pain, or anger, or even apathy. But all
    narcissistic injuries lead to rage. The two aren’t just linked; the
    two are the same. The reaction may look like sadness, but it
    isn’t: it is rage, only rage.
    With every narcissistic injury is a reflexive urge towards
    violence. I’ll say it again in case the meaning was not clear: a
    reflexive urge towards violence. It could be homicide, or
    suicide, or fire, or breaking a table— but it is immediate and
    inevitable. It may be mitigated, or controlled, but the impulse
    is there. The violence serves two necessary psychological
    functions: first, it’s the natural byproduct of rage. Second, the
    violence perpetuates the link, the relationship, keeps him in the
    lead role. “That slut may have had a whole life outside me, but
    I will make her forever afraid of me.” Or he kills himself—
    not because he can’t live without her, but because from now
    on she won’t be able to live without thinking about him. See?
    Now it’s a drama, but the movie goes on.
    So if you cause a narcissist to have a narcissistic injury, get
    ready for a fight.
    Saddam is not experiencing a narcissistic injury: he is still the
    main character in the movie. If he was sentenced to life in
    prison, to languish, forgotten, no longer relevant, no longer
    thought about, that would be a narcissistic injury— then his
    rage would be intense, his urge towards violence massive. But
    who cares? There’s nothing he could do.
    But remaining the main character, he has accomplished the
    inevitable outcome of such a movie: he has become a martyr.
    Even in death, he is still the main character. That’s why the
    narcissist doesn’t fear death. He continues to live in the minds
    of others. That’s narcissism.
    I’m not saying executing Saddam wasn’t the right thing to do,
    and I’m not sure I have much to add to theoretical discussions
    about judgment, and punishment, and the sentence of death. It
    doesn’t matter what your political leanings are, what matters is
    we look at a situation that has occurred, and use whatever are
    our personal talents to try and predict the future.
    I understand human nature, and I understand narcissism. And I
    understand vengeance. Saddam was a narcissist, but this
    wasn’t a narcissistic injury.
    This was a call to arms.
    We should all probably get ready.
    Xanax, Vicodin, Percocet,
    Ritalin and Valium
    January 2, 2007

    When patients complain about doctors, it’s usually about


    overcharging and undercaring. When doctors complain about
    doctors, however, it’s usually about those with “loose”
    practice, especially in the inner cities , who seem to
    overprescribe Xanax and Percocet.
    But let’s ask a different question: what would happen if all of
    these doctors disappeared? If there was no fast and easy way
    to get prescribed legal Xanax, would all the Xanax seekers just
    disappear?
    In large part, many psychiatrists and primary docs have the
    luxury of proclaiming that they “don’t give out Xanax and
    Percocet” because there is somewhere else for those patients to
    go. Dr. Smith from University Clinic doesn’t have to haggle
    over #10 Percocets because the patients can go to other
    doctors who are much more— comfortable, let’s say— giving
    out #90 Percocets a month.
    I was trying to think of an analogy. Black market jumped to
    mind, but these items aren’t illegal nor illegally obtained.
    Surprisingly, the best analogy I found was illegal immigration.
    In this case, illegals supply a required function that the
    existing distribution of the laborforce does not satisfy. Without
    that supply of illegals, the very existence of the industries that
    use them would be threatened. There would not be as many
    restaurants, or as many different kinds. And costs would be
    reduced elsewhere, maybe in unsafe ways. Additionally, like
    illegal immigration (and black market economies), the
    situation exists in the open— precisely because of its
    necessity.
    So if the “loose” Percocet prescribers disappeared, two things
    would happen: first, Percocet would be pushed into the ilicit
    underground trade. It is already partly there. It would become
    more abused with the removal of even the rudimentary
    medical supervision. Second, the practice of medicine itself
    would change drastically. It’s easy to say that low back pain
    should only be treated with NSAIDs or physical therapy and
    weight loss, but it’s easy only because the the 100 million
    scripts a year for Percocet are being written by people who
    don’t say that. It’s also easy to be dogmatic that SSRIs should
    be the first line agents for the treatment of anxiety as long as
    you’re willing to purposely ignore the 50 million combined
    yearly scripts for Xanax and Klonopin that non-academics are
    writing. (For reference: Lipitor is 63 million.)
    These commonly maligned inner city doctors actually serve as
    a pressure valve on the rest of medicine, in the same way that
    illegal immigration is a pressure valve on labor and industry.
    I’m not judging the actual clinical utility of these drugs, nor
    am I saying that “loose” practice is good or bad. I am thinking
    about what role, if any, such practice has in the larger scheme
    of medicine. And I’m convinced that it’s actually quite
    enormous.
    What proportion of the inner city population, for example,
    goes for routine preventative medical care— checkups,, blood
    draws, etc— only because that doctor also gives them Percocet
    for back pain? How many people fill the Glucophage only
    because there’s a Percocet on the same script? I have no idea
    — is it 15%? If it is, is it ethical, by ” not prescribing
    narcotics,” to create circumstances in which patients self-
    select inferior medical care?
    Let’s assume Dr. Smith is one of the best doctors in America
    and he has unparalleled success at treating diabetes in his
    patients. However, he never gives Percocet or other narcotics:
    “that’s my policy.” Patients looking for Percocet— for abuse
    or legitimate purposes— will not go to him, and consequently
    get inferior diabetes care. Is this ethical?
    I’m not saying that the Dr. Percocet won’t give good care; I
    think you understand that my point is how seemingly unrelated
    medical decisions may in fact be the key medical decisions.

    From a simple patient advocacy perspective, I think it’s


    possibly both disingenuous and unfair to have a “policy” on
    narcotics. Whether the risks outweigh the benefits isn’t
    something that can be answered a priori— each patient’s
    situation is different. So saying “I don’t give Xanax” willfully
    ignores the uniqueness of each patient’s existence, as well as
    the clinical data that says the thing actually does work.
    Treating the patient with maxims and guidelines that result in
    the patient leaving treatment to go elsewhere is, arguably, the
    opposite of medical care. Medical treatment often requires
    unorthodox and unproven maneuvers, but always with an eye
    towards the risks and benefits, and to the single goal of
    improving the patient’s condition.
    I don’t have all the answers, but I have a lot more questions.
    Vote
    January 3, 2007

    Hi. Vote for me for Best Medical Blog.


    http://www.medgadget.com/2006bestmedical.php
    Borderline
    January 5, 2007

    Narcissism- what I believe to be the primary disease of our


    times— is one side of a coin. The other side— the narcissist’s
    enabler— is the borderline.
    If the analogy for narcissism is “being the main character in
    their own movie,” then the analogy for borderline is being an
    actress.

    Note the difference: the narcissist is a character: an invented


    but well scripted, complete with backstory, identity. The
    narcissist is trying to be something— which already has a
    model. Perhaps he thinks himself an artist type, or a tough guy,
    or the type interested in spiritualism, or like the guy in the
    Matrix. Types, characters. The borderline is no one: the
    borderline waits for the script to define her.

    Her? Yes. Narcissists are mostly hes, and borderlines hers.


    (Not always, sure.)

    The classic description includes: intense, unstable


    relationships; emotional lability; fear of abandonment. The
    borderline has no true sense of self.

    Ironically, the borderline is a borderline only in relationship to


    other people. The borderline has a problem with identity only
    because other people in the world have stronger identities.
    Your Dad wants you to be one way, so you do it. Your
    boyfriend wants a different woman; so you do it. Your
    husband wants something else; so you do it. Who the hell are
    you, really? You have no idea, because you are always
    molding yourself based on the dominant personality in your
    life.
    This si done mostly out of fear of abandonment: if you don’t
    “be” the person they want, then they’ll leave you, and then
    what? (Borderlines don’t end relationships— they end
    relationships for another relationship.)

    The narcissist creates an identity, then tries to force everyone


    else to buy into it. The borderline waits to meet someone, and
    then constructs a personality suitable to that person.

    If a borderline is dating a guy who loves the Dallas Cowboys,


    then for sure, she will love the Dallas Cowboys. If, however,
    she breaks up with him, and then dates a guy who loves the
    Giants, then she’ll love the Giants. But here’s what makes her
    a borderline: she will actually believe the Giants are better.
    She’s not lying, and she’s not doing it for him; she actually
    thinks she thinks it’s true. Everyone else on the outside sees
    that it is obviously a function of whom she’s dating, but she is
    sure she came up with it on her own. And she’s not play
    acting: at that moment that she believes, with every fiber of
    her being, that the Giants are better.

    Here’s the ironic part: if a borderline was shipwrecked on a


    desert island with no one around, she’d develop a real identity,
    of her own, not a reaction to other people. Sorry, that’s not the
    ironic part, this is: she’d become a narcissist.

    The bordeline has external markings of identity: tattoos,


    changing hair colors, clothes. You may recall I said almost the
    same thing about the narcissist: the difference is, of course, the
    borderline changes her image as she changes her identity— in
    other words, as she cahges the dominant personality in her life;
    but the narcissist crafts a look, an identity, which he then
    defends at all costs: “I would sooner eat fire ants than shave
    my mustache.” Of course. Of course.

    All those silly movies about a woman moving away, or to the


    big city, and she “finds herself:” that’s a borderline becoming a
    narcissist.

    If you look back on past long term relationships you’ve had,


    and are completely perplexed as to what on earth you ever saw
    in each of those people that kept you with them for a year;
    well, there you go.

    This is why narcissists marry borderlines, and not other


    narcisstists. Two narcissists simply can’t get along: who is the
    main character? Meanwhile, two borderlines can’t be with
    each other— who supplies the identity? The narcissist thrives
    with the borderline because she provides for him the validation
    that he is, in fact, the lead; the borderline thrives with the
    narcissist because he defines her. And, as she will tell you
    every single time, without fail: “you don’t know him like I
    do.” Everyone else judges his behavior; but the borderline is
    judging his version of himself that she has accepted.

    Go back to my white high heel shoes example. The narcissist


    demands his woman wear white high heel pumps not because
    hem ay like them himself— he might or might not— but
    because he is the type of man that would be with the type of
    woman who wears white pumps. He thinks he’s the
    sophisticated, masculine man of the 1980s, so she damn well
    better be Kim Bassinger from 9 1/2 Weeks. Blonde hair, white
    pumps. She could weight 400lbs, that’s not the point (though it
    will become one later.) So she wears the shoes, and starts to
    believe she likes them, starts to believe that she is that woman.
    He reinforces this with certain behaviors or language towards
    her (he’ll open the door for her, push her chair in, etc. You say,
    “well, what’s wrong with that? Nothing, except that he ALSO
    beats her when she doesn’t wear the shoes.)

    It’s almost battered-wife syndrome: what keeps her with tat


    maniac is that when he’s not beating her, it seems like he is
    actually being kind to her, so great is the difference between
    being beaten and simply not being beaten. Meanwhile
    everything he does wrong has an external explanation: it was
    the alcohol, he’s under stress, etc. And she’s doing this
    rationalizing for herself, not for him, because it is vital to her
    own psychological survival that he actually be who he says he
    is, that he actually have a stable identity that things happen to,
    because her identity depends on his being a foundation.
    That’s why the therapist has to maintain such neutrality,
    consistency in the sessions. It’s not just to avoid conflicts; by
    being the most dominant (read: consistent) personality, the
    borderline can begin to construct one for herself using the
    blueprints of yours as a guide.

    If the borderline sounds like a 15 year old girl, that’s because


    that’s what she is. The difference, of course, is the actual 15
    year old girl is supposed to be flaky, testing identities and
    philosophies and looks until she finally lands on the one that’s
    “her.” But if you’re 30 and doing that, well…
    ––—
    (BTW, if you want to understand the mystery of women’s
    addiction to shoes, here’s my take: shoes are the article of
    clothing that represent possibility. Each shoe is a different
    look, a different character, and she can select “who” she wants
    to be that day. You might not notice the difference, but she
    feels it. This is not borderline— it’s normal, but it’s normal
    because the shoe changes and the rest of her doesn’t.)
    Neither Is This Is A
    Narcissistic Injury
    January 9, 2007

    I have another unrelated post coming, but a quick word on


    insults vs. narcissistic injuries, and why this distinction is so
    important.
    Narcissistic injuries have nothing to do with sadness. They are
    always and only about rage.
    The narcissist says, “I exist.” A narcissistic injury is you
    showing him that he does not exist in your life. Kicking him in
    the teeth and telling him he is a jerk is not a narcisstic injury—
    because he must therefore exist.
    Let’s say I’m a narcissist, and you send me a 10 page letter
    explaining why I suck, I’m a jerk, I’m an idiot; you attack my
    credibility, my intelligence; and you even provide evidence for
    all of this, college transcripts, records from the Peters Institute,
    you criticize my penis size, using affidavits from past and
    future girlfriends— all of this hurts me, but it is not a
    narcissistic injury.
    A narcissistic injury would be this: I expect you to write such a
    letter, and you don’t bother.
    This is most easily seen in the failing marriage of a narcissist.
    The reason it’s important is because the reaction of the
    narcissist to either “insult” is different. In the first example, he
    will be sad and hurt, but he will yell back, insult you, or cry
    and beg forgiveness or mercy—he will respond— maintain the
    relationship. He’ll say and do outrageous things that he knows
    will cause you to respond again, to prolong your connections,
    even if they cause him misery. He doesn’t care that it makes
    you and him miserable— he cares only that there is a you and
    him.
    But in the latter case where you ignore him, humiliate him—
    an actual narcissisitic injury— he will want to kill you.
    –-
    And before everyone flames me, I am not trying to give a
    scientific explanation of the pathogenesis of narcissism. This
    is simply one man’s opinion of how we can specify what it is,
    and what it may predict, past or future. Nor am I suggesting
    this isn’t “treatable”— anyone can change. It may not be easy,
    but it is always possible.
    And I also do not mean to imply that all narcissists will kill
    everyone who injures them. The point is rage. They may never
    act on it, or they may break a window, or attempt suicide, etc.
    Not Competent To Make
    Medical Decisions?
    January 10, 2007

    As a forensic psychiatrist, I am often called to evaluate


    someone for their “competency”— to make medical decisions,
    to make financial decisions, to stand trial, and (theoretically)
    even to be executed.

    In these various consults, the basic question is this: are they so


    impaired, that they don’t understand the relevant issues and
    can’t make rational decisions?

    Many psychiatrists find this complicated and time consuming


    work, because they focus on the nuances of the patient’s
    symptomatology and illness. They try to get extensive past
    histories, corroborating information, etc, etc. All this is
    important, but they miss the forest for the trees.

    Now this is, of course, only my opinion. But it’s important that
    you hear this opinion, because I am, apparently, the only
    person who has it, so you won’t hear it anywhere else.

    The truth to competency evaluations is this: the patient is the


    least important factor.
    First, everyone is assumed to be competent, not incompetent.
    There’s no such thing as
    “evaluate for capacity to refuse treatment”— there is only
    “evaluate for the lack of capacity to refuse.” The default
    condition is competent. It is up to the clinician to show
    sufficient evidence to take away his right to make decisions;
    not up to clinician to determine if he can make decisions. And
    in order to take away their rights, you have to have an
    exceptional reason. Not a valid reason, an exceptional one.
    Not “benefits outweigh risks” but “treatment is so urgently
    necessary that it justifies this gigantic suspension of his civil
    rights.”

    For example, if a patient is preposterously psychotic: eating


    feces, seeing aliens, channeling the Devil, and he has a
    temperature of 100 and you want to give him a Tylenol and he
    says no, can he refuse? Can you force him to take it?
    Absolutely he can refuse, no way can you force it. Even if he
    doesn’t know what Tylenol is; even if he thinks it’s a mind
    control pill from the CIA. Because the relevant factor is the
    Tylenol— it is not necessary— not his psychosis, not matter
    how severe.
    You can actually determine compentency without seeing the
    patient. No lie. Observe:
    Surgeon asks if a patient is competent to refuse a necessary
    surgery. Ok, when’s the surgery? “Next Thursday.” Consult
    over: competent. If it can wait until next Thursday, it isn’t
    urgently necessary, and it doesn’t matter what his reasons for
    refusing are: you can’t force someone to do something
    unnecessary right now. On top of this, capacity evaluations are
    time sensitive; it’s competency now, at this moment— you
    can’t judge whether they will or will not be incapacitated in
    the future. Again, note that in this example, I didn’t describe
    the patient’s mental state; it isn’t relevant. What’s relevant is
    the simple question: is there any overwhelming justification
    for me to force someone into this?

    Doctors have a very difficult time with this concept, so I’ll


    give you an analogy: innocent until proven guilty.

    So residents want very badly to tell me about the history, the


    symptoms, that the patient is depressed or delirious— in more
    than half of their case presentations, they never even mention
    the required treatment (“it’s a competency eval to refuse
    treatment”)— and their frustration with me is palpable (“wait,
    just let me tell you about his–”) because I keep interrupting
    them to ask about the necessity of the treatment.
    I’ll repeat: the treatment is the important thing, not the patient.
    Competency/capacity evaluations are situation specific. There
    is no such thing as “incompetent to refuse treatment”— there
    is only the specific case at hand: incompetent to refuse this one
    specific treatment in this one specific case at this one specific
    time.” Only judges are allowed to decide general
    imcompetence. You’re not a judge, are you? Then shut up.
    And thus we come to the point: as clinicians trained in
    medicine’s implicit system of parens patriae, they think they
    should be allowed to overrule the patient to do what’s best for
    them.

    And you say: well what’s wrong with that?


    First, what the doctor thinks is best is irrelevant. We are
    talking about “substituted judgment” which means “what the
    patient would have wanted if he were competent.” This is not
    the “best interests” standard, in which doctors decide what’s in
    the “patient’s best interest.” The two might be different. So
    again, the standard is not what the doctor thinks is right, but
    what the patient wants. Period. You don’t like it? Go back to
    Russia.
    Second, is the “slippery slope” argument. If you’re allowed to
    usurp a patient’s rights to give them non-emergent treatment,
    where does it stop? Can you force psychotics to stop drinking
    or smoking? etc, etc.
    Third is the reverse problem: if you are allowed to usurp their
    rights for non-emergent treatments, are you therefore obligated
    to do so? Is it your job to chase them around and make sure
    they take their digoxin? And if they don’t— then what?
    Involuntary commitment? Slip it in their drink? Really? If my
    wife dies of digoxin toxicity because the doctor gave it in her
    drink, but her other doctor was slipping her Lasix, who do I
    stab?
    Fourth: what if the doctor is wrong? Maybe the patient knows
    what’s best for himself, given the context of his life? I mean, it
    could happen, right?

    And the fifth problem is political: if a clinician can determine


    what’s best for patients— even if its not emergent— why can’t
    the government? Because they’re not clinicians? How about
    government doctors? (“The U.S. Corps of Psychiatrists have
    decided all Democrats need Zyprexa.” Like that?) It amazes
    me how obvious it is to many doctors that they should be
    allowed to do “what’s necessary”— forced antipsychotics,
    involuntary commitments, etc— and these same doctors are
    apoplectic over Guantanamo. Under what possible logic can
    we allow that a psychiatrist should be allowed to detain a
    patient against his will, for the safety of others, and not allow
    the government to do the same? Oh, you think you are in a
    better position than the government to decide who is
    dangerous and who is not? Then look around you, ye mighty,
    and despair.

    Let me explain to you the bind that you psychiatrists have put
    yourselves in. If a guy says he’s going to kill his girlfriend,
    then you’re obligated to protect and/or warn: you hospitalize
    him, or call her, or both. But if you decide he is not in any way
    under the influence of psychiatric illness, and you decide you
    should simply call the cops to let them handle it, you’ll find
    they have absolutely no obligation to do anything because no
    crime has yet been committed. Despite the fact that the side of
    the police car says “To Protect And Serve” they have no legal
    obligation to do either— but, here’s the kicker—you still do! If
    he kills his girlfriend, you get sued, not the cops. Think about
    this.

    For the record, I’m not saying the government should have this
    power, I’m not saying Guantanamo is a good thing; I’m saying
    doctors shouldn’t have the power either.

    Before you argue with me, understand that I am not trying to


    be dogmatic, I understand the nuances of everyday practice.
    But this is a power you do not want, you should use it with
    reluctance and care, because every time you use it it hurts you,
    it chips away at the wall that stands between you and society,
    the wall that allows you to say, “look, I’m just a doctor, I just
    treat illness, I can’t be responsible for people’s behaviors.”

    –-
    P.S. It goes without saying, but I’m saying it— if you do find
    someone lacks capacity to make a serious, urgent decision, for
    the love of God and all that is holy, don’t then take it upon
    yourself to make the decisions for him. Move to a surrogate
    decision maker— spouse, kids, parents, relatives, etc; anyone
    but you!

    P.P.S. Also remember that every time you determine a


    surrogate decision maker is needed, you are also responsible to
    evaluate that surrogate. It has happened more than once that I
    suggest the husband as a surrogate decision maker only to find
    that he’s even more whacked out than she is. Don’t laugh; you
    should cry.
    P.P.P.S. In Massachusetts, patients who are adjudicated
    incompetent automatically get the court— not doctors or
    family members— as the surrogate decision maker. Happy
    now?
    P.P.P.P.S. Controversy is heavy, but here are the things that, to
    my reading of the law, are not allowed to be done without
    court order: psychosurgery, forced sterilization, admission to
    psych hospital (but not medical), ECT, and antipsychotics.
    There is sufficient case law to allow forced antipsychotics in
    cases of dangerousness or emergency ( Washington; Rogers;),
    but I’m not willing to concede much more than that.
    P.P.P.P— oh, come on: The Supreme Court has also opined
    about when it is ok to involuntarily medicate prisoners with
    antipsychotics: 1) Is it an important government interest? 2)
    Would antipsychotics further this interest? 3) Are the
    medications necessary to further this interest? (i.e. is there no
    other way?) 4) is the antipsychotic medically appropriate? You
    will notice that without 1), you can’t do it. “Important
    government interests” are things that touch the Constitution,
    like right to a speedy trial. This is a slightly different situation,
    but I thought you should know.
    More on Medical
    Competency
    January 12, 2007

    The primary rebuttal to my thesis of personal autonomy is,


    “well, we doctors are just trying to do what’s best for the
    patient.” This is categorically false (words chosen carefully.)
    What they want is what’s best for that particular medical issue
    because it leads to the betterment of the patient; but this is not
    the same as taking the patient’s life in total and deciding what
    is best overall for their lives. What the patient wants in their
    lives may be, to them, worth the risk.
    And I’m not saying the doctors aren’t trying to do what they
    think is best; but you don’t think George Bush, et al, are doing
    “what they think is best” for us? (Before you give a reflexive
    answer, grow up.) Allowing doctors extraodinary powers to
    treat against one’s will is no different than executive privilege,
    an example chosen carefully because it highlights the
    political/societal nature of the process, over the scientific.
    Here’s an example. It is almost axiomatic that a person with a
    hemoglobin of 4 who refuses a transfusion is incompetent.
    Nothing they could say could possibly justify their refusal—
    except that they are Jehova’s Witnesses. I observe psychiatrists
    routinely dismiss these evaluations, and they’re inwardly
    proud of their progressiveness: “No, he doesn’t need an
    evaluation, he can refuse, that’s his religion, his personal
    beliefs.” 1) This seems pretty preposterous; are you saying
    cultural dictums outweigh personal choice? A person can’t
    choose, but his culture can choose for him? 2) Is it possible
    that even a Jehova’s Witness might actually want a transfusion
    but feels pressured by his peers to refuse? Isn’t this more
    properly the purview of psychiatry— helping people deal with
    the pressures in their life— rather than the lazy preemption of
    personal choice? 3) Is it possible— maybe, I’m just asking—
    under the right circumstances— that even a Jehova’s Witness
    could be incompetent? I’m just speculating— that their refusal
    is due to delirium?
    And let’s not discount expediency, whereby the doctor simply
    doesn’t have the time to wait for the patient to get on board the
    treatment trolley. e.g. primary medical team wants to put a guy
    on IV antibiotics, but the patient refuses, he wants to go home.
    Most of the typical debate surrounds their mental state, and not
    the following simple question:

    ME: Well, if he refuses, what are the alternatives?


    THEM: We’d have to discharge him on oral antibiotics.
    ME: Would this work?
    THEM: Well, it’s not ideal. There’s a good chance he’d
    end up back here in the hospital in a few days.
    ME (not punching anyone): if he has someone at home
    who can help take care of him, etc, he, unfortunately,
    (squeezing the thumbtacks in my hand) has the right to
    refuse.
    THEM (frustrated, angry): Fine. Whatever. They have to
    sign an AMA discharge, and know that we’re not
    responsible for what happens.

    Note the final aggressive maneuver. It’s the only thing they
    can do to “punish” the patient— for not doing what they
    wanted. It’s more clearly seen when I say this:

    ME: Unfortunately, (tacks in hand again) his refusal


    doesn’t discharge our obligation to treat. He’ll need an
    outpatient appointment within a day or so.
    THEM: No, I’m not doing that. If he doesn’t want to
    follow my prescribed treatment, I’m not going to alter my
    schedule for him.
    ME: Unfortunately, if you were ready to find him
    incompetent and keep him in the hospital, lawyers won’t
    understand why you didn’t follow such a sick person
    more closely as an outpatient.
    I always blame lawyers, not because they are to blame, but
    because it’s the only thing doctors really understand. But
    either the patient is really sick, and we can have a discussion
    about incompetency, or they’re not, and we shouldn’t be
    having the discussion.
    Another piece of idiocy I get from other doctors is this: well,
    would you want your mother to refuse? Exactly what in the
    word mother presupposes an inability to make decisions? But
    they miss the crucial point: that even if she was incapacitated,
    the person who would decide for her would be— me. Her
    family, or, if necessary, a judge. Substituted judgment.
    Consequently, the family would have to be involved anyway—
    so involve them now.
    Rather than force a family member to have to go against her
    wishes to do what is in “her best interest,” it would be better to
    help them convince her to do what you think is best. The time
    spent during the consult should be devoted not towards
    assessing their competency— let’s face it, if you can’t tell in
    five seconds that they’re incompetent, then they’re probably
    competent— but towards educating the patient, conveying
    some empathy and assurance, and getting them to choose for
    themselves what is best for them.
    Because some day in the future they’re going to get sick again,
    and they may be much less interested in coming back in for
    treatment if they think we’re going to just do what we want to
    them.
    Competency To Commit
    Suicide?
    January 19, 2007

    You knew this was coming, right?


    A patient with a pre-existing living will (“no life support, no
    intubation, no blood products”) attempts to OD, is brought to
    the ER, and requires intubation to live. So now what?
    What makes this situation needlessly complex— i.e. it is
    actually quite simple— is two major misunderstandings.
    First, questions about living wills are only appropriate in cases
    of irreversible, terminal illness. In other words, if a person has
    a notarized living will saying no intubation, can they get
    temporary intubation to stabilize them, with the expectation
    that they will survive and go on with life? Of course. So that a
    living will exists is mostly irrelevant unless we are dealing
    with irreversible, terminal illness.
    Generally, suicides lack capacity to make decisions about life
    saving procedures; we assume that psychiatric disease is
    impacting their ability to make rational decisions. Substituted
    judgment, as the standard, can be here interpreted to mean
    “what the patient would want, now that he has damaged
    himself through a suicidal act, but if he was now also free of
    psychiatric disease.” So it’s possible that free of depression he
    might still actually want to die; but in non-backwards cultures
    (gauntlet thrown down!) we assume this is unlikely.
    Second, there’s quite a bit of confusion on what a living will
    actually is. It’s a type of advance directive (not the other way
    around.) It’s a document to be read and interpreted by one
    reader, the surrogate decision maker. Period. Not the doctor, or
    the Ethics committee, but the surrogate.
    This sounds confusing, because it is typically the doctor who
    reads the living will— but that’s because generally there isn’t
    a dispute, and the doctor actually becomes the surrogate. But
    what if there was a dispute? What if the wife wants him alive?
    Consider Florida: if a patient has a terminal illness, and if
    there is no surrogate available, the doctor can proceed
    according to the living will. But— and this is the big but:

    If there is a dispute or disagreement concerning the


    attending physician’s decision to withhold or withdraw
    life-prolonging procedures, the physician cannot proceed
    pending an expedited judicial review.

    (Within seven days.)


    In other words, either the potential surrogates AND the doctor
    agree with the living will, or you go to court. Or: just because
    there’s a living will, doesn’t mean you get to do what it says,
    over the objections of anyone.
    The other type of Advance Directive is the power of attorney.
    Usually legally specified, the spirit still remains an appointed
    surrogate who will interpret the living will: family members,
    etc.
    So now, in the above scenario, we have a situation where a
    living will is to be interpreted by a surrogate (say, the wife) in
    the spirit of “what he would have wanted if he wasn’t so
    depressed.” I think you see the difficulty that arises, and why,
    the obvious, easy, and likely only legally defensible maneuver
    is to treat aggressively, psychiatrically stabilize, and debate
    later.
    In difficult questions, it can be useful to get guidance from
    areas that have direct stake in the matter.
    Most life insurance policies are invalidated in suicide. This
    would include a living will/advance directive withholding of
    life sustaining measures following a suicide attempt, even if
    this took place years later. In other words, the fact that doctors,
    et al, decide the patient “has capacity” to die, insurance
    companies are not bound by this.
    For you all with strong opinions on the abortion question,
    here’s a noodler to show you your inconsistent logic: should a
    terminally ill pregnant woman by allowed to invoke a living
    will and end life sustaining treatment? If you say yes, then you
    must also agree that abortion is ok; if you say no, then abortion
    can’t be ok (otherwise, why are you forcing her to stay alive?)
    In most states where abortion is prohibited or restricted, a
    pregnant woman may not invoke a living will— by virtue of
    being pregnant, all measures will be given over the objections
    of the woman, unless they don’t help the baby and are actually
    harmful to the woman (i.e. you can’t hurt her to keep her
    alive.) (P.S. the State is obligated to pay for all costs if
    insurance won’t.)
    Here’s the homework question for this week: If our society has
    determined that there is no right to suicide, can a convict
    sentenced to death waive his automatic appeal?
    Competency to Be Executed
    January 21, 2007

    If society has determined that a right to commit suicide does


    not exist, can a convict sentenced to death waive his appeal?
    First, consider the legal standard for such a waiver: you have
    to be competent to do it. Competency is defined by Dusky v.
    U.S.: do you have a rational understanding of the
    charges/issues; do you have the ability to aid in your own
    defense (i.e. work with a lawyer.)
    It should be obvious that if you were competent to make it
    through trial, you probably meet both criteria. Indeed, Justice
    Powell, in Ford v. Wainwright speculated that competency to
    stand trial likely presumes competencies for execution. (But
    the Court ruled that a formal review is needed in these
    situations.)
    And, many do waive their appeal— for various reasons.
    Possibly some accept their guilt. Some may have other reasons
    for dying: prison sucks; they’re depressed; etc.
    The trick of this question is that the appeal is not for the
    defendent, it is for society. It is to ensure that the death
    sentence is appropriately used (not excessive, prejudiced, etc.)
    So in some states, a defendent does not have the right to waive
    his appeal; appeals are required by law.
    So waiving an appeal is not a right anyone has; this is not to
    say it can’t happen— it’s just not your right to do it, it is an
    option allowed to you after careful review. The primary
    (competency) standard is whether the waiver is “knowing,
    voluntary and intelligent.” It seems logical to infer that the
    “intelligent” can only mean an acceptance of your guilt and
    the punishment as appropriate; but this also presupposes that
    you are factually guilty (you can’t think your punishment is
    appropriate if you didn’t actually do it).
    Note, therefore, that statutory appeals and the absence of a
    consitutional right to waiver are consistent with the idea that
    no one can be competent to commit suicide (and we will leave
    out the case of terminal illness (which, some argue, is identical
    to the scenario of execution.))
    There’s a byproduct of this. Can you be incompetent to be
    executed? If you are incompetent to stand trial, trial gets
    postponed. Does your execution?
    The typical test for incompetency to be executed is (using
    Texas as an example; they execute the most people) if the
    defendant does not understand 1) they are to be executed,
    imminently; 2) the reason they are being executed.
    You can see that nowhere in this test does it ask if you are
    psychotic, or think you are immortal. If you say, “they want to
    execute me on Monday because they think I killed that girl,
    but really it was aliens that did it, and besides, I can’t die
    because God will protect me— in fact I wish we would do the
    execution today because I want to bring about the Rapture”
    then you are competent. (However, in this scenario, you
    wouldn’t be able to waive your appeal.)
    I emphasize this point— the absence of any psychiatric tests—
    because otherwise we have what happened in Texas in April of
    2006: The judge thought Steven Staley was incompetent to be
    executed— experts had said he was too mentally ill— so
    Staley was sent back to the prison psychiatrists to be forcibly
    medicated to restore him to competency— to be executed.
    This puts doctors in the bizarre ethical quandary of treating
    someone to kill them.
    Sell v. US made it explicitly ok to forcibly treat someone to
    restore them to competency to stand trial, because otherwise
    (remaining incompetent and postponing their trial) violated
    their constitutional rights to a speedy trial, etc. But this ruling,
    in my opinion, therefore made questionable whether you could
    forcibly medicate people for any other circumstance except
    competency to stand trial.
    But it is pretty obvious to me that trial competency requires a
    considerably higher degree of cognitive function: it’s more
    than just knowing something, you also have to be able to
    rationally manipulate information and assist in your own
    defense. Execution competency requires none of this, just a
    binary, yes/no understanding of two questions. And therefore,
    it is a rare case that the forced administration of antipsychotics
    would get a person to answer these two questions.
    Keep in mind that they made it through a trial— in my
    opinion, they met a higher competency standard. So to say
    they are incompetent to be executed means they must have
    become sicker after the trial was over.
    I’m not debating the morality of the death sentence. I’m
    pointing out that involving psychiatry at the execution stage
    virtually guarantees the execution will not take place. If you
    somehow decide to say that someone is too mentally ill to be
    executed— if you go that far— then I can forsee almost no
    circumstance ever that the person will become competent. It is
    likely unethical to force medicate someone to be executed; and
    even if they were, what doctor is going to be sure— go on
    record— they have improved enough?
    Many are going to disagree with me. They’ll say that Ford is
    really about (moving towards) prohibiting the execution of the
    mentally ill (not just the legally insane); in the example above,
    since the person thinks he is immortal, he would not actually
    understand the ramifications of execution, so could not be
    executed. We can debate this all day; I stick to a strict reading
    of the test because the alternative puts doctors in the position
    of deciding who is to be executed.
    I’ve written about doctors staying clear of social policy issues,
    and this is a good example. The decision to execute is
    society’s through the legislature and via the judicial system,
    not doctors’ as the philosophe-proxies of the apathetic
    bourgeoisie. Doctors are nearly the worst deciders of justice
    imaginable (and rightly so, as the practice of medicine
    inherently precludes its application.)
    Further Thoughts on
    Competency To Be Executed
    January 26, 2007

    I took the data in the paper “Killing the Willing: “Volunteers,”


    Suicide and Competency” and drew this chart.
    The paper is fascinating. It observes that although blacks are
    disproportionately represented in executions versus the general
    population, volunteers to be execute— i.e. people who waived
    their appeals— are overwhelmingly white, male, and have
    psychiatric illnesses, especially borderline, depression, and
    psychoses (and an additional 10% have substance abuse)—
    which is basically your demographic for suicide attempts. 30%
    also had prior suicide attempts.
    So the author asks: if there is no such right to assisted suicide
    (indeed, any suicide at all), can there ever be a waiver of the
    appeal in capital cases? Even if the defendant is competent, if
    suicide is a motivation, the author writes, “their decisions
    should not, indeed must not, be honored, at least so long
    assisted suicide is not available to other persons in the
    jurisdiction.”
    The counter argument, of course, is that competency is a legal
    matter, and the person’s motivations beyond that are irrelevant.
    For example, if a guy is sentenced to prison and wants to go,
    he still goes.
    McClesky v. Kemp (1987) attempted to abolish the death
    penalty under the argument that executions were influenced by
    racial discrimination. This was rejected. But Atkins v. Virginia
    (2002) did abolish the executions of the mentally retarded.
    Consequently, abolition of the death penalty, or at least a
    drastic curtailing of it, is more likely to occur along lines of
    competency and mental state, rather than any appeal to
    morality, race, or class.
    I thought I knew how I felt about this issue, and now I am not
    so sure. But before anyone forms their opinion, I would
    strongly urge everyone to read the dissent by Scalia in the
    Atkins case. It should be required reading for every
    psychiatrist, whether you agree with him or not.
    Atkins v. Virgina and the
    Execution of the Mentally
    Retarded
    January 27, 2007

    Once again, I appear to be all alone.

    …Because of their disabilities in areas of reasoning,


    judgment, and control of their impulses, however, [the
    mentally retarded] do not act with the level of moral
    culpability that characterizes the most serious adult
    criminal conduct… [over the past 13 years the] American
    public, legislators, scholars, and judges have deliberated
    over the question whether the death penalty should ever
    be imposed on a mentally retarded criminal. The
    consensus reflected in those deliberations informs our
    answer…

    So opens Atkins v. Virginia, as opined by Justice Stevens.


    It seems unassailable that the mentally retarded should not be
    executed. Justice Stevens spoke of a consensus; the APA’s
    amicus brief to the Court stated:

    (1) there is a clear and unmistakable national consensus


    against the imposition of the death penalty on persons
    with mental retardation, and (2) the American people
    oppose the execution of individuals with mental
    retardation because the practice offends our shared moral
    values. (emphasis mine.)

    So once again I am the sole hold out to national consensus.


    Okay. If I am to grant that such a national consensus does exist
    — which it most obviously does not— it is not in small
    measure due to misunderstanding what mental retardation is: it
    isn’t Down’s syndrome. It isn’t a guest spot on the Howard
    Stern Show, it isn’t finger paints and a baseball cap at age 30
    moaning, “I wanna eat tato chips!”
    If it was this, I’d agree a consensus might even be close to
    unanimous. Ironically, such a consensus would be irrelevant as
    such individuals don’t commit capital offenses.
    But this is not what mentally retarded is. Atkins, the above
    defendant, was determined by the defense expert to be MR
    because of an IQ of 59. With this IQ, he was able to get drunk
    and smoke pot (which, FYI, does not diminish responsibility,)
    drive a car (which he was licensed to do), kidnap and drag his
    victim to an ATM to force him to withdraw $200, then drive
    him to an isolated spot and shoot him 8 times— not to mention
    be competent to stand trial, cooperate in court and with his
    attorney, etc. He was also able to pull of 16 other felonies in
    his life. An IQ of 59 allows reading at a 6th grade level—
    comic books are 4th grade and Time Magazine is 9th grade.
    But that was Atkins. A diagnosis of MR is an IQ less than 70.
    Can someone with an IQ of 70 appreciate that shooting your
    kidnapping/robbery victim in the chest 8 times and dumping
    him in an isolated location is really, really, wrong? From 1976-
    2002, 44 people with “mental retardation” have been executed;
    all but 2 had IQs at least 58.
    So a categorical exemption for the mentally retarded might be
    sensible if someone could tell me exactly what mentally
    retarded means. Because the psychiatric definition quite
    obviously covers individuals well within competency
    standards. And that’s the point.
    Here’s an example: if the exemption was for “Down’s
    Syndrome” then this would be plausible, because a) we can
    reasonably agree how Down’s impacts the defendant; b) we
    can identify it. But “retardation” means— what? Mentally ill,
    as an exemption, is worse— does depression count? Only
    psychosis? Does the presence of only a hallucination count, or
    do you have to have a thought disorder? “Schizophrenia?”
    What’s that? The John Nash type, or the homeless crackhead
    type? How about borderline? Narcissism? If you can’t be sure
    of what constitutes “mentally ill”, how can you make a blanket
    exemption for it?
    We can take this debate up a level, and observe that with every
    other psychiatric disorder that impacts on legal matters, the
    question for psychiatrists is simply, “what’s his disorder?” or
    “how does the disorder impact this case?”— we have an
    advisory capacity, leaving the ultimate decision of culpability
    up to the courts. In this way, we put some distance from the
    outcome. That’s what expert testimony is all about. Fair
    enough. But now, with MR, the diagnosis automatically gets
    you out of execution. As long as the IQ test comes back 59,
    the sentence changes. Mental retardation is binary, apparently,
    and if you are fortunate enough to have it, you live—
    regardless of how well you understood the wrongness of your
    actions, or how egregious were the crimes.
    Which is ridiculous. There are practically no valid measures
    for any psychiatric illnesses— everything is up for debate and
    interpretation. MR especially is a continuum disorder. Factors
    as trivial as which IQ test is used, or when it is taken, can
    affect the diagnosis. One study finds a 6 point increase using
    older tests vs. the newer version of the same test.

    “Our findings imply that some borderline death row


    inmates or capital murder defendants who were not
    classified as mentally retarded in childhood because they
    took an older version of an IQ test might have qualified
    as retarded if they had taken a more recent test,” Ceci
    says. “That’s the difference between being sentenced to
    life imprisonment versus lethal injection.”

    But now the law has set an arbitrary and empty, binary cut off
    for execution. Psychiatrists now actually choose the sentence.
    Not inform the sentence— choose it.
    I’m fairly certain the APA didn’t think about this when it filed
    its amicus brief. They never think these things through,
    because they believe they are an instrument of social change.
    But, like forced medication to render competent to be
    executed, psychiatrists have now boxed themselves into a
    corner. It is now solely up to them— and their “tests”— to
    decide who gets executed.
    Consider the ethical dilemma for a forensic psychiatrist asked
    to evaluate for MR: given that the defendant can fake MR; and
    given that finding the defendant does not “have” MR—or
    suspecting that he is faking MR— is exactly equivalent to
    sentencing him to death, can there be any other medically
    ethical outcome than finding they are MR? Think well. In
    other words, an answer is forced, an answer is created, simply
    by asking the question. The situation here is identical to the
    judge leaning over and asking, “Do me a favor and decide for
    me. Should I hang him or put him in prison?” Um, well, gee,
    it’s up to me? um, since you asked…
    I know, doctors are going to inwardly smile, pat themselves on
    the back for their cleverness; after all, the goal is to abolish the
    death penalty for everyone, one group at a time. And I am sure
    there are organizations who will actively, openly, exploit this
    loophole.
    Notwithstanding the laudability of this goal, this isn’t about
    the death penalty, it’s about who decides the death penalty.
    Just remember, when society allows psychiatrists to decide
    who lives or dies, then psychiatrists will also decide who dies
    or lives. I want everyone on the planet to take a very deep
    breath, and think about this.
    When Your Patient’s Parent
    Is A Psychiatrist and A
    Patient and You Just Want
    To Go To Bed
    January 31, 2007

    If you want to test the faith of a psychiatrist in their “science”,


    present them with one of their own.
    In my career I have treated a few dozen children/spouses of
    doctors, and about a dozen of psychiatrists. Treating patients
    with these connections is difficult, if we are to be honest, for
    two reasons: 1) a lot of the trickery and hand waving we use
    on regular patients won’t work with them, because they know
    the game. 2) we feel tremendous pressure to do a good job,
    because we feel that we are being graded.
    The result is we almost always do an inferior job.
    Notwithstanding the admonition against treating family, the
    reality is that if they knew what to do, they wouldn’t be
    referring them to you. And the trickery and bs are vital parts of
    the dance: these say you have really no idea why this works,
    but you’re optimistic, so you are offering a framework to think
    about how it could work. The framework doesn’t have to be
    “true”— it has to be internally consistent.
    But the countertransference towards the patient and his family
    is so strong that we do things we should not, think things we
    should not.
    Treatment is even harder when both the patient’s psychiatrist-
    parent/spouse is also a psychiatric patient somewhere. If you
    want to see an entire department blow an aneurysm
    simultaneously, say, “I’m getting X as a patient, and X’s mom
    is a psychiatrist— and a patient in the Bipolar clinic!”
    In any other scenario, a mom in the bipolar clinic would
    suggest that the child had a similar disorder, by virtue of being
    a first degree relative. But in these cases, psychiatrists read it
    differently: it means the mom made the kid insane. It was the
    mom’s fault. Not genetics, or biology, or even shared
    environment: specifically bad parenting. And not bipolar—
    personality disorder.
    I can make a statement that is completely unqualified, without
    exception: never, not once, has anyone hearing of this scenario
    said to me something like, “bipolar in educated families is
    difficult to treat.” In every case, again without exception,
    every single person who has heard of the situation has said the
    same exact thing: “Oh my God, she’s a borderline, and the
    mom is even more crazy.”
    What’s interesting about this, to me, is two things. First, how
    immediate, reflexive, and certain everyone is of this
    assessment— given even before they ever see the patient, only
    hearing that the mother of a patient is a psychiatrist. “Mom’s a
    psychiatrist…” Boom. Case closed. Out the window goes
    diagnosis, biology, serotonin, kindling, TSH, whatever— it is
    immediately predicted to be personality disorder due to an
    unhealthy relationship between parent and child (or spouses).
    Overinvolved, underinvolved, abusive, manipulative,
    whatever.
    Medications are inevitably thought of as band-aids— likely to
    be changed thousands of times over the lifetime— or proxies
    for therapeutic maneuvers (“I will nurture you by giving you
    extra Klonopin to get you through the holidays, but then I will
    be a disciplined parent-surrogate and reduce it in January.”) A
    family history of CNS lymphoma is less telling than a Dad
    who is a psychoanalyst. The adult child is crazy because the
    parents made him crazy.
    That’s the first thing. The second thing is this: they are almost
    always right.
    More in next post.
    What Goes Wrong In A
    Psychiatrist’s Family?
    February 2, 2007

    So maybe I am generalizing a bit, but I’m trying to get at


    something that isn’t easily explained by science: why do so
    many psychiatrist families go bad in the same way?
    In my experience (see, there’s my disclaimer) psychiatrist-
    parents go wrong in a very specific way. They judge behavior,
    not the person. It sounds like a good thing, I know. For kids,
    it’s a disaster.
    Psychiatrists identify the behavior, but then focus on changing
    not the behavior directly, but the underlying cause of the
    behavior— which is still not something intrinsic to the person.
    If a guy with bipolar spends $10,000 in a week, psychiatrists
    link the behavior to the bipolar, and then try to medicate the
    bipolar. (NB: “the patient has bipolar,” not “the patient is
    bipolar.”)
    The obvious problem here is that maybe the guy spent $10,000
    in a week because he doesn’t give a damn? Or he wanted to
    impress some girl? i.e. just because someone has bipolar,
    doesn’t mean every breath he takes is related to bipolar.
    Psychiatrists are going to deny that they make it so simple, but
    in actuality they do: the moment you raise the dose of
    Depakote, you are sending the message that the behavior was
    related to bipolar.
    The psychiatrists with children-patients handle their kids in the
    same way. They teach them what they are allowed to do and
    what they are not, what is acceptable and what is not— but
    make no judgment on the kids themselves. Doing this denies
    the kid’s identity, which is the whole purpose of childhood to
    begin with. Rules then exist in an invented framework, or
    worse, in a vacuum. There’s no internalization of the rules;
    there’s no superego. Just some arbitrary limits on id.
    If you tell a kid that a behavior is unacceptable, the kid has
    learned nothing about himself; he’s only learned that this one
    thing is something he can’t do. But if you make the kid own it
    — make the behavior part of his identity, then he has a chance
    to change his identity. Instead of learning it is unacceptable to
    take his brother’s potato chips away, he can learn that he has a
    choice: to be the kind of person who takes chips, or the kind of
    person who doesn’t.
    I understand the trickiness of this; you don’t want to make the
    kid feel like he is a bad person. But you do have to find a way
    to teach him that if he does that thing again and again, then he
    is a bad person. Is that what he wants? Who are you, kid? Who
    do you want to be? This also allows his to take personal credit
    for doing something good:
    And you can see the creation of a future borderline here. For
    God’s sake, will someone please tell me who I am? Give this
    storm of emotions some context? Right now, I get
    angry/sad/thrilled/terrified over nothing, it just comes over me
    — I wish I could be angry/sad/thrilled/terrified over
    something. But all people ever do is tell me what I can and
    can’t do. If I do something bad, people freak. If I do something
    good, no one even notices. No one likes me for me, they just
    over/underreact to what I do.
    There’s a second lurking trouble: parents’ control of their
    affect.
    The psychiatrist isn’t supposed to get mad at his patient; but
    then he comes home, and tries very hard not to get mad at his
    kid— just tells him the behavior is unacceptable, gives him a
    time out, whatever. But guess what? The psychiatrist is
    exhausted, eventually his patience runs out, and BAM! a
    tsunami of anger.
    calm&firm…calm&firm…calm&firm…EXPLOSION.
    The explosion part can come at any time, depending on how
    much patience the parent has that day. And that’s exactly the
    problem. What does the kid learn? That this ethereal rulebook
    for what is acceptable and unacceptable only has two, binary
    results: no affect, or all affect— and you never know what
    you’re going to get.
    In the biz, this is called inconsistent parenting.
    What the kid needs to know are the rules of the game; they
    need the parent to be consistent, predictable, so that they can
    be safely chaotic, experimental, exploratory off of your
    foundation. You want her to know exactly how you’ll react if
    she tries pot, you want a superego so well constructed you’re
    superfluous. And you want levels of emotion, different things
    get you more or less angry. We know you went berserk
    because your boss is a big jerk whose been riding you all day,
    but your two year old thinks you went berserk because she
    spilled the milk. Geez, sorry. May as well try heroin, what’s
    the difference?
    It doesn’t necessarily mean you have to be an angry parent—
    your predicted reaction could be anxious acceptance or loving
    disappointment— but it has to be predictable. And it has to be
    about the kid, not the behavior. The kid needs to know you’re
    connecting with them, not what they do, or else they’ll think
    that the only way to connect is by behaviors.
    You can see the further development of a borderline here: what
    the hell do I have to do to get some emotional response from
    you? Kill myself? Keep pushing until you finally blow up? I
    don’t even feel like I’m alive, but I’m not sure that you are
    either— or is it just me, that I matter so little that I can’t even
    get a little affect? You’re insanely jealous if I talk to another
    guy, but you totally ignore me when I’m with you. At least with
    jealousy you’re being real with me. Etc.
    Trust me on this: at age 2, a kid feels your rage and your love
    the same. It’s exciting, and they haven’t yet learned to fully
    differentiate the two feelings. What counts is the amount of
    emotion, not which emotion. (Horror movies and porn are the
    same to a 14 yo for this reason.) Fast forward 20 years— that
    all-out screaming match with your boyfriend felt weirdly
    relaxing.
    And so you have a scenario: busy psychiatrist, often tired,
    can’t generate much emotion past anger— and it can come at
    any time. No deep connection with the child as a person— as
    their kid, yes; as the sum total of their behaviors, yes— but not
    as a developing individual. The kid learns that as long as some
    things are done correctly— e.g. school— they can get away
    with other things that the parent won’t notice, e.g. pot.
    Oh, and this is the best part: if the kid (adult or child) becomes
    a psychiatric patient, they now have a bond with their parent—
    and the parent’s over-involvement in their kid’s psychiatric
    care is the framework for a relationship. It’s analogous to
    helping them build a go cart.
    And that’s all the kid ever wanted anyway.
    Geodon Is Not BID
    February 6, 2007

    If one more person tells me Geodon “doesn’t do anything,”


    I’m going to choke them with the capsules. If it’s never
    worked in your practice, how do you explain the numerous
    efficacy studies? All flukes? All of them? It couldn’t be you?
    Probably everyone has heard Geodon must be taken with food.
    But that’s not to prevent nausea or protect the stomach lining,
    it’s to get the drug to be absorbed.
    You’ll have to take my word for it right now that 120mg is the
    a base dose. (120mg Geodon=10mg Zyprexa=3mg Risperdal.)
    This is amazingly hard for psychiatrists to appreciate (“there
    are equivalences? And those are the doses??”) But it’s even
    harder to get them to understand the relationship to food:
    Geodon needs fat to be absorbed.

    80mg on an empty stomach (blue line) gets you the equivalent


    of 40mg if taken with food. That’s half the dose. In other
    words, if you dose your Geodon “all at night” (no food) then
    you’re getting about half of what you thought you were. (In
    chronic dosing this will be less of a problem, but 30-50%
    increased absorption with food is a good guideline.)
    Hospitals: they dose BID, which means morning and night,
    which means no food either time. Guess what happens (or
    doesn’t).
    BTW, crackers won’t do it. The graph above is with 800
    calories, 400 calories of fat. That’s a meal, not juice.
    If your doctor gives you less than 120mg and then gives up, he
    doesn’t understand the proper dosing of Geodon. If he doesn’t
    know about the importance of food, then you’re in big trouble.
    Forget about reading journals, he’s not even listening to the
    reps. (I know: because they’re biased.)
    I bring this up partly as a public service message, but also to
    explore the curious observation that even though many doctors
    know this already, they still don’t dose with food. I can’t
    imagine laziness is the answer. There is some weird thinking
    that this isn’t relevant in the “real world” because food is
    weaker than medication. Drug-drug interactions matter; drug-
    food couldn’t be important. And if it was really important,
    someone e would have mentioned it.
    Everyone complains about diabetes and weight gain; here’s a
    drug that likely doesn’t have these problems. But because it
    doesn’t have those toxicities, it therefore can’t be “strong,” or
    effective.
    I’m not trying to advocate for Geodon. I’m pointing out that
    much of our perception of a treatment’s efficacy can come
    simply from our mishandling of it; and to alert humanity to the
    inherent bias in ourselves. If we’ve never gotten Geodon to
    work, then not only do we think it doesn’t work, but we think
    everyone who says it does work is a Pfizer schill.
    Seroquel had this problem, too. Six years ago, no one used
    Seroquel. Now everyone uses it. Did they improve it? No. It’s
    marketing, but in reverse: Astra Zeneca didn’t delude
    everyone into thinking it works when it doesn’t; we deluded
    ourselves into thinking it didn’t, when it did. So whose fault is
    that? Depakote: six years ago Depakote was untouchable, it
    was the king of bipolar treatment. Now? Did we get new data
    saying don’t bother? Did they make the drug weaker? This is
    the key: the data that brings us today’s conclusions is the exact
    same data that gave us the past’s, opposite, conclusions. In
    other words, no one actually read the data; they based their
    conclusions on something else. Clinical experience? No.
    The bias goes well beyond “Pfizer paid that doctor off”— it
    comes from a belief system (“meds are life savers” vs. “meds
    are band-aids”; nature vs. nurture; your own race/gender; your
    family history of mental illness/drug abuse (or lack of it); your
    desire to be a “real doctor” etc, etc) that is much deeper and
    exerts a much stronger control over your thinking. To the
    exclusion of any new information.
    And, of course, it’s so much a part of you that you don’t see it
    as a bias. And other people (patients) don’t know it’s there, so
    they’re at the mercy of your unexamined assumptions.
    The solution is exhausting, and no one will like it: constant
    critical re-evaluation of your beliefs. Both the science (as
    much of it as there is) and countertransference. And, most
    importantly, long looks at your own identity. How did you
    come up with it? Because, in fact, you did.
    What Is The Best and
    Healthiest Coffee To Drink?
    February 11, 2007

    A short digression on my fourth favorite subject.


    Does coffee raise blood pressure? Does coffee elevate
    cholesterol? Does coffee hurt your liver? Does coffee taste
    delicious?
    At the outset, you need to know that not all coffee preparations
    are the same. The diterpenes cafestol and kahweol are the
    alleged cuplrits in the negative effects of coffee, especially
    raising cholesterol and increasing risk of coronoary artery
    disease. However, these are lipid soluble and are almost
    entirely filtered out by paper filters. Mix coffee grounds and
    water in a pot, and boil. Pour off the cofffee into a glass.
    Drink. Now look at the glass. That oily residue is— well, oily
    residue. You don’t get that with a filter.
    For example, here is the breakdown of lipids in coffee: filtered
    coffee: 7mg/cup. Boiled and unfiltered (Turkish): 60-
    160mg/cup. Metal screener (french press): 50mg/cup. The
    types of lipids in each were the same (no selectivity in lipid
    filtration.) So how you make your coffee matters.
    Blood pressure: as long as you’re a regular drinker, don’t
    worry.
    Reports of coffee elevating blood pressure are misleading,
    because they aren’t done they way we drink coffee: daily.
    Going from nothing to a triple espresso raises blood pressure;
    but chronic coffee drinking eventually allows for normalized
    blood pressure.
    For example, the much repeated finding “unfiltered boiled
    coffee causes a significant elevation in blood pressure,
    especially in women” is misleading: the study actually found
    that if you switch exclusively to boiled unfltered coffee from
    filtered coffe, your systolic blood pressure rises about 4mm
    Hg. However, switching from filtered coffee to abstinence did
    not have any effect on blood pressure or heart rate. Another
    study found a trivial change in blood pressure (-3.4mm Hg)
    after two months of abstinence (afgter 5 cups/d.)
    Interestingly, a metaanalysis of 16 studies found that chronic
    caffeine (400mg/d) raised systolic blood pressure by 4 mm
    Hg. while 5 cups coffee/d (>500mg caffeine ) only raised it
    1.2mm Hg.) This was corroborated by another study finding
    >5 cups lead to 1.35mm Hg increase.
    Cholesterol: raised slightly by unfiltered coffee, and
    possibly with filtered.
    Initial reports had found that drinking unfiltered coffee was
    associated with higher triglycerides and cholesterol levels than
    filtered coffee, because the filter removed almost all (80%) of
    the causative substance. Another study found unfiltered caused
    higher cholesterol (but not TG) than filtered; filtered coffee
    had no effect on lipids over no coffee at all.
    These findings were slightly contradicted in a recent study:
    Abstaining after 4 cups/d reduced cholesterol by about
    12mg/dl. Drinking filtered coffee raised cholesterol by about
    11 mg/dL. For perspective, 4 cups/d of whole milk would raise
    cholesterol by about 14mg/dL.
    The question t ask here would be, how good was the paper
    filter?
    Coronary/heart disease: no.
    Retrospective analyses find that >4 cups/d, but not <2/d, had
    almost double the risk of coronary disease; however,
    prospective studies found no increased risk.
    A review identified possible explanations for an increased risk
    of heart disease in coffee drinkers including a genetic
    predisposition to slower caffeine metabolism in some people,
    and the presence of diterpenes (which raise cholesterol) in
    unfiltered coffee . However, the same review found several
    studies indicating a protective effect of moderate coffee
    drinking, which they conclude is related to the antioxidants.
    One study found heart attacks more frequent in coffee drinking
    women than abstainers: but was only usefully relevant at <7
    cups/d, which doubled the heart attack risk. However, a
    gigantic 85000 middle aged women prospective 10 year study
    found no effect of 6 or more cups coffee/d on coronary heart
    disease.
    For what it’s worth, unfiltered coffee seems to be associated
    with higher rates of heart attacks than filtered.
    But it pays to wait: a week after I initially posted this, an 8
    year prospective study in the elderly found a dose dependent
    (i.e. greatest >4 servings) protective effect of caffeine in
    cardivascular mortality (reduced by 50%) (but, oddly, no effect
    on cerebrovascular mortality). Importantly, these were
    normotensive individuals.
    Suicide: Opposite of smoking: drink up.
    Gigantic 10 year prospective study of 86626 female middle
    aged nurses: suicide rate was reduced by 60-70% in those who
    drank more than 3 coffees/d, all other factors controlled.
    A Finnish study of 43000 people over 14 years— 216 suicides
    — found that 2-5 cups/d moderately (30%) reduces suicide
    risk, while >8cups increases risk 1.5 times. (For reference:
    “heavy drinking” (weirdly: 2 drinks/d) or smoking had about
    the same risk.)
    A 1993 study looking at death from any cause found a
    reduction in suicide risk (RR 0.87 per cup) with increasing
    coffee.
    Liver cancer and cirrhosis: can’t hurt, may help, especially
    if you’re an alcoholic.
    The same 1993 study above also found a lower risk of
    cirrhosis (RR 0.77/cup). The same authors, in a more recent
    study, again find such a reduction in risk, and find lower levels
    of liver enzymes ALT and AST. An Italian study found coffee
    reduced the risk of hepatocellular carcinoma from any cause
    (Hep B, C, alcohol, etc); same in the Japanese, and in the
    Japanese in a prosepctive trial. And in Americans chronic liver
    disease rates were half in 2 cups/d drinkers.
    Recent evidence suggests that this may be partly due to
    caffeine, but also to phenolic acid antioxidants which are not
    present in tea. The authors cite reports of such ingredients’
    protective effect sagainst various forms of liver damage
    (including Tylenol.)
    So if you’re going to drink coffee, there are two prudent things
    to do. 1) drink filtered coffee, made with a good filter. 2)
    drink medium roast, not dark roast. The roasting process
    burns off volatile chemicals such as caffeine and the
    antioxidants.
    For this reason, my vote for best, healthiest, and most
    delicious coffee to drink is Dunkin’ Donuts.
    Lost TV Series: Desmond’s
    Fear and Trembling
    February 15, 2007

    I’m no Lost expert, and I doubt the writers were thinking


    along these lines. But yesterday’s episode got me thinking
    about how we become who we are.
    For non Lost fans: Desmond believes he can sometimes see
    the future; he can see that Charlie will die. He also believes he
    is responsible to push a button; if he does not, the world ends.

    He meets an Oracle, who also sees the future— e.g. she knows
    the man in the red shoes (Wicked Witch?) will die— but
    explains that it is futile to try and save him, because “the
    universe has a way of course correcting,” that is, destiny will
    find another way to take his life. Save him from the scaffolds,
    tomorrow he gets hit by a bus.

    So Desmond now knows Charlie is going to die. He’s


    prevented the death twice, but he’s feeling the futility of it all
    — destiny is coming, hungry, and it will be satisfied.

    Desmond has to choose whether or not to continue trying to


    delay the inevitable. Desmond is the Cowardly Lion. He’s
    afraid, he’s confused.

    So be it. But the important question is not whether Desmond


    will continue to try to delay Charlie’s death, or just give up.
    The real question is why Desmond actually believes such a
    choice exists. How does he think he knows the future? Anyone
    else in his shoes would have come to a very different, more
    logical, conclusion: this is insane. What, he can predict the
    future? Worse: what, he’s the only reason Charlie is alive?
    He’s so— necessary? Isn’t that narcissism?

    You might say, “well, in the logic of the show, Desmond


    knows he can predict the future, and so he tries to save
    Charlie.” Wrong, and this is exactly the point. Remember how
    he correctly predicted the outcome of the soccer match— but
    was wrong about which soccer match he predicted? Sure, ok,
    Charlie’s going to die. When? 2014?

    Was Charlie really going to die in the water? Was he really


    going to get hit by lightning? Is Desmond actually saving him,
    or is it all— wishful thinking?

    So what makes Desmond’s story so powerful is not simply that


    he chooses to save Charlie again and again; what’s more
    important is that he chooses to believe in a life that where he
    must make such a choice.

    If Desmond knew he could predict the future— if it was a fact


    that he could predict the future— then saving Charlie would
    have little moral heroism. Any fool a step up from absolute
    evil would have tried to prevent a horrible outcome if he knew
    for certain what was going to happen.

    What made Desmond worthy of admiration was, exactly, that


    he did not know for sure he could predict the future. He took it
    on faith that he could, and then proceeded to live his entire life
    based on this single, faith based, assumption. He put his
    money where his mouth was.

    Desmond took a leap towards faith, not a leap of faith. He


    didn’t have faith to leap with. He went towards it, picked it.
    He didn’t know the button needed pushing, and so, like a
    soldier, took responsibility to push it. He took on faith that the
    button needed pushing and then furthermore decided it was his
    responsibility to push it, defying logic and sanity and evidence
    and, well, everyone else. The action wasn’t just heroic; it was
    heroic and defining.

    He decided that he was going to give his life meaning,


    importance, even if it was the most insane, solitary, depressing
    meaning available; and at the great risk that he could be
    wrong, a life wasted.
    If you know for certain God exists, there is nothing noble in
    believing in him. It’s only when you take the great gamble to
    live your life, your entire life, as if He exists— at the risk of
    being wrong, at the expense of an easier, happier life— that
    you define yourself as something greater. And once Desmond
    so defined himself, arbitrarily, he was able to take the next
    steps necessary to grow, evolve.

    And he does grow. Almost immediately, he becomes a better


    man: after accepting the logic in a worldview in which he can
    predict destiny’s path, he then also accepts a responsibility—
    saving Charlie— that he also knows is futile. He knows he has
    to fail, eventually, but he’s going to keep doing it anyway,
    because he thinks he can transcend his own logic.

    And because of this, he will succeed.

    That’s the Key in the Failsafe. How can you say that the button
    absolutely must be pressed, if there is a simple way of
    bypassing it? If pushing the button is the only way to save the
    world, why is there even a failsafe in case you stop pressing it?
    It’s a tricky answer: it’s because while the button was being
    pressed, the Failsafe did not exist. The Failsafe represents
    Desmond not failing, even in the face of reality. It isn’t a pre-
    existing backup. Desmond’s existence created the failsafe.
    Metaphorically, the Failsafe didn’t exist until Desmond took
    the final step: after accepting the futility of his actions, but
    deciding to do them anyway, he then decided he would not
    fail.

    No matter what happens— no matter how certain the reality—


    he knows he can not fail, and so he will always will a solution.
    It’s the religious existentialist position. Kierkegaard didn’t
    think logic and reason was going to get us to any absolute
    truth, and it certainly wasn’t going to help us understand an
    Unintelligible God (which is the same thing.) You just have to
    go to faith, embrace it, create a life using it as a postulate, and
    move forward.

    It’s narcissism done the right way. And, I suspect, it’s the
    secret to a meaningful life: picking an existence that is of
    value to more than just yourself, even if that existence defies
    the logic of reality— your biology, your environment, and, of
    course, everyone else. And once you have chosen who you
    want to be, once you have defined the parameters of this life,
    you force it to be true, as real as any gene or social factor. And
    know that once you have invested your life in this identity, this
    existence— all or nothing, even in the face of the doubt and
    terror that accompanies your “rational” self– it will be
    impossible to fail.

    …as ye have always obeyed, not as in my presence only,


    but now much more in my absence, work out your own
    salvation with fear and trembling.
    Pediatric Bipolar. Yeah.
    Okay.
    February 19, 2007

    Rebecca Riley is the 4 year old who died of psychiatric drug


    overdose— she was on 3 of them— supposedly with a
    diagnosis of bipolar disorder. If you want the scoop from a
    psychiatric perspective, you should read this post from the
    resident blogger (no pun intended) at intueri.
    But I’ll add two things. Let me be very clear: it is not unlikely
    a 4 year old has bipolar— it is absolutely impossible. This is
    because bipolar disorder is not a specific disease with specific
    pathology that one can have or not have; it is a description of
    symptoms that fall together. We decide to call a group of
    behaviors bipolar disorder— and meds can help them, for sure
    — but this decision is completely dependent on the context of
    the symptoms. Being four necessarily removes you from the
    appropriate context, in the same way as having bipolar
    symptoms during, say, a war, also excludes you from the
    context. You might still have bipolar, but you can’t use those
    symptoms during the battle as indicative of it. If I transplant
    you to Brazil, and you can’t read Portugese, does that make
    you an idiot?
    I don’t mean that 4 year olds can’t have psychiatric symptoms.
    I’m saying you must be more thorough, more attentive to the
    environment. As soon as a person— a kid— is given a
    diagnosis, it automatically opens the flood gates for bad
    practice that is thought to be evidence based. That’s what
    makes the diagnosis so dangerous. Instead of, “should I use
    Depakote in this kid?” it becomes “It’s bipolar, so therefore I
    can use Depakote.”
    Secondly, we must all stop saying these drugs are not indicated
    for kids. That’s meaningless. We can debate whether they
    should be used or not in kids, but you can’t say they shouldn’t
    be used because they’re not indicated. To quote myself (lo, the
    narcissism):

    Thus, categorizing a medication based on an arbitrary


    selection of invented indications to pursue—and then
    restricting its use elsewhere—may not only be bad
    practice, it may be outright immoral.

    I do not make the accusation lightly. Consider the


    problem of antipsychotics for children. It is an
    indisputable fact that some kids respond to
    antipsychotics. They are not indicated in kids. But don’t
    think for a minute there will be any new antipsychotics
    indicated for kids. Who, exactly, will pursue the two
    double blind, placebo controlled studies necessary to get
    the indication? No drug company would ever assume the
    massive risk of such a study— let alone two— in kids.
    And which parents will permit their child in an
    experimental protocol of a “toxic” antipsychotic? Rich
    parents? No way. The burden of testing will be
    undoubtedly born by the poor—and thus will come the
    social and racial implications of testing on poor
    minorities. Pharma is loathed by the public and doctors
    alike, and the market for the drugs in kids is (let’s face it)
    is effectively already penetrated. There will not be any
    new pediatric indications for psych meds. Not in this
    climate. Think this hurts Pharma? It’s the kids that suffer.

    It’s funny how psychiatry always tries to appeal to a higher


    authority (FDA, “studies”, clinical guidelines, thought leaders,
    etc) except when it gets in trouble. And then it’s always the
    same refrain: “no one can tell me how to practice medicine.”
    Just How Many Drinks A
    Day Is Bad?
    February 20, 2007

    Is a glass or two of wine a day good for you? You would think
    this would be an easy question to answer, but it’s not, and
    that’s because of this:
    How many glasses of wine are in a bottle?
    If you answered 4-5, continue reading. Because guess what?
    Apparently the answer is eight. No, I’m not kidding. Yes, they
    are serious. Unplug your monitor and ram it into your skull as
    hard as you can.

    “Doctors don’t know. They pretend to know. Because


    they have a rectal thermometer in their pocket. As if it
    were an appeal to a higher authority.”— Lewis Black

    It comes down to this: medicine doesn’t have all the answers,


    but in presenting their recommendations it sounds like they do.
    And we get confused.
    “Two drinks a day.” What’s a drink? Are the health
    benefits/risks of whisky and wine identical? Then why lump
    them together? And if the answer is, “well, we don’t know
    enough yet” then why are you making recommendations with
    the authority of medical certainty?
    The reason wine’s benefits/risks seem confusing is that no one
    emphasizes the size of a “drink.”
    A “drink” is often defined as 10g alcohol— that’s 1/8 of a
    bottle of wine.
    Many reference guides, in an attempt to make things simple to
    understand (if you’re drunk, maybe) use 10g/drink as a
    standard. There are 750ml in a bottle of wine. If the bottle is
    13% alcohol by volume, then there is 98ml alcohol per bottle.
    Alcohol’s specific gravity is .79, so there are 77g alcohol in a
    bottle. That means that there are 7-8 “drinks” in a bottle of
    wine, which, if I may editorialize, is so preposterous as to
    hardly merit comment.
    Similarly, for 5% beer, there is 0.05 x355ml x 0.79= so 14g
    per 12 oz can. Is a beer a drink and a half?
    Alcohol content varies greatly among wines and beers:
    Also, each wine has a different alcohol content— 12.5% is the
    typical French ideal, and most wines are built (i.e. alcohol
    osmotically removed) to stay under 14% because the tariff
    increases above that. There is a leeway of 1.5% in the listing,
    so 12.5% could be 11% or 14%. That’s a 2 “drink”/bottle
    difference.
    In the past few years, and especially with California wines,
    Syrahs, Zinfandels, places with hot climates, the trend has
    been towards using higher Brix (sugar content) grapes. (Riper
    means more sugar, which means more alcohol.) About 55% of
    the sugar ferments to alcohol, and the common 25 Brix grapes
    convert to a 13.75% wine. Plus you lose some water in the
    wine making process, so it may be even higher than that
    (15%).

    To complicate things further, each policy group advocates


    different safe drinking levels that are nearly incomprehensible
    to the layman, unless you convert them to some common
    measure (here, I convert to grams): The U.S. government says
    no more than 2 drinks per day— but that’s 14g each. France
    says no more than 5 per day— but it’s 12g each. Britain says
    3-4 “units”— at 8g each! Do the British know this? A British
    study (in Scots) found that people generally pour out two, not
    one, unit per drink. It’s no wonder people are confused.
    A better conversion is this: there is 77g alcohol in a 13%
    bottle of wine. That’s equivalent to almost a six pack. Go.
    Blood Alcohol Content: as accurate as a New York Times
    poll, but you can still go to jail.
    Converting to grams as a reference for drinking is useful
    because it allows you to predict your BAC. Here is how
    everyone tells you to calculate it: If you drink 40g alcohol and
    weigh 70kg, your BAC will be .05% (40g/70000g). Or, if you
    weigh 70kg, every 14g beer will raise your BAC by .02% Or,
    every 1/4 bottle of wine raises the level .035%. Isn’t math fun?
    I have seen countless “reference tables” using this method.
    But the units of BAC are g alcohol/100ml water. You’re not all
    warer, are you? You’re about… 60% water? So that 40g
    alcohol in really in 70kg x .6= 42kg water. 40g
    alcohol/42000ml water= .09%. Congrats. You’re drunk. Sort
    of.
    In practice, those reference tables telling you your estimated
    BAC already incorporate the Widmark constant— the
    percentage body water. It can range from 40-85% water. The
    more water you have, the lower will be your BAC. Women
    have less water, so their conversion runs lower (40-50%).
    Muscle= more water; fat=less water. The problem, obviously,
    is while BAC calculations use a standard— for example, my
    .6, above— individuals can vary greatly. Hence, lawyers.
    But wait: Breathalyzers. It’s measuring the alcohol content of
    your breath, not blood. What’s the ratio of alcohol in breath to
    blood? 2400:1? 2100:1? Generally, breathayzers are calibrated
    to underread your alcohol level, by about 10%. So even
    though most humans run 2400:1, it is calibrated at 2100:1. But
    don’t try to argue “individual variability” of a breathalyzer in
    court: 2100:1 is part of the statute, and thus your reading is
    your sentence. But remember, liquid to gas transitions are
    described by Henry’s coefficient: heating a substance (e.g.
    alcohol) puts more in the air (breath); cooling the air (breath)
    makes the substance stay in liquid (blood). So before you blow
    into the machine, hyperventilate and roll in the snow.
    The point here is that you— and guidelines— cannot predict
    your BAC based on how many “drinks” you had, because
    there are so many confounding variables.
    Note that BAC doesn’t tell you how drunk you are— tolerance
    might mean you’re an effective Lisp programmer at .1%, or
    you’re beer goggling at .02%. At a given weight, higher
    percentage body fat= more drunk. Also, food delays
    absorption. Finally, some people metabolize alcohol faster
    than others; the old rule “a drink an hour” is based on the
    assumption that you metabolize 10g alcohol per hour (or your
    BAC falls by .01%/hr)— but in you it may be 20g/hr (e.g. a
    daily drinker), or 5g/hr (e.g. young woman rarely drinks, on
    Tylenol) etc.
    But legal driving limit is usually .08%. And 50% of the time,
    .4% is death, so there’s that.
    Health Benefits of Wine? Or No?
    So since the term “drink” is uselessly vague, in reviewing the
    literature on wine and beer’s effects, I’ll do my best to convert
    to grams of alcohol. Just remember that a bottle of wine is
    77g, and 12oz 5% beer is 14g.
    Cholesterol, triglycerides, coronary artery disease: about
    half a bottle of wine, but at least 20g/d, raises
    HDL,;decreases TG, CRP, fibrinogen, and decreases risk
    of CAD.
    Generally, moderate alcohol consumption (say, 30-40g/d) is
    associated with decreases in mortality. This is hypothesized to
    be related to a) its HDL raising effect; b) its reduction of pro-
    inflammatory proteins CRP and fibrinogen (i.e. it’s anti-
    inflammatory.)
    One of the studies, in Nature, that popularized “moderate
    consumption” was this: 40g/d (from beer) for men, 30g/d for
    women, reduced inflammatory markers C-reactive peptide
    (35%) and fibrinogen (12%), increased HDL (10%), with no
    change in TG or liver enzymes. after 3 weeks of drinking. The
    study called this “four glasses” but a better way of
    understanding it is three beer cans or half a bottle of wine.
    Also: BAC 1 hour after drinks was 10mmol/l. Yes, mmol.
    Sigh. 46g/mol: BAL .046%
    A prospective study confirmed the “well-known” relationship
    between alcohol consumption and HDL, which rose from 40
    to 50 with >30g/d alcohol.
    A German study of 7000+ people found HDL rose, and
    fibrinogen decreased, for women who drank 10-20g/d and men
    >30g/d.
    A Danish study found an interesting relationship: women who
    drank at least once per week had lower risk of CAD than
    abstainers; but drinking more often did not promote the effect.
    But for men, daily drinking (more than less frequent drinking)
    was associated with the lowest risk.
    Oxidative Stress: doesn’t ethanol cause lipid peroxidation
    (free radicals?) Answer: you’re not drinking ethanol,
    you’re drinking wine—which probably increases
    antioxidant capacity.
    This is how you get plaques: free radicals in your diet (e.g.
    cooked fat) promote LDL oxidation, which goes on to promote
    arterial plaque formation. Free radical scavengers, such as
    Vitamin E, would lessen this effect— but are consequently
    reduced. Importantly, the LDL from a meal is more susceptible
    to oxidation than normally circulating (fasting) LDL.
    Alcohol promotes oxidation in test tubes. So why wouldn’t it
    do so in people? For example, a careful study controlled for
    many confounding variables that are associated with high or
    low alcohol intake— such as smoking, vitamins, exercise, etc
    — and found that the more alcohol consumed, the higher the
    oxidized LDL, with no change in HDL. Where did the
    protective effect go? One possibility jumps to mind: median
    consumption was 6g/d; and the above studies found the
    relationship with the higher “doses.” And you need to be a
    regular drinker: 96 hours after a single dose of wine there was
    no effect on LDL. Surely I’ve made this up? No: 300ml red
    wine (better than 300ml white wine) inhibited oxidation (e.g.
    LDL oxidation). The likely explanation is that even though
    alcohol can cause oxidative stress, wine— and it’s constituents
    (polyphenols, resveratrol, etc) may overwhelm this effect. But
    you have to drink enough (>300ml) so that it overwhelms
    alcohol’s effects (but not so much your wife leaves you.)
    Additionally, wine’s beneficial effects in preventing oxidative
    stress may be enhanced when you have more oxidative stress
    to begin with. Take the easy case of eating a fatty meal. The
    LDLs that result from this meal are more likely to be oxidized
    than the normal fasting LDLs in circulation. Drinking 400ml
    of wine with a meal made these post-meal LDLs more
    resistant to oxidation than even the existing LDL, and
    maintained the Vitamin E levels. And in case you’re a rat, in
    rats who were force fed a high cholesterol diet, wine reduced
    the cholesterol levels and improved antioxidant parameters.
    Not just meal related oxidative stress: 1/3 bottle of red wine a
    day for two months in people who just had angioplasty
    substantially increased antioxidant reactivity and decreased
    oxidative damage. There is a logic to this: the lower your CRP,
    the better is your natural antioxidant capacity, and wine lowers
    CRP proportionally more if it is already high. A glass of wine
    (or one espresso- how do you like that!) was equivalent to an
    orange or 200g spinach in antioxidant capacity.
    Homocysteine (which causes coronary plaques)? Maybe it
    goes up a little, but that might not matter, especially if
    you’re drinking wine.
    42 men got to drink half a bottle of WHITE wine a day for a
    month: lower oxidation products (and coincident increase in
    free radical scavengers and HDL), but also increased
    homocysteine.
    A prospective study found that after 6 weeks of 30g/day of
    wine/beer/spirits, homocysteine levels were higher than in
    controls. Folate levels were also lower (except in beer—
    because beer has about 30ug folate/beer and0.1ug vitamin
    B6/beer.) Folate and B12 are cofactors in the conversion
    (methylation) of homocysteine which is then broken down
    (sulphyrated) with vitamin B6 as a cofactor; so low
    folate/B12= high homocysteine. Similarly, in chronic
    alcoholics homocysteine was much higher— but less so with
    beer.
    And again, but with 40g/d drinking wine and spirits for three
    weeks, homocysteine went up 9%. Beer had no effect. But B6
    went up with all drinks (more with beer). Not only does B6
    facilitate homocysteine degradation, it is also an independent
    inverse risk factor for cardiovascular disease.
    But perhaps amounts are relevant: in another prospective
    study, 1/2 bottle/d of red wine for two weeks had no effect on
    homocysteine, while doing the expected increase of HDL and
    antioxidant capacity.
    A study using pig coronary arteries found that while
    homcysteine impaired endothelial cell relaxation, red wine
    negated this adverse effect.
    It appears that homocysteine goes up, but that doesn’t translate
    to any increased cardiovascular risk because of some
    beneficial effects of the wine, which may include B6,
    antioxidants, increased HDL and increased antioxidant
    capacity.
    Blood Pressure? Answer: No serious effect below a bottle
    of wine a day.
    German study (above) finds <80g/d associated with <2 mmHg
    increase; >80g/d associated with 4-6mm Hg increases.
    American Idol makes mine go up more.
    Much of the negative data on blood pressure is perplexingly
    inaccurate. By “perpelxingly” I mean that the errors could not
    have simply been oversights, could they? People are lumped
    together, as are quantities and types of alcohol, giving
    misleading results. For example, in an article entitled,
    “Alcohol is Bad For Blood Pressure“— seriously, that’s the
    title of the scientific article— the authors state:

    Since then, large-scale prospective studies from Japan (6)


    and the US(7) have indicated that the risk of hypertension
    increases twofold with alcohol intake of 30–50 g/day or
    more.

    Hmm. “Increases twofold.” I’m not sure what article they


    read, but reference 7 pretty clearly says the opposite:

    Our principal finding was the association between the


    consumption of low to moderate amounts of ethanol (up
    to 3 drinks per day) and either the incidence of
    hypertension or increase in blood pressure levels in
    blacks. In white men, there was no evidence of an
    increase in systolic or diastolic blood pressure over time
    at this level of consumption. Similarly, for most
    beverages, a low to moderate intake of alcohol was not
    associated with a higher incidence of hypertension in
    white men and with an increased incidence in black men.

    And later:

    the observation that low amounts of alcohol intake may


    not increase blood pressure in most race-gender strata
    could lead to a more tolerant view of the consumption of
    alcohol in small amounts…

    Black men who drank heavily had double the incidence of


    hypertension (defined as a jump to > 140/90): 15% vs. to 30%
    in drinkers. But I should add that the risk was relevant only in
    black men who drank beer or spirits; only 8 out of 250+ drank
    any wine at all.
    Thus, blood pressure is minimally affected by wine, and even
    beer or spirits, if other variables are controlled. There is a
    negative effect of beer and spirits in blacks that needs to be
    explored, as does the effect of wine in blacks.
    Pancreatitic disease: How many drinks before you’re in
    trouble? Answer: >30% of your daily calories from alcohol
    if you poor nutrition; or >1 bottle wine/day for 25 years,
    especially if you eat like a pig. Smoking=death. (But you
    knew that.)
    You’d be amazed at how hard this simple question was to
    answer.
    As an aside, almost every study done in 2005-2007 on alcohol
    and pancreatic disease was done in Japan or China. I’m sure
    there’s a reason for this, but for the life of me I can’t tell you
    what it is. And if someone is able to explain to me how the
    Japanese and Chinese physiologies are generalizable to
    everyone, I’d like to hear it; but that’s what happens.
    The main problem with the studies is that risks of pancreatitis
    are associated with an arbitrary cut off that does not reflect the
    actual toxicity of alcohol. For example, a study found that >2
    drinks/d, compared to <2 drinks/d, was significantly
    associated with pancreatic necrosis. So we’re all going to die?
    The problem is that this association was either/or, not
    calibrated to amount. For example, what if those who had the
    necrosis all drank more than 10drinks/d? It would still be true
    that the risk was higher at >2 drinks/d. So why 2/d as the
    cutoff? “The cutoff of two drinks per day was selected based
    on animal studies which have shown that the equivalent
    consumption of two drinks per day in rats results in
    measurable change in pancreatic histology and
    physiology(13).” So, of course, I looked up (13): in rats who
    received 12%, and worse with 36% of their calories from
    alcohol increased pancreatic protein hypersecretion, starting
    the road to pancreatitis. If you eat 2000 calories a day, then
    this would be equivalent to a little more than 1 bottle of
    wine/d.
    A Japanese study found that the traditional rates of pancreatitis
    among alcoholics— 2-5%— may be low: they find that 9-17%
    of people who drank >150g alcohol/d developed alcoholic
    pancreatitis. The alcoholic pancreatitis patients began drinking
    at a younger age (18), drank for 20 years) and drank 180g/d
    alcohol. Additionally, they cite other studies where meat and
    lipid may be co-factors.
    An interesting study found the risk of acute pancreatitis may
    be increased in the first day of withdrawal of drinking; these
    drinkers had drank an average of 700g/week (400-900g), and
    3600/two months. Alcohol suppresses inflammation, so this
    may be a rebound inflammatory response.
    A Chinese study found that smoking, high meat and heavy
    drinking was associated with pancreatic cancer. Heavy
    drinking was “>20 cup-years;” basically, 11g/d for 20 years, or
    22 g/d for 10 years, etc. The article did not address the hihger
    rates od ALDH2*2 allele of aldehyde dehydrogenase in the
    Chinese, which slows the metabolism of aldehyde (and allows
    it to build up— see below.)
    Another Japanese study (come on) found risk increased 10 fold
    for >100g/d, and >30 years of drinking.
    Alcohol alone is not a risk factor for pancreatic ductal
    adenocarcimona, which is most closely associated with
    smoking. Alcohol may indice pancreatitis and diabetes, which
    are themselves risk factors. Also, acetaldehyde, an
    intermediary metabolite of alcohol which is ordinarily quickly
    metabolized to acetic acid, is procarcinogenic; heavy drinkers
    with cancer, vs. alcoholics without cancer, had higher salivary
    aldehyde levels due to fast metabolism of alcohol to aldehyde.
    (I SPECULATE that binge drinking, and frequent exposure to
    acetaldehyde (read: hangovers) is more dangerous than low
    but daily drinking.)
    Finally, you should know that many studies describing the
    risks of alcohol are not able to control well for smoking, which
    is a major risk factor. Consider that 60% of chronic
    pancreatitis cases are smokers; but 80% of alcoholic chronic
    pancreatitis cases are smokers. And high BMI is a risk.
    Diet and alcohol: in animal models of alcohol induced
    pancreatic disease, & calories due to alcohol is the measure.
    For example, one mouse model uses 24%, and the mice had
    BAL 100mM (.46%). Most animal modesl use about 30%.
    One study disputed the high protein/high fat risk of
    pancreatitis by finding that humans with pancreatic or liver
    disease took 50% of their calories as alcohol, and the worst
    cases had the highest percentage intake. A study in Mexico
    found high overall caloric intake (4110 vs. 2250 in healthy
    controls) was the risk factor, but dividing the average daily
    alcohol (124g=868 cal) by calories (4110) gives you 21%
    calories from alcohol.
    The type of alcohol here is not described. Was it red wine?
    Vodka? Beer? You decide.

    So there are two prongs: high caloric intake, especially


    from fats and protein, and consequent high BMI, along
    with alcohol (>100g/d, conservatively;) or poor nutritional
    intake with higher proportion of alcohol calories (>30%).
    With both, smoking is a profound risk factor, especially for
    cancer.
    Stop smoking.
    Resveratrol:
    Resveratrol (a type of estrogen (DES)) is a polyphenol
    contained in wine (and fruits, grapes, etc.,) that is itself anti-
    inflammatory and antithrombogenic (it’s a COX1— COX2?—
    inhibitor), as well as possibly being neuroprotective. It
    probably is an anti-flu drug. It can possibly prolong life span
    through SIRT1 (which is how calorie restriction prolongs life.)
    Resveratrol is one possible explanation for why the French can
    eat fried butter sandwiches with a bottle of wine and still tell
    their grandkids about it.
    There is no accepted dose. A bottle of red contains about 1mg,
    unless you’re drinking muscadine wine (Florida grapes, some
    ports, etc.) It appears to have no toxicities.
    I bring it up here only to tell you that as much as I think
    resveratrol is super and all, it oxidizes very quickly after the
    bottle is opened. So drink fast.
    Calories:
    There are 7 calories/gram alcohol. So each bottle of wine has
    about 550 calories. Each light beer is 110 calories. There are
    about 50 calories in a shot of whisky.
    Summary And Conclusions:
    Disclaimer: I’m not recommending anything to anyone, I’m
    not your doctor, results may vary, substantial penalty for early
    withdrawal (HA!). Don’t drink if you have GI disease. Or if
    you drive. Or if you’re on medications. Or if you’re an idiot.
    Especially if you’re an idiot.
    But it appears to me that 30-40g (1/3- 1/2 bottle) of wine
    alcohol a day is fine. Enjoy it. (Unfortunately, I’m a whisky
    guy.) It seems to work best if you drink it with food. Everyone
    else should just mellow the hell out. This unprioritized rigidity,
    this obsession, with “health” and “prevention” is idiotic and
    counterproductive. Today I cooked my family bacon and eggs.
    BACON. Take that, AMA’s beliefs.
    Some caveats: most of the association studies, above, do their
    best to control for confounding factors, but sometimes this is
    impossible. As a basic generalization, the person who drinks
    1/2 bottle wine with dinner is likely to have a very different
    life than one who drinks 4 beers/day after work,
    notwithstanding the obvious confounding variable of alcohol
    with/without food. So it may be impossible to say that wine,
    itself, is what is beneficial.
    Despite this— and why this is relevant to a psychiatry blog—
    the error is to assume that one is “the type of person who
    drinks wine, and so would have lower risks” vs. “the type of
    person who drinks beers, and so would have higher risks.” It
    may be more accurate to consider that if one chooses to
    become the person who drinks wine with dinner instead of
    beer after work, a variety of other factors may also change. As
    a simple example: beer at a bar is conducive to smoking, wine
    at home isn’t. Beer after work every day may be sabotaging
    your family life; a choice to switch to wine at dinner may
    improve things at home. &c., &c.
    This is important. It is the thesis of this blog: nothing matters
    more than your will. Even if wine and beer are themselves of
    no consequence to one’s health, the lifestyle that follows with
    the conscious choice to drink either one is of consequence.
    Every choice you make influences your identity, and not the
    other way around; the sooner you accept this, the sooner you
    can become the person you want to be. You get to pick who
    you are. Go pick.
    (State laws prevent me from receiving donations of wine (or
    whisky.) My drink is Balvenie 15 year. It’s about $65. Just
    saying.)
    See also: Is This The Real Secret of Wine’s Health Benefits?
    Clarification On What Goes
    Wrong In A Psychiatrist’s
    Family
    February 27, 2007

    Many interesting and varied reactions to my post, “What Goes


    Wrong In A Psychiatrist’s Family?” It struck a nerve with a lot
    of people, and others couldn’t relate to it at all. But I would
    like to clear up one element:
    It’s not that even handed, calm, unemotional criticisms
    directed only to the child’s behavior is wrong; it is that no one
    does it well. And that’s where it all falls apart.

    SOME psychiatrists think/try to do something noble (criticize


    behavior and not the child itself) but they are HUMAN, and
    get tired. They will eventually get angry, and, from a kid’s
    perspective, when the parent gets angry is what matters. What
    did I do to piss Dad off?
    The opposite of this, call it the non-psychiatrist parent, is calm,
    then gets a little angry, a little more angry, a little more angry,
    then yells, screams. There’s a build up. A few years of this and
    you realize that there are some things that make Dad a little
    angry, and other things that make him really angry. There’s
    normal, varying levels of human emotion to different
    situations.
    But the child of a psychiatrist doesn’t get that. He gets binary
    emotional states. “Lying is not acceptable behavior.” Later:
    “Yelling loudly is not acceptable behavior.” Later: “Picking
    you nose is not acceptable behavior.” Later: “Stealing is not
    acceptable behavior.” What’s the relative value? A kid has no
    idea— he thinks the value is decided by Dad, not intrinsic to
    the behavior. “Eating cookies before dinner is not acceptable
    behavior.” Later: “Kicking your brother is not acceptable
    behavior.”
    Ok, now here it comes:
    After seven or eight or twenty five “not acceptable behavior”
    monotones, Dr. Dad can’t take it anymore; he explodes.
    “Goddamn it! What the hell is the matter with you?! What are
    you doing?!!” All the anger and affect gets released, finally.
    The problem— the exact problem— is this: the explosion of
    anger came at something relatively trivial. Maybe the kid
    spilled the milk.
    So now the four year old concludes that the worst thing he did
    all day was spilled the milk— not kicking his brother, or lying,
    or stealing. Had he not spilled that milk, Dad wouldn’t have
    gotten angry.
    Add this up over, say, a year: mostly flat, neutral monotones,
    peppered with unpredictable yelling patterns, inconsistent
    explosions, and now the kid can’t form a hierarchy of good
    and bad. In fact, what he learns is that good and bad are
    defined almost exclusively by the reaction he gets from others
    (e.g. Dad) and not the behavior itself.
    You say: but the kid’s not an idiot, he’s going to know that
    stealing is worse than spilling milk. Well, how is he going to
    learn that, except from you? You say: just going through life—
    every kid eventually learns it. Yes, they learn that it is worse,
    but not why it is worse. The conclusion is that the hierarchy of
    bad and worse is determined by the severity of people’s
    reactions.
    You say: the solution is that Dr. Dad needs to work on
    maintaining his calm all the time, and not exploding. Well, it’s
    not going to work: he’s human. Eventually the electric bill will
    be too high, or his wife cheats on him, or he has the flu, or he’s
    stuck in traffic all day. And he’ll explode (or, the alternative:
    check out. “I’m not dealing with this anymore.”)
    Consider this: a kid knows exactly how his father feels about a
    certain patient, or colleague, or friend, because he sees a
    consistent and predictable reaction in the Dad every time the
    person is mentioned. But the kid does not have that clear link
    for himself. There’s more informational affect from Dad
    talking to a patient on the phone then there is when punishing
    you.
    Contrast this with the reaction of, say, a hypothetical “angry
    Dad” who has six beers a day after work: he’s always pissed
    off. Always. Even though he flips out over spilled milk, he
    flips out over everything. The consistency of his anger makes
    the anger attributable to him— “Dad’s insane”— not to you or
    your behavior. You don’t infer from this that what you did is
    good or bad— you’ll have to learn that elsewhere.
    But just as you’ve identified Dad as “Angry Dad” you might
    also infer that he hates you, that you are a bad person. This is
    clearly not a good thing, but the point is that you develop an
    identity from it, you get defined (though negatively.) The
    inconsistency of the psychiatrist-parent’s anger is confusing;
    why this thing, and not the other thing? Why so much
    consistent (same kind and amount) affect talking to an auto
    mechanic, and so little affect— especially consistent affect—
    with me?
    So you have a psychiatrist-parent, who works long hours; who
    tries hard to be neutral even in punishment; who gives little in
    the way of emotional information about a kid’s identity, but is
    so obviously clear about other people; who once in a while
    explodes, inconsistently, over unpredictable things.
    Here it is again, where it all goes wrong: the child develops an
    identity which is about the reactions of others. “People’s
    opinions of me are based on how I make them feel.”
    Disclaimer again, and for the last time: not all children of
    psychiatrists go insane, not all psychiatrists suck as parents, I
    don’t know what I’m talking about, Bush lied, etc, etc. Please
    understand I am not criticizing psychiatrist parents, I’m trying
    to understand something.
    You come home, and find your kid has spilled the milk. How
    do you react? Ok, now ask your kid: how do you think I’m
    about to react? The answer, ideally, should be the same. If it’s
    not, you’ve got a problem on your hands.
    This Is How I Know Society
    Is Collapsing
    February 28, 2007

    From Psychiatry Vol 4. No. 2, Feb 2007 p.42:

    “Second, paternal postpartum depression might be related


    to lower levels of estrogen.”

    I didn’t read any further because both my eyeballs exploded.


    The Psychological
    Uncertainty Principle
    March 7, 2007

    A commenter, who I believe is a physics undergrad (his blog


    here) emailed me some of his thoughts on narcissism, and
    wrote:

    …those studies where people rank each other in a room


    for different attributes having never met them… I think
    what’s going on is we assign people personalities based
    on how they look and force them to become a certain
    thing, creating a whole custom world for them…

    which puts the idea of “profiling” on its head. Do we actually


    ever “figure people out,” or do we change them into what we
    think they are by the act of engaging in a relationship (on any
    level) with them? It sounds a lot like a psychological version
    of quantum entanglement:

    When two systems, of which we know the states by their


    respective representatives, enter into temporary physical
    interaction due to known forces between them, and when
    after a time of mutual influence the systems separate
    again, then they can no longer be described in the same
    way as before, viz. by endowing each of them with a
    representative of its own… By the interaction the two
    representatives have become entangled.

    Which, unfortunately, sounds a lot like this (p. 236):

    The unreflective consciousness does not apprehend the


    person directly or as its object; the person is presented to
    consciousness in so far as the person is an object for the
    Other. This means that all of a sudden I am conscious of
    myself escaping myself, not in that I am the foundation of
    my own nothingness but in that I have my foundation
    outside myself. I am for myself only as I am a pure
    reference for the Other.

    You can’t know who a person is without relating to them, and


    once you do that, you irrevocably change them.
    Only in relationship to another do you get defined. Sometimes
    you can do it with your God; but either way, any adjective has
    to be placed on you by someone else. Are you brave? Strong?
    funny, stupid, nervous? All that comes from someone else. So
    when someone relates to you, they define you. You can try to
    control this— hence the narcissist preying on the borderline to
    get her to see him the way he wants to be seen— but
    ultimately it’s up to the other person.
    So we’re are, or become, whatever a person thinks we are?
    No, it’s worse than that— we want to be what they think we
    are. That’s why we maintain the relationship, otherwise we’d
    change it. (“I divorced her because I didn’t like who I
    became.”)
    We do it because it is easier, and it serves us. You’re kind
    because he sees you as kind— which in turn allows him to be
    seen as someone who can detect kindness. And you accept that
    you’re kind— or mean/vulnerable/evil/brilliant— because it
    serves you— there’s some gain there. But a strong person
    accepts that on the one hand the other person gives you
    definition, and on the other hand you are completely
    undefinable, free, at any moment, to redefine yourself. You
    can defy him, biology, environment and be anything.
    You say: but I can’t be a football star just because I want to.
    But that’s wanting someone else to see you in a certain way.
    Do you want to play ball? Go play ball. “But I won’t get on
    the team.” Again, that’s wanting to change someone else.
    Change you first.
    But what about— identity? That’s the mistake, that’s bad faith.
    Thinking that our past is us; what we did defines us. Our past
    can be judged— what else is there to judge?- but it can’t—
    shouldn’t— define us, because at any moment we are free to
    change into something, anything else. And so, too, we can be
    judged for not changing.
    Ultimately, you are responsible for everything you do and
    think. Not for what happens to you, but for how you choose to
    react. Nothing else made you be. Nothing else made you do.
    Trinity said it best: The Matrix cannot tell you who you are.
    Reciprocal Determinism And
    Why Punching People Out Is
    Way Cool
    March 9, 2007

    A quick addendum to my previous post on the “Psychological


    Uncertainty Principle.”
    A reader pointed out that some of this is explained by
    “reciprocal determinism”, which basically means that you
    respond to your environment, but then force a change in your
    environment which further changes your behavior. For
    example:

    1. “Girls don’t like me. Girls don’t like me. Girls don’t like
    me.” Repeat x 100.
    2. So a girl thought she liked you, but then met you, and
    now decided you’re a nutter. So she bolts.
    3. Now you have proof girls don’t like you.

    It sounds like reciprocal determinism says who you are affects


    your environment, which then affects you.
    That’s wrong. In the above example, it wasn’t ever true that
    girls didn’t like you. You made it true. You changed your
    behavior, somehow, that made it so that girls don’t like you.
    You received some gain from making it true that girls didn’t
    like you— perhaps it helps you avoid intimacy, etc, etc.
    So your identity never enters the equation. Reciprocal
    determinism is about behavior, not identity. Albert Bandura
    (the originator of this concept) was responding to Skinner’s
    behaviorism.
    Wikipedia’s article on reciprocal determinism is a perfect
    example of this exactly wrong use of the concept. They
    describe how low MAOA enzyme can cause you to be
    antisocial. In fact, it is the opposite: having low MAO-A does
    nothing, but having high MAO-A seems to be protective. The
    reason people became antisocial (synonymous with criminal)
    in those studies was that they were abused— in essence, they
    imitated the behavior.
    The experiment Bandura is famous for speaks to my point
    about the absoluteness of your responsibility for your identity:
    kids watched adults beat up a bobo doll, and were then put in a
    room with a bobo doll, and, surprise, the majority then
    imitated this behavior, even using the same hitting techniques
    and repeating the same phrases the adults did. Nothing genetic
    or even environmental affected this outcome— almost all the
    kids did it (and almost none of the control kids who didn’t
    watch the adults beat up the doll).
    So watching the Matrix causes kids to go Columbine? Bandura
    would have said yes. But oddly no one ever wonders why then
    the cooking channel doesn’t result in more pies, or why porn
    hasn’t prompted rampant depilation. Bandura’s theory of
    reciprocal determinism required a key element: reinforcement.
    There has to be a gain in the imitation, in the identification.
    You may have “learned” the violence by watching it, but you
    won’t display the violence unless there is some reward— it
    isn’t just a reflex, some part of your core identity. You decide
    to imitate it, because it rewards you. How? “I want to be just
    like my Dad” (except he beats Mom.) “Neo is so cool.”
    (Didn’t he kill all the human security guards?) “Thug life!”
    Etc. Note that no one ever imitates the violence of, say,
    Gollum. Want to know why? Because Gollum never scores
    any chicks.
    So once again, you pick who you are. Or: you picked who you
    are, how you behave, whether you know this or not. So now
    ask: why did you pick this person, this identity? And what is
    preventing you from changing any or all of it?
    Sleep Loss And Moral
    Judgment
    March 14, 2007

    There’s an article making the rounds that I’d like to kill off
    right now, before it becomes a meme, or worse, another
    unsupported postulate common among psychiatrists.
    The title of the Reuters news story about the article (in Sleep)
    is this: “Sleepless nights may hinder moral judgments.” And
    has sentences like this: “[subjects] took a longer time to mull
    over the morally charged questions when they were sleep-
    deprived than when they were well rested. This was not the
    case with the more minor, non-moral scenarios.”
    And there’s your self-serving, exculpatory imbecility of the
    day: a sleepless night or two turns us into lycanthropes, or at
    least hyenas. (“I was so tired I couldn’t think straight.”)
    Fortunately for the existentialists, the Reuters reporter didn’t
    actually read the Sleep article, which doesn’t actually say this.
    The Army study subjected volunteers to 53 hours of sleep
    deprivation and presented them with a battery of moral
    dilemma type questions (“is it morally appropriate or
    inappropriate to do X if Y is at stake?”)
    In contrast to the obvious suggestions of the Reuter’s title, the
    study found that it took sleep deprived subjects longer to
    identify something as morally appropriate, but had no effect
    on how long it took to label it inappropriate. In fact, relative to
    a non-moral issue, sleep deprived subjects were able to label
    something as morally inappropriate faster.
    Quoting the authors:

    When tested at rested baseline, participants showed no


    significant differences between response times for
    scenarios judged as “appropriate” versus those judged as
    “inappropriate” …. In contrast, when deprived of sleep
    for over 53 hours, these same participants showed
    significantly greater difficulty judging emotionally
    charged MP (personal moral) courses of action as
    “appropriate” relative to judging them as “inappropriate.”

    In other words, sleep deprivation made it harder for them to


    say something was right, but not harder to say it was wrong.
    To use a metaphor, you “know” things are wrong; but you may
    have to judge if they are right.
    The study also looked into whether people labeled something
    as morally appropriate more often if they were sleep deprived,
    i.e. were they more permissive. First, if the subject had high
    emotional intelligence, sleep loss had no effect. Secondly,
    having an “average” emotional intelligence lead to an increase
    in the number of scenarios labeled appropriate: 2/10 when
    rested vs. 4/10 when sleep deprived. In other words, people
    with high emotional intelligence have stable, “unwavering”
    moral judgments, even in the face of sleep loss. Or, put
    another way: if you’re clear on what you believe, sleep
    deprivation isn’t likely to confuse you.
    This is important because the Reuter’s title, and indeed the
    psychiatric utilization of this idea, puts the ability (or inability)
    to make moral judgments on external factors— “he was sleep
    deprived, and that impacts your judgment.” This is prima facie
    false; but anyway is not supported even by the very science
    they themselves use to back the claims.
    We can set aside the debate on whether chemicals and
    psychosis can alter moral judgments; but I think it’s fairly safe
    to say that if your moral judgments are affected by 53 hours of
    sleep deprivation, sleep isn’t the problem.
    ––-
    Note: the study also found that caffeine did not reverse the
    alterations in moral judgments due to sleep loss. I don’t buy it;
    more later.
    Pathological Liars
    March 18, 2007

    So you think you might be dating a pathological liar? No,


    you’re not. He’s just a big jerk.
    The popular stereotype of a pathological liar— a chronic liar,
    deceiver, who lies to get out of things, or into things; who tries
    to con you into something, or control you; who cheats on you
    and then denies it, makes up stories about where he was— all
    this is wrong. It’s malingering, but it isn’t pathological lying.
    He’s a tool, but he’s not psychiatric.
    “Pathological lying” is often interchanged with “pseudologia
    fantastica.” (NB: many psychiatrists use pseudologia fantastica
    interchangably with confabulation— this is also wrong, as will
    be described below.) Pathological lying was originally defined
    as complex lies which are internally consistent, that may drag
    on for years and— and this is the key point— do not have an
    obvious purpose or gain. They’re not trying to con you into or
    out of anything. They’re just making crap up.
    The lies are unplanned, spontaneous. Once told, they generally
    stick (for years)— but it’s fair to say the pathological liar
    doesn’t know what he’s going to say until he says it. He is a
    bullshit artist who makes it up as he goes along, and who then
    semi-believes his own crap.
    And the lies aren’t even useful lies. You ask him what he did
    last Saturday and he tells you he went to the museum; and
    maybe he says at the museum he saw a guy try to rob the gift
    shop, but he got caught by two off duty cops wearing blue
    hats. And later you learn he was really at a movie with his
    girlfriend and you think, why the hell did this freak make all
    that up?
    That’s why it’s called pathological.
    A pathological liar is like a 4 year old kid, who tells you what
    happened to him down by the lake. Meanwhile, there’s no
    lake.
    The important question here is this: does the pathological liar
    know he is lying? Or does he believe his stories? Is he lying,
    or is he delusional?
    The answer is: both. Sort of.
    He is not delusional, but he hovers in that half-world of the
    narcissist (oh, there’s that tie-in), where the lies are believed
    until he gets caught, but then— and this is the move that only
    a few can pull off— he acknowledges that the “facts” are lies,
    but not the essence, the spirit. “Ok, look, I’m not really in the
    CIA.” But in his mind, he knows that if conditions were right
    — if something big went down— he could be exactly like a
    CIA agent, and that’s close enough. If he saw a suicide
    bomber, he’d be able to movie- kung fu him, grab the Sig
    Sauer and squeeze off a few rounds. He also knows which
    wire to clip. How does he know? Because he’s in the CIA.

    If aliens actually did come and attack us, he knows he would


    actually be able to fly a spaceship.
    Pathological lying is not “confabulation.” In both cases, lies
    are told spontaneously and freely, without clear intent,
    purpose, or gain— except that in confabulation, the reason the
    person lies is to fill in the deficits in his memory; he can’t
    remember what actually happened. Hence confabulation is
    associated with dementia (“when I was 18 I went to Paris with
    my unit and I saw… 8 puppies get eaten by Chamberlain and
    de Gaulle— hand to God I saw it”), and especially with
    alcoholic dementia/hallucinosis (“I don’t know what happened
    to me— six guys jumped me… yeah… six… Canadian guys, I
    think they were Satanists, no, wait, Stalinists, yeah, that’s
    right, and they could read my mind…”)
    What about biological correlates? There aren’t any, because
    this isn’t a disease, it’s a description. Here’s an example: an
    article entitled, “Prefrontal white matter in pathological liars”
    found massively (20%+) increased prefrontal white matter,
    and a 40% decrease grey/white matter ratio in pathological
    liars, as compared to both controls and antisocials. But before
    you crack an anatomy book to figure out what that means
    (more prefrontal white matter= more ability to think and
    reason), you should know that the subjects they labeled
    “pathological liars” were really people who purposely and
    frequently lie to get a gain— in other words, they were big fat
    evil scumbag liars, but not pathological liars. What this study
    found was that people who frequently lie develop a better
    brain for manipulating information, remembering stories, etc
    — which is interesting, but not all that surprising.
    My take is that pathological lying is a disorder of identity; the
    person imagines for himself an separate identity, and then
    fantasizes experiences and events which may be otherwise
    ordinary and predictable— he went to the museum— but in
    his mind happen only to “that” person. The lies hold the clues
    to that identity, but they may not be obvious. For example,
    maybe the part of the lie that’s important isn’t that he saw a
    guy rob the gift shop and get arrested, but that he was at the
    museum by himself— the point is that he imagines himself a
    loner, or an artsy type, etc. Or maybe he’s sees himself living
    in a world where crimes happen frequently. And maybe he
    thinks he’s a superhero.
    The pathological liar doesn’t place much value in experience;
    it’s all in identification. He doesn’t need to be in the military to
    know exactly what it’s like, because he’s watched enough war
    movies (e.g. one) or read Tom Clancy. (Aside: that’s the huge
    appeal of Clancy and Crichton— enough detail to make you
    think you know the inner workings of the professions they
    describe.) It’s wrong to dismiss the lies as valueless; like
    Zelig, these people do have an intuitive grasp of the relevant
    thought process, emotions, affects, and even consequences of
    the experiences they describe. They’re just made up. So when
    he gets caught in his lie, he secretly blames the other person
    for not appreciating that whether it’s a lie or not is trivial,
    irrelevant; it still affected him just the same.
    ––––––
    (It would be interesting to study whether (true) pathological
    liars are able to provide a better “profile” of criminals, heads
    of state, etc, than professional profilers, and what
    supplementary factors might improve the accuracy of the
    profile. (“Here are some videos/documents on Vladimir Putin.
    Tell us what you think. Then, go out to dinner with this
    beautiful blonde ex-FSB agent and see if you come up with
    any further insights.”) I suspect also that pathological liars
    would more predictably pass the new fMRI lie detectors; these
    detect binary lies (“are you this or are you not this?”) but
    pathological liars hold contradictory truths simultaneously and
    thus may not register as deceptive. (P.S. I think I know how
    the test procedure can be altered to pick this up; but I also
    think I know how these tests can be reliably beaten. If anyone
    wants to study this, let me know.))
    Here’s What Governor
    Spitzer Should Do With The
    Pedophiles: Send Them To
    Cuba
    March 19, 2007

    So Spitzer, et al have passed a law that allows courts to


    involuntarily commit sex offenders to psychiatric hospitals
    until they are “no longer” dangerous— even if they have not
    actually committed a crime, or have served their sentence.
    Said Spitzer:

    “…protecting the public from those individuals whose


    mental abnormalities cause them to make sexual attacks
    on others.”

    “Mental abnormalities?” That they are bad people I can see;


    but what, precisely, is the nature of this mental abnormality?
    And it “causes” violence? Causes?
    The ACLU of course opposes such an obvious violation of
    civil liberties— but they make the same mistake:

    “…locking someone up indefinitely because he has a


    mental abnormality and may commit a crime in the future
    creates a constitutional nightmare,” said Bob Perry of the
    New York Civil Liberties Union.

    “...because he has a mental abnormality.” Why the


    qualification? Is that relevant? And why does everyone agree
    that there is a “mental abnormality?”
    Blame Kansas v. Hendricks, the 1997 decision in which it was
    decided that dangerousness + a “mental abnormality” is
    sufficient to involuntarily commit someone (in that case, a
    violent pedophile) indefinitely— even after he has already
    served his sentence. Here’s the trick: there would be no other
    justification for this violation of substantive due process
    except some mental abnormality that forces you to do things.
    The only way we can justify indefinitely locking up
    pedophiles is to call them psychiatric patients.
    What’s a “mental abnormality,” exactly? The Court left the
    definition up to the states, but it suggests some dangerous
    synonyms, like “personality disorder.”
    Here’s another: mental retardation. Is mental retardation—
    now a exclusion for execution— sufficient for indefinite civil
    commitment? They’re not going to get better, are they?
    There are two main problems with this law. The first is
    constitutional: you simply cannot lock up a person,
    indefinitely, unless they committed a crime.
    Exactly what is the difference between the Guantanamo terror
    suspects and pedophiles incarcerated further after their
    sentence has been completed? Both are being held under the
    (likely accurate) presumption they’re going to cause trouble in
    the future. Both are driven by an inner and virtually
    unalterable desperation to commit their respective offenses.
    Hell, you can even use the same battery of questions to screen
    for both (“God has given you an odd gift: a schoolbus full of
    docile 8 year olds. What do you do?”) And both are equally
    explained and treated by modern medicine and psychiatry (i.e.
    not at all.)
    At least the Guantanamo detainees are not U.S. citizens— they
    are not entitled to our constitutional rights. For better or worse,
    American pedophiles are.
    If you are against one, you’re against both. They’re the same.
    The law’s second problem is social and categorical: these laws
    interpret certain violent behaviors as psychiatric in nature,
    without any scientific or even descriptive basis. In other
    words, it medicalizes behavior simply because it does not
    know what else to do with it. It says, “only someone whacked
    out of their skull would be a pedophile.”
    And some will say, and what do you expect from a culture that
    so sexualizes youth? Actually, humanity has been sexualizing
    its youth for thousands of years; it’s only in modern times that
    we’ve placed an absolute prohibition on acting on it. As I
    recall, teens getting married was the norm in the Renaissance;
    the ancient Greeks had institutionalized a form of pederasty-
    for-education trade.
    I bring this up not to justify having sex with kids (duh), but to
    show that it is quite obviously not a psychiatric disorder. It is a
    crime that you choose to commit.
    There is too much emotion around sexual predators, and it
    confuses the issues. For example, why do we register them?
    We don’t register serial killers, con artists, unabombers, etc.
    The argument, “well, wouldn’t you want to know if a sex
    offender was living in your neighborhood?” isn’t valid: I
    assume everyone is a sex offender. Seriously. Especially
    around my kids. And wouldn’t you want to know the Zodiac
    killer moved in?

    Don’t misinterpret my support of civil liberties as


    permissiveness; if you’re really worried that a sex offender
    will offend again, make his criminal sentence longer, harsher.
    If society wants to make pedophilia a capital offense, fine. But
    for the love of God, don’t turn sex offenders over to the
    psychiatrists, the two have nothing to do with each other. You
    may as well send them to the sociologists, they have about as
    much to do with them.
    This is an extremely bad law, and by bad I mean bad for
    everyone except the bad guys. It sets up the argument that
    certain “behaviors” are so a part of one’s identity that they
    cannot be altered or prevented, and therefore culpability is
    reduced while dangerousness is magnified. It allows the
    government yet another avenue to lock people up without
    crime. And worst of all, the penultimate decision about who
    should be locked up for society’s benefit is made by the
    absolute worst group to make this decision: psychiatrists.
    Psychiatry becomes a tool of the state.
    The last major country that ran this way was the USSR. But
    things are different now, I know. I know.
    A Primer on Pedophilia
    March 22, 2007

    This is the most important part: most pedophiles aren’t


    sexually attracted to kids.
    Like most other terms used in psychiatry and politics, the
    meaning appears to be self-evident, but it’s actually wrong.
    Other examples include “insane,” “antisocial” (it means
    criminal), and “inflammable.” (“Inflammable means
    flammable? What a country!”)
    Pedophile had originally been divided into two groups, fixated
    and regressed. Interestingly, even these terms don’t mean what
    they look like they mean. They don’t describe what kind of kid
    the pedophile likes; they describe why he is a pedophile.
    Fixated pedophiles are fixed in a certain developmental stage,
    and are exclusively attracted to kids.
    Regressed pedophiles, using the original definition, prefer
    adults but, if stressed, will regress to an earlier developmental
    stage; this regression leads them to prefer children. The
    regressed pedophile likes kids because he himself has
    “become” a kid (more technically: he regresses to a pregenital
    sexuality, which finds its satisfaction in oral (e.g.
    masturbation, fetishism) or anal impulses (e.g.
    sadomasochism) and its natural compatriot, the child.)
    The terms homosexual and heterosexual apply to the primary
    object choice, not necessarily the sex of the victim (e.g.
    “heterosexual molester of boys.”) Fixated pedophiles tend to
    be (i.e. think of themselves as) homosexual, and regressed
    (think of themselves as) heterosexual.
    But the easiest way, and most forensically useful way, is to
    simply describe pedophiles according to their sexual object
    preference: Fixated pedophiles are true pedophiles, they are
    only sexually aroused by kids. Opportunistic (regressed)
    pedophiles would rather have a hot 25 year old, but will take
    the best offer. Regressed pedophiles don’t think they are
    pedophiles.
    Remember, whether they are homosexual or not isn’t the
    differentiating factor (e.g. male homosexual regressed
    pedophiles prefer adult men but would settle for a kid.
    Heterosexual fixated pedophiles prefer kids.)
    An example of the fantasy life of each is illustrative: the
    fixated pedophile might be married, but will take a feature of
    the adult and “see” it as child like. Maybe the slope of the calf,
    the hair style, etc. Fetishism is also important, and there is a
    clear (to the pedophile, not to anyone else) direct link to
    children (a type of cloth or pattern; sounds such as bells,
    crowds; language or words, etc.)
    The regressed, or opportunistic, pedophile does the opposite:
    “I know she’s only 13, but have you seen her ass?!”
    So now you can see why all of our attempts at catching
    pedophiles before they offend are doomed to absolute failure:
    they’re everywhere. I know no one will admit this, but
    remember how hot you thought Britney Spears was in the
    original video “Hit Me Baby One More Time?” Guess what.
    You’re a pedophile. You say, “but I’d never act on it.” Well,
    you say a lot of things.
    But that’s the crux, of course: desire and action are very
    different things, and, arguably are controlled by entirely
    different parts of the brain, or personality factors, or superego
    departments. Not a day goes by I don’t want to plasma gun 50
    people I meet. But, so far body count = 0. This is why we can
    only be judged on our behaviors, not our thoughts (though a
    person must judge himself on his thoughts.)
    You don’t know what a person is capable of until they are
    presented with the temptation, so I’m saying we shouldn’t
    tempt them. The problem with opportunistic pedophilia is that
    it is opportunistic, not pedophilia. The goal isn’t the child; it’s
    ejaculation. And you simply don’t know where a person’s
    “line in the sand” for ejaculation is. At what point do they say,
    “this is probably not right?” Not: “this is wrong,” that’s
    usually easy to describe. Probably wrong. 16? 14 if they’re
    famous? 12 if you’re in Thailand?
    The guy on the IM or chat who gets a 14 year old girl to meet
    him at the pier— he’s a “regressed pedophile.” He would have
    liked her to have been a 25 year old NFL cheerleader; but, let’s
    face it, a 25 year old NFL cheerleader would sooner swallow
    her own eye than hook up with this freak, and he knows it. So
    he bypasses her (“they’re all sluts”) and cons a 14 year old. It’s
    no surprise that 75% of heterosexual pedophiles described
    their offenses as “compensation.”
    Fixated pedophiles are sometimes described as “child
    centered.” In fact, they see themselves as the peers of the
    child, and prefer to interact with the child on its level (while
    regressed pedophiles try to elevate the interaction with the kid
    to adult level.) They’re not in it “for the sex” but for the
    emotional connection. For the regressed, the sex is the whole
    point. And here’s your forensic problem: a regressed pedophile
    kidnaps a kid to have sex with. Once done, well, anything can
    happen. If the kid “liked it,” (maybe defined as “didn’t put up
    too much of a fight”) there’s a good chance they’ll meet again.
    But if the kid didn’t like it… A fixated pedophile kidnaps a
    kid to— live with. That fantasy rarely gets realized (kid likely
    doesn’t want to move in) and violence can therefore occur. But
    appreciate the difference: for a regressed pedophile, the
    violence is part of the offense. For the fixated, violence is
    secondary or utilitarian.
    I can already hear the screaming objections. Look, I’m not
    trying to defend anyone, I’m trying to explain the offenses, the
    thinking. In simple terms, your child is a billion times more at
    risk from “pedophilia” with an adult they know (30% of
    victims have known their attacker for a full year prior to the
    offense), who is already married with kids of his own that he
    has not molested, then they are from the registered pedophile
    who lives in your city who was hoarding child porn in his
    mom’s basement. I know it sounds cooler and more self-
    righteous to rail against the pedophile than to worry about
    your (weak-minded) social contacts, because you think you
    know them, and especially since they outnumber you. By a lot.
    You say, “but certainly not everyone is a pedophile, there must
    be something specifically different about them?” Or, if you
    work for the Supreme Court: “there must be some mental
    abnormality which is properly the domain of medicine?”
    No. Not in a way that’s useful. For example, a very recent
    MRI study of fixated pedophiles vs. controls found pedophiles
    had decreases in grey matter (smaller brains), especially in
    certain brain regions (orbitofrontal, ventral striatum, limbic
    regions), and generally decreased intelligence. But before you
    see this as proof that pedophilia finds its origins in brain
    biology, the physical brain changes didn’t predict anything you
    might expect (number of offenses, psychopathy, etc)— but it
    did predict obsessiveness. In other words, this study found
    biological evidence of OCD spectrum pathology, but not of
    pedophilia, per se. No, pedophilia isn’t a disease with distinct
    physical pathology, and no, it isn’t properly the domain of
    psychiatry.
    I may write a “profile” of the pedophilic sex offender, and
    another post reviewing the developmental and biological
    studies so far. Or, I may just go have a drink (or 4.)
    Not Yet Ready For Porn
    March 27, 2007

    Surprising results from the study, “Magnetic resonance


    imaging of male and female genitals during coitus” in BMJ:

    We did not foresee that the men would have more


    problems with sexual performance (maintaining their
    erection) than the women in the scanner.

    There is so much wrong with that sentence.


    Here’s What Happened
    When I Went To LAX With
    No ID: Nothing
    March 31, 2007

    This has nothing to do with psychiatry, except that it’s about


    my jet-setiing ways, and that’s what psychiatry is really all
    about, after all.
    A while ago I read an article in Wired called “The Great No-
    ID Airport Challenge,” and I finally mustered the courage to
    try it.
    There are two checks at security. At the first, they simply look
    to see if your ticket matches your ID. If it does, they send you
    off into one of the several metal detector lines, where you wait
    to place your belongings on the belt, take off your shoes, etc.
    I hid my ID in a magazine, and talked myself out of my main
    worry: what’s the worst that could happen? I mean, I can’t be
    the first guy in LAX to not have an ID, right? Surely, there
    must be some system to handle these occurrences?
    So I wasn’t worried about being turned away so much as being
    extremely delayed; my fantasy was that they’d take me to the
    “back room” and I’d have to “con” my way through, i.e.,
    verbally convince them I was not a terrorist.
    Well, none of that happened. What did happen paralleled the
    Wired story: the security lady said, “no ID?” and I said, “I lost
    it and—” and she cut me off. And sent me over to a closed
    security lane, which was promptly opened and staffed. They
    gave me the SSS treatment— they x-rayed and manually went
    through my bag, waved the wand over me, patted me down—
    and that was it. I walked to my gate.
    Here’s the important part, in case you missed it: by not having
    ID, I totally bypassed the long lines in the regular security
    lanes. I saved myself— what, 30 minutes?
    It then occurred to me that I could have bypassed the line
    going to the first security lady— another 10 or so minutes—
    by walking directly up to her and telling her I was panicked
    because I had lost my ID, what should I do? My money says
    that instead of telling me to get back in line, she would have
    simply sent me to the empty security lane.
    For those who don’t know: SSSS on your ticket means you
    have been “randomly” selected for additional screening. It can
    appear on your printed ticket, or a screener can write if if they
    don’t like the looks of you.
    Worse Than The Flu
    April 2, 2007

    Here’s a little case report, about me, a cautionary tale about


    working too hard.
    I had to go to Chicago for a case. It took three days. It took a
    lot out of me. There was the jet lag, and the work, and
    skipping meals, and sleep deprivation. I barely sleep at home,
    but all I could get in the hotel was 2 hours/night. I usually
    drink about 3 cups of coffee (16 oz each— so I guess that’s 6
    actual cups) a day, but with this level of stress and tiredeness I
    was drinking 4-5. And, dare I admit it, I took a Provigil.
    I could feel myself getting sick on the last day. Just get
    through it, I thought. Sick later. Work today.
    I got home, exhausted. The next morning I felt sick, wiped out,
    achy. There you go, I said. I have the flu. I struggled through
    work, taking naps when I could.
    As the day progressed, I got worse. Weakness, tiredness,
    horrible nausea, headache. I gagged at the thought of food, but
    I forced myself to at least drink Gatorade. Gatorade is the
    artificially sweetened sweat of male bicyclists. Every word of
    that description disgusts me. I drank the purple one.
    Day 2 came, and I was worse, not better. Not even the same—
    much worse. The headache was ruthless. The nausea had
    become motion sickness— turning my head was a lunar
    launch. The arthralgias, bizarrely, had disappeared— except in
    my neck, which had become very painful and stiff. I couldn’t
    turn my head well. I could barely walk, I could barely think.
    I went to work.
    The weakness and lethargy had also changed— into
    narcolepsy. It wasn’t weakness— I was drugged. I fell asleep
    for only a second at a time, but it overtook me every moment I
    wasn’t active. Driving. Watching TV. Standing at a urinal. On
    an elevator. During phone calls. I could not stay awake.
    Simply closing my eyes would drop me into Stage IV sleep. I
    could still be talking, but if my eyes were closed I was asleep.
    And what I said was nonsensical.
    I was almost helpless. I took Tylenol. Motrin. Tylenol +
    Motrin. Nothing. And I could not stay awake. The head and
    neck hurt so much that the only solace was sleep, which I
    couldn’t stop anyway.
    What kind of flu was this? And something worried me: why
    didn’t I have a fever?
    By day 3 I had what can only be described as the worst
    headache of my life. The nausea was constant.
    Worst. Headache. Of. My. Life.
    I rarely get sick, I rarely take pain relievers. I do 3 sets of 50
    push ups a day. I’m pretty healthy, and I’ve never been
    incapacitated. I only say this as background for my next
    sentence: I was so sick I could not see.
    Light hurt me, hurt my head. I could not look at the monitor,
    or TV. I wanted to be in a quiet, dark room— asleep. With
    morphine. And the medical student in me solved the mystery:
    headache, stiff neck, photophobia, no fever. I had finally done
    what I had been threatening to do for so long: I had popped an
    aneurysm. I thought: so this is how it ends.
    Nausea. Headache. Neck stiffness. Exhaustion.
    Exhaustion.
    Oh my God, could I be in caffeine withdrawal?
    As soon as I thought it, I knew that was it. I couldn’t believe it.
    I’d never felt it before because I’d never not had coffee before.
    And that first day back, being a little off, I skipped it— which
    made me worse, and then the withdrawal hit.
    I made some coffee. It smelled like battery acid. I put ice in it
    and drank it, one cup all at once. I gagged, twice.
    Within ten minutes, I was 10% better. In 30 minutes, I was
    50% better. In an hour I was 95% cured. From unable to move,
    to almost complete cure.
    Jesus.
    The cure was so total, the reversal so profound, that I actually
    couldn’t remember how sick I was. I thought I must have been
    exaggerating.
    So my body reminded me.
    Four hours later, I started to feel that motion sickness again.
    By the fifth hour, I was on the floor again, same stiff neck and
    headache. And the nausea was worse: the thought of drinking
    the battery acid again was too much for me.
    But I did it. And again, an hour later, I was completely cured.
    How “real” is caffeine withdrawal? Clearly, my own
    experience takes it out of the theoretical realm. But what
    about:
    the average coffee junkie when he goes to the hospital?
    the psych patients who smoke 1 or 2 packs a day, 4 or 5
    coffees a day, and get admitted on the unit where it’s only
    decaf and a smoke break a shift?
    The case reports of neonates born to heavy caffeine drinking
    mothers, who went into serious withdrawal. Three neonates
    had caffeine in their urine! Symptoms include irritability,
    rigidity, hypertonia and hyperreflexia.
    And then there are the kids.
    What about all those kids who drink a lot of soda— say, two
    cans/d (100mg total)—and maybe sometimes they don’t get
    their dose? One study of such 10year olds found that missing
    one dose of 100mg made them less alert, had more headache,
    and performed more poorly on cognitive tasks. But how many
    parents (or doctors) would have thought about this? Another
    study also found kids in withdrawal got little headache, but get
    more myalgias than do adults. Who is savvy enough to
    attirbute these subtleties to caffeine?
    Has anyone else wondered if the prevalence of ADHD doesn’t
    parallel caffeine use and sleep deprivation, especially in kids
    (kids don’t take naps anymore)? And remarked that the main
    treatments are— stimulants?
    Referencing myself: What is the best and healthiest coffee to
    drink?
    Farewell, Depression
    April 4, 2007

    Write this day down: 4/4/07, it is the first day of the new
    psychiatry. Everything changes, starting today.

    Today, in the New England Journal Of Medicine, is an article


    ostensibly about the lack of additional benefit from adding an
    antidepressant to a mood stabilizer. This is both surprising and
    not surprising: surprising, because, well, you’d think two
    drugs would be better than one. Not surprising because, well,
    if the first drug worked, why would a second even be
    necessary? (See #8). And if the first didn’t work, how do you
    know the improvement didn’t come entirely from the second
    drug?

    If this is all the article said, it would not be worthy of mention,


    let alone the herald of a new dynasty.

    The study also found that the studied antidepressants did not
    induce mania. That this should have been prima facie obvious
    even to a 9 year old without the benefit of eyes (what’s an
    antidepressant? They’re not all chemically similar, so why
    should they all be blamed for the same side effects?) isn’t the
    point here.
    The true importance of the study is contained in three
    statements. If you blinked, you would have missed them.

    The first is this:

    Mood stabilizers were initially limited to lithium,


    valproate, the combination of lithium and valproate, or
    carbamazepine. In 2004, the protocol was amended to
    define mood stabilizers operationally as any FDA-
    approved antimanic agent.

    The second is this, from the abstract:

    Our study was designed to determine whether


    adjunctive antidepressant therapy reduces symptoms
    of bipolar depression…

    And the third is this:

    In summary, for the treatment of bipolar depression, we


    found that mood-stabilizingmonotherapy provides as
    much benefit as treatment with mood stabilizers
    combined with a standard antidepressant.

    Psychiatry is not about science, it is about language, politics.


    What’s happened here is that “mood stabilizer” now includes
    atypical antipsychotics; and— compare what the study was
    designed to show and what they spun it to show— we’ve gone
    from “polypharmacy is not better” to “monotherapy with
    mood stabilizers [read: antipsychotics] is just as good as two
    drugs at once.”
    There’s a subtlety there, and that subtlety is magnificent.
    Note the authors: Sachs, Bowden, Calabrese, Thase, etc— the
    same people who pushed psychiatry into flowchart
    polypharmacy; where Depakote was always first line for all
    phases of bipolar disorder, and any exacerbations that
    developed were treated with the addition of a second
    medication.

    What the article is saying is that academic psychiatrists are no


    longer behind antidepressants and antiepileptics. SSRI and
    SNRI use will decline from here, as will Depakote. They’re
    behind antispychotics. And antipsychotic use is positioned to
    explode.

    It goes without saying: only the antipsychotics are still


    branded.

    But without academics pushing SSRIs, their use will wane—


    and, importantly, so will their support of the diagnosis “Major
    Depression.” This is going to sound controversial, inane, but it
    will happen.

    Look for upcoming articles finding that “Depression” is


    overdiagnosed, that it is really just— life. Look for articles
    that now find SSRIs aren’t that effective after all, that the old
    “10% better than placebo” is a statistical trick with little
    clinical utility. That they are way overused in kids.

    You might say, wait, isn’t the decline of polypharmacy a good


    thing; that SSRIs are overused in kids; that they aren’t that
    great; and that depression is overdiagnosed? All of this is true,
    but this isn’t psychiatry finally coming to its senses; this is
    psychiatry entering the manic phase. Sure, it’s less SSRIs for
    kids; but it’s more antipsychotics.

    Because simultaneously there will be articles pushing the idea


    that recurrent unipolar depression is really bipolar depression;
    that there are common genetic or heritability patterns; that the
    epidemiology and course is similar, etc. The move will be to
    squeeze out MDD into “life” and bipolar. This done,
    antipsychotics become first line agents. Oh, and look for
    antipsychotics to get FDA approvals for kids.

    I wish I could make this clearer, but I’m still recovering from
    my recent bout with death. There’s no science here, only a
    tinkering with language and loyalties, with staggering results.
    Don’t blame Pharma quite yet— this is a NIMH study.
    I am not against antipsychotics, and I have long tried to tell
    anyone who would listen that the data clearly show they are
    superior to antiepileptics. But this isn’t psychiatry suddenly
    waking from a coma, aha! it turns out the existing data do
    show antipsychotics are mood stabilizers! Instead of using
    them to replace antiepileptics, they will use them to replace
    everything: SSRIs, benzos, antiepileptics, stimulants, etc.
    And polypharmacy will only be reincarnated— in the form of
    multiple simultaneous antipsychotics (Abiliquel, anyone?),
    with preposterous pharmacologic justifications (“this one acts
    on serotonin, so it’s the antidepressant, and this one on
    dopamine, so it’s the antimanic.”) If anyone says that to you,
    stab them.
    You don’t get many changes like this, maybe once every ten
    years— the last was the beginning of the Depakote era, and
    before that was the advent of SSRIs, each with it’s own
    erroneous semantics (“kindling model;” “serotonin model of
    depression.”)
    I wish all the patients in the world good luck, you’ll need it.
    Not because of the antipsychotics themselves, which will work
    or not, oblivious to doctor and diagnosis; but because of the
    doctors, who take little interest in examining the evidence
    behind their practice, and even less interest in reevaluating its
    core principles; and who lack the courage to even treat what
    they see, instead resorting to artificial, and wrong, paradigms
    and algorithms. There’s not even pseudoscience here.
    Psychiatry is being lead by the siren call of semiotics, and it is
    saying, follow me, I am made of words…
    The Trouble With Psychiatry
    — “Not Even Wrong”
    April 11, 2007

    I recently read Martin Gardner’s review in the New Criterion


    of Lee Smolin’s The Trouble With Physics, and Peter Woit’s
    Not Even Wrong: The Failure of String Theory.
    I am almost finished Smolin’s book, but I wanted to make a
    comment about Gardner’s piece. Writing in the New Criterion,
    he should have appreciated a wider view of the books, that
    they speak to more than physics. They’re just as much about
    psychiatry.

    Because I suck at writing, I’m a much better speaker, I often


    have difficulty getting my ideas— which are already baffling
    — across to people indoctrinated in psychiatric mythology.
    But Gardner does a great job, so I’m simply going to quote
    him verbatim. I don’t think he’ll mind. Just substitute the word
    “psychiatry” anywhere you see “physics.”

    He sees string theory as not a theory—only a set of


    curious conjectures in search of a theory. True, it has
    great explanatory power, but a viable theory must have
    more than that. It must make predictions which can be
    falsified or confirmed.

    Consider that the terms “borderline” and “narcissist” which


    have supposedly no predictive power, yet give you more
    information than the epidemiologically valid and “reliable”
    diagnosis “bipolar.”

    In a chapter on sociology, Smolin introduces the concept


    of “groupthink”—the tendency of groups to share an
    ideology. This creates a cultlike atmosphere in which
    those who disagree with the ideology are considered
    ignoramuses or fools. Most physicists tied up in the string
    mania, Smolin believes, have become groupthinkers,
    blind to the possibility that they have squandered time
    and energy on bizarre speculations that are leading
    nowhere.

    The last part is key— who among psychiatrists are willing to


    say, “holy crap, we just made this all up as we went along!”
    The other book Gardner reviews is Not Even Wrong, the title
    coming from Wolfgang Pauli’s quote that a theory was so
    ridiculously unscientific that it was “not even wrong.” Quoth
    Gardner: “By this he meant it was so flimsy it couldn’t be
    confirmed or falsified.”
    Gardner quotes another writer (Glashow), in an indictment of
    why the masturbatory nature of psychiatry is detrimental to its
    own practitioners. Replace “string theory” with “bipolar
    model:”

    Until string people can interpret perceived properties of


    the real world they simply are not doing physics. Should
    they be paid by universities and be permitted to pervert
    impressionable students? Will young Ph.D’s, whose
    expertise is limited to superstring theory, be employable
    if, and when, the string snaps?

    And closing with a quote from the physicist Gerard ’t Hooft:

    Actually, I would not even be prepared to call string


    theory a “theory” rather a “model” or not even that: just a
    hunch. After all, a theory should come together with
    instructions on how to deal with it to identify the things
    one wishes to describe, in our case the elementary
    particles, and one should, at least in principle, be able to
    formulate the rules for calculating the properties of these
    particles, and how to make new predictions for them.
    Imagine that I give you a chair, while explaining that the
    legs are still missing, and that the seat, back and armrest
    will perhaps be delivered soon; whatever I did give you,
    can I still call it a chair?
    I wish I could write better, more clearly. I can’t. But at least
    read Gardner and Smolin— if the problem of loose science
    and groupthink occurs in the hardest of the sciences, physics,
    it most certainly occurs in psychiatry. The first step in
    recovery, of course, is admitting you have a problem. We may
    never get past this step. The second step is to stop pretending
    you’re something you’re not, stop trying to make judgments
    and pronouncements about which you know nothing: Wovon
    man nicht sprechen kann, daruber muss man schweigen.
    Atypicals for Maintenance
    Bipolar
    April 16, 2007

    In my post on the NEJM article about antidepressants in


    bipolar depression, some people couldn’t see how I made the
    leap to a political movement away from SSRIs and seizure
    drugs, and towards atypicals.
    First, I’m not against atypicals. I have long advocated for
    fluctuating doses of antipsychotic instead of Depakote. I do
    think they can treat depressive states. I don’t disagree with the
    study or the data.
    What I find perplexing is the timing. I was trying to show how
    academic psychiatry has now decided to move towards
    atypicals. Why now?
    Here’s an example. Eduard Vieta just released his hit single,
    Current Approaches to the Treatment of Bipolar Disorder With
    Atypical Antipsychotics, in Primary Psychiatry. In it, there is
    only one short paragraph on Depakote, describing its one
    maintenance study, in which (it states correctly) Depakote
    didn’t beat placebo. That’s it. 81 words.
    Find me one other article written before 2007 that is so curt
    and dismissive of Depakote.
    It goes on to explore the data on atypicals— and there’s quite a
    bit. It rightfully concludes, “atypical antipsychotics have
    shown promising results in bipolar disorder maintenance
    therapy.”
    But here’s the point: with two exceptions, all studies on
    atypicals referenced here came from 2004 and earlier. The two
    exceptions were from 2005.
    So it’s not new data, it’s old data. Did they suddenly read the
    back issues? Holy crap, atypicals might work? That’s why that
    NEJM piece is so important. It marks the point where
    academia has decided to embrace atypicals and move away
    from Depakote. If this move was really data driven, they
    would have done it in 2004. Hell, they would have done it in
    2001 when the Depakote maintenance study didn’t beat
    placebo.
    There’s no conspiracy here, there’s no exploitation of the weak
    for personal profit. I’m not saying these are bad people, not at
    all. They are not conscious of it. That’s what makes this
    politics, not science.
    You have an academic career, you want to do clinical research,
    who’s going to pay? NIH money is hard to get. So you turn to
    Pharma. You “get” to do a clinical trial of Depakote for the
    treatment of bipolar. When you’re done, maybe they hire you
    to do another one.
    You, personally, don’t even get the money— the department
    does, and they use it to pay your already set salary. But you get
    a career, an identity. But you start to believe the prejudices of
    your chosen stomping grounds, and ignore the shortcomings.
    You become a nationalist. You start to believe that Depakote is
    first line, despite data; or that all seizure drugs will work; or
    that this thing you called bipolar is actually what you’re
    treating. That there are actually two poles.
    Then the money dries up. But Abilify says, could you do a
    clinical trial of Abilify for bipolar? And you say, sure, why
    not? maybe Abilify could be an add-on? And then it’s
    monotherapy. And then Seroquel funds a study.
    The last part is when you don’t simply move on from
    Depakote— you distance yourself from it. “You know, its data
    was never that great, it was really just an antimanic, and
    anyway, it had horrible side effects.” It’s the next step of
    political hypocrisy: I was never really a citizen of that nation, I
    have really always been a citizen of the world.
    The APA Says The Media Is
    Making Women Really Hot
    April 18, 2007

    So the APA has come out against the sexualization of women


    in the media. Praise Jesus. And not a moment too soon.
    Oh my God. If society could just expand it’s historical horizon
    past winter, we’d realize that women have been sexualized for
    centuries. It’s only in modern times that women are allowed to
    be in control of it.
    No. I’m not worried about girls, What we should be worried
    about are the boys. What happens to a boy who is told by the
    media that women are sexualized, they are objects, they are
    sluts? And then he goes out into the world and discovers they
    aren’t? That they won’t sleep with him? That, try as he might,
    they won’t do all the things he was promised in ads, movies,
    porn? But they might be willing to do it with someone else,
    even women?
    Depression? Or maybe misogyny? And maybe he starts hating
    women so much he, oh, I don’t know, shoots 30 people at a
    college?
    Women have been tweezing and preening and primping since
    day uno. Near as I can tell, porn hasn’t drastically altered this.
    Interestingly, it has made young men more self-conscious, not
    just about penis size, but also body hair, fat, fingernails, etc.
    The cultural problem is neurotic, immasculated men whose
    only outlet is masturbation and violence.
    Are we going to be honest or political? I don’t know any
    women who if given a choice would prefer “not sexy” over
    “sexy.” If I have a daughter, I would want her to be in control
    of her sexuality, not under the control of it (in other words, the
    opposite of me.) I want her to be smart and sexy. I just want
    her to be her.
    No. No, the problem isn’t my daughter becomes a slut; it’s that
    she gets beaten by some whacko who wants her to be. Or
    doesn’t want her to be. Or does, but only when…
    The real problem for the women of our society isn’t a lack of
    self-esteem. It’s a lack of weapons.
    And no, I’m not kidding.
    Cho Seung-Hui is Ismail Ax
    April 18, 2007

    I know nothing more about the case than anyone else with a
    FIOS connection, but for what it’s worth, “Ismail Ax” seems
    like a gaming avatar. I know a lot of people are trying to link it
    to Islam, who knows, maybe, but if anyone out there is tight
    with the gamers— especially True Combat and Battlefield 2—
    or if you have a teenage son— I’d ask around.
    Cho Seung Hui: It’s The
    Movies, Stupid
    April 19, 2007

    I still haven’t had time to really look at this situation, but I


    have to address this nonsense about his psychiatric history: it’s
    irrelevant.
    He didn’t do this because he was on Prozac, or he was Bipolar.
    Look at it the other way: are we going to say that people with
    bipolar are more likely to go homicidal? If so, should we do a
    Kansas v. Hendricks for bipolars? (in which the Supreme
    Court said it was ok to lock up pedophiles indefinitely, even in
    the absence of a crime, since “pedophilia” makes you a priori
    dangerous.)
    If you want to really understand why he did it that way, you
    have to find out what article of media he was imitating. Take
    the photos, the manifesto, and google it until you find the
    movie the handguns came from; the book (or comic book) the
    manifesto came from. He didn’t come up with this stuff on his
    own, he is imitating something. For Klebold and Harris it was
    the Matrix and Doom. What movie is he imitating? Find it.
    Because it isn’t about mental illness, or genetics. It’s about
    identity, it’s always about identity, and sometimes the identity
    you choose doesn’t work out that well. So, emergently, you
    grab an identity which has appeared to work— you imitate a
    movie, a game, a comic.
    I’m not saying movies made him do it; I’m saying he was
    looking for an excuse to do it, and he went through the usual
    catalog: movies, comics, games. Come hell or high water, he
    was going to kill someone. But in terms of prediction, the
    operative question is, if this guy goes homicidal, how will he
    do it? He didn’t strap explosives to his chest, not because it
    wasn’t available, but because it didn’t match the identity he
    wanted to have— that he got from a TV show or movie.
    Ismael Ax, handgun to the head, hammer cocked like a bat to
    the right, knife to the neck— all those stills from his video
    clips you see on CNN aren’t random, they’re a specific
    imitation of something else. Find the thing he was imitating,
    and you have found him.
    Because he didn’t exist, that’s the problem. He picked an
    identity, and no one liked it, it backfired- no chicks— so he
    moved to plan B: pick an identity that absolves him of the
    guilt of shooting 30 people.
    Stop looking in the DSM. Start looking in IMDb.
    Schizophrenia and Dry
    Cleaning?
    April 19, 2007

    A reader (who wants me to write an article on autism and


    paternal age— I swear I’m getting to it) sent me a reference to
    a 2007 article finding an increased rate of schizophrenia in
    those born to parents who were dry cleaners (all Jewish,
    negating a racial association). The authors speculate it’s
    tetrachloroethylene exposure.
    There were 4 cases of schizophrenia, out of 144 dry cleaning
    families. What’s interesting is that in 3 of the schizophrenia
    cases, the father was the dry cleaner.
    How does it happen? There are two possibilities: one is that
    tetrachloroethylene is neurotoxic in developing fetuses, so the
    dad must have somehow brought it home with him to the
    pregnant mom. Or, it affects male sperm/ germ cells.
    As for Cho, I don’t know if his parents were dry cleaners in
    Korea, or if they started when they all came to the U.S. But
    something worth investigating.
    BTW: not that this would excuse him even if it were true.
    To Leslie, the reader: if you want credit, put in a comment and
    I’ll put your contact info up here.)
    A Final Thought On Cho’s
    Mental Illness
    April 23, 2007

    A thoughtful reader concerned about backlash against the


    mentally ill asked me to write a piece basically saying that not
    all mentally ill people were homicidal maniacs.
    It’s a fair request, but in this case it’s counterproductive.
    Here’s what I mean: you want to say that “not all mentally ill
    people are violent.” You want counterexamples to Cho’s
    example. But that’s a defensive posture, unnecessary
    because… Cho wasn’t mentally ill. He was a sad, bad man
    who killed people because his life wasn’t validated. There was
    no psychosis, there was no cognitive impairment, there was no
    psychiatric impairment in insight in judgment. There was a
    lack of sex, but that’s not yet in the DSM.

    Not to reduce his life down to a soundbite, but he was a guy


    who thought he deserved better by virtue of his intelligence
    and suffering; found himself in a sea of mediocrity but
    couldn’t understand why he couldn’t therefore excel; and,
    worst of all, found that all the things he thought he deserved
    eluded him— especially hot chicks, who not only dismissed
    him and found him creepy, but, worse, chose to be with the
    very men he thought were obviously inferior to him. It’s
    Columbine all over again. It’s almost even the same day.

    Forget the Prozac, forget the involuntary commitment (where


    he was found by the court to be “a danger to himself and
    others”— that’s standard boilerplate, it is clinically
    meaningless). Those are red herrings. You may as well blame
    wearing black t-shirts. He’s not mentally ill; he’s an
    adolescent.
    The difference, the single difference, between us and him is
    that when we were sulking in high school, we listened to Pink
    Floyd or U2. He watched Oldboy. We had a battered copy of a
    Playboy down at the creek under a rock, that was so creased
    we had to infer the boobs. He had the internet. Maybe we
    bought a pocket knife, or— wow— a butterfly knife. He
    bought two Glocks.

    In other words, the difference is this: he decided to shoot 30


    people, and you didn’t. That’s it. I know it’s not a satisfying
    answer, I know we want explanations, but there aren’t any.
    Forget genes, forget DSM. He chose to do something bad, he
    knew it was bad, but he did it anyway.
    Don’t worry about the mentally ill. Worry about the nut
    politicians and media outlets who will look to the easy and
    convenient excuse of mental illness, rather than have to do the
    hard work of figuring out why our society is melting.
    Older posts on Cho here, here, and here.
    Desmond’s Teleological
    Suspension of The Ethical—
    Or My Novel?
    April 23, 2007

    A few weeks ago I had used a Lost storyline to explain my


    own view that we pick our own identities, rather than have
    them given to us through either genetics or the environment. I
    made Desmond the Abraham in Kierkegaard’s Fear And
    Trembling.
    The crux of the episode and the analogy is that Desmond
    thinks he can see the future, and see that Charlie will die. But
    Desmond then makes a vital moral step: he decides that it is
    also his responsibility to keep this character alive. (Quoting
    myself:)
    The real question is why Desmond actually believes such a
    choice exists. How does he think he knows the future? Anyone
    else in his shoes would have come to a very different, more
    logical, conclusion: this is insane. What, he can predict the
    future? Worse: what, he’s the only reason Charlie is alive?
    He’s so— necessary? Isn’t that narcissism?
    If Desmond knew he could predict the future— if it was a fact
    that he could predict the future— then saving Charlie would
    have little moral heroism. Any fool a step up from absolute
    evil would have tried to prevent a horrible outcome if he knew
    for certain what was going to happen.

    What made Desmond worthy of admiration was, exactly, that


    he did not know for sure he could predict the future. He took it
    on faith that he could, and then proceeded to live his entire life
    based on this single, faith based, assumption.
    That was Feb. 15. Strangely, I just saw last week’s episode, in
    which Desmond turns out to have once been a a monk, and he
    has a discussion about Abraham and Isaac with another monk;
    the wine they make is named Moriah; and later Desmond
    explicitly references the test of faith— straight out of Fear
    And Trembling.
    I suppose this could be a coincidence.
    Another possibility is the writers read and and love this blog
    and have gone and reshot future episodes based on my ideas.
    HA!
    Another possibility is I write for Lost. HA HA!
    But the final possibility is the most likely, and it has less to do
    with Lost and more to do with the direction of our fiction.
    Pre 9-11, fiction, and especially sci-fi, had a distinctly post-
    modern flavor. The main character wasn’t really a person, but
    reality— that it was wrong, or hidden. This culminated in the
    Matrix. The important concept wasn’t altering reality for some
    purpose; it was that reality itself was a fabrication, the
    Demiurge hiding real reality behind a fake one.
    The story goes that Darren Aranofsky (director of Pi) and
    Jared Leto walked out of the Matrix and asked, “What kind of
    science fiction movie can people make now?” The point was
    that the postmodern slant, cyber-realities, etc, were done as
    well as they could be. So, too, CGI. From now on anything
    else would be coattail riding. (Think how Pulp Fiction
    degenerated into Go and 2 Days In The Valley.) The genre was
    finished.
    So what’s next? Well, for Aranofsky the answer was the mind
    (see The Fountain), but I’d suggest an even broader answer:
    ideas. The next genre of sci-fi, or fiction- has to be about the
    conflict of ideas, identities.
    If I was going to write a novel— and who says I’m not?— I’d
    take advantage of our societal narcissism, our search for
    identity— and, more importantly, for excuses why we have
    certain identities; our fear of death manifesting as age-
    postponement; and the decline of truly meaningful
    relationships to write a sci-fi novel about what really keeps us
    linked to each other.
    The operative question would be: if you could be anyone, had
    unlimited power, what would be the ethical system you use to
    make choices? Who lives, who dies, who suffers, who
    doesn’t? How do you decide?
    The first element would be Faith. So, with a parting wave to
    postmodernism, the protagonist can see the future or alter
    reality, except that he’s not sure he can do this. Worse, every
    time he alters reality by avoiding a future he has supposedly
    seen, he creates a new future he didn’t predict— but this is, of
    course, no different than normal life. In other words, by
    avoiding the future he predicted, he negates the proof that he
    saw the future. So he has to have Faith that he has this power,
    in the absence of any evidence. The protagonist of my book
    won’t have any objective evidence that he is right or doing the
    right thing, he simply will have to believe, to decide, that he’s
    right. It has to be identical to, say, psychosis.
    In Lost, Desmond still has objective evidence that he predicted
    the future, even though it gets altered; he sees an arrow; they
    did talk about Superman; the parachutist looked the way he
    foresaw it. So this isn’t exactly a leap of faith. Similarly, if
    Abraham really knows God exists, then sacrificing Isaac isn’t
    wrong or even strange— God wants, God gets.
    Unlike Desmond, who has to decide only if he should save
    Charlie, my character would have to both decide he can see
    the future, and also that it is his responsibility to act on it. This
    brings us to:
    The second element, Duty. In making these decisions and
    accepting these beliefs— altering reality along the way— he’ll
    have to establish a hierarchy of good and bad. What is he
    supposed to do? Does he have any duty towards anything? For
    the plot, this will require some symbol, metaphor. A good one
    might be a piece of jewelry— some object which changes
    depending on the chosen duty. It’s a ring, it’s a sword, it’s a
    bandage, etc— it’s the same “object” that he carries, but it
    changes.
    The third element is Rage. When you believe something that
    no one else believes— especially if you believe you are
    somehow better, or even different, than others; and if others
    directly oppose you in this belief, the inevitable consequence
    is rage. How to depict this?
    The fourth element is Love. The negating force for Rage. This
    character will need to identify what he loves, and how—
    platonic, romantic, etc; a plot-trick might involve altering
    reality and therefore altering the character of his love (for
    example, a woman he loves may later become his sister, etc.)
    To make the reader share the magnitude of the protagonist’s
    Faith dilemma— in order to ensure that the reader does not
    “suspend disbelief” and automatically buy into the
    protagonist’s powers (the way we have with Desmond,) you’d
    have to write the book from the perspective of a second
    character, who describes the story of the protagonist. You
    should never actually get to interact directly with the
    protagonist, you should never actually hear him speak, only
    this second character. This way, you’re never sure what to
    make of the protagonist or his adventures.
    Preliminary thoughts, anyway. Looking forward to the next
    Lost and JJ Abrams stealing my ideas. ;-)
    Is Cho The Question?
    April 25, 2007

    Quick speculation. As 13 year old kids like this usually create


    an identity from multiple sources- so far we’re pretty sure the
    main movie was Oldboy— I wonder if he didn’t also identify
    with the Question (the comic). He signed his name as a
    question mark, he wore the same baseball cap, gloves with
    short sleeve shirt. And, in case you weren’t once a lost male
    adolescent, the Question is Vic Sage, ex-philosophy major
    turned TV reporter who is also a vigilante. And the 30+ issues
    are all about his struggle with identity.
    None of this is relevant to why he did it, of course. It’s fun to
    speculate, but of no predictive value. These are costumes,
    roles. They just help him “get into character,” which in this
    case is a man alone fighting injustice, greed, and abuse, using
    whatever tools he has. Of course, he was fighting college kids,
    and his tools were semi-automatics, but who am I to dispel a
    good illusion?
    Finally, let me reiterate that the presence or absence of mental
    illness is irrelevant, at least as far as prediction goes. So let’s
    say he was a violent schizophrenic. Would you jail him before
    he commits a crime, just in case? Bush does that with
    Guantanamo, you know. Do you send him to a psych hospital,
    like they do/did in the USSR? That process will be
    magnificently abused by your government, I assure you.
    More posts on Cho here, here, here, and here.
    “Inflammable Means
    Flammable? What A
    Country!”
    April 26, 2007

    You’re going to say that I made this up. I am not making this
    up. I wish I was, because then I could say,“stop making things
    up,” and everything would be ok. But it really happened, and I
    can’t stop things from really happening. So I drink.
    This is the conversation I had with another psychiatrist. He is
    wearing a Ermenegildo Zegna suit. It fits him well.
    I say, “… so if I have him [hypothetical bipolar depressed
    patient] on Depakote and Seroquel, once he’s stable I try to
    reduce the dose, or even stop one of the medications.”
    He shakes his head. “I would never stop the mood stabilizer.”
    “Why— wait, which one’s the mood stabilizer?”
    “The Depakote.”
    “But how do you know it wasn’t the Seroquel? That’s the
    problem with starting two drugs immediately, you don’t know
    which one worked.”
    “Well, you need them both. Especially if you’re adding an
    antidepressant.”
    “What antidepressant?”
    “Seroquel.”
    “Seroquel’s an antidepressant?”
    “In this case it is, you’re using it for bipolar depression.”
    I blink my eyes, to make sure I still can.
    “Then what’s the Depakote?”
    “The Depakote is the mood stabilizer.”
    “But how do you know the mood stabilizer isn’t the
    Seroquel?”
    “The Seroquel is the antipsychotic.”
    A voice tells me to stab him.
    “Why can’t you just use the Seroquel— the antipsychotic-
    slash- antidepressant— alone as a first try? What benefit does
    the Depakote give you over the Seroquel?”
    He says it slowly, enunciates, because he deduces that I don’t
    speak English. “Because the Depakote is the mood
    stabilizer…”
    He looks at me. I look at him. He is wearing a yellow Bolgheri
    tie. In my mind it is on fire.
    “…Besides, if you use Seroquel off label like that, you’ll get
    sued.” Blaming lawyers, the last refuge of the incompetent.
    “And for what? Why take the risk?”
    It’s at this point I realize he’s not wearing socks. “If you’re
    going to use that logic, Depakote isn’t indicated for mood
    stabilization, either.”
    He looks at me incredulously, then suddenly he realizes
    something. “Oh, okay, right, I see what you’re saying now…
    but at least Depakote has FDA approval for Bipolar Disorder.”
    QED. He’s very happy now. I can’t find the waiter. Why is my
    drink empty?
    There’s an uncomfortable pause. He wants to show me he’s a
    skeptic, too, that he’s carefully pondered these issues.
    “I have a theory, have you ever used meclizine (a drug for
    vertigo) as a mood stabilizer?”
    “No, I had never heard of that.”
    “I haven’t tried it either, but it might make sense: meclizine
    stabilizes your balance, so perhaps it could stabilize your
    moods?”
    I want to call the State Board of Medicine but realize I’m in a
    different state and I don’t have the number in my phone. “I
    doubt the insurance companies would ever cover it.”
    He slowly, purposefully, nods his head. “Fucking meddling
    managed care.”
    I tell people all the time, don’t get sick, don’t ever get sick, but
    no one listens to me.
    A Quick Word on Porn’s
    Effect On Your Penis
    April 27, 2007

    A reader commented that I was minimizing porn’s negative


    effect on women, that ubiquitous internet porn has damaged
    womens’ psyches irreparably. That it makes women have to
    conform to some impossible standard.
    Nay.
    Porn is not the problem. I’m not saying it’s a tremendous boon
    to society, but you can’t blame porn for failing relationships,
    the pressure on women to attain impossible standards of
    appearance and performance; and male disinterest in normal
    sexual relationships.
    Certainly porn puts pressure on women, but the effect is not
    directly from porn, or even from men. Here’s an example that
    the reader offered: porn forces the women to shave. Not
    exactly— they want to shave. Why they want to is a cultural
    discussion, but it isn’t because men are explicitly commanding
    them to do so.
    Certainly, porn has affected men. Ok, women want to shave;
    why do men suddenly want to, also? And, I’d expect that a
    frequent porn user (whatever that exactly is) might have some
    difficulty with arousal in normal (or repeat) circumstances.
    But there’s a greater problem that can’t be blamed on porn.
    Every comic since Marx (Groucho, not the other nut) has
    joked about how men want sex and women don’t. But in the
    past three or four years, I’ve heard comics make the opposite
    jokes: women want it, men could just as easily pass it up. Men
    are disinterested in sex with their established partners. As
    comic Mark Maron put it, “[I prefer masturbation because sex]
    takes up too much energy and it involves other people.” Men
    always are ready for new women, but what happens to sex
    with your partner over time? Sure, ordinarily it may decline a
    little, but this is different: this is male disinterest, “lack of
    energy,” lack of motivation to keep a connection with one’s
    partner alive. The penis may still go up— but everything else
    is gone.
    Let’s face it, porn may make women feel inadequate, but how
    the hell adequate can a woman feel if her boyfriend/husband
    would rather watch TV than have sex? “But I’m tired.” How
    tired could you possibly be?
    So there are two parts to the problem. The easy, and smaller,
    part is media/porn objectification of women, and its effects on
    women and men. But the second, more crucial part is male
    “impotence” (metaphorical) and apathy. Let me be clear about
    this: porn might magnify this effect; but it doesn’t cause it.

    I know no girl in the world is going to believe this, but it’s


    true: if you ask the average guy over 30 if they’d rather be
    with a girl they have been with many times before or
    masturbate, they’ll pick masturbate. You know why? Because
    their soul bailed out when they were 15— because they are
    narcissists. What in life is worth aspiring to? You don’t feel a
    part of anything bigger, everything seems distant, unreal.
    Everyone is waiting for something to happen, for their life to
    “start”— they’re 40 and they’re still waiting. (As Mike
    Birbiglia joked, “I’m not going to get married until I’m
    absolutely certain nothing else good can happen in my life.”)
    Concepts like loyalty don’t even get a token nod, because
    today they seem outright preposterous.
    And men have a distorted view of what it means to be loved.
    They want to be loved not for who they are, but who they
    think they are. “I’m an actor.” “I’m a major force in WoW.”
    “I’m a fiscal conservative but a social liberal.” What he wants
    is his girlfriend to say, “I love him because he is such an
    intellectual, he knows so much about politics.” What he
    doesn’t want is her to say, “I love him because he’s good to
    me.”
    “Sure it’d be better to be with a girl, but when are you actually
    ever with a girl? They don’t want you, they want what you
    represent— a good job, security, to be taken care of, a big
    penis.” It doesn’t occur to them that the woman who doesn’t
    want these things in her man might be the one to avoid?
    I suspect— I haven’t been able to do the survey— that even
    sex is a form of masturbation for these guys. That they see
    you, but they don’t see you. The arm, the breast, the hip, all
    these become fetishized and transport him to another world.
    Our birth rate is 2.1; France 1.7; Spain 1.3; Russia 1.3. In two
    generations, there will be 1/2 as many Spaniards, excluding
    immigration. We can’t even get it up long enough to procreate.
    That’s not porn’s fault. It doesn’t help, sure, having the
    internet’s tubes tied isn’t going to fix that problem. Men are
    becoming less interested in establishing meaningful
    relationships with other people as an ultimate goal than in
    inventing identities for themselves.
    Does Media Reporting Of
    Suicides and Homicides
    Promote Copycats?
    April 30, 2007

    I won’t give a detailed answer to this question here (it seems


    to be no), but there is an article making the reddit rounds now
    that I need to kill before it becomes another meme (like that
    other badly reported story about psychiatry.)
    The article is from BMJ 2002, called Influences of the Media
    On Suicide, and it puts its conclusion right at the top:

    Reporting and portrayal of suicidal behaviour in the


    media may have potentially negative influences and
    facilitate suicidal acts by people exposed to such stimuli.
    Recent systematic reviews by others and ourselves
    (unpublished) have found overwhelming evidence for
    such effects.1 (emphasis mine)

    And it offers about 8 references in support. And so now every


    nut with a microphone can proclaim it loudly: it’s the media’s
    fault.
    We may want to take a pause and examine these 8 references:
    none of them offer anything close to “overwhelming
    evidence.” For example:
    Reference 1— the one directly cited for the above statements
    — is indicative of the type of “overwhelming evidence” that
    exists. The study finds that media reporting of suicide is
    extensive and detailed, but not that there is a clear link to
    future suicides.
    In the summary, the authors use phrases like, “dearth of
    literature,” “evidence is less reliable,” “few studies
    permitting/demonstrating [the link],” “does not demonstrate
    consistency,” “many studies fail to demonstrate” over 11 times
    in the 3 pages describing the studies.
    Despite this, they are sure the link exists— but they don’t
    actually show the link, they infer a link. The authors repeat
    phrases, “it is fair to conclude that the evidence suggests an
    association [exists]” “tends to suggest,” “probably reasonable
    to regard the association is causal” 13 times in two pages.
    Under these criteria, it’s reasonable to assume the Matrix is
    real.
    Reference 3 (not even linked correctly) is a letter to the editor,
    describing two cases, where the method of suicide was
    affected by internet, but not the decision to commit suicide.
    And the methods were rather weak: one guy took two pills of
    castor oil, and the other woman tried to drink water. No, I’m
    not kidding.
    Reference 5 is frequently cited in support of media’s impact. It
    supposedly says that a TV show with a Tylenol OD caused
    more Tylenol ODs: 20% of these suicidal viewers said it
    influenced their decision to attempt suicide in the first week
    post broadcast. Maybe— that 20% is really 6 people. And
    most had attempted Tylenol OD in the past. Oh, and the
    authors note that while 17% of the suicidal viewers’ choice of
    Tylenol was influenced by the show, some of them chose not
    to use it because of the show.
    Reference 12 is probably the most cited reference in this field.
    In 1978 Vienna built a subway, which soon became a popular
    method of suicide. So the government established guidelines
    for reporting— specifically, that the method not be mentioned
    — and subways suicides decreased by 80%. Fantastic. Overall
    suicide rates didn’t change, though. Too bad.
    So much for the “overwhelming evidence” for a soon to be
    media soundbite.
    The article doesn’t make a good case for media influencing the
    decision to kill yourself, though I’ll admit that it may influence
    the method. And that’s where it gets tricky.
    It’s important to make a distinction between copycat suicides
    and copycat homicides: more poeple die in the latter, and, let’s
    postulate, they didn’t want to die. That has to be part of the
    calculus in media reporting. Copying suicide by water (instead
    of pills) is different than copying a 30 person massacre
    (instead of killing, say, one person.)
    But you have to weigh this against the societal costs. The
    solution offered in these articles is to restrict media reporting. I
    think we can agree that the media are neither liberal nor
    conservative, but sensationalists, their bias is titillation. But to
    allow anyone, especially government, to affect the content of
    reporting— literally, the information we are allowed to have—
    seems exactly the wrong solution to a problem which may not
    actually exist. (e.g. I know it seems prurient, but I actually
    want to know all the details of David Kelly’s suicide.)
    Not to mention that if you say the media are partly
    responsible, then you’re saying that you’re less responsible.
    (More on copycat suicides here, and on university
    suicides/copycats here and here.)
    University Suicides On
    Schedule
    May 5, 2007

    I came across this in my regular survey of the internet: a


    student (?) listed all the suicides at MIT hung it up in a bus
    schedule frame.
    The suicides’ names, ages, method, etc, can be found here.
    But there are a few notable findings:
    First, you should know that MIT and Harvard have some of
    the highest suicide rates.
    But, strangely, almost half of the suicides at MIT were grad
    students or former grads— 13/30 since 1990. (Since 1980 , 16
    grads at MIT vs. 8 at Harvard.)
    Since 1990, there have been a lot of suicides by jump off a
    building— 10/29. In the U.S., this is extremely rare, while in
    Hong Kong, 50% of suicides are jumps from buildings. (None
    of the jumpers here were even Asian.) (The only school that
    comes close is a rash of six jumpers in 2004 at NYU (no
    Asians.) The first three happened witin 30 days of each other,
    and the last two happened in the same week a year later. Only
    1 was a grad student. As near as I can tell, NYU hasn’t had
    any jumpers before or since— in fact, they hadn’t had any
    suicides since 1996.)
    A lot were women: 7/29 (25%), 8/29 if you count the
    Wellesely student who was renting on campus. In the U.S., it’s
    15-20% females.
    8/29 were non-white males; 4/29 were non-white females, so
    12/29 were not white. In the U.S., non-whites represent about
    10% of all suicides. And 2/3 of non-white suiciders in the U.S.
    are black.
    February was the most popular month for suicides (6), January
    second place (4).
    All three suicides that occurred in April (2000, 2001, 2003)
    were women. 2000 and 2001 were both sophomore women,
    who died on 4/10 (burning/OD) and 4/30 (cyanide poisoning.)
    I don’t have the demography of MIT, but it seems that grad
    students, Asians and women are at higher risk for suicide at
    MIT.
    And if someone asks you how to get to the roof, lie.
    (NB: MIT students, I know, small samples and statistical
    significance. I know.)
    (Second NB: I looked into each suicide as best as I could, and
    I was able to supplement the spreadsheet linked above. For
    example, I found two additional jumps from buildings. But in
    this process it discovered that one “suicide” (KM) might not
    have been a suicide; and, even more interesting, he was linked
    to the suicide of another student at MIT (RG). I use the initials
    here, but their full names are clearly public, and already
    contained in the spreadsheet.)
    (Third NB: to the guy who made the suicide schedule— some
    of the dates and methods are wrong (for example, April.)
    Nothing major, but if you want my list let me know.)
    University Shootings: I’m
    Sure It’s All Just A
    Coincidence
    May 7, 2007

    While preparing the post on the unusual characteristics of the


    suicides at MIT, I looked up university shootings and found,
    well… draw your own conclusions:
    Dec. 6, 1989: Gamil Gharbi, 25, engineering student at the
    University of Montreal, kills 13 women and wounds others (he
    released the men.)
    Nov. 1, 1991: Gang Lu, 28, physics grad student at the
    University of Iowa, shoots his dissertation advisor and five
    people and himself.
    Aug. 15, 1996: Frederick Davidson, 36, grad student in
    engineering at San Diego State, shoots three professors at his
    dissertation defense.
    Aug. 28, 2000: James Easton Kelly, 36, a grad student at the
    University of Arkansas, dropped from the PhD program and
    shoots his dissertation advisor and himself.
    Oct. 21, 2002: Huan Xiang, 38, senior at Monash University
    (Australia) uses five 9mms to kill two students and wound
    others before being subdued.
    May 10, 2003: Biswanath Halder, 62, former student, returns
    to Case Western with two 9mm and opens fire, supposedly
    over a failed lawsuit against the school.
    Oct. 28, 2002: Robert Flores, 40, Gulf War vet and failing out
    of University of Arizona Nursing College, comes in with 5
    guns and shoots three teachers and himself.
    Jan. 16, 2002: Peter Odighizuwa, 42, grad student recently
    dismissed from Virginia’s Appalachian School of Law, shoots
    the Dean and a few others before getting subdued by students.
    Sept. 13, 2006: Kimveer Gill (fun pics here), 25, opens fire
    with automatic weapons at Dawson College (Montreal), kills
    20 and himself.
    And, of course, April 16, 2007: , Cho Seung Hui, 23, the not
    mentally ill former stalker of two women who shot up Virginia
    Tech.
    So graduate school is so stressful it makes people snap? Or is
    that just the Gulf of Tonkin?
    Too old, too disconnected, too— weird— to be accepted or
    acceptable in a closed environment where social life is as
    important, if not more important, than academic performance;
    where individuality is really flavored homogeneity (“no, dude
    — my iPod is white“); where “what frat?” says more than
    “what major?”; riding the internet while everyone gets a lot
    more sex, with a lot better looking people, than you; and, the
    last straw, your only claim to university related self-esteem
    gets forcibly “taken” from you.
    And no, it’s not the universities’ fault, and it’s not the media’s
    fault, it’s not mental illness, antidepressants, the “permissive
    society,” porn, or lax gun laws. These are the convenient
    banalities politicians will use to appeal to a mindless base. No.
    This is what happens when you don’t know who you are. And
    it is only going to get worse.
    Another Final Word On
    Cho’s Mental Illness
    May 8, 2007

    Hi. Not surprisingly, many peoples have not liked my Cho


    comments. Here’s an example from a psychiatrist, and I
    responded with a comment there that I might as well put here.
    As background, most people are yelling, “how the hell can you
    say this guy wasn’t crazy? He was talking to imaginary
    friends, he thought he was an Ax, etc.” As point of fact, these
    weren’t delusions because he knew they weren’t true, but
    that’s a side point.
    Psychiatric pathology exists on a spectrum. It’s not binary “ill”
    or “not ill,” and impairment in one realm doesn’t explain
    impairment elsewhere. A diagnosis does not define all of your
    existence, or even all of your actions.

    I should not, however, have said he wasn’t mentally ill. What I


    should have said was he was not insane: he knew what he was
    doing, he knew what he was doing was wrong, and he had the
    ability to control himself. So he is entirely to blame, i.e., the
    mental illness, even if substantial, is incidental.
    You might say, ok, he’s not insane, but only someone with a
    mental illness would do this. It doesn’t lessen his culpability,
    however.
    Well, actually, it does: you can’t execute the mentally ill, for
    example. Forget about your personal stance on the death
    penalty. Fact is, mental illness is rapidly becoming an
    exclusion to a sentence that everyone else is subject to. I know,
    it seems so righteous to say the mentally ill shouldn’t be
    executed. Ok, here: it would mean you can be sentenced to
    death, but he can’t. Does that make any sense, moral or legal?
    Clearly, maladjusted and sexually frustrated college kids don’t
    often go on rampages, so there was something in him that
    moved him to this. Perhaps that was the mental illness. But
    add up the body counts in the past twenty years. What’s in
    common in mass murderers isn’t mental illness, but
    frustration, impotence (metaphorical) and anger. Or are all
    those suicide bombers in Israel bipolar?
    You’ll say, “but he wasn’t a suicide bomber.” His mental
    framework had much more in common with a suicide bomber
    than with John Wayne Gacy.
    But let’s put this aside and ask a different question, about us,
    not him: why do so many people want him to be mentally ill?
    Because its an explanation that doesn’t implicate society, or
    themselves. It means the world can be divided into “us” and
    “them,” which is always fun. It’s the easy scapegoat that
    seems to be so obvious as to be unassailable.
    And if it is mental illness, what do we intend on doing about
    it? My bias implies harsher sentences, societal changes, etc—
    we can debate that later. But if it is all mental illness, then
    what? Do we lock up the “mentally ill” like we do pedophiles
    and terror suspects, before they even commit a crime, just on
    suspicion? And who decides who is suspicious? Psychiatrists?
    Do you trust every psychiatrist to be good at this? Or should it
    be the government?
    Would you have been happy— I mean this in all seriousness—
    if George Bush had Cho arrested last year for being a terror
    suspect? Which part of that bothers you? It would have been
    legitimate, because he was dangerous. So is it that he was
    arrested before he committed a crime, or that George Bush did
    it? See? This is what you’ll have to contend with with these
    policies.
    Oh yeah. Treatment. You want to make “treatment”
    mandatory? Great. Tell me exactly who should decide who
    needs treatment, and for how long, and what kind. And tell me
    how this treatment is going to work— what is the specific end
    point?— and for how long, and tell me what we should do
    when the treatment doesn’t work.
    You can’t just make this stuff up as you go along, enacting
    policies which are politically expedient but destroy the society.
    Ask Vladimir Putin. Oh, wait, bad example.
    Why We Are So Obsessed
    With Culpability vs. Mental
    Illness
    May 10, 2007

    As the thesis of this blog states: psychiatry is politics.


    I’d like to offer an idea for consideration.

    The reason there’s so much give and take about whether Cho
    was ill or not, and whether he was culpable or not, has to do
    with what psychiatry actually is: the pressure valve of society.

    Our society does not have a good mechanism for dealing with
    poverty, frustration, and anger. I’m not judging it, I’m not a
    left wing nut, I’m simply stating a fact; ours is not a custodial
    society, and it does little to “take care of” (different than help)
    these people.

    So it has psychiatry, it fosters psychiatry, and it creates a


    psychiatric model in which these SOCIAL ills can be
    contained.

    The inner city mom who smokes daily marijuana to unwind,


    with three kids who are disruptive, chaotic in school, etc—
    society has really nothing to offer her. But it can’t let her
    fester, because eventually there will be a full scale revolution.
    So it funnels her and her kids and everyone else like her into
    psychiatry.
    Whether she “actually” has “mental illness” or not is besides
    the point. Without the infrastructure of psychiatry, hers would
    be an exclusively social problem with no solution. But with
    the infrastructure of society, her problem is no longer a social
    problem, and no longer the purview of the government (or
    fellow man, etc)—it is a medical problem.
    Consider that one of the fastest ways for this woman to get
    welfare— and ultimately social security— is for her to go
    through psychiatry.
    So, too, the angry, the violent, the frustrated…
    Hence, discussions about whether mental illness reduces
    culpability are red herrings. It’s about reducing culpability, it’s
    about reducing society’s obligation to deal with it.
    Society is basically saying this (I’ll quote myself):

    …if they’re poor or unintelligent, we will never be able to


    alter their chaotic environment, increase their insight or
    improve their judgment. However, such massive societal
    failure can not be confronted head on; we must leave
    them with the illusion that behavior is not entirely under
    volitional control; that their circumstances are
    independent of their will; that their inability to progress,
    and our inability to help them isn’t their (or our) fault;
    that all men are not created equal. Because without the
    buffer psychiatry offers, they will demand communism.
    The Girls Of Pfizer
    May 13, 2007

    http://www.youtube.com/watch?v=F_tkar2rLEQ
    Oh, get over yourselves. That’s hilarious.
    The Wrong Lessons Of Iraq
    May 24, 2007

    Don’t ask me about Iraq.


    But I do know something about our collective response to the
    Iraq war, to the Bush presidency, and to our times, and it says
    a lot about our cultural psychology. And it helps predict the
    future.
    It’s sometimes easier to evaluate one’s personality, and thus
    make predictions about it, by examining the defense
    mechanisms the person uses. In difficult situations, specific
    people will use a small set of specific defenses over and over;
    so much so that we often describe people exclusively by that
    defense, e.g. “she’s passive aggressive.”
    Taking Iraq and President Bush as starting points, and
    examining the defense mechanisms we use to cope with both,
    yields the unsurprising conclusion that we are a society of
    narcissists.
    While this discovery is familiar to readers of my blog, what
    might be a surprise is what this heralds for our society
    politically and economically. It isn’t socialism, or even
    communism, as I had feared. It’s feudalism. It’s not 2007. It’s
    1066.
    Let’s begin.
    Splitting
    Splitting— reducing the other person to a binary abstraction of
    all good or all bad, is a primitive, or regressive, defense
    mechanism used when the emotional level and complexity is
    greater than a person’s capacity to interpret it. For example,
    once your boyfriend cheats on you, he becomes a jerk,
    completely. Even things he had done that were good— like
    give money to the poor— are reinterpreted in this light (“he
    only did that to get people to like him.”) Who splits? Someone
    with a lot of unfocused rage and frustration, i.e. the
    “primitive” emotions.
    Currently, our social psyche has three main targets of splitting:
    President Bush, terrorists, and liberals. Depending on your
    political bent, two of those are often conflated.
    Splitting says: Bush is all bad, period. Nothing he does is
    good, and if it is good, it is from some malicious of selfish
    motivation, or an accident related to his incompetence to even
    be self-serving. Similarly on the other side, liberals are weak,
    corruptible, treasonous.
    Splitting is always polar; once something is declared “all bad,”
    an opposite is necessarily declared all good. Importantly, this
    isn’t a comparison between the two— he is bad, but she is
    better; it’s perceived to be two independent, unconnected,
    assessments, even though to anyone else looking from the
    outside, they are so obviously linked. So hatred of, say,
    liberals is thought to be independent of your preference for
    Bush, but in reality it is only because you hate liberals that you
    like Bush. The hate comes first. And this splitting makes it
    nearly impossible to acknowledge any of Bush’s faults. It is a
    fair guess that many people voted for either Bush or Kerry not
    because they liked their candidate, but because they hated the
    other candidate. This is the important part: that made them
    think that they liked their own candidate objectively. Not,
    “Kerry is better than Bush,” but “Kerry is a great candidate.”
    Period. That’s the illusion of splitting.
    (Further evidence of the relatedness of splitting: once it’s
    gone, it’s gone. Anyone voting for Kerry in 2008?)
    But splitting is rarely about the target, it’s a convenient
    heuristic to get the subject out of having to accept the
    complexity and totality of the other, and of their own emotions
    about their environment. In short, when things get heavy, it’s
    easier to just label black and white and work from there.
    Splitting is the reaction to intense anger and frustration in
    those people who discover themselves to be powerless.
    Inherent in the act of splitting is apathy. You don’t try to find a
    solution to the problem person, the split is the solution. It
    allows you not to have to deal with the other, because you’ve
    decided that the other is irredeemable.
    Our apathy is everywhere. There’s a war on, and, except for
    the TV news, you’d never know it. No one talks about it
    (except in brief, obvious, “knowing” soundbites, cribbed from
    the Daily Show.) No one protests. The emotional focus is on
    Bush, not on a solution to the war, or anything else.
    Here’s an example: If, in the midst of no-liquids-on-airplanes
    Orange Alert, Cho was able to kill 30 students at Virginia Tech
    using two Glocks, how many students could a band of better
    armed jihadists kill? A quick back-of-the-envelope calculation
    provides a reasonable estimate: all of them. We’re not ready,
    but, more importantly, we are not trying to be ready. Not
    because we don’t think it could happen, in fact we’re all pretty
    sure it is going to happen— but because our entire emotional
    energy is diverted to the “all bad” other, be it Bush, liberals, or
    terrorists. “Terrorists— but I thought you just said…?” Yes,
    because that’s what splitting is, emotion directed at an
    abstraction of someone. We may hate “terrorists,” just not
    those 6 terrorists right there. Real terrorists pass under our
    noses without even a sneer. Can anyone name one, just one, of
    the NJ terrorists alleged to have been planning an attack on Ft.
    Dix? We’re too busy hating terrorists.
    The problem wasn’t that people thought Saddam helped the
    9/11 hijackers; the problem is that no one can name any of the
    9/11 hijackers. That would require work, emotional
    commitment, an understanding of the complexity of the Other.
    Much easier to say, “Saddam is evil…”
    Bush is fascist and stupid, and that’s it. Case closed. Now who
    wants pizza?

    Projection (scapegoating) and some Displacement:


    Placing all the blame on Bush gets us out of the hard work of
    introspection: why did they attack us in the first place? What
    do we do when Bush leaves? What should we do now?
    Blaming Bush for being an incompetent anti-Muslim
    warmonger purposely avoids the question of why 50% of the
    country was in favor of the invasion of Iraq. And some of the
    dissenters were against it only because they thought the costs
    were too high. Bush didn’t attack Iraq: we all did. Right or
    wrong, we have been headed for a military clash with the
    Middle East for at least 34 years. And we are on schedule to
    have another in two or three years. Are we going to ask why
    that is, or are we going to look to CNN for an analysis of the
    Gulf of Tonkin?
    Scapegoating also legitimizes apathy— we can start 2009
    fresh. “Sorry world— it wasn’t us, it was Bush.” The trouble
    is, only our allies believe this. The scapegoating is really a
    defense; those beliefs and emotions we attribute to that
    “cowboy Bush” are really our own. Ask our enemies, who are
    certain that it’s America that’s the problem, not just Bush,
    because our enemies have a larger historical view. Last time
    Iran challenged us was Carter. Was he a Halliburton
    warmonger? Did China/Korea prefer Truman? Putin wants
    Reagan back?
    There isn’t really an easier way to say this: that cavalier,
    simplistic attitude towards history; myopic beliefs which
    bypass logic or reason, supported only by intuition and faith;
    and a hatred of others who have a radically different
    perspective on humanity— that’s not Bush, that’s us. I’m not
    even saying this perspective doesn’t have some merit; but
    know thyself, yo.
    Most of our enemies share a common social philosophy that,
    at its core, is psychic: don’t trust any country where women
    are regularly more powerful than men; where individuals are
    more important than a collective; and where personal beliefs
    and freedoms trump historical identity. Because that means
    that its men are weak, its individuals are selfish, and they
    cannot be trusted to act in the long term interests of their own
    people. Rather than responding seriously to this insane
    worldview, with equal fervor— and it’s so easy to do it— the
    country has instead chosen to release this press statement:
    “Bush lied.”

    Denial:
    Since it’s all Bush’s fault, there isn’t actually any underlying
    problem to deal with.
    A football analogy is perfect: once you know your team isn’t
    going to the Superbowl, the mindset and the focus changes to
    next season’s draft, even while the current season is still on.
    No more sadness, no more heartache. Focus on the future frees
    you from the pain of the present (though you pay lip service to
    it with inanities (“if the Colts are going to make it next year,
    they’re going to have to run the ball and put some points on
    the board.”)) Meanwhile, you’re still losing this season.
    We simply hold our collective breath and wait for 2008, when
    the “problem” (Bush) will go away.
    Trouble is, the rest of the world isn’t waiting, and the real
    problem isn’t going away, it’s going to get much worse.
    One might make the argument that the only reason we haven’t
    been attacked again is that everyone “knows” Bush is “insane”
    and would invade them. Whatever. Point is, we are in denial
    about much larger political problems than George Bush.
    I’m only using terrorism as a convenient example, though
    larger political realities are in play. Chavez, Hu Jintao, Putin—
    they’re not reacting to Bush, they are preparing for his
    departure.
    “If only Al Gore had won…” Then what?
    Here’s an example I fear no one will understand. The Iranians
    took 15 British soldiers hostage. I don’t know what constitutes
    an act of war, but I figure this is pretty much it. The soldiers
    surrendered without a fight (ironically, so as not to start an
    international incident), and then pretended to go along with the
    Iranians. They did the song and dance “we are bad, we are
    imperialists, Ahmadinejad is good, we’re sorry, thanks for
    being so nice to us” and were eventually released.

    So I’m sure those soldiers were


    thinking, “look, I know who I
    am, I know I’m not a coward,
    I’m not helping the Iranians,
    but I have to do whatever is
    necessary to get out of this
    mess.” What they are
    saying is that they can
    declare who they are, and
    what they do has no
    impact on it. “I am a hero,
    regardless of how I act.”
    That’s the narcissist
    fallacy. Whatever they
    may think about
    themselves, the fact is that they did help the Iranians, and they
    are not heroes. But I can see that it is ego protective, I can see
    why they might take this perspective. There are few things in
    life worse than being taken hostage by the Iranians, so I
    understand why they would choose this type of self-deception,
    why they would turn to narcissism for defense. Bottom line is,
    I guess you can’t fault them for playing along.
    But here’s the thing: when they returned home to Britain, they
    were heralded as heroes by other people. Including the British
    government. Based on what? They didn’t actually do anything;
    heroism isn’t simply living through a bad experience. Well, of
    course: based on the fact that they are heroes who had to
    pretend to be something else.

    That’s the narcissist’s tautology: you are what you say you are
    because you said you are. What makes it an example of our
    collective narcissism is that we agree— we want it to be true
    that they, and we, can declare an identity.
    This is further evidenced by the British public’s outrage— not
    that they were being called heroes, but that they were allowed
    to sell their stories to the media. Not that they received false
    honor— who cares about that nowadays?— but that they
    received legitimate money.
    Here’s the part Americans can’t get: why would Iran put them
    on TV when everyone is going to know it was forced? Unless
    you are saying that the Iranians, and only the Iranians, are so
    completely delusional that they actually believe the
    servicemen were thankful and apologetic, then this show had
    to appeal to some broader audience. Other people had to
    believe this was the real thing. Is it possible— and I’m just
    asking here— that we are the only ones who don’t believe
    these statements were meaningful?
    In other words, is it possible that our enemies judge us by our
    actions, regardless of intent— and if you support Ahmadenijad
    on TV, then that counts— while we retreat into the narcissists’
    hideout of identity-as-declared, where any actions can be
    disavowed as “not who we are?”

    Reaction Formation: Sorry, Everybody; We’re Closed


    Reaction formation is an ego defense against id; when you
    want something that violates your identity, you shift violently
    to the opposite. The secretly gay man who is loudly anti-gay.
    It’s “going overboard.”
    Have the interventionist Bush years taught us that we need to
    be more involved with the world, and work with our allies and
    enemies to reach a common ground? No: it’s that everyone
    else is nuts, and the less direct contact we have with them, the
    better.
    I find it fascinating that the key lament against Bush is not
    ideological, but “realist.” You might think that women’s rights,
    civil wars, and pending genocides might be the pet issues of
    the Left, but increasingly Americans— right and left— feel
    that many people are simply not worth saving. That certain
    people aren’t ready for democracy. Women’s rights, while
    ideal, can only come after “they” (it’s always they) make some
    necessary preliminary steps. And that, no matter what, it’s
    never worth a ground assault if they don’t really want us
    involved.
    Not even on principle. Genocide in Darfur? Forget about
    sending troops to Darfur— we don’t even want to talk about
    Darfur. Any of the candidates mention Darfur? It’s only used
    as a comparator: since we haven’t/shouldn’t send troops to
    Darfur where things are worse, we shouldn’t have sent them to
    Iraq.
    Isolationism is the easy defense because we can pretend no
    one hates us. Good luck with that.
    No More Foreign Adventures
    What are the political ramifications of this defensive posture?
    Here’s an example: what happens if we are ever attacked
    again? It puts the nuclear option higher on the list of
    responses. Maybe not at the top, sure, but no way will we
    tolerate the costs of invading another country, no matter how
    well planned.
    The nuclear weapons are no longer the last resort. Think about
    this.
    Count Up Your Defenses: We’re Narcissists
    The primary sustenance of narcissism is control.
    Why did the gods punish Prometheus? It wasn’t just stealing
    fire: “I gave humans the illusion they weren’t doomed.” You
    think you’re in control of your destiny, because you can smoke
    cigarettes. Well, you’re not.
    Narcissism is identification without identity. It’s making
    something up and then fighting to the death to maintain it. It’s
    “the zeal of a convert.” It’s not really you, but boy oh boy
    don’t let anyone tell you that. You’ll sacrifice anything—
    happiness, money, comfort— in order to maintain control, to
    get people to think you are who you say you are. All that
    matters is people see you how you want to be seen— even if
    you’re really something else.
    There are three ways to protect an empty identity: violence,
    power, and money.
    Enter Feudalism
    Lord, vassal and fief. The lord owns the capital; the vassal gets
    to use it, and profit from it, but he doesn’t actually own it—
    the “it” being the fief. In return for the profits, the vassal
    agrees to fight for the lord.
    How does a man get his woman to act the way he wants, dress
    the way he wants, be the way he wants— so that he can be
    seen the way he wants? He allows her to live in his world and
    profit from the splendor of it in exchange for her allegiance
    and deference. What if his world actually sucks? Then he just
    beats her.

    What do we want, now? Identity-


    products. Things which signal to others
    who we want to be. IPod, Aeropostale,
    blogs. “This is me.” We want brands.
    Coke vs. Pepsi may not be relevant, but
    you can start a civil war by saying
    “Apple sucks, Microsoft is way better.”
    You don’t realize it, but blindly
    identifying yourself with externalities
    negates your significance in the world.
    You’re not a person, you’re a block. I don’t know you, but I
    know if you own a Mac, you voted for Kerry. Guess what?
    That means that Apple carries a lot of power with Kerry. But
    you don’t, not once you fell into this branded trap.
    The joke is that Halliburton controls the government. What
    saves this from actually being true is that Halliburton is a
    public company— anyone can buy into it. Even if they did
    control the government, you control them— it nets out. And if
    you don’t like the way they do business (or if you do,) the
    shareholders, or at least the biggest shareholders, can do
    something about it. But if Halliburton were not public, then all
    that power would be concentrated in the owners. You could
    work for Halliburton and profit that way, but you don’t share
    any of the power.
    But now things are different. Not since the 1980s, and before
    that never, has there been this much M&A activity, share
    buybacks and privatization. While this boosts share prices in
    the short term, as privateers bid up the price in a takeover,
    there’s a huge downstream cost: the company is no longer
    public. You don’t get to profit from it unless you work for it.
    Each privatized company, or the private equity firm who owns
    it, becomes a little lord. You want money? They demand your
    service. It is the opposite of owning a stock, where you
    demand their service. It’s more than just a concentration of
    wealth among the few. It is also a concentration of control,
    and, more importantly, risk. You may not be able to profit
    from it, but if something goes bad, for sure you’ll be asked to
    pay for it.
    If you think Halliburton is unaccountable to the public now,
    imagine when it goes private. And it will go private.
    Furthermore, as these companies become (more) multinational
    — as they derive less of their profits from the fertile soil of the
    U.S. economy, they will be less beholden to its government. In
    fact, they will have more control over the government.
    I think it’s stupendous that there is an individual campaign
    contributions limit of $2000, equalizing the effect among rich
    and poor. But this actually promotes feudalism: instead of rich
    donors buying some access to a future official, several rich
    donors get together to form a PAC to influence your vote. That
    gets them much more power than they had as individuals. In
    effect, they become the lord, and the candidate the vassal. And
    your $2000 vote is next to worthless.
    I won’t be the last to make this universally horrifying
    observation: if Hillary Clinton wins the 2008 election, then an
    entire generation of people— 24 years— will have been ruled
    by either a Bush or a Clinton. Why do we keep picking them?
    Because they’re the best? No— because they’re a brand. That
    saves us from thinking. And, conveniently, it gives us a
    scapegoat: the system is stacked against us, for them. Feudal.
    Remember, the defining emotion in narcissism is rage,
    frustration. Collective narcissism comes from collective rage,
    frustration. So Marx was wrong (yes, again.) Feudalism
    doesn’t precede capitalism, it follows inevitably, logically,
    after capitalism—if something, anything— goes wrong. In
    capitalism, not everyone succeeds, but everyone feels like they
    could. In a working capitalist model, class divisions would be
    fluid, people could go up and down based on their intelligence
    or work ethic. The mail boy could become the CEO. But if the
    classes become fixed, such that a mail boy could never
    become CEO— only other CEOs can become CEO— you get,
    well, feudalism.
    When that happens— when your future is limited, the
    tendency is to withdraw, get control over your local
    environment (family, friends, blogs, etc) and create an identity
    where you do have value above mail boy, even though in
    reality you are the mail boy. You get angry, frustrated,
    resentful— at “them,” the people who have more power than
    you.
    Here’s an example. On Thursday 5/10 I was listening to NPR,
    and the NPR interviewer said, oil companies are making huge
    profits, shouldn’t they have to eat into those profits to lower
    the price? And the interviewee responded that he’d prefer the
    prices to be higher, or even there to be a tax, which would
    result in less gas consumed, which would be better for the
    environment, etc. And the NPR interviewer responded
    something like, and I’m quoting from memory, “so if you need
    to hit them [oil companies] in the pocket, reduced demand
    would be another way of doing it.”
    Wow. WOW. The psychological pivot point for her wasn’t
    lower prices for the consumer, but hurting the oil companies.
    That’s where her head was at. And she’s a reporter! You see
    that anger, resentment, that powerlessness, disenfranchisement
    not in working capitalism, but in feudalism.
    There’s a hint of feudalism in the air already; universal
    healthcare, better, broader social security— this is the lord
    taking responsibility for the economic well being of its people,
    in exchange for “service.” It’s not socialism because there isn’t
    a redistribution of wealth— the wealth and power are actually
    more concentrated— it’s a lease of wealth.
    We are much more interested in how we will brand ourselves
    than in what we will do. We’ll sell out our votes, our safety,
    our liberties and general freedoms in exchange for a safe,
    mostly hands-off environment where we are free to pretend to
    be someone. Yes to isolationism. Yes to expediency, yes to
    individualism. Just give me a little space. And don’t tell me
    what I can and can’t wear. My clothes are who I am.

    It’s not a clash of ideas, USSR vs. US; it’s more visceral,
    personal. People hate us for us, we hate Bush for Bush, there’s
    plenty of hate all around, so we retreat inside ourselves and
    our denial. We’re leveraging the future for short term control
    of our micro-environments, selling ourselves in exchange for a
    25 year lease. We want to be renters, not owners, so we don’t
    have to fix the toilet. Meanwhile, the world trudges on.
    Why Fly When You Have
    Tuberculosis?
    May 30, 2007

    Have you heard about the nut who, after being diagnosed with
    a rare tuberculosis, takes two transatlantic flights? Putting
    everyone at risk? Especially after doctors managed to track
    him down in Europe to tell him his tuberculosis strain was
    “extensively drug [isoniazid and rifampin] resistant” and very
    dangerous, and ordered him into isolation? Why would this
    nut do it?

    The man told a newspaper he took the first flight from


    Atlanta to Europe for his wedding, then the second flight
    home because he feared he might die without treatment in
    the U.S.

    He wasn’t in the Sudan, or Kazakhstan— he was in Italy. And


    he went to Prague to catch a plane to Canada SO THAT HE
    COULD DRIVE TO THE U.S.
    I suggest everyone think long and hard about this, before we
    take any further steps down the road towards universal
    healthcare. You can’t give away what you didn’t pay for.
    5/31/07 Addendum: AK (see comments) discovered that the
    guy is actually a personal injury lawyer. That’s irony. And his
    new father-in-law is a CDC doc specializing in… go on,
    guess…
    I Win Again
    May 31, 2007

    Seems like some people liked my Iraq post.


    Other people hated it, of course, keeping in check my gigantic
    ego. Thanks!
    6/5/07 Addendum: But wait: PsyBlog has decided I have the
    “Best Psychiatrist’s Blog.” Take that, Lisa’s beliefs!
    If These Guys Aren’t
    Invested, Then It’s Over
    June 4, 2007

    Late last night I saw National Georgraphic: Inside The Green


    Berets. The platoon was having a memorial for one of the
    Berets who had just been killed by an IED, and the Green
    Beret giving the eulogy says, “he wasn’t just fighting for his
    country, he was fighting for a higher cause— he was
    protecting each of us.”
    Army of One, I guess.
    “The Copycat Effect:” Does
    Reporting Violence Lead To
    Violence?
    June 4, 2007

    A reader asked me to read his book before saying


    that copycat suicides is not a real phenomenon.
    To be fair, his book is really good. It is worth the
    price even as a reference guide/catalog of suicides
    and homicides that share similar characteristics,
    which are striking. While the majority of the
    information is a google search away, the fact is
    that he actually did the searches. It’s also a good read— it
    neither bores you nor crams the conclusions into your head.
    But, I respectfully disagree. I think.
    The main disagreement I have with the book is that he
    conflates two phenomena. His stated thesis of the book is that
    media reporting of violence and suicides begats copycats.
    However, in support of this premise, he uses examples of the
    media itself (e.g. movies) causing copycats.
    A perfect example of this is the Werther Effect, so named for
    the Sorrows of Young Werther, the 1774 comic book by Goethe
    in which the protagonist kills himself because he can’t get the
    girl. Subsequently, there were numerous copycat suicides—
    staging it (same clothes, same desk) as Werther in the novel.
    Ok, I get it— that’s a copycat. But that’s not an example of
    media reporting causing copycats.
    In contrast, here’s an example of a reporting-induced copycat:
    Coleman relates the Bergenfield Four. For a few months, there
    were rumors that a bunch of kids who called themselves “The
    Burnouts” had made a suicide pact. In September of 1986 their
    leader killed himself; in March of 1987 four others carbon
    monoxided themselves in a parking garage, leaving a note that
    clearly linked the deaths. One week after that, a cop found two
    other kids trying to do the same thing in the same garage. The
    day after the original four suicides, but in Illinois, two other
    teens suicided the same way (in a garage, in fact.) Coleman
    writes that by checking newspapers, he counted 22 teen carbon
    monoxide suicides in two weeks— 47 in a month.
    But then there’s the case of Barry Loukaitis, who in 1996 shot
    two kids and a math teach, and said he got the idea from
    Stephen King’s Rage, Pearl Jam’s Jeremy, Natural Born
    Killers and The Basketball Diaries. Coleman writes that “the
    media attention…triggered a series of similar events.” So, in
    these copycats, was it Basketball Diaries or the evening news?
    It’s hard for me to see how the news can be more influential to
    a suicidal kid than the movie itself— do kids even watch the
    news?
    In fairness, he does cite numerous examples of media
    reporting induced copycats (check out the chapter “Planes Into
    Buildings” for a wild ride) but overall the argument is
    weakened by using both together. I left the book reasonably
    convinced that media can inspire copycat violence, but not that
    they inspire violence itself. In other words, I think those
    Werther scholars were going to kill themselves somehow, but
    they decided to shoot themselves (as oppposed to self-
    immolation) because of the book.
    The distinction— media or media reporting— is important
    because the solutions are different. Here’s an example: the
    book opens with the story about how one month after Marilyn
    Monroe’s suicide, 197 (mostly blonde women) “appear to have
    used the model,” to suicide— an increase in the suicide rate of
    12%. Furthermore, the suicide rate never went down after that.
    “This is the copycat effect working with a vengeance.” Maybe.
    Or maybe the graphic description of the suicide wasn’t to
    blame, but rather that a huge icon had done it at all. Are they
    copying her, or is society ripe for self-destruction? Either way,
    should we not report that Monroe killed herself at all? How
    much do you control information to protect the people? If the
    government is doing the controlling, then I can’t imagine the
    answer should be anything other than “not at all, get the hell
    out of my face.”
    I’ve always said that the “mainstream media” is neither liberal
    nor conservative— they are sensationalist. Of course I think
    they overreport, and overdramatize unusual violence. But I see
    that as more of a symptom of our culture than the cause of
    anything. You could close down all news portals, it won’t
    change the amount of violence. Sure, maybe you wouldn’t
    have thought of playing Russian Roulette. But you were going
    to come up with something.
    Coleman wrote a thorough book, using the type of diligent
    research the CIA is supposed to be good at: compiling open
    source information and forming links. I only partly disagree
    with his conclusion, and I am still open to further arguments.
    But I am against the solution.
    It’s worth remembering that, in response to the copycat
    suicides, Sorrows of Young Werther was banned in Germany. I
    know I am one of only 8 people who has actually read it, but
    do we really want it banned? Maybe “dangerous” books need
    to be delayed by a generation to be published? And you see
    my problem.
    Absent direct power or wealth, the only thing that keeps us
    free is information. I believe it is worth the risk of copycat
    suicides, especially since influencing the choice of the method
    of suicide isn’t the same as influencing the choice of
    commiting suicide.
    Paris Hilton or Mary
    Winkler? Forensics Gone
    Awry
    June 10, 2007

    I’ll take Paris any day.


    So Paris goes back to jail after the behind the scenes/cover of
    darkness/MK-ULTRA deal she made to get out of jail early
    was met by the public with consternation.
    As near as I can tell, a/her private psychiatrist (his blog here—
    mine’s better, dammit) visited her for two hours in jail, then
    made a plea to the sheriff that serving her sentence in jail was
    psychiatrically harmful to her. So they let her out to serve it at
    home.
    The argument here, of course, is that this is rich-white-girl gets
    special treatment; and the easiest way to do it is to use
    psychiatry. And people say, “see? This is they type of abuse
    we can expect if psychiatry is allowed to influence legal
    matters.”
    Fair enough. I don’t know Hilton’s case, whether it was a
    appropriate or not, I don’t know Dr. Sophy; all I can say is,
    yes, the potential for abuse exists, but perhaps it is balanced
    out by the cases in which it is helpful to society.
    But consider the reverse situation, and read it carefully
    because then I’m going to punch someone:

    SELMER, Tennessee (AP) — A woman who killed her


    preacher husband with a shotgun blast to the back as he
    lay in bed was sentenced Friday to three years in prison,
    but she may end up serving only 60 days in a mental
    hospital.
    Mary Winkler must serve 210 days of her sentence before
    she can be released on probation, but she gets credit for
    the five months she has already spent in jail, Judge Weber
    McCraw said.
    That leaves only two months, and McCraw said up to 60
    days of the sentence could be served in a facility where
    she could receive mental health treatment. That means
    Winkler may not serve any significant time in prison.

    Same gripe: look how people use psychiatry to manipulate the


    legal system— “only two months for killing someone?!” and
    while I agree that’s pretty pathetic, what’s worrying me is this:
    who the hell spends five months in jail without getting a trial?
    This probably didn’t occur to you, and that’s why it still
    happens. If I kill my preacher husband, I have the right to a
    speedy trial. If I can’t get a speedy trial, I get to pay a fee to be
    released, and then show up in court when the government gets
    their act together. But what if I don’t have bail money? How
    can the courts justify indefinite incarceration in the absence of
    a trial?
    Enter psychiatry. You get a psychiatrist to evaluate the person
    and determine that he is not competent to stand trial. They
    recommend 60 days involuntary commitment/treatment in a
    psych hospital in order to “restore them to competency.” If at
    the end of 60 days the evaluator comes back, and if he still
    thinks they’re not competent— they get (re)committed again.
    Etc.
    Trial competency has very specific requirements:
    understanding how you wish to plea, the possible sentences,
    working with your lawyer, etc. Being depressed or psychotic,
    per se, isn’t the determinant— only if it seriously impacts your
    ability to, say, understand the charges against you.
    But in the vast majority of cases I have been involved in, the
    report really only reflects the presence of a mental illness, not
    its impact to the case. As if it is de facto proof of
    incompetency. It’s not.
    But here’s the move: the “psych hospital” they get
    involuntarily committed to is actually their cell.
    Technically, they are supposed to be committed to an inpatient
    hospital. Many jails have them on the premises. But if the
    commitment is for 60 days, and the psychiatrist treating them
    (i.e. not the evaluator) thinks they are cured, then they get sent
    back into population (their cell). Maybe they continue on
    medication; maybe they see the psychiatrist weekly for
    “outpatient” visits.
    Or maybe, maybe, the treating psychiatrist doesn’t think they
    need any treatment. So they spend their commitment in
    exactly the place they started.
    Worse, much worse, is how many people I see that I say are
    competent and still wind up recommitted for two months. Six
    months. A year. Think I’m kidding? It is impossible to even
    estimate how many charts I have read that indicate no
    psychiatric contact— not medication, not therapy, not
    psychiatrist— for the entire duration of their commitment.
    And why should there be? The treating psychiatrist doesn’t see
    anything to treat.
    You’re probably thinking about murderers and rapists; but the
    majority of these cases are theft, assaults, drug possessions.
    Can anyone explain to me what possible justification exists for
    locking up a guy charged with possession for eight months, no
    trial? And I’ll pretend the guy is whacked out of his nut
    psychotic. Ok? Any justification at all?
    I’m not saying you can’t sentence him to eight months— cane
    him, for all I care; I’m saying you can’t jail him for eight
    months without a trial. Is anyone listening to me?
    The system is designed with simply one outcome in mind:
    keep the poor with high recidivism rates and minimal social
    resources in jail— a sort of half-way house for the
    disenfranchised— until you can’t possibly justify it any longer,
    and then give them a quick trial, accept the guilty plea (“what
    guilty plea?”) and sentence them to time served and probation
    — where you can add further controls.
    It’s debatable whether keeping potential terrorists in Cuba is a
    good idea. But when the State starts using pyschiatry to
    manage their population…
    I know you think I am exaggerrating. I’ll bet you’re not poor.
    FTAC: Forensics Gone Awry,
    And I told You So
    June 12, 2007

    Following from my premise that the erosion of civil liberties


    and descent into fedualism necessarily coincides with the rise
    of psychiatry, I found a short article in the Economist, the
    magazine of record of the Whig Party, which explains that
    British Government runs a “Fixated Threat Assessment
    Centre,” i.e. capturing stalkers. It has 4 cops, and a forensic
    psychiatrist and psychologist.
    You probably think that the shrinks are “profilers.” Maybe
    they are. But their real value is in their power to do what cops
    can’t: involuntarily commit people who they feel are
    dangerous. Quoting the Economist:

    The Met [cops] defines its [suspects] as those who are


    “abnormally preoccupied with certain ideas or people.”
    The inclusion of “ideas” gives it wide remit. Could those
    abnormally pre-occupied with the idea of jihad— or,
    indeed, human rights— be considered fixated
    individuals?

    Disclosure: I actually think this is clever— why not tap the


    legal resources of psychiatrists to help catch bad guys? But
    that’s exactly the point: no one should have the ability to use
    that power extra-psychiatrically. It’s seductive and it has no
    recourse for appeal, no controls.
    The article goes on to state the FTAC has been operating for 8
    months with no official announcement; it won’t say how many
    people it has caught or tried; and, of course, it can’t, because
    of confidentiality of the “patients.”
    Good luck, everybody.
    This Will Either Mean
    Something To You, Or It
    Won’t
    June 14, 2007

    It’s a heavy moment, the first time you realize you are older
    than Han Solo.
    The Sopranos Finale
    Explained
    June 15, 2007

    We meet at our regularly scheduled


    Monday lunch spot, and my friend says,
    “did you see the Sopranos finale?” No.
    “It sucked, nothing happened. It was
    completely unsatisfying. It just ended
    with him sitting in a diner, eating with his wife.”
    “What did you expect would happen?”

    “I don’t know, something, some closure. Maybe he gets


    whacked or something.”
    “How did it end?”
    “He’s just sitting there, eating an onion ring, and Journey’s
    playing, and suddenly it ends. Like the film broke. And they
    go right to the credits.”
    I had never seen an episode of the Sopranos, but I knew at that
    moment that Tony Soprano had died.
    Before I explain, I’ll tell you that last night, drunk at a hotel
    bar around midnight, there was The Sopranos on the TV above
    me. It was the last five minutes, but I recognized it
    immediately from my friend’s description. Tony sitting in a
    booth, his wife slides in and he gives her a grunt-greeting
    reserved only for the most familiar of contacts— beyond love
    or friendship— then another guy comes over and joins them.
    Meanwhile, suspicious characters abound— the Member’s
    Only jacket prominent, a signal of belonging vs. exclusion; his
    daughter trying to park the car— figuring things out on her
    own, she’ll get it eventually— and, of course, Journey’s Don’t
    Stop Believing.
    And, like my friend said, the show simply stopped. The bar I
    was in had been silent— but a collective groan arose when the
    credits rolled. Everyone hated it.
    I was right. He was dead.
    I knew he had died because I knew my friend. He is a human
    being living in our times, possessing an element of natural
    narcissism common to all of us. Remember, the narcissist
    believes he is the main character in his movie. This is why
    they— we— have such trouble with death. In any movie or
    show, even when the main character dies, the movie continues
    (the movie never ends/it goes on and on and on and on). It is
    still about him— you see the reactions of other people to his
    death, you see consequences.
    But in reality, when you die, it ends. There’s no more; you
    don’t get to see the reactions of other people to your death.
    You don’t get to do anything.
    I knew Tony Soprano was dead because it was too abrupt, too
    final, for my friend, and for everyone in that bar. There was no
    denouement, there was no winding down, no debriefing, no
    resolution. Not even a struggle for survival— at least let him
    draw his gun! No death on your terms. And, most importantly,
    the death didn’t seem to flow logically from the show. The
    death made no sense, it was arbitrary. It was unsatisfying.
    In other words, it was too real.
    We all have an element of essential narcissism in us, that’s part
    of having an identity. But it alters our relationship to death. We
    want it to flow logically from our lives, and most of the time it
    does. But sometimes it doesn’t. Except for heroes and
    suicides, no one gets to choose the time and place of their
    death, nor the manner. Nor can we control people’s reactions
    to our death.
    All we can do is choose the life we leave behind. Choose.
    Dr. Nasrallah Asks Questions
    That No One, Including He,
    Wants Answered
    June 20, 2007

    But I’m going to try.


    His editorial appears in the journal Current Psychiatry, of
    which he is the editor. I respectfully disagree.

    Why did TV commentators assume the crime was caused


    by “evil” and “psychopathy,” instead of a medical illness
    in a young man with many psychiatric manifestations?

    Because that’s the logical assumption. The two are not


    mutually exclusive as implied by the question, and, while
    “evil” and “psychopathy” are attributions, medical illness
    requires a basis in pathology. Commentators could not have
    known whether or not he was medically ill, nor if this illness
    had anything to do with the violence, but it is definitional that
    the act was evil.
    Reversing the question reveals the fault in logic: why didn’t
    commentators assume he was mentally ill? Is that the default
    assumption in the absence of evidence?

    Why do most people assume that a psychotic individual


    driven by delusions is too “incompetent” or “confused”
    to plan and carry out a complex series of deadly
    assaults?

    Does anyone assume this? This is a straw man argument. What


    is really being asked is: why do people assume that if the
    attack was complex and deadly, it had to be done by an evil
    mastermind, not a psychotic person? And no one assumes that,
    either. The question is sleight of hand; it tries to make the issue
    binary, psychosis vs. evil. The two are not necessarily
    correlated in either direction (right?)
    As above, reverse the question to see the logical flaw: should
    people assume that complex, deadly attacks are the work of
    someone who is psychotic? Is psychosis—or, indeed, any
    mental illness— a risk factor for extreme violence? That
    doesn’t bode well for a society with “25%” mentally ill, as
    claimed below.

    Why did the mentally ill student receive no follow-up care


    before the crimes, even though he had received
    psychiatric treatment?

    Perhaps he didn’t want any follow-up care? I know: “but look


    what happened!” Perhaps we can envision a scenario where a
    group of experts make a judgment about someone’s
    dangerousness in the absence of a crime or any concrete
    evidence (which would allow ordinary legal channels to be
    used), and then can commit, or restrict this person’s freedom,
    until they are no longer considered dangerous. We already
    have this: it’s called Guantanamo. And before you say there’s
    a difference, let me assure you there is not. Quis custodiet
    ipsos custodes?
    (NB: the context of the quote by Juvenal has an interesting
    parallel: it is about enforcing morality. “My friends always tell
    me, lock her up! Restrain her! But who watches the
    watchmen? The wife will then start with them…”)
    Several issues are being mashed together to extract the favored
    response, “we need better mental health care.” But it’s not
    valid. If a psychiatric patient commits murder, he goes to jail.
    If you have good reason to suspect he is about to murder, you
    commit him. If you feel he is about to murder, but do not have
    enough evidence to commit him, you contact whomever is
    necessary (potential targets, etc). And if he is a student, you
    tell the administration so they can put him on temporary leave.
    This is key: it is morally wrong, not to mention illegal, for a
    psychiatrist to force a person to get treatment he does not
    want. But it is entirely legal, and desirable, for a school to
    insist that a person receive treatment as a necessary condition
    of returning to the school— if and only if there exists a risk
    towards others.

    Do medical record requirements in the Health Insurance


    Portability and Accountability Act (HIPAA) protect
    individual privacy at the expense of public safety if a
    patient is seriously mentally ill?

    No; did any one say they did? If we have reason to suspect
    imminent risk of harm to self or others, we have multiple
    avenues/obligations to deal with the situation, confidentiality
    and privacy be damned. In fact, if psychiatrists simply feel a
    person is dangerous in the absence of any concrete evidence
    (direct threats, storing weapons, etc), they can “violate” the
    patient’s (constitutionally non-existent) right to privacy. They
    can tell anyone they need to—the school, parents, whomever.
    What psychiatrists can’t do is lock them up or commit them,
    or force them to take drugs, just based on their “feeling,”
    without a solid reason. And thank God.

    If the university administration had known about the


    student’s psychiatric disorder, would he have received
    better treatment and supervision? Or would he have been
    stigmatized or expelled, whether or not he responded well
    to medications and counseling?

    What, exactly, is meant by “psychiatric disorder?” Schools


    don’t expel people because they have a mental illness; they
    expel them because they are dangerous to have on campus. If
    Cho had been determined to have been dangerous—regardless
    of the cause, whether it be mental illness, drugs, or Satan’s
    direct influence, why shouldn’t he be at minimum suspended?
    (This is very different than being suspended simply for having
    a mental illness.)
    I’ll repeat: it’s not discrimination because he has a mental
    illness; it’s discrimination because he is thought to be
    dangerous, regardless of the reason.
    We can’t force him to get treatment, but neither do we have to
    tolerate his Oddboy, knife wielding nonsense. Being on
    campus is a privilege, not a right. He either stops, gets
    treatment, gets a girlfriend, whatever— or he gets off campus.

    How can roommates or teachers receive adequate


    information to help a mentally ill student or monitor for
    treatment adherence when HIPAA rules prevent even
    families from knowing details of mentally ill adults’
    diagnosis or treatment?

    I’m not sure how many different ways this question is wrong,
    but six is a fair guess. Why should roommates receive any
    information? (Or, if things are so bad that they should be
    receiving information about the person’s mental state,
    shouldn’t someone else be involved?) Is the dissemination of
    information for the benefit of the patient, or the protection of
    everyone else? It’s different information. Why is it
    roommates’, or teachers’, or the schools’ responsibility to help
    monitor treatment adherence? If they are “helping” monitor
    for treatment adherence, are there any repercussions for failing
    to do this?
    This is the creep into a custodial society, the social
    consciousness flip side of Bush style privacy violations. I
    know it looks like we want this; I swear to you we don’t.

    Because the home-to-college transition can be very


    stressful, should colleges require freshman courses on
    how to recognize distress and seek help?

    My head just detonated. How many credits will this be worth?


    Is there a test?

    Given that schizophrenia, bipolar mania, and psychotic


    depression often emerge between ages 18 and 25, why
    have colleges and universities not adopted early
    screening and intervention?
    Because they are colleges, not health maintenance
    organizations. They don’t screen for pregnancy, STDs,
    lymphoma… By the way, if the university administration did
    screen for students’ psychiatric illnesses, are you obligating
    intervention? If the student refuses, then what? Expulsion?

    Are mentally ill persons more dangerous than the general


    population, or is that perception based on highly
    dramatized media reports of isolated incidents?

    This question should have been asked first. If they are more
    dangerous, then this debate is really about screening for
    mental illness as a risk factor for violence. It means that it is
    ok to expel people for having a mental illness; for more
    aggressive commitment and supervisory maneuvers; for, well,
    Kansas v. Hendricks. If you want to go down this road, good
    luck, I’ll wait for you in Russia. But if they are not necessarily
    more dangerous, then most of your other questions are moot;
    we should be treating mental illness, not violence; and we
    should be dealing with violence as violence, not as the
    inconvenient symptom of mental illness.

    When will health insurance cover brain diseases that


    manifest as thought disorders or behavioral aberrations,
    such as schizophrenia or obsessive-compulsive disorder,
    in parity with brain diseases that manifest as muscle
    paralysis, such as stroke or multiple sclerosis?

    When you can show that they are diseases, not heuristic labels
    of behaviors. Schizophrenia is easy; what about ADHD?
    Should it be covered in parity with strokes? Asked another
    way: given finite resources, are they better allocated towards
    the treatment of strokes or ADHD? I’m not making a moral
    judgment, I’m asking about practical outcomes. Do you get the
    same outcome for your dollar in ADHD as in strokes?

    Given that >25% of the U.S. population has a


    diagnosable and treatable mental disorder, why is our
    mental health system so fragmented, so inadequate, and
    so underfunded? And why is there no public outcry to fix
    it?
    Wow.
    25% have a diagnosable mental disorder? What definition are
    we using here? If we are talking about the DSM, then does
    voyeurism count? (NB: I refuse treatment.)
    As evidenced by this editorial, more and more behaviors are
    classified as, or at least taken as prima facie evidence of,
    mental disorders. Following, it is a simple exercise to
    determine that, in fact, 100% of people have a diagnosable
    mental disorder. 100% of people have a medical disorder as
    well, if it includes the disorder “pain.”
    It’s sleight of hand. Psychiatry can help these 25% (or 100%),
    regardless of whether they really have a “disorder” or not. But
    that doesn’t identify them as necessarily the realm of medicine
    or psychiatry. This is the “mission creep” of psychiatry—
    away from biology, as it claims it relies upon, and towards an
    instrument of social change. Perhaps it can tackle poverty,
    globalization, and terrorism next? Furthermore, labeling (not
    discovering— labeling) something as a psychiatric disorder is
    done to imply exclusivity: e.g. if it “was” mental illness, than
    it wasn’t evil. People will dispute me on this, but re-read this
    editorial, its point is exactly this distinction.

    Finally, as a parent and husband, I have one last


    question: how can we console the bereaved families of
    the Virginia Tech students and faculty who suddenly lost a
    son or daughter, husband or wife in the prime of life?

    One way would be to not reduce what happened to the simple


    result of an untreated illness. “If only he had been in
    treatment.” Really? Is that all it takes?

    For them, improvements in mental health care on our


    college campuses will come too late.

    And for the rest of us, these “improvements” come perhaps too
    soon.
    So At Least Two People
    Agree With Me
    June 22, 2007

    From the New Yorker, 6/25/07

    If I could change this cartoon in any way, I’d add three words
    to the caption: “So I drink.”
    And, as a bonus, I come across this sentence in Walter Russell
    Mead’s essay in the current issue of Foreign Affairs:
    The French have long felt that Englishmen do not like women,
    are bored or frightened in their presence, and turn to drink as a
    substitute for female company.
    I don’t know how accurate the stereotype about Englishmen is,
    but the link between alcohol and women is dead on.
    Damned If You Do… No,
    That’s All. Damned If You
    Do.
    June 27, 2007

    In case there was any doubt that psychiatry is on the march


    (from Psychiatric Times June 2007):

    The mass murders at Virginia Tech [sic: there was only


    one mass murder] could lead to harsher laws restricting
    [mentally ill people’s] rights… Perlin, professor of law at
    NYU, predicted that several states will try to change the
    basis for involuntary commitment from danger of harm to
    self and/or others to the need for psychiatric treatment.
    [emphasis mine, but really, does it need emphasis?]
    Mr. Perlin said he expects the U.S. Supreme Court will be
    asked to rule on such a statute’s constitutionality within
    10 years. “I am already counting the votes.”

    Me, too: Scalia, Thomas, Roberts, Alito, Ginsburg— strange


    bedfellows, indeed, but Scalia and Ginsburg spend every New
    Year’s Eve together— against; Souter, Kennedy for; the rest is
    anyone’s guess (Stevens may not even be there.)
    The second article, from the same issue, accidentally describes
    the crux of the psychiatry/violence dichotomy. In “Mental
    Health Staff Can’t Sue If Injured By Patient,” the writer
    explains how it is rare, and generally discouraged, for staff to
    sue or press charges against a patient who is violent and
    injures them.

    Patients who attack mental health professionals in


    hospital settings are rarely prosecuted and usually cannot
    be sued for civil damages [said] Ralph Slovenko, Ph.D. at
    the annual meeting of the American College of Forensic
    Psychiatry.
    …Authorities usually take the position that it would be
    inconsistent to prosecute a person who has already been
    hospitalized for reason of mental illness…
    … a New Jersey Court ruled [that] to convict a mentally
    ill person for displaying symptoms of mental illness…
    could not be justified constitutionally or morally.

    Anyone disagree? Choose carefully. Here’s the problem: the


    exemption from prosecution isn’t for the insane behaving
    insanely, or the schizophrenic exhibiting psychosis; the
    exemption is for any patient. “Patient” in this context, is
    defined as anyone who is in the psychiatric hospital. In other
    words, it’s not a label based on pathology; it’s a label based on
    geography.
    This may surprise many people, but psychiatrists hospitalize
    non-mentally ill people all the time. Any resident will lament
    how often they are confronted with the malingering drug user
    who fakes suicidality to gain admission. Well, if you admit
    him— strike that, if he has ever been admitted— then he is a
    de facto patient. If he kills you, he is automatically in a
    different legal status than if he murdered you in a supermarket.
    For example: no death penalty.
    It goes without saying, of course, that even the presence of
    mental illness shouldn’t free one from prosecution. That’s why
    we have the legal construct of insanity.
    Here’s the clincher:

    The situation is analogous to the “Fireman’s Rule” in tort


    law, he said. A firefighter… cannot sue the owner of a
    burning building for injuries sustained in firefighting.

    … I assume because a firefighter must have a reasonable


    expectation of fire-related danger. Fine. But if the firefighter,
    while fighting the fire, gets shot in the face by one of the
    meth-lab workers inside that the owner of the building is
    employing to make methamphetamine, is there no basis for a
    suit? Does reasonable expectation of a certain level of danger
    extend to, well, to volitional acts of violence that have nothing
    to do with the physical structure that the violence happens in?
    The reason I mention these two articles together is because
    they are the same. “Mental illness” is a term so vague and
    empty that it is dangerously useless. Reducing one’s
    responsibility, or restricting their freedom, based on such an
    arbitrary term is, well, insane. Doing both at the same time is a
    tacit acceptance of classism; that some have the responsibility
    to rule, and some have the responsibility to be ruled.
    Oh, I know: everyone hates George Bush because he has no
    respect for civil liberties. Ok.
    When I Said Doctors Were
    Too Involved In Social Policy,
    This Isn’t Exactly What I
    Meant
    July 3, 2007

    “Seven of the eight people arrested are doctors or medical


    students…”
    No psychiatrists, but it’s only Tuesday.
    The Most Important Article
    On Psychiatry You Will Ever
    Read
    July 10, 2007

    I’m warning you.


    Let’s begin with a simple drive down a
    country road, say, I10.

    The Three Problems of Psychiatry:

    You know those white dashed lines separating the lanes in a


    highway? How long are they? Answer: _____________ Most
    people I ask say 3 feet. The real answer is 10 feet. Surprised?
    And that’s the first problem in psychiatry: perspective. Your
    perspective is always driving at 60mph, so they look 3 feet
    long. Unless you change your perspective, you never get to see
    the truth. Worse, much worse, you go through life confident
    they are three feet.

    Which brings us to the second problem: closed mindedness.


    Even though I’ve told you the truth, you still don’t believe it—
    that’s how powerful your perspective is. “He must be talking
    about some other lines, maybe in France?” Unless you change
    your perspective, you will never be open to the truth, to the
    discovery that what you have thought, for your entire life, is
    wrong. Unless you get out of your car and measure those lines,
    you’ll never accept the truth.
    Which brings us to the third problem: if you do try and change
    your perspective, get out and measure those lines, you will be
    quickly dispatched by a minivan to the face for your lack of
    faith.

    The irony of it all was not lost on Paris. Or was it coincidence? Irony?

    Here is a picture of a molecule of Seroquel:

    It’s a single molecule. Count them.

    Seroquel, like all atypical antipsychotics, binds to multiple


    receptor types. Seroquel blocks, with varying affinity,
    histamine (H1), alpha 1 (a1), dopamine (D2), etc, etc. You can
    imagine a molecule having different spokes to it, that each bind
    to different receptors. Here’s a graphical representation of this,
    made famous by Steven Stahl, MD, at the University of
    California, and formerly with Styx:
    Consult your doctor if you are at risk for esophageal rupture

    The other way this is often represented is with a pie chart:

    From the video Serocool (Styx, 1981)

    A typical understanding of this pie chart is that the various


    sizes represent “amounts” of blockade. So, here, Seroquel is
    very antihistaminergic—so it causes a lot of sedation. It is
    moderately an alpha1 blocker—which is what causes
    orthostasis (lightheadedness/dizziness/grogginess). And much
    less of a D2 blocker, which is what actually provides the
    antipsychotic effect. You can also see that Seroquel’s H1
    section is bigger than Zyprexa’s, which explains why Seroquel
    is more sedating than Zyprexa. (1)
    One molecule gets you H1, a1, 5HT2a, D2

    Two molecules gets you twice as much H1, a1, 5HT2a, D2


    So this is so
    easy to
    visualize
    that anyone
    can
    understand
    it. But
    unfortunatel
    y this
    representation is misleading, it leads you to think something
    that is not completely accurate, in the same way that looking at
    Nancy Pelosi makes you think of that guy in Raiders of the
    Lost Ark:

    BUT HOW CAN COLOR PICTURES BE WRONG?


    One of the central themes of the postmodern critique of our
    values is that aesthetics must trump truth as long as aesthetics
    remains undefined. That’s the semiotic conundrum, why
    psychiatry is politics: the truth is demanded only when it
    supports a preset ideology.
    WHAT THE HELL ARE YOU TALKING ABOUT?
    Nothing. Let’s move on.

    The mistake is that those pie chart sections aren’t amounts,


    they are affinities. They are preferences. Here’s a metaphor.
    Imagine you have only one molecule of Seroquel. Where does
    one single molecule prefer to go? It can’t go to four different
    places, right? It has to “choose.” And most likely it chooses to
    go to H1. The spokes don’t cause the effect— the spokes fit
    into receptors— the receptor causes the effect. So if it binds to
    H1 receptor, the other spokes remain unused.
    Let’s say you are a gentleman, and as such prefer blondes by
    virtue of their fair hair, lithe contouring, and receptiveness to
    new ideas. If you’re in a room with 10 brunettes and two
    blondes, do you go to everyone, equally? (Assume for this
    gedankenexperiment you have only the one, non-mechanical
    penis.) No, you make a bee line for the blondes.

    Tom was thankful he was sober enough to avoid the ugly one
    WHAT IF ALL THE BLONDES ARE TAKEN?
    This is a safe bet. Sadly, since not every blonde will support
    your ideas for a ménage, you’ll have to settle for the brunettes.
    Painful, I know. I can call you in a script for Viagra.
    So one molecule goes to H1. What about two molecules? Or
    three? Or 13 gazillion?
    Think how sedating 25mg of Seroquel is (trust me, it’s
    sedating.) Why isn’t 32 times more— 800mg— lethal?
    Certainly 32mg of Xanax is more than a short nap, so what’s
    the difference?
    Instead of thinking that the drug binds to all receptors
    simultaneously, a better analogy would be a champagne
    fountain, like at a wedding. Except I hate champagne, so
    pretend it is a rum fountain. Rum fills the top level, overflows
    into the second level, then that overflows into the third, etc.
    You can’t get anything into level 3 until you fill levels 1 and 2.
    And, once you’ve filled level 1, you can’t put anything more
    into it.

    Get it? So level one can be labeled H1, level two is alpha 1, and
    level 3 is D2. (2)
    So you can see that, at some dose, there is no more increasing
    sedation with Seroquel. You’ve filled up level 1— the H1
    section. Going from 25mg to 50mg is a big jump in sedation
    (level 1), but going from 400mg (level 3) to 800mg is not felt
    to be an increase in sedation. It’s the same amount of sedation,
    because by the time you hit 400mg, you were all full up. (3)
    But there’s a dark side to my analogy, and it isn’t the rum fits.
    Here’s the thing: if one molecule of Seroquel goes to H1, and
    not to D2, then can it have any antipsychotic effect? No. One
    molecule binds to H1, so it isn’t an antipsychotic, it’s an
    antihistamine.

    DOESN’T THE BOX CLEARLY SAY ANTIPSYCHOTIC?


    Yes, it does. Weird, isn’t it?
    Until this drug is blocking a significant number of D2
    receptors, it is not functioning as an antipsychotic. Important:
    the antipsychotic effect of one molecule of Seroquel isn’t so
    weak you just can’t see it— it is exactly and precisely zero.
    The drug can’t be called an antipsychotic unless it is behaving
    as an antipsychotic, regardless of the product labeling.

    ARE YOU SAYING THE FDA ARE A BUNCH OF


    UNSCIENTIFIC ASS-MONKEYS?
    What?

    At some amount of D2 blockade, these things will be


    antipsychotics. What amount? Theories abound, but look at it
    this way: 10mg of Zyprexa blocks a certain number of D2
    receptors. How much Seroquel, Risperdal, or Geodon does it
    take to block the same number? Answer:
    10mg Zyprexa = 500mg Seroquel = 3mg Risperdal= 120mg
    Geodon. (4)

    This is the problem so many doctors have. “I tried him on


    Seroquel, it didn’t work.” Really? At what dose? Because
    higher doses aren’t stronger—they are completely different.
    The behavior of Seroquel at 100mg is completely different than
    the behavior and effects at 500mg. 500mg is an antipsychotic;
    100mg is not an antipsychotic. I know it looks like it’s five
    times more, but it’s not—it’s the addition of a completely new
    level. It’s like adding a new “drug.” Just because the FDA calls
    it an antipsychotic, and that word is printed on the box, doesn’t
    mean it is.
    DOES THAT MEAN 5mg ZYPREXA = 250mg SEROQUEL?

    So you weren’t listening.

    Reducing these doses by half pretty much extinguishes the D2


    blockade. Reducing the dose puts you into a different “level.”
    They’re not half as good as they were, they’re completely
    different.

    The drug isn’t a tease. It doesn’t give you a little bit of efficacy
    at a low dose, “oh, it’s working a little bit—he must be a
    Seroquel responder—I’ll just increase the dose to get more
    efficacy.” Another way of saying it is this: the absence of
    efficacy at 250mg is in no way predictive of what might
    happen at 500mg, because the two doses are working at
    different receptors.

    So, yes, 5mg Zyprexa is equal to 250mg Seroquel for


    psychosis, in the same way that an academic psychiatrist is like
    a certain Congresswoman from California: they all do nothing.
    ZING! (5)
    Next up: Oh, No, Not Effexor, Too?

    –––––––––––-
    1. The pie chart is wrong, wrong in the same way that Pamela
    Anderson is wrong, i.e. right in many ways. This is an in vitro
    pie chart, derived from affinities of receptors ripped out of the
    cadaverous remains of former tax attorneys. It may not
    represent what happens in an actual human body when
    confronted with unequal distribution of drug and receptors,
    number, and subtypes of receptors. It also doesn’t account for
    competition from other endogenous chemicals, drugs, or ice
    picks in the skull. All this notwithstanding, they are still
    usefully inaccurate. And all this is just a metaphor anyway.
    2. This is not technically accurate. Receptor systems don’t fill
    up, i.e. become saturated, before the next system is impacted.
    More accurately, there exists a certain level of binding at one
    receptor such that it then becomes equally likely that it goes
    elsewhere. So my rum fountain should be more accurately
    labeled “the effects from H1 blockade” and “the effects from
    alpha 1 blockade.” Those effects do “max out.” Also, a drug’s
    maximal effect can occur well before 100% saturation of a
    system; for example, 10% H1 blockade may be all that is
    necessary to get maximal sedation, such that increasing binding
    to 20% doesn’t get you more effect. Nor might a drug be able
    to bind to more than 10%. So while binding saturation is often
    used interchangeably with maximal effect, they are not the
    same.
    3. Drugs bind to specific receptors, but also nonspecifically
    (i.e. everywhere else.)

    Note that binding is related to the rates of the binding


    (Kd=Koff/kon)
    If you want a real world example, look at Zyprexa, below— a
    real human in a real PET scanner eating real Zyprexa:

    If you increase the dose from 5mg to 30mg, serotonin binding


    increases from 95% to 100%. Do you expect to “feel” much
    difference? But D2 binding
    goes from 55% to 85%. That
    you’ll feel.)

    4. Be careful: these are the


    equivalents for D2 blockade—
    for antipsychosis. If you are
    using Zyprexa for, say,
    anxiety, then maybe D2 isn’t
    the relevant system. Maybe it’s
    the serotonin that’s relevant. (I
    have no idea; NO ONE HAS
    ANY IDEA.) So the
    conversion doesn’t hold. Do you understand? If you are using
    10mg Zyprexa tablets to clog a toilet in some heroin fueled
    Consumer Reports product test down at the American Standard
    offices, you don’t need 500mg Seroquels to get the same
    clogging action. Ok?
    5. Actually, this isn’t true either. 250mg Seroquel has trivial D2
    blockade, but Zyprexa 5mg still has some (55%). So 5mg
    Zyprexa is more likely to treat psychosis than 250mg Seroquel.
    The equivalences are really to be used the other direction: if
    you needed 15mg of Zypexa, you will likely need more than
    600mg Seroquel…
    IF YOU LIKE IT, DIGG IT— OR REDDIT IT— OR
    SEND ME MONEY— OR RUM—
    No, Not Effexor, Too!? The
    Most Important Article On
    Psychiatry You’ll Ever Read,
    Part II
    July 17, 2007

    In which Anne Neville agrees to believe


    pretty much anything anyone ever tells
    her, ever, and Richard discovers people
    are gullible idiots.

    Go back and read Part I. Hurry.

    Let’s review the idea of sequential binding. A drug with


    affinity for multiple receptors doesn’t bind to all of them
    simultaneously, but rather sequentially, like an aging
    polygamist, starting with the system for which it has the
    greatest affinity. Eventually, this maxes out, and it goes and
    adds the receptor system for which it has the second greatest
    affinity.
    Once it has maxed out a receptor system, pushing the dose
    doesn’t get you any more of that effect (or side effects.) You
    don’t get less, but you don’t get any more. You know what else
    is like that, sort of? Chlamydia.

    Let’s look at an SSRI, Celexa. That first S stands for selective


    (serotonin reuptake inhibitor.) All of its clinical effect is
    coming from one single receptor system; this rum fountain has
    only one level— and it’s not that deep. By about 20mg, you’ve
    gotten as much serotonin effect as you are going to ever get.
    Certainly, by 40mg, you’re all done. Do you expect the clinical
    difference from 10mg to 20mg to be significant? Maybe. How
    about 20mg to 40mg? Not so much. 40mg to 60mg? You woke
    me up for this? Don’t touch me.

    In other words, there’s only one level in Celexa’s rum


    fountain, and it’s pretty much filled by 40mg. Pushing it to
    60mg (“Now, with 50% more citalopram!“) gets you a whole
    3% more serotonin transporter binding. Which is
    embarrassing. I said don’t touch me. Do it again and I’m
    calling an adult.

    So what about Effexor, the serotonin/norepinephrine reuptake


    inhibitor, invented at Wyeth Labs by Kirsten Dunst, aka
    Vitamin C?
    From the American Journal of Psychiatry study:

    la, la, la , la , la, la ,la ,la ,la ,la


    la ,la ,la,la, la,la
    yeah, yeah, yeah,
    la, la, la, la, la, la, [repeat x 36]
    we will still be friends forever [sic]

    Which is exactly the point. You don’t get both S and N at all
    doses, it is, again, sequential: level 1 is S, maxed out by 75mg;
    and level 2 is N. Guess when level 2 (N) really kicks in?
    150mg.
    So anything after 150mg is really two systems at once, with
    the N increasing from there. 300mg is the same amount of S as
    150mg, but the N is more.
    Would you expect 75mg Effexor to be generally more
    efficacious than 40mg Celexa? No, because they are both
    doing the same thing: blocking about 80% of serotonin
    transporters. But what about after 150mg, when you have S
    and N?
    From An Inconvenient Truth, 2006

    This is why Effexor studies only show superior efficacy at


    doses above 150mg— because at 150mg, you start adding N
    on top of your already maxed out S. It’s not adding more of
    the same drug, it is like adding a second drug. It’s not more
    Effexor; it’s taking a maxed out SSRI, and adding a NRI. It’s
    like being with Princess Leia, but then adding Princess Ardala.
    And if you understood that joke, you should put down Yars’
    Revenge and kill yourself.
    Let me be clear: I’m not saying Effexor is or is not better than
    an SSRI. I am saying that

    1. it would be impossible for it to be better then SSRIs,


    across a population, at less than 150mg.
    2. if it is going to be better, it would be better after 150mg,
    and only because you are adding a second system.
    3. If you are a doctor who “went all the way” up to 75mg
    Effexor for depression (or 300mg Seroquel for psychosis,
    etc, etc) and then stopped it because “it wasn’t helping at
    all” then you should probably punch yourself in the
    testicles/uterus, you have missed the point. How one
    responds at 75mg IS NOT AT ALL PREDICTIVE of
    what might happen at 150 or more (or, for Seroquel and
    psychosis, 500mg or more) again, and for the last time,
    because higher doses aren’t more, they are different.(2)
    You can see this most clearly if you look at an MRI:

    which is self-explanatory.(3)

    What you may want to ask is this: why haven’t you heard this
    stuff before? You think I discovered all this, in my basement
    lab, the one I use to create Jessica Simpson clones? I’m the
    Ponce de Leon of psychiatry?(4) Why the accepted delusion
    that a drug is the same, regardless of dose? Perhaps it’s
    because this supposedly only applies to the newer drugs? The
    old ones— Thorazine, Elavil, Pamelor, Remeron, Wellbutrin
    — all blunt instruments, single receptor system drugs?
    Why do we think that an inanimate object has a fixed identity,
    when even a person doesn’t?
    Next up: Aren’t Two Drugs Better Than One?
    ––—
    1. From the Celexa package insert: (warning: PDF— clear
    your schedule)

    2. Punching yourself in the testicles/uterus is not likely to help


    you learn this, it is more for my benefit.
    3. It’s technically an fMRI, bt the point is the same.
    4. Ponce de Leon did not actually discover psychiatry, but he
    was the first to make it available to the masses.
    IF YOU LIKE IT, DIGG IT, OR SEND ME RUM—
    Why I Am Against Mental
    Health Parity
    July 27, 2007

    The U.S. Senate is poised to vote on the Mental Health Parity


    Act of 2007, a cleverly named piece of legislature which
    conveys the warming sentiment of equality and
    progressiveness. But the Act is fatally flawed; not only does it
    not necessarily help patients, but it will likely worsen an
    already broken system. It should not be passed.
    There are two broad reasons to be against this Act, economic
    and social.

    First, the economic. Looked at generally, it makes no sense to


    provide equal coverage for something that exists in and of
    itself— diabetes, tumors, hypertension, etc— with something
    that, whether or not it exists, can be called into existence by
    the force of a single person’s voice. If 50 psychiatrists say you
    do not have depression, but I say you do, who is right? But my
    voice has immediately entitled you to substantial benefits.

    It is a fairly simple matter to see how extra hospital days may


    or may not benefit an acute hyperglycemic crisis; it is entirely
    subjective whether they help someone with depression. Nor
    am I being heartless: a psychiatrist may be tempted, out of
    kindness, sympathy, or expediency (“well, it’s Friday, let’s just
    discharge him Monday”) to keep a person in the hospital
    longer if there is no impetus to limit inpatient days. Not only is
    it not obvious that this is beneficial, but a strong case can be
    made that it may be detrimental, fostering dependence,
    confirming a “sick role,” etc. To be clear: it may be true that
    extra days are beneficial, but there is nothing to go on but the
    judgment of the psychiatrist.

    The mistake is providing extra resources with no additional


    accountability. To improve care, it is necessary to justify the
    expenditures. I know it seems like we should trust the
    judgment of the noble doctors, but, well, we can’t. Simply
    having a deeper well from which to draw does not promote
    better care, and likely leads to waste. This follows from the
    most important flaw of the U.S. healthcare system: the user of
    the money— the doctor— has no accountability for the use of
    the money. In no other business does this uncoupling exist.
    Why keep hospital days short or use fewer medications at
    better doses, etc? Why not prescribe two antipsychotics at
    once, or keep them a few extra days? It’s so much easier…

    The single solution to this is to remedy the flaw: make doctors


    in charge of the budget. “Here’s how much you can spend per
    patient. Go.”

    Simply put, this Act does not guarantee improved care for
    patients; it guarantees improved payments to psychiatrists.
    While I am all for getting paid more, we should probably
    focus on the stated purpose of the Act.

    The second, social, problem is more nuanced, but arguably


    more important. The substantial problem with the bill is that,
    while it asks for parity in coverage for mental illness, it does
    not actually define a mental illness. That is left to the
    individual insurers. Thus, they can choose to cover
    schizophrenia and not depression; bipolar but not ADHD, etc.
    Better than nothing, you say? Observe:

    If most insurers choose to cover bipolar disorder, but not


    “straight depression,” there is the very real likelihood that
    psychiatrists will simply diagnose bipolar. This already
    happens, especially to justify inpatient admission. While
    numerous “reliable and valid” tools exist to make diagnoses,
    these are rarely used in everyday practice. In most cases,
    diagnoses are based on clinician bias, feeling, medication
    justification, and expediency. So many of the psychiatric
    disorders end up being treated with the same medications
    anyway— antidepressants and antipsychotics— so why fight a
    diagnosis?
    But the social ramifications of an overdiagnosis of “bipolar
    disorder”— or any psychiatric diagnosis— cannot be
    overstated. I’ve mentioned how psychiatry becomes an
    instrument of social change. I hardly need repeat the legal
    ramifications of mis/overdiagnosis; but medicalizing what
    might otherwise have been labeled and handled as social ills
    also means that these issues will be handled by people—
    doctors— who have the least resources available to make
    significant changes. How do you reduce poverty and domestic
    abuse with Zyprexa?

    The current state of insurance coverage for patients is not great


    by any means; but this Act will not offer any improvements
    and will cost more. A better Act would be one which ties
    benefits to outcomes.
    I am hardly insensitive to the plight of the mentally ill and
    their need for psychiatric services. However, the goal should
    be, specifically, better care for patients, not more money for
    psychiatry. The two are easily conflated, but they are not
    necessarily the same. At some point, you have to stop buying
    people’s silence.
    –––-
    Stay tuned for Part 3 of The Most Important Article On
    Psychiatry You Will Ever Read (here’s Part I)
    Aren’t Two Antipsychotics
    Better Than One? The Most
    Important Article on
    Psychiatry, Part 3
    August 2, 2007

    MY PSYCHIATRIST WANTS TO GIVE ME TWO


    ANTIPSYCHOTICS AT THE SAME TIME. WHAT
    SHOULD I DO?

    Undoubtedly, your first impulse will be to punch him in the


    testicles, but as you know, the Kellogg-Briand pact (1928)
    expressly forbids this. However, it is notably silent on the
    issue of voodoo/ shark attacks, which can be used with
    discretion.

    Go back and read Parts 1 and 2. I’ll wait.


    Antipsychotics exhibit their antipsychotic effect through D2
    blockade. (1) Got it?

    Take a look at the following figure again, showing % blockade


    of receptors (serotonin or dopamine) as a function of dose.
    So you’ll observe a few things.

    First, these antipsychotics will have equivalences in dosage. If


    you use 10mg Zyprexa as a baseline, how much dopamine
    does it block? 70%. How much Risperdal does it take to block
    the same amount? 3mg. Therefore, 10mg Zyprexa = 3mg
    Risperdal. If you look at the graphs for the other
    antipsychotics (not shown— sheer laziness), you get the
    following conversion for antipsychotic effects:

    10mg Zyprexa = 3mg Risperdal= 500mg Seroquel= 120mg


    Geodon

    Interestingly, most comparator trials done— which look at


    symptom responses— show these same equivalences. For
    example, ZEUS Geodon vs. Zyprexa trial: 126mg
    Geodon=11mg Zyprexa. This shouldn’t be surprising since
    THAT’S HOW THE DRUGS ARE WORKING.
    Second, no drug company can claim their drug has superior
    efficacy, because, again, they’re all working through the same
    mechanism. Certainly, people tolerate each drug differently,
    but that’s not efficacy, is it? Certainly an individual might
    respond to one better, but you have no way of predicting that.
    You simply cannot tell, by looking at someone, which drug
    will work and which won’t. I’ll show you: which drug will
    work best for this guy?

    It’s a trick question: the correct answer is penicillin.


    The only way a drug company or study could claim to find
    superiority is if they don’t use comparable dosages. “We found
    that Risperdal 6mg was significantly more effective than
    100mg of Seroquel.” Really? Bite me.

    Third, and this is really a math question: Since there are a


    finite number of D2 receptors in your skull, if you are on 6mg
    or Risperdal— which blocks 90% of them, and the doctor
    decides to augment with some Zyprexa, where’s the Zyprexa
    going to go? Answer: your thighs.
    Tom recognized her instantly despite the red anonymity bar

    It’s not going to D2 receptors, because they’re all already


    blocked with Risperdal. So it’s just going to go around to other
    receptors— H1, a1, M1, etc— all of which have nothing to do
    with bipolar or psychosis. Issues of tolerability aside, mixing
    two antipychotics is no different than giving more of just one
    antipsychotic.

    “Abiliquel”— taking Abilify and adding Seroquel— is sheer


    idiocy of such magnitude that even Eli Roth is repulsed. The
    first time someone told me what Abiliquel was, the room
    became filled with the sounds of six guys screaming in horrific
    pain, and that was because I was punching them in the
    testicles. Why not just give him Motrin + Advil? Oh: “But I
    use it cleverly: I give 15mg of Abilify and 25mg of Seroquel.
    See?” I see. I see that you’re bleeding from the testicles. Guess
    why. You give 15mg Abilify— that’s acting as a D2 blocker.
    25mg Seroquel isn’t even a D2 blocker, it’s an H1 blocker,
    you’re paying for an antipsychotic and getting Benadryl. You
    say, “well, I know,” (liar), “but I’m using the Abilify as an
    antipsychotic and Seroquel as a sedative.” But, Gwyneth, you
    could have gotten the exact same effect by giving Abilify and
    Benadryl+trazodone— which would be cheaper, and safer; or
    giving simply 500mg Seroquel alone, which would have
    gotten you both antipsychotic effect and sedative effect, thus
    reducing the cost by half, etc, etc. Remember that scene in the
    movie Hostel where Matthew McConaughey gets bitten by a
    radioactive lab rat and transforms into an immortal superhero?

    Matthew McConaughey (Owen Wilson) proves there can be only one.

    No? Do you know why? Because you knew better than to see
    that celluloid atrocity. How come you didn’t know better than
    to prescribe two antipsychotics at once? You don’t mix Zoloft
    and Paxil together, do you? Haldol and Prolixin? Seriously, do
    you just make crap up as you go along, or do you have
    pharmacological non-sequitors prepared in your Moleskine?
    The same, by the way, goes for all you nutboxes who work in
    hospitals. If you have a patient on, say, 10,000mg of Seroquel,
    and he goes into an ER and gets indignant and flips a table
    over, and you inject him with 5mg of Haldol (90% blockade),
    you think that 10,000mg of Seroquel is doing him any good as
    an antipsychotic? I gots news for youse all: every time you prn
    (emergency dose) someone with Haldol, their brain is only on
    Haldol. Any other antipsychotic you give them that day is
    strictly a monetary gift to Big Pharma; you may as well PayPal
    them $180 and spare the patient the exposure.
    On second thought, you may as well PayPal me.
    ––––––-
    1. There may come a day where a drug is invented that works
    through some other mechanism, maybe glutamate, but as of
    right now, all the available antipsychotics work through D2
    blockade. Everything else is irrelevant. Now, these other
    receptors might be relevant for other effects (reducing anxiety,
    antidepression, etc) but let’s try to focus on the specific
    problem and not get all Andrew Weil here.
    How Do You Treat Atrial
    Fibrillation?
    August 6, 2007

    It could be important…
    Say you have a patient with a history of two heart attacks.
    That’s bad. Now say he has atrial fibrillation. That’s worse.
    Now let’s say he is on no meds.
    What do you do? You’ll treat two distinct problems: the
    history of ischemic heart disease gets a beta blocker, which
    has been shown to reduce mortality and improve quality of
    life. A-fib gets amiodarone, the generally accepted treatment.
    Atrial fibrillation is a very fast but erratic twitching of the
    atrium. While a-fib can be annoying— palpitations, anxiety,
    etc— it is a major cause of embolic stroke; the uncoordinated
    flapping of the atrium leads first to blood stasis in a less
    moving part, then flicking off of clots which happily go to
    your brain. Hence, anticoagulants are common.
    Beyond this, treatment of a-fib can be divided in two parts:
    rate control, with beta blockers, or rhythm control, with drugs
    like amiodarone. The question is, which is better, and which is
    safer? Traditionally, amiodarone was thought to be more
    efficacious.
    Before I give you the answer, I want you to be aware of the
    form of the question. The question requires that you see a-fib
    as a distinct (disease) state, where risks and benefits of its
    treatment are considered. It is, analogously, “what are we
    going to do about John’s left arm? It’s a big jerk, always
    punching people. Is what we do going to work? Is it worth it?”
    A study in the NEJM pitted sotalol, a beta blocker, against
    amiodarone for the effiacy and maintenance of a-fib.
    What they found was, as expected, amiodarone was the best:
    (The curves are read as “what are the chances you remain
    symptom free at x days?” People are all symptom free on day
    1, so the chances are 100%. As time goes on, you get sicker.
    So at day 600, you have a 10% chance of being symptom free
    on placebo, but a 70% chance on amiodarone. )
    What was surprising is what’s best if the patient has ischemic
    heart disease along with a-fib:

    If you have ischemic heart disease, sotalol was as good as


    amiodarone. And, presumably, a beta blocker is less toxic than
    amiodarone (though the study did not show this.)
    But there’s a further point to be made here, about information
    bias. Since beta blockers are already standard of care for any
    patient with ischemic heart disease, it doesn’t actually matter
    whether they have chronic a-fib or not. The history of
    ischemic heart disease is more important— singularly more
    important— than the a-fib.
    So the guy above only gets a beta blocker. Think about this.
    Whether he had “regular” ischemic heart disease, or ischemic
    disease and atrial fibrillation, the treatment is the same, single,
    drug.
    This is entirely the opposite of what happens in psychiatry. In
    psychiatry, we pay lip service to a “disease state,” but end up
    treating each disorder as if it was separate. So a schizophrenic
    with negative symptoms (apathy, anhedonia, amotivation) gets
    an antipsychotic and an antidepressant, even though the
    antidepressant probably isn’t necessary. It may seem like both
    are necessary, but that’s because you gave them both at the
    same time. How can you know which was relevant med?
    Bipolar is worse: a “mood stabilizer” and an antipsychotic and
    an antidepressant (or Lamictal) each for a different symptom.
    The nod to “disease state” however, is the dangerous one: all
    the meds are continued, even though each was started for a
    specific symptom that resolved.
    And, this does not even begin to account for the overlapping
    pharmacology of many of the meds (like giving two
    antipsychotics for different “symptoms.” )
    In psychiatry, the incidental gets as much attention as the
    substantial. But it is so hard for people to step outside
    themselves and say no to medication overkill.
    This impulse towards polypharmacy- shotgun symptom
    management— will never change unless there is a financial
    incentive, or, more accurately, negative reinforcement. And I
    have one: give doctors a medication budget per day per
    person.
    Lawsuit Funding
    August 9, 2007

    Sponsored post: as many bloggers are, I was offered $30 to


    review someone else’s site/product. Ordinarily I pass, but this
    one caught my eye for reasons which will become clear.

    Anylawsuits.com offers non-recourse cash advances for


    pending lawsuits.

    Here’s how it works. Joe sues his doctor for, say, damages of
    $100,000. Trials last anywhere from one to 30 years. When
    might Joe get paid?
    This firm will call your lawyer, determine how much you’ll
    probably get, and give you that money today, up front, no
    strings attached. If you lose, you never pay it back. If you win,
    you pay them back plus “fees,” which I am guessing means a
    percentage of the award.
    The reason this works is because most of the time the case is
    settled. For example, this firm may give Joe $8000 up front,
    because they’re lawyers, they’ve talked to your lawyer, and
    they know it will settle for about 10%.
    So such a service is great for people who are hurting for cash
    (for example, you get injured and lose your job); or who may
    need the money simply to keep the suit going.
    But— and here is the problem, at least for defendants (i.e.
    me)- it seems a very low risk way to get some money.
    Take med mal. There are plenty of times that a patient is
    injured, and plenty of times when the injury is the result of a
    doctor’s negligence. However, in the vast majority of cases
    (that’s right, I said vast majority) no suit is ever filed. The
    patient doesn’t bother. It’s not worth the headache, the time,
    the meetings with lawyers— for what? The possibility of
    eventually settling for $5000 after 6 years?
    But now, it’s that much easier for someone to file a suit,
    including a nuisance (frivolous) suit. In essence, why not? You
    get your money immediately. Hell, once you get your money,
    you don’t even have to be motivated to do a “good job” of
    “appearing” damaged, because you already have your money
    that you never have to pay back. And as long as the numbers
    are small (<$10,000) my experience is that hospitals usually
    settle.
    Are You Good At Reading
    Faces?
    August 11, 2007

    Do I look like I’m bluffing, bee-atch?

    Can you correctly identify emotions if they only briefly flicker


    across the face? How good do you think you are?
    Try the test.
    Was a certain emotion harder or easier for you? Did it seem
    like some of the faces flickered faster than others? It may not
    have anything to do with the emotion. It might be the test.
    Did you notice how some emotions flicker across the screen
    faster than others? (They don’t, really.) This might lead you to
    conclude that you are not as good at perceiving certain
    emotions. But that might not be the case.
    The problem with the test is that certain expressions in this test
    lateralize to one side of the face— the expression is mostly
    visible on one side. (See contempt 4 and 8.) Depending on
    which emotion is displayed, and which side of the brain is
    dominant in you, reading one side of the face may be easier or
    harder for you.
    For example, contempt goes to the boy’s (4) left face, but girl’s
    (8) right. It might have been easier (or harder) for you to
    perceive if it went to a given side.
    To show this, get a mirror, place it perpendicularly on the
    screen on the z-axis (out), facing the side of the expression.
    Then, look into the mirror (not the screen) and see if the
    expression is easier or harder. If it is, the problem for you is
    lateralization, not expression reading.
    As a rule of thumb, anger and contempt are naturally (i.e
    spontaneously) expressed on the left face of right handed
    people.
    As an aside, I wonder if people who are “face blind” (can’t
    read faces) aren’t a) majority left handed; b) have the most
    difficulty reading right handed people’s expressions, especially
    anger. Can they tell when a dog is happy or sad?
    (Considerably more symmetric in facial expression, don’t ask
    me why.)
    As an interesting experiment, photograph yourself making the
    various emotions. Then, video yourself (and I don’t know how
    you’d do this) spontaneously making the expressions, for real
    (have a friend bring you a naked chick, a bag of maggots, your
    rival, Sandra Oh, etc) and compare. How does your fake differ
    from your natural? Look carefully. What part of your face did
    you “forget” to fake?
    Liars are easy to spot, because they are faking their
    expressions. Pathological liars, however, are much more
    difficult, because they aren’t really faking.
    How To Take Ritalin
    Correctly
    August 14, 2007

    This is a post about Ritalin, Adderall, Dexedrine, and others—


    it is meant for those for whom it is written. You know who you
    are.
    I’ve written three textbook chapters and a couple of articles on
    stimulants, and I may or may not have taken them at one time
    or another, so I’m an expert.
    Because I work in a university hospital, and because I’m, well,
    different, I get approached by college or med students at least
    once a week for Ritalin or amphetamine prescriptions. Every
    one claims to have “ADD.” (NB: I don’t give them out.)
    They want the Ritalin to help them study. I get it. I’m not
    advocating it, but if you are going to use Ritalin you should
    probably do it intelligently, to maximize the gains.
    First, a disclaimer: you should only get Ritalin for indicated
    disorders by prescription from a physician. Ok? Because the
    doctor will rigorously apply artificial and unreliable diagnostic
    categories backed up by invalid and arbitrary screens and
    queries to make a diagnosis. So after this completely
    subjective and near useless evaluation is completed, your
    doctor should be able to exercise prudent clinical judgment to
    decide if Ritalin could be of benefit. In other words, he will
    ultimately decide based on little else but his own prejudices
    and/or consult the Magic 8 Ball. That’ll be $250, please. Cash
    appreciated.
    That said, the key to amphetamines and Ritalin is to stop
    thinking of them as stimulants, and to think of them as
    reinforcers.
    Let’s conceptualize how these drugs work. Imagine getting a
    brain scan while you are performing a task. The parts of your
    brain you are using for the task will light up, brighter than
    those you aren’t using.
    Now you drink coffee (1). The whole brain lights up brighter,
    proportionally.
    Now you take amphetamines. The parts of your brain that you
    are using light up brighter, but the parts you aren’t using go
    darker. Get it? Caffeine is a global brain stimulant, while
    amphetamines focus your attention, reducing distraction.
    This is entirely selective and controlled by you. You have to
    decide what you want to focus your attention on. If it’s
    reading, the reading parts of your brain will be brighter. But if
    you stop reading and decide to talk to your friend on the
    phone, you know, the hot one with the hotter roommate, then
    you’ll be more focused on that (obviously). Attention is
    always decreased when it is split among several tasks. In other
    words, you can only concentrate on one thing at a time, even
    though it may feel like you are doing two things at once.
    While amphetamines and Ritalin do stimulate you and keep
    you awake, using them to pull an all nighter completely
    subverts their awesome power. If you want a stimulant, drink
    coffee or Red Bull. Amphetamines should be saved for
    reinforcement.
    You want to set up a study situation that as closely as possible
    resembles your testing context. Do you take tests in the middle
    of the night? Using multicolored highlighters? With The Daily
    Show on in the background and eating Doritos? Then you’re a
    pig, and you deserve to fail. You’re dead to me.
    You should study in the morning, at a desk, under the same
    “fed” conditions as on test day. (So you would have eaten
    before taking the test, not snacking at the test.) Quiet room, no
    distractions. Remember, attention is decreased with multiple
    stimuli in normal conditions, but on amphetamines, this will
    be be greatly magnified. Studying while talking to your friend
    means your “talking to friend” parts of the brain are brighter
    while your ““studying” parts of the brain are darker. Same
    thing with listening to music and studying.
    Take the amphetamine (takes about 30 minutes to “kick in.”)
    Study, straight, with no distractions or interruptions, for about
    four hours. Quit. You’re done. Amphetamines give you about
    4 hours tops of great concentration. Go to lunch, the gym,
    watch a movie, etc.
    The power of amphetamines is this: you take them again, in
    the same dose, 30 minutes before your test.
    In a metaphoric sense, taking the amphetamines during the
    test, under the same circumstances as you had been previously
    studying, will “remind” the brain of that context. If you see a
    question that “resembles” something you studied, your mind
    will be primed to recall it better.
    Remember I said you can only concentrate on one thing at a
    time, that attention decreases when it is split? The trick here is
    to make everything about studying into one large “thing.”
    Here’s an example: if you listen to a symphony, you will hear
    music. Musicians, however, hear both the music and every
    single instrument. They can attend to each instrument
    individually and simultaneously hear how each instrument fits
    into the larger context. A non-musician can’t do that. If he’s
    concentrating on the oboe, he doesn’t “hear” the violas.
    Studying has to become a large symphony, everything doing
    its part correctly, expectedly. So on performance day (testing)
    you play the same symphony. You’re not trying to concentrate
    on each part, if you’ve practiced enough it should be second
    nature. The amphetamine helps facilitate this.
    Addicts can get physical feelings of withdrawal or “high”
    simply by being presented with the cues— the environment—
    of their drug use. And they key into these cues much faster
    than non-drug related cues. That’s what you’re looking for
    here. The amphetamine feeling “reminds” you of what you
    studied.
    For example, what you don’t want to do is NOT take
    amphetamines at testing if you had used them to study; or take
    them at testing if you didn’t use them to study. Or change the
    dosage, or change anything else you eat. (2)
    Similarly, you should only be taking one pill a day. Don’t take
    amphetamines to study AND later to do other things (like go
    out at night.) You are destroying the context specific
    reinforcement. Additionally, tolerance to amphetamines
    happens pretty quickly— if you take them every day, you’re
    going to need higher doses as time goes on. Ideally, you’d use
    them only for the last stretch of time before the test. For
    example, maybe you’d take them only the last week or so
    before the test, when you are studying from back tests as
    opposed to a textbook. (See the context?) And you’d stop
    using them after the test, give yourself a break, etc.
    As a public service announcement, don’t worry too much
    about grades. This is America, not Germany, where success is
    determined by the solidity of your goal and the amount you are
    willing to work. I know you don’t believe it now, but it’s true.
    Go have a drink.

    IF YOU LIKE IT, DIGG IT AND MAKE A DONATION


    and hey, what gives with the trilogy The Most Important
    Article on Psychiatry You Will Ever Read? It’s funny, dammit,
    so digg it!
    –
    1. What is the best and healthiest coffee to drink?
    2. NB: diet and amphetamines are powerfully interactive.
    Acidic foods/beverages will rapidly accelarate the clearance of
    amphetamines. In other words, dexedrine + orange juice = a
    lot less dexedrine. (BTW, does anyone have any idea how to
    make footnotes with Moveable Type?)
    Hong Kong Suicides,
    Revisited
    August 16, 2007

    A reader asked me to help promote the Hong Kong Mental


    Health Support Group. My first reaction (after being flattered)
    was to silently muse, “well, why Hong Kong only?” What’s
    the difference? I realize that people from Hong Kong might
    like the sense of community, but I’d bet anyone from Hong
    Kong is already plugged into a community— why another one
    for mental health issues? What’s the real advantage?
    Understand that I am not an idiot— I see how people would
    feel more comfortable, but I’m asking whether there is any
    real, actual, measurable benefit to a culture specific group vs. a
    general group.
    Which got me thinking of this: in the massive push for
    biological bases for mental illnesses, have we ignored the very
    real influence of culture on mental health? And suicide?
    Cultural influences so strong, that they not only overwhelm
    biology but even probability?
    In numerous articles (e.g. here) the debate is whether a famous
    suicide incites others to also commit suicide (who would not
    have otherwise) or if it simply incites people who would have
    committed suicide to simply copy the method.
    It occurs to me that this question is flawed, because it assumes
    all people— races, genders, nationalities, ages— are the same.
    Two articles about suicide in Hong Kong. for background,
    95% of the people in Hong Kong live in high rises.
    Coincidentally, or causally, 50% of all suicides are by jumping
    out/off a building. 30% are hanging.
    Prior to 11/23/98, almost no one ever lit charcoal briquets in a
    closed room and killed thmselves by CO poisoning. On that
    day, however, someone did do this (supposedly imitating a
    Japanese movie), and the case went to the front pages of the
    newspapers. And then this happened:

    See that spike? That’s not random, man.


    What is even more unusual about Hong Kong, in comparison
    to the U.S., is that this increase in charcoal suicides was not at
    the expense of another method— in other words, more people
    committed suicide overall—23% more:

    The increase in overall suicides in Hong Kong were only


    related to increases in the charcoal poisonings. In essence, it
    was as if a whole new subset of people were killing themselves,
    specifically by this method.
    Who were they?
    Mean age was 39 (the second study found ages 24-39;
    compare to 47 for jumping and 55 for hanging) and 64% were
    men. 90% happened at home. Only 20% used sedatives or
    alcohol coincidentally.
    Interestingly, charcoal suicides are on the rise in Taiwan,
    China overall, and Japan, where they had a rash of charcoal
    suicide pacts.
    So the questions to answer— and I’m soliciting answers—

    why does the copycat phenomenon, at least with respect


    to charcoal, clearly exist in east Asia, when it barely
    exists in the U.S./Europe? Is it cultural, and what are the
    relevant factors?
    what kind of people are using charcoal (is it different than
    the jumpers?) For example, is it men creeping on middle
    age, who have no job, live at home, etc, shamed by their
    lack of success?
    If the above evidence is true, and the charcoal suiciders
    would not have killed themselves otherwise, what is it
    about the charcoal or the copying that incites them to
    want to die?
    Interest Rates and The
    Moral Hazard: Why You
    Must Buy GOOG Now
    August 21, 2007

    Here’s what’s happening in the stock market: people bought


    stocks on credit, and now they can’t pay it back because the
    interest rates are too high, and their collateral caught on fire.
    And the lenders want their money back, now.
    This has everything to do with psychiatry.
    The TV news keeps talking about subprime mortages—during
    the housing boom, people took mortgages, with no money
    down, at low introductory rates, and now these rates (ARMs)
    have increased, so their mortgage payments have increased.
    But the housing market has simultaneously fallen, a lot, so that
    the price of the house is often worth less than the whole
    mortgage. In other words, you’d be better off simply walking
    out the door and defaulting.
    But what’s happening in the markets is about more than
    mortgages, it’s about credit. Partly from losses, but mostly out
    of fear, lenders are unwilling to offer the easy credit—or credit
    of any kind.
    Typically, hedge funds borrow massively against capital. If a
    hedge fund has $X, they can borrow from banks 10X. As long
    as the market is stable, they can make the interest payments on
    that loan, just like you would for a credit card. But if the
    market goes down, not only can they not make the interest
    payments, but worse, the bank calls them up and asks for all
    its money back—at once. If the bank sees the market tanking,
    it will call in its loans—a margin call—because it suspects that
    every moment it waits is a greater chance of default. So the
    hedge fund has to raise money by selling things, or dipping
    into the initial capital. But what if the initial capital of $X was
    actually other people’s mortgages, which hedge funds bought
    as an investment—and are now nearly worthless? The answer
    is the old adage: when you can’t sell what you want, sell what
    you can. So they sell everything, and the market tanks
    uniformly. That’s why Google, which has nothing to do with
    mortgages and has no debt of its own, was off 70 points.
    I know a lot of people don’t care about hedge funds, the bath
    houses of the super rich. And therein lies exactly the problem
    we are addressing today.
    The average person’s assessment of all this is this: fuck ‘em.
    They were making easy money for too long, for nothing
    (defined here as capital; they simply borrowed the money to
    make more money). If they go bankrupt because the market
    takes a dive, too bad.
    The problem is that credit isn’t just about hedge funds, or even
    mortgages. Without this credit, private equity firms, and hedge
    funds, don’t invest capital in languishing or dying companies.
    (Remember Dunkin’ Donuts 20 years ago vs. today?) If they
    don’t invest, the company goes bankrupt, and people lose their
    jobs. These people who lose their jobs don’t therefore spend
    their money on other products, so other companies lose profits
    (which is why, in these cases, food and household products
    stocks remain stable—you still gotta eat— while auto, luxury
    goods, electronics- expensive, less necessary stuff—stocks go
    to the toilet. That’s a recession.)
    So credit is necessary; and the only way to supply easier credit
    in these circumstances is for the Federal Reserve to lower the
    interest rates. Lower rates mean easier borrowing means
    everything can continue. And stocks go back up.
    And, of course, hedge funds make billions, again.
    So the balance the Fed has to strike is this: can they supply
    enough liquidity, e.g. make borrowing as cheap as possible—
    so that businesses can stay afloat, and mortgages can get
    refinanced and people can stay in their homes—but not send
    the message to hedge funds that every time something bad
    happens, the Fed’ll come in and save the day?
    This is often called the Fed Put (or, properly, the Greenspan
    put or Bernanke put, named after the Fed chairmen.) A put is a
    trading instrument that reduces risk; it’s basically like buying
    insurance on your investments. If Bernanke routinely lowers
    rates whenever things get bad, then people will begin to
    anticipate that he will do it again. The consequence—wait for
    it, wait for it—is that people take on more risks. They know
    there’s a limit to their losses. Which is exactly the opposite of
    what the Fed wants—they’re lowering the rates because
    people took on too much risk (credit) in the first place, and
    lost.
    This is called the Moral Hazard, and I capitalize it because it is
    to be revered. It defines humanity. Forget about psychiatry,
    forget about economics, human beings can be rigorously
    distinguished by their behavior vis a vis the Moral Hazard,
    and, even more rigorously than that, how they apply the Moral
    Hazard it to others.
    Nothing, nothing, is more important than this concept. Let’s
    begin.
    Next up: The Moral Hazard
    disclosure: long GOOG; though I’m confident Warren Buffett
    will buy CFC and it goes to 30, I wouldn’t buy that death trap
    now even if it came with two Raiders cheerleaders and a brick
    of platinum.
    The Moral Hazard
    August 22, 2007

    (This is Part 2— click to read Part 1)


    If you behave badly because you know you’ll get away with it,
    that’s being “bad.”
    A Moral Hazard is different. If you behave “worse” than you
    would have otherwise, solely because you know that you
    won’t have to bear the consequences, then you have a Moral
    Hazard.
    I’ll emphasize: the key is that your behavior is in itself not
    necessarily “bad.” It is simply worse than your behavior
    otherwise would have been, because you know there won’t be
    consequences.
    Here’s why it’s called a Moral Hazard: if there are no external
    consequences, the only thing that would prevent you from
    behaving worse is an internal set of rules.
    Where do these internal rules come from?
    Let’s run some examples, starting with the current credit
    problem:

    Too much risk (credit) got the hedge funds (and us) in
    trouble. If Bernanke lowers rates to save the economy,
    and thus inadvertently bails them out, the hedge funds
    have learned they can take bigger risks next time, because
    they know Bernanke will (inadvertently) bail them out
    again. It’s not that Bernanke wants to bail them out, he
    doesn’t. He wants to save the economy—but the hedge
    funds now know he will repeatedly do this and can act
    “worse.”
    Insurance: If you have no car insurance, you drive very,
    very, very carefully. The Moral Hazard describes when a
    person, upon getting insurance, drives “worse” (read: less
    slowly, rolling stops; doesn’t avoid talking on cell phone.)
    NB: he is not driving badly; he is actually driving
    normally. But he’s driving worse than “very carefully.”
    The term “worse” is relative to other behavior. The point
    is that his behavior has comparatively worsened because
    he doesn’t have to worry as much about the
    consequences.
    Moral Hazard is cited everywhere in the universal
    healthcare debates: if healthcare is free, people may be
    less attentive to preventative measures, or overuse
    medical care. Before you scoff, imagine behavior if you
    had to bear all the cost personally. To counter the Moral
    Hazard, we have limits, deductibles, co-pays, etc.
    A subtype of the Moral Hazard is the principal-agent
    problem, in which one party has more
    information/knowledge they can use to maximize their
    own benefit. A doctor, having considerably more
    information/knowledge than a patient, can use it to
    maximize his benefit, not even necessarily at the expense
    of the patient. For example, he could bill for an extra
    service. He can ask the patient to return more often than
    necessary to get the extra visit fee, perform unnecessary
    tests, etc. So, too, lawyers, and politicians, etc.
    A more interesting example is the doctors who
    recommend a treatment modality— for example,
    Depakote for maintenance bipolar—because it furthers
    their career, though it may not be as effiacious as another
    modality or more toxic.
    People invoke the Moral Hazard to complain about easy
    bankruptcy laws: if there are no consequences to
    declaring bankruptcy, people could borrow excessively
    and then simply walk away.

    But what causes the Moral Hazard? Why do all people, to


    varying degrees, fall prey to different forms of the Moral
    Hazard? Why, and to what extent, does behavior worsen when
    there are no consequences?
    Causes of the Moral Hazard
    Succumbing to the Moral Hazard means that you have priced
    your gain above the loss of the other. Let me be clearly
    emphatic: your gain is priced not above the gain of the other,
    but specifically above the loss of the other. That’s what makes
    it a Moral Hazard, and not an economic or strategic hazard.
    They know their actions cause a harm to the other, but do it
    anyway.
    So the real question is, what makes people not care? Let’s be
    clear that I am not talking about evil; I’m talking about the
    context dependent decisions of gain vs. loss.
    There are two cases:

    1. The loss is determined to comparatively trivial. The


    inattentive insured driver knows that insurance rates will
    be raised, but he figures he himself only caused a tiny
    part of that raise, which is considerably outweighed by
    his gain of getting to use a cell phone in the car.
    Similarly, each individual hedge fund figures it
    contributes very little to the overall risk cycle.
    2. Unknown sufferer. While it is necessary that someone
    suffer some loss, it is not necessary that the specific
    identity of that someone be known. In fact, not knowing
    the specific identity makes it that much easier to find in
    favor of your gain, that much easier to be seduced by the
    Moral Hazard.

    It’s case 2 that is the psychiatrically interesting one. What


    about when the person harmed is clearly identified? How do
    you facilitate, psychologically, the harming of that person?
    The answer, of course, is to strip that person of their
    individuality, and see them only as an extension of you, your
    situation.
    And so we return to it.
    The Moral Hazard and Narcissism
    The Moral Hazard is narcissism. The degree to which one is
    susceptible to the Moral Hazard is the measure of the
    individual’s narcissism.
    Remember, this isn’t about evil; it’s about what psychic
    variables make “your gain vs. their loss” calculations easier or
    harder to solve.
    In an extreme case where a clearly identifiable person is
    greatly injured—say, a doctor who prescribes chemotherapy to
    a non-cancerous patient just to collect fees—the person can act
    precisely because he fails (or chooses not) to see the person as
    a separate entity—he only sees the person as it impacts
    himself.
    The Simpsons‘ Mr. Burns used to refer to his employees as
    “organ banks.” That’s narcissism.
    The Moral Hazard is, in essence, the opposite of Kant’s
    categorical imperative.
    So the causes of Moral Hazard are the degree to which a
    person

    1. is able to see others as individuals and not only as they


    impact himself;
    2. has an internalized set of rules that do not change
    regardless of how it impacts himself.

    Everyone has a level of narcissism, thus, everyone faces Moral


    Hazards.
    It’s not that only narcissists fall prey to Moral Hazards; it’s
    that narcissism is what allows you to see a Moral Hazard,
    where others don’t. Consider the principal-agent problem: Say
    you’re a lawyer. You could easily bill for an extra hour, no one
    would know. Ok: did that ever occur to you?
    So the variables all impact your response to a Moral Hazard,
    and are covariant: your level of narcissism; your gain vs. their
    loss; the identity of the person harmed, etc.
    The Application of the Moral Hazard to Others
    But an even better description of the relation of narcissism to
    Moral Hazard is how your behavior creates a Moral Hazard
    for others.
    A good example is parenting. If a three year old throws a
    tantrum, you can either appropriately deal with it, or give in to
    it. But if you give in, you know the kid will throw a bigger
    tantrum next time, because he has learned there won’t be any
    repercussions. There are two things you want: you want to
    teach him that these rules will be consistently applied, “so
    don’t try to get away with it;” but, more importantly, that rules
    in general are consistently applied, so learn the rules and
    internalize them, with no consideration of your own gain—
    don’t try to calculate if you can get away with it, even if you
    can get away with it. That second lesson is how you prevent
    (reduce) narcissism.
    So good parenting requires that you always address tantrums
    in the same way— consistently. Eventually, he internalizes the
    rules, they become part of his personality. You have thus
    averted his facing Moral Hazard; you have saved him from
    narcissism.
    But now you’re in a store and he throws a tantrum. The Moral
    Hazard still applies, but there’s a new variable: your
    embarrassment. Do you deal with the tantrum the same way as
    at home, or do you give in— stick a cookie in his mouth, buy
    the toy, whatever— just to shut him up, hoping to deal with it
    back home? Clearly, the latter likely reinforces bad behavior.
    You know this. What do you do?
    Do you teach him rules are rules, no matter where and what—
    save him from narcissism; or do you let him slide this time and
    reinforce that rules are context dependent— in essence,
    reinforce his narcissism?
    How you teach your kid about the Moral Hazard is, in fact,
    your own personal Moral Hazard: do you gain a little at the
    store, at a loss to his development?
    Now you can see how your creating Moral Hazards for other
    people reflect your degree of narcissism. Let’s say it’s a fact
    that free auto insurance leads to worse driving. If you are a
    politician who votes for free auto insurance because you will
    gain in popularity, knowing that it causes a Moral Hazard for
    others which is to the loss of still others, then you have double
    the narcissism.
    (Read Part 3 . The markets are stable today, and GOOG is up,
    thank God.)
    The Fed’s Dilemma: The
    Moral Hazard
    August 22, 2007

    So the Fed has an interesting problem: whatever it does—


    raise rates, cut rates, etc— it causes a Moral Hazard, but to
    different people. To whom does it want to teach the wrong
    lesson?
    Or, choose: rich get decimated, poor get poorer; or rich get
    richer, poor get by?
    This is part 3— click for Parts 1 and 2)
    So the Moral Hazard for the Fed is that by cutting rates, it lets
    the hedge funds know that they will always be bailed out, that
    losses will always be contained. So go ahead, take more risks.
    If that was all there was to it, the story would be boring. But
    there’s more.
    Let me state explicitly that the mess we’re in is exclusively
    due to too much, too easy, credit. In order to have prevented
    this, rates should have been higher, but to raise them now—
    when no one can pay anything back—would be death. So rates
    either must at least remain the same, or get cut.
    Here’s the problem:
    If they don’t cut rates, many lose their homes; some hedge
    funds go under; some franchises, that borrowed money to open
    their stores, go under; people lose their jobs; so there’s less
    money in the system, and we get a recession. Divorce
    inevitably follows. But note clearly that while everyone loses
    in this scenario, the poor get hurt much more than the rich do.
    (This is why it is a political certainty that they will cut rates, at
    least four times, before Nov. 2008.)
    If the Fed cuts rates, we get a bailout— people keep their
    homes, hedge funds don’t go under— but the the rich get
    richer while the poor simply don’t get poorer. Even the
    thought of rate cuts has pushed the prices of most stocks back
    to the levels they were before the correction. They will only go
    higher from here. In fact, the Moral Hazard here is that hedge
    funds learn that they’ll always get a bailout, so they take even
    greater risks for greater profits. But your house doesn’t
    increase in value, it just doesn’t melt in the snow. Asset prices
    and profits increase; wages don’t. The gap between rich and
    poor expands.
    This is complicated by a point so obvious that it is never
    mentioned: rich and poor are experiencing two entirely
    different economies— one with inflation, and the other in
    recession.
    Here’s an example of this wealth gap. One metric the Fed used
    to measure inflaiton is the Consumer Price Index, which is an
    aggregate of prices across sectors: food, energy, clothes, etc.
    But in the past few years, the important metric has been the
    CPI omitting food and energy prices, because, supposedly,
    food and energy prices fluctuate wildly and thus are not stable
    enough to measure inflation. Have you seen the price of oil for
    the past 6 years? Does it look like its fluctuating wildly, or just
    staying high? So whereas the CPI shows prices overall have
    risen, the CPI “ex food and energy” incorrectly shows prices
    relatively stable, because it omits the two main sectors that
    show inflation.
    The rich don’t “see” increased energy prices. (Are their fewer
    SUVs on the road?) They see credit tightening. They see their
    asset prices falling. They see “growth” declining. That’s
    recessionary. They want a rate cut. But if you get a rate cut,
    prices go up.
    What do you do if you’re poor, and you have less money, but
    prices are on the rise? You go see a psychiatrist, that’s what.
    It’s a tricky situation, so I’ll summarize it here: prices have
    been rising, if you look at all prices. So rates should have been
    higher. Had they been higher, people— everyone— would not
    have borrowed so much, so poor wouldn’t be seduced by low
    rate mortgages, and rich wouldn’t have leveraged credit to bid
    up asset prices (including real estate.)
    But at this second, everyone needs a rate cut, because
    everyone “sees” a serious deflationary pressure. (If your
    biggest asset is your house, and its worth 3/4 what it was a
    year ago, that’s deflationary.) The result of this rate cut will be
    that the existing inflation, heretofore ignored by everyone, will
    be magnified. So while the poor will not have more money
    (they’ll simply not have less), the rich will get much richer.
    Inflationary pressures will be much better handled by the rich,
    for obvious reasons.
    And so the Moral Hazard. The Moral Hazard for the Fed is
    that by bailing us out— and they will— easy credit and the
    Bernanke put will worsen the cycle. And so the Fed plays a
    game, a stupid game but what else can it do? It orders rate cuts
    on key market days (options expirations) only days after it
    pretends it is worried about inflation; random Fed robots utter
    conflicting statements about the health or malaise of the
    economy— all in an attempt to make it appear as though the
    inevitable rate cut is going to be canceled. It’s all about the
    Moral Hazard.
    But the game can backfire: if markets anticipate this is a game
    — if they are sure there will be a rate cut, and they rise (Bank
    of America bought a stake in Countrywide, that’s how sure of
    a bailout they are) then there’s no need for a rate cut after all.
    Which causes markets to fall…
    But it’s the wealth gap that we should be worried about, soon
    to be greatly increased. Wealth gaps mean feudalism. They
    mean, on the one hand, universal healthcare— everyone gets
    the same; on the other hand, flow chart medicine— since
    everyone gets the same, let’s just make a flowchart.
    It also means mental health parity, which is really a way to
    funnel the poor into the only outlet we have to deal with their
    rage: psychiatry.
    (Part 4 tomorrow)
    (Long BAC)
    Child Rapist-Murderer John
    Couey Loses By Eight
    August 24, 2007

    Here’s an example of what I’ve been talking about.


    I’ll spare you the details, but John Couey is found guilty of
    kidnapping, raping, then burying alive, 9 year old Jessica
    Lunsford. Here’s the part relevant to our disussion: defense
    attoneys said Couey could not be executed because he was
    mentally retarded— his IQ was tested by the defense at 64.
    (They even let him color with crayons during trial.)
    But, and I’m quoting:

    Circuit Judge Ric Howard in Citrus County ruled that the


    most credible intelligence exam rated Couey’s IQ at 78,
    slightly above the 70 level generally considered retarded.

    That’s it, people. 8 points. We may not agree whether the death
    penalty is good or bad, but can we at least agree that decisions
    of life or death shouldn’t come down to, well, how stupid you
    are?
    The Other Soprano
    Psychiatrist
    August 27, 2007

    (Finally watching the series on DVD.)


    Carmela Soprano, wife of mobster Tony
    Soprano, is so unhappy in her marriage
    that she goes to see an old, Jewish, psychiatrist, which is a leap
    for her as she is not too keen on psychiatrists— or Jews, for
    that matter. She describes her ambivalence about her husband:

    Carmela (crying): He’s a good man, a good father.


    Dr. Krakower: You tell me he’s a depressed criminal,
    prone to anger, serially unfaithful. Is that your definition
    of a good man?
    Carmela: I thought psychiatrists weren’t supposed to be
    judgmental.

    Dr. Krakower: Many patients want to be excused for their


    current predicament because of events that occurred in
    their childhood. That’s what psychiatry has become in
    America. Visit any shopping mall or ethnic pride parade
    and witness the results.
    …You’ll never be able to feel good about yourself. You’ll
    never be able to quell the feelings of guilt and shame that
    you talked about, so long as you’re his accomplice.

    Carmela: You’re wrong about the accomplice part,


    though.

    Dr. Krakower: You sure?


    Carmela: All I did was make sure he’s got clean clothes
    in his closet and dinner on his table.

    Dr. Krakower: So “enable” would be a more accurate job


    description for what you do than “accomplice”. My
    apologies…
    Take only the children—what’s left of them—and go.

    Carmela: My priest said I should work with him, help


    him to become a better man.

    Dr. Krakower: How’s that going?

    Carmela: I would have to get a lawyer, find an apartment,


    arrange for child support…

    Dr. Krakower: You’re not listening. I’m not charging you


    because I won’t take blood money. You can’t either…

    Let’s pretend that this isn’t TV, and that this old psychoanalyst
    knows something about the therapeutic process. Why say this?
    What defense mechanism is so prominent in her? What’s the
    single sentence Dr. Krakower can say that changes this
    conversation from an irresponsible breaking of therapeutic
    neutrality to a means of overcoming a powerful defense that
    allows for life decisions based on insight? He says it at the
    end:

    Dr. Krakower: One thing you can never say: You haven’t
    been told.

    Therapy isn’t about being happy, it’s about honestly knowing


    who you are, and then picking a suitable life. Every day you
    must consciously choose who you are. Choose.
    Birth Order: Are First Borns
    Always Older Than Their
    Siblings?
    September 4, 2007

    Yes, but it doesn’t mean younger children can’t be older than


    someone, too. Everyone’s a winner!
    That said, according to USA TODAY and Science Magazine
    the oldest kids are the smartest. Let’s assume that this is
    correct. What’s the reason?

    The most common explanation is “resource dilution:” the


    oldest usually gets the most parental resources. In any given
    day, the oldest receives more attention than any of the sibs.
    The more attention you receive, the more you develop. The
    attention (more reading, more activities, more conversation) is
    supposed to give the oldest kid the emotional resources to
    grow.
    That’s fine, but it doesn’t explain why only-children aren’t the
    smartest, for example. (Common answer: the parents of an
    only child didn’t want more children because it took time
    away from themselves; so the only-child actually receives
    “less” attention than other kids in other families. Maybe, but it
    can’t be true for all such families. (Can it?))
    But I favor a different explanation.
    First, oldest kids get parentified: “go watch your brother and
    sister!” “Make sure this baby doesn’t roll!” “Look, I know
    you’re only five, but I can’t get up right now, do me a favor
    and go into the kitchen, get out the lasagna pan, set the upper
    oven to 450, chop up the garlic and I’ll be there in a minute.”
    Oldest kids may not be smarter, they may just have had to
    grow up faster; they have to learn to think fast, improvise, etc.
    This might explain USA TODAY’s survey of CEOs: 50%
    were first born, while 20% were last born.
    But second, there’s this: “you idiot! you chopped the garlic
    with a steak knife!?”
    You learn fast, lessons your younger sibs don’t learn as early
    in life. And, specifically, you learn a) what adults “do”
    (because you’re often expected to replicate it); b) that you are
    always under scrutiny— so perform, don’t bother trying to
    hide; c) that you are under more scrutiny than your sibs— in
    other words, that they are “special.” Not better, but singled out
    for more responsibility, more scrutiny than others. For some
    reason, you are different.
    Here’s something interesting: more than likely, you are
    attempting to frame this post in terms of your own childhood.
    Were you the oldest, youngest, what happened, etc. Why
    doesn’t it occur to you to frame it in terms of your own
    children?
    If you’re a parent of more than two kids, ask yourself the
    following: who do you yell at the most? Would you trust your
    youngest today to do things you trusted your oldest to do at
    that same age (e.g. watch a baby?) When you need a kid to do
    something for you, who do you ask?
    I know you’ll have “reasons” why you pick the first, but the
    important part is that for whatever reason, you are picking the
    oldest.
    Identity comes easier to the oldest born, because it is
    reinforced (positively or negatively). “You know better,
    “you’re supposed to,” etc. It’s pretty easy to see how
    narcissists are almost always the oldest child. (And borderlines
    the youngest, or only.)
    Depending on why they get more scrutiny and more
    responsibility, they develop differently.
    Maybe by the time the parents get to the third kid they’re too
    tired to uphold the same level of performance— so it is that
    the youngest seems to get away with more; maybe the parents
    realize they were too tough with the first. In this case, it’s too
    late for the oldest, but the benefit to the younger ones is
    greater. Maybe they thus get more positive attention and less
    punishment or control. So maybe they become artistic, or pick
    a career that’s unusual.
    But sometimes a relational pattern is established, like dating
    the same kind of guy over and over. A pattern develops, where
    the oldest “never does anything right” (because he’s expected
    to do what would never have been expected of the youngest)
    and parents are repetitively in an emotional state of anger or
    frustration. Soon, that’s how they relate to each other; the
    oldest on the defensive, or trying to perform, the parents on
    full alert, ready to go insane. Even when the kid grows up and
    stops making such “stupid mistakes,” the pattern is already
    firm: the parents relate to him by leves of anger and
    frustration.
    The result in this situation is that the oldest goes on to succeed
    — amazed, really, at how easy the world is and how little is
    actually expected of or necessary from him, in comparison to
    what went on at home— but is simultaneously bitter, resentful
    of how easy it is for other people to be happy when they want
    to be, despite their lack of successes. These people can easily
    become abusers (especially emotionally) (“I hate your
    emotions!”); they can become alcoholics (“I hate my
    emotions!”); insomniacs (“I hate that another day has passed
    and I have done nothing of actual consequence, nothing,
    nothing, nothing.”)
    (For more on prenting/developmental issues, search the site for
    “parenting.”)
    Number Needed To Treat
    September 5, 2007

    How a relatively unused metric can help


    you score chicks at the Limelight.
    That’s right, I said score chicks. You got a
    problem with that?
    Current Psychiatry has an article about
    Number Needed To Treat which is so
    staggeringly abstruse that it is nearly unreadable, observe:

    A non-statistically significant NNT would have a CI that


    includes a negative number and a positive number: When
    comparing intervention A with intervention B, A might be
    better than B or B might be better than A. One bound of the
    CI may be a NNT of 10 and the other may be –10. It would
    be tempting to describe the CI as –10 to 10, but this would
    be misleading.

    and later:

    The truth-operation is the way in which a truth-function


    arises from elementary propositions. According to the
    nature of truth-operations, in the same way as out of
    elementary propositions arise their truth-functions, from
    truth-functions arises a new one. Every truth-operation
    creates from truth-functions of elementary propositions,
    another truth-function of elementary propositions i.e. a
    proposition. The result of every truth-operation on the
    results of truth-operations on elementary propositions is
    also the result of one truth-operation on elementary
    propositions.Every proposition is the result of truth-
    operations on elementary propositions. Here it becomes
    clear that there are no such things as logical objects…
    which is strange, because NNT was invented specifically to be
    easy to understand and apply. Oh well.

    Number Needed To Treat is the number of people who would


    need to receive the treatment before you could appreciate a
    difference between the treatment and something else.

    Remember that one time after the riots when you looted the Rite
    Aid and grabbed a bunch of pills that you thought were
    Lexapros, but could be penicillin—how many depressed people
    would you have to give the pills to before you could be
    confident that they were Lexapros, and not penicillin? For
    example, if you give it to two people, and both get better, you
    can’t be certain it wasn’t all placebo effect, right? Conversely, if
    neither person gets better, it doesn’t prove they were both
    penicillins, right? You’d have to try it on more people. How
    many? Whatever the answer is, that’s the Number Needed To
    Treat.

    So NNT is related to the difference between a) how well the


    treatment works; b) how well the comparator works.

    Here’s how to calculate NNT: “what is the difference in the rates


    of success between two maneuvers? Divide into 100.”

    The year is 1984 and a guy who looks disturbingly like any of
    the guys from Jefferson Airplane (formerly Flock of Seagulls)
    goes to the Limelight in NYC to mack some stellas (he still calls
    them that, but that’s because one of them hit him in the back of
    the head with her husband’s fist) and always manages to get one
    to go home with him: “persistence beats resistance,” the bouncer
    told him, and this proved to be good advice, along with the thing
    about Halcion, and rolling your suit jacket sleeves up, all of
    which… wow… really, thanks… outstanding. And the leather
    tie thing.
    (1)

    Inside, he gets shot down 8 out of 10 times. (“Whaddya want?


    They’re all dykes. ‘WHERE’S THE BEEF?’ Ha! I kill me!”)
    Over the course of the year, before he heads to the Hamptons for
    the summer to frighten women into lesbianism there, his
    Visicalc spreadsheet shows that the 20% success rate is pretty
    consistent. 1 in 5 times he’s at a girl’s breast like a .14 BAL
    slammed into an airbag. Here, a found a picture of him and his
    friend doing just that on my internet cache, along with other pics
    that I told my mom I have no idea how they got there:

    A threesome with the guys from A-ha.


    So 20% success rate— — “1 in FIVE, ace!” That’s how smooth
    he is. He’s even more smooth than that guy in the Shakira “Hips
    Don’t Lie” video, no, not the guy from the Fugees, I mean this
    guy:

    Trevor knew if he could just win the dance off, Molly would go steady with him.
    But first was the little matter of his invisibility.

    But let’s say he spent his time simply sitting at the bar and
    keeping his crap hole firmly shut, never going up to women at
    all— they came to him— maybe they saw his internet profile—
    and he still scores 1 in 10 times. So while he can brag to his
    friends that his rap is so tight (2) that it doubles his success rate
    (from 10% to 20%), in fact it only raises it 10 percentage points.
    His number needed to treat is therefore 10 “divided into 100”:
    100/10=10. He has to actively approach ten extra women to be
    able to attribute one success to his rap.

    So let’s review:

    his nightly success rate: 100%.


    his rap’s success rate: 20%
    his “shutting up and just sitting there” success rate: 10%.
    Here’s how these stats would appear in his daily life:
    Personal ad in the Village Voice: “100% better! I so rule!”
    City Order of Protection: “…risk to the women of New
    York was increased ten percentage points…”
    Case report in Journal of Infectious Diseases: “Number
    Needed To Harm: 10”

    LET’S SAY I WANT TO GET ALL SCIENCEY. CAN YOU


    USE REAL PSYCHIATRIC EXAMPLES THAT DON’T
    INVOLVE PEOPLE I WILL EVENTUALLY SEE ON BILL
    KURTIS’S AMERICAN JUSTICE?
    American Justice was canceled, it’s now called Where Are They
    Now? That notwithstanding, here’s your psychiatry, from a
    study done by a bunch of scienticians. What’s the Number To
    Treat for Depakote for prevention of mood episodes in one
    year?

    That’s 17, seventeen. STOP PRESCRIBING DEPAKOTE. (3)

    In practice, the more studies you can pool together, the more
    accurate/useful will be your calculated NNT, though
    simultaneously how you pool data can affect the NNT. Consider
    two trials, one with 10000 people and an NNT of 60— but that
    sucked in design and execution; and another with 50 people and
    an NNT of 2, but much better design, etc. Simply adding the
    raw numbers of people together will skew the data in favor of
    the large but error-ridden NNT.
    SO WHAT’S ALL THE FUSS OVER NNT? WHY DO DRUG
    COMPANIES REFUSE TO PUBLISH THEM?
    The NNT helps you decide if the treatment is worth it.
    ISN’T THAT WHAT THE FDA IS FOR?
    No, the FDA— wait— are you serious?
    IF YOU KNOW A DRUG IS HELPFUL, ISN’T IT ALWAYS
    WORTH IT? IF THE DRUG HELPS EVEN A LITTLE, AND
    HAS FEW SIDE EFFECTS, WHY NOT GIVE IT TO
    EVERYONE WHO COULD BENEFIT?
    Because this isn’t France, commtard. Who’s going to pay for all
    these pills?
    Pretend a drug exists that can reduce the risk of heart attacks in
    people with high cholesterol by 50%, and let’s call it Lipitor.
    Pretend it costs $5/day, so $1825/yr. Is reducing the risk of heart
    attack by 50% worth $1825/yr? I say yes, so long as we’re
    talking about me.
    But let’s pretend the actual reduction is from a baseline rate of
    8% to Lipitor’s 4%. So the NNT for Lipitor compared to
    placebo is 100/4=25. 25 people have to get Lipitor to prevent
    one heart attack. 25 people is $45,625/yr. Is $45,625 worth it to
    prevent one heart attack, or, at that price, should we maybe just
    stop eating donuts?

    You can see how an insurance company might not want to cover
    certain medications. What’s amazing to me is how skeptical
    everyone is about Pharma, how they distrust anything they say,
    and whine that the drugs are too expensive, but they’ve all
    bought Pharma’s biggest scam: that these drugs are necessary.

    The only way to solve this problem is to force doctors to


    consider the cost of the medications.
    Give the doctor a budget, say, $20/day per patient, and let him
    choose whatever drugs he wants, generics, brand, doses, etc. “I
    can give you Viagra if you stop eating donuts and get off
    Lipitor. In fact, you might be able to use the Viagra if you stop
    eating donuts.”

    Doctors hate this, partly because they see individuals and want
    to maximize gains in that single individual, but mostly because
    they’re lazy. It is much easier to give a drug that works (e.g.
    Lipitor) than to affect behaviors (e.g. donuts.) But it’s only
    easier because they don’t have to think about the cost. Doctors
    are completely sheltered from the cost analysis, all they see is
    “50% reduction in heart attacks? I’d be crazy not to!”
    The only time a doctor cites prescription drug costs is as a
    stepping stool to mount his high horse.
    Make them pay, things will be different. Then you’ll see doctors
    communicating with one another, psychiatrists with
    cardiologists, etc, trying to decide what meds to use on a guy.
    Currently, doctors don’t even know what other doctors
    prescribed in a patient. They don’t decide anything— they hit up
    the flowchart.
    I stand by this assertion: I can reduce overall pharmacy costs by
    20%, yet still maintain outcomes. In other words, I can save $20
    billion a year. There, I just helped pay for Iraq. I know, you’re
    going to say Iraq isn’t worth the money, etc, etc. Bite me. It’s
    not even lunchtime, and I just paid for Iraq. What have you done
    today? Face!
    Here’s some NNTs to keep you warm at night:

    Ritonavir vs. placebo in AIDS— death in a year: 14


    Aspirin vs. placebo in treated hypertensives— MI in a 4
    years: 208
    Flu shot vs. placebo— flu symptoms in a season: 12
    Prozac + folate vs. Prozac alone- depression response in 10
    weeks: 5! (Wow?!)

    –-

    (1) Before you nutbags flame me, I know that’s not Flock of
    Seagulls, and I’m not necessarily trying to say they look alike,
    nor am I trying to imply that one guy, the Flock of Seagulls guy,
    and the guy from Hall and Oates are in fact the same person,
    ok? Sometimes people look like other people. (4)

    (2) He wouldn’t
    have actually said
    that in 1984. What
    he would have said was
    “Say hello to my little
    friend!” even though it has
    nothing to do with the
    topic at hand, because
    that’s what everyone was
    saying in 1984. Do you
    know why? Syphilis,
    that
    ’s
    wh
    y.
    (3)
    So
    me
    one
    is
    going to email me and say that NNTs based on survival data
    should be calculated using hazard ratios, and not on the
    difference in rates. You know what I have to say to that? Go to
    hell, that’s what. I could also respond that both methodologies
    provide estimates of the NNT, and the difference between the
    two results is small and inconsequential, and anyway still within
    the 95% confidence interval, but I’m sticking with go to hell.
    (4) Which totally reminds me of a hilarious bit by Patton Oswalt
    (from memory, so…):

    …people are getting plastic surgery to look like famous


    movie stars, Brad Pitt, George Clooney— good looking
    men, for sure, but let’s have a little perspective. If they had
    plastic surgery in the 70s there’s be guys walking around
    looking like Hall and Oates. “Yeah, all right, life is good…
    I look like Daryl Hall from Hall and Oates… I’m on a
    pussy train that’s never going to derail, never!
    How Doctors Don’t Think
    September 6, 2007

    Jerome Groopman’s book, How


    Doctors Think, is porn for doctors.
    While ostensibly about the ways in
    which doctors make errors, the
    real message is sure to elicit
    hands-free climax in clinicians:
    “good” doctors make fewer
    mistakes because they go beyond
    statistical probabilities and
    treatment algorithms to consider
    the whole patient. They use their
    clinical judgment. Many of the
    enemies are the usual suspects,
    insurance companies, Pharma.
    While the book is worth reading, it isn’t worth reviewing, I’m
    afraid— I’ll egocentrically say I think I already covered much
    of his ground.
    But what is worth reviewing is a review of his book, by
    Charles Lambdin, a grad student in psychology. The review is
    called How Doctors Think They Think. And it is outstanding.
    You should read the article in its entirety, this guy gets it, I’ll
    add only two short points specific to psychiatry.
    Groopman acknowledges that medicine has considerable data
    and science available to it, but doesn’t like blindly following
    “evidence based medicine” because it fails to take into account
    the nuances of the individual sitting in front of you. Through a
    good interview, a doctor has access to extra information, often
    subtle, that an algorithm or “evidence based medicine” doesn’t
    have, that can increase his accuracy rate. Fair enough.
    Lambdin, however, points out that doctors are susceptible to
    all sorts of errors and biases in the application and detection of
    this “extra” information, that can make these augmented
    decisions even worse than simply applying the algorithm
    blindly. Touche.
    The problem in psychiatry is a little different, however: here,
    psychiatrists make biased and error-prone judgments— often
    simply prejudices— that they use to augment studies and
    evidence which themselves are faulty and biased. It never
    ceases to amaze me how people are suspicious of drug
    company studies, but not at all suspicious of studies from the
    universities or the NIH— they don’t have any biases there? Is
    it magic that allows me to predict that an NIH study will find
    the generic the best choice? Researchers not only can
    influence the data— mostly unconsciously, but also by not
    publishing a study that didn’t show the expected results— but
    also which questions to investigate, and how questions are
    framed. Is there any possible reason Harvard, Yale, and
    Cleveland will always find a reason to study Depakote or
    Lamictal? And now Seroquel? But not Zoloft (now generic?)
    An example of this is the the doctor who has a patient who has
    no history of bipolar, and any rating scale or screen would not
    suggest bipolar, but uses his clinical skills (read: bias) and says
    “there’s something about him” and “discovers” that the patient
    is an undetected bipolar— but then puts him on Depakote,
    because that’s what the “evidence” shows is the first line for
    bipolars. Really? Which studies did you read, again? The
    orange ones? In the Trapper Keeper?
    As anyone who has ever dated a girl who was too much into
    the occult will tell you, astrology is difficult. It has a highly
    structured set of rules— math, really— so precise and
    complex that, theoretically, any two astrologers should
    independently arrive at the same result, which is correct
    enough times to keep people from breaking out into hysterical
    laughter all the time. However, astrology is crap, right? Some
    other factors explain the few successes. Is the fact that so
    many schizophrenics are born in the spring related to Mars
    rising in Orion, or to a virus women contract in the winter?
    Etc. In other words, just because a system is reliable, doesn’t
    mean it’s valid.
    The other point is on the subject of “zebras”— rare, outlier
    diagnoses that should be investigated last after more common
    and likely ones. Lambdin writes:

    Oddly, Groopman rebukes doctors guilty of “zebra


    retreat,” but bungles the example this term is derived
    from. He quotes: “When you hear hoofbeats, think about
    horses, not zebras.” The actual lesson is, “When in
    Wyoming, if you hear hoofbeats and think you see
    stripes, it’s still probably a horse.”

    In psychiatry, however, the problem isn’t suspecting a rare


    disorder before a common one; it is inventing a disorder rather
    than dealing with the complexities of a person’s life. “It’s not
    bipolar—he hasn’t responded to Depakote or lithium— I think
    it may be Intermittent Explosive Disorder.” If you apply the
    same rigor, analysis and logic, alien abduction is also on the
    differential. As I’ve written before,

    the real problem of a critique of our cultural models is to


    ask, when we see a unicorn, if by any chance it is not a
    rhinoceros.

    — Umberto Eco

    (Thanks to reader Walter F for sending me Lambdin’s review.)


    Will Lilly’s New Glutamate
    Agonist Antipsychotic Be A
    Blockbuster?
    September 7, 2007

    It really depends on what you’re asking. But the answer is yes.


    But don’t by LLY yet.
    LY404039 is a highly selective glutamate receptor agonist
    (mGlu2/3). This receptor controls the release of presynaptic
    glutamate, so this drug actually decreases the release of
    glutamate.
    LY404039 isn’t well absorbed, so a prodrug form of it, called
    LY2140023 was used. After ingestion, it is hydrolyzed to the
    active LY404039.
    In the main study, 40mg BID was tested against 15mg
    Zyprexa and placebo. Zyprexa 15mg was only slightly more
    efficacious than LY2140023. This doesn’t mean the new drug
    is inferior— it could simply mean equivalent efficacy requires
    more than 80mg.
    The selling point of the drug will be the absence of weight
    gain— in fact, there was an average of .5kg lost vs. Zyprexa’s
    .5kg gain. Prolactin, akathisia and other EPS were no different
    than placebo.
    There’s the background. Now here’s some things you need to
    know to really assess the drug’s potential.
    First, this is a glutamate agonist. The logic is that its opposite,
    PCP— a glutamate antagonist— produced psychotic like
    symptoms: “positive” symptoms of psychosis: hallucinations,
    thought disorder, delusions, agitation, and some “negative”
    symptoms: flat affect, anhedonia, emotional withdrawal, etc.
    All antipsychotics treat postive symptoms (acutely, at least—
    tolerance develops quickly.) Negative symptoms are much
    harder to treat— atypicals are considered to be better for them
    (whether they are or not is not the point here.)
    In order for this drug to be a meaningful advance, it has to be
    better for negative symptoms than what exists. In the Nature
    study, LY2140023 was as good as Zyprexa 15mg in reducing
    negative symptoms, so this is optimistic, but I want for more
    than 97 people to get it.
    Second: one side effect the authors did not discuss is the 4%
    rate of increased CPK. CPK increases from antipsychotics
    indicate that excess muscle rigidity is causing muscle
    breakdown; muscle proteins then clog up your kidneys,
    leading to death, a disorder called, neuroleptic malignant
    syndrome (NMS). In this study, placebo and Zyprexa did not
    cause increased CPK. In this era of diabetes and weight gain
    paranoia, we forget that ten years ago doctors were insanely
    obsessed with NMS and TD. Forensic lectures to psychiatrists
    dealt nearly exclusively with suicide and TD/NMS. If this isn’t
    fresh in the minds of residents, it certainly will be in the
    FDA’s. I’d need to see more details about this to see if the
    FDA would even approve the drug at all, let alone get used by
    doctors.
    But Will It Sell?
    Oh, yes.
    No one who is not a doctor will believe me, but I swear this is
    true: whether the drug works or not is irrelevant. What matters
    is that academics tell us to use them. (And I’m an academic,
    which is uncomfortable to talk about.)
    This is a novel agent, with a novel mechanism of action, and
    no weight gain. Look back in history at another such drug:
    Abilify.
    It was launched in Nov. 2002. By March 2003, it had 4%
    market share— $80M in sales in 2003. By 2004, it made
    $191M with 10% market share. In the second quarter of 2007
    it made $324M. And most psychiatrists do not have high
    opinions of Abilify, but they use it because “it doesn’t cause
    diabetes.” Zyprexa made $4.4B in 2006, and psychiatry hates
    it, for God’s sake. Think about that.
    In terms of the existing atypicals, LY would likely gain at the
    expense of Abilify— the other weight neutral drug— and
    Zyprexa, which will be generic soon anyway. But docs will
    use it anyway for the novelty factor and concoct every
    whacked out pseudo-pharmacological/semiotic reason to use it
    everywhere.
    In Furious Seasons there was some skepticism about
    antipsychotics being a $12B domestic market. I think $12B
    may be too low. Remember, antipsychotics aren’t going to be
    just for schizophrenics; they will also be used in “bipolars”—
    however we decide to expand that diagnosis— and as
    antidepressants. SSRIs are going generic, which means that
    they will not be used. Each SSRI ran about $4B a year— that
    entire market gets catabolized by antipsychotics. And don’t
    forget mood stabilizers (read: Depakote). In the old days (like,
    Thursday) it was “antidepressant + mood stabilizer+
    antipsychotic.” Next year it will be “antipsychotic +
    antipsychotic of different mechanism.” I’ve already spoken of
    Abiliquel. LY-Quel, anyone? Abilif-LY? Zy-LY?
    As an investment, Lilly is no good yet. I don’t know how this
    drug will get past the FDA unless the NMS issue is
    satisfactorily quashed. Meanwhile, Zyprexa sales won’t fall,
    but there’s no growth. 51-56 is the range, enjoy it.
    Why Is This Funny?
    September 10, 2007

    Because it’s true.


    Is the thing going to be serious, or not? If you think not, then
    monitoring it won’t make any difference because it won’t be
    serious. If you think it could be serious, then you should be
    monitoring it whether or not there are lawyers in the world.
    Are you saying that the only reason you would take this thing
    seriously is because of lawyers? Then thank God there are
    lawyers.
    If you blow it off and it turns out to be serious, then you made
    a mistake, you were wrong. Then becomes the question of
    whether you were negligent. Would others in your profession
    have also blown it off? If so, then it wasn’t negligence.
    Doctors often think that if they don’t do something- a test,
    document a finding, etc— they’ll get sued. “I have to check
    the level.” “I have to document “no suicidality.”” “I have do
    an AIMS test.” “I have to give him a copy of the PI.” The
    reason is “I’ll get sued if I don’t.”
    But lawyers can’t sue you for not doing these things. They
    only sue you when something bad happens. If nothing bad
    happens, you could be drawing penguins in your chart,
    lawyers will never know.
    Forget about lawyers. Be a doctor: do you need to check that
    thing, or not?
    If your clinical behavior is significantly different because of
    the existence of lawyers, you need a massive overhaul of your
    thinking and practice. You have lost your way. And patients
    will suffer.
    (See #4.)
    The Scariest Thing I Have
    Ever Seen
    September 13, 2007

    And it’s wasn’t this.


    I went to see the remake of
    Halloween by Rob Zombie. I’ve
    seen a lot of horror movies in my
    life, but John Carpenter’s original
    Halloween was one of the best—
    and I can prove it.
    There’s an important psychiatric
    difference between the original and
    the remake. In the original, you
    don’t know Michael Meyers. At all.
    We know a little of his background
    by description only. We don’t know why he has to kill
    everyone (“rage” is the single unsatisfactory answer offered.)
    He never talks, never runs, never jumps, never emotes,
    nothing. He doesn’t even die, he pauses. He’s a robot. You
    never see his face, either. He wears a mask, but that’s basically
    his real face. He’s not a human being, he’s a force of evil.
    There’s no person there to rehabilitate. You don’t incarcerate
    him, you set him on fire. (It doesn’t work.)
    In the remake, however, Michael’s childhood is graphically
    portrayed. Cursing, torturing animals, horrible parents, stripper
    mom, etc. Now, he’s a person. All his future murders are part
    of that context. Is he responsible? The product of his
    environment?
    Does it matter? You butcher 40 people, and that’s pretty much
    all I need to know. But now I’ve sat through thirty minutes of
    his childhood, so it inserts itself in my judgment. To some,
    that’s why you need to know the context. To me, that’s the
    distraction to the truth of the behavior. I don’t want to know
    why he’s butchering people. I want to know if fire will stop
    him. (It doesn’t.)
    It also makes the movie suck: before, you were terrified of
    Michael Meyers. Now, you’re not as scared, and you hate him.
    You know why you hate him? Because he’s a person.
    But that’s not the scariest thing I have ever seen.
    Let me start by saying the movie is brutally graphic— torture
    porn. How this thing didn’t get an NC-17 is beyond me. The
    cursing alone hits you— it’s diarrhea, flowing, disgusting. The
    violence is beyond overkill, it is relentless. Jesus, we get it,
    stop killing the dead girl! The movie is also profoundly loud,
    in the horror movie vein: quiet quiet quiet DEATH!!!!!
    Plenty of naked women, very naked, I’m not sure how you can
    be more naked than naked but somehow they are— and they
    get slaughtered. The link between sex and violence is smashed
    into your skull. I defy anyone to get an erection within a week
    of this movie.
    The movie is draining. By the end of it, you are just exhausted,
    empty, numb. Nothing you see in the real world has any
    energy or affect attached to it, because you’ve been
    supersaturated by affect. You need a drink. A lot of them.
    Whisky. And you are completely sickened by all of humanity.
    The original Michael Meyers made the “right and wrong”
    distinction so much more visceral. This just makes you want to
    vomit on everyone you see. You think: every person could be a
    potential Michael Meyers given the right/wrong family
    dynamic.
    The violence is brutal, long, rageful, it is hate, hate, hate, and
    the victims aren’t killed, they are obliterated, like a jack-o-
    lantern on a Detroit mischief night.
    Which brings me to the scariest thing I have ever seen in my
    entire life.
    So I go to the 1015p showing, along with the usual crowd of
    degenerates who need to see this kind of movie in the theatre
    at 1015 pm on a weekday. Not criticizing, just saying.
    Midway through this gore fest I need to go to the bathroom. Or
    maybe I just need a Zyprexa. But as I walk down the steps, I
    see something that literally makes me freeze: for a second, I
    actually die.
    On the screen is a murder so grisly I cannot actually describe
    it, but I don’t even see it, it doesn’t register at all— I’m
    looking instead at this. What I see cannot be real.
    A second later I breathe, and it’s an audible gasp. And what I
    see, what I see— is this:

    Maybe the picture is too dark. Or maybe it’s your unconscious


    deliberately blocking it out. So I’ll tell you: it’s a double
    stroller.
    I’ll also tell you that after the movie I waited in the lobby to
    see— what did I expect? It was a five year old girl and a three
    year old boy. And an infant. They walked out like it was
    nothing. A man and woman, in their twenties— and since
    you’re asking, both white and obese— pushing two kids, 3 and
    4? 4 and 5? They walked out like it was nothing.
    The other people now in the lobby were murmuring,
    whispering, pointing, but not about the movie —? –!!! –????
    No one could believe it. Even the degenerates were horrified.
    By this time it’s about 1230 am. The boy yawns.
    I found myself inventing the most insane justifications: they
    slept through the movie. The parents had fortunately given
    them all a Xanax— or maybe they’re deaf and blind? Maybe
    they were under a blanket watching Nemo on DVD.
    In Lancet there’s a study linking ADHD to food additives.
    Because, you know, that matters.
    Addendum: given the controversy this article has generated,
    I’ve posted an explanation and apology.
    This Needs To Be Explained
    September 15, 2007

    145000 unique visitors may not seem like a lot to those in the
    porn industry, but it’s a lot for me, and especially for a
    “throwaway post” like the one on Halloween.

    Getting on Digg and the front page of reddit certainly is the


    cause of this, but not the explanation. The post got over 200
    comments, not counting what my spam filter destroyed; more
    importantly, the post went to places like metafilter, where it
    had over 170 comments— more than any other post that week.

    Why?
    About half of the people didn’t like the article at all. A lot said
    it was badly written. (I know.) A lot disagreed with what they
    thought were my points— the same points that made the other
    half like the post.

    There were four elements of the post that received the most
    attention.

    Are violent films bad for kids? Very polarized debate.


    Interestingly, the debate was always personal and
    negative: “watching horror movies didn’t affect me.” No
    one asked whether currently violent people had watched
    horror movies as a kid, and if it had an impact. And no
    one suggested they’d be okay with taking their kid to one.
    What is “torture porn?” Are horror movies really porn?
    To call it porn implies something— what is the nature of
    that implication?
    I was surprised by the number of people whose main
    criticism was the photo of the stroller— that it wasn’t
    scary. “It’s just a stupid stroller!” That is an example of
    concrete thinking, and I’d bet that those people like
    Halloween, Hotel, etc, but are not touched by them (i.e.
    they go to sleep with the lights off no problem.) I’m not
    criticizing, just profiling a preference set.
    Why did I refer to the parents as “obese” and “white?” Is
    that really relevant?

    I posted a comment on metafilter that is worth


    repeating/rephrasing here:
    1. I suck at writing. Some of the criticisms of my points are
    really the result of this. Not an excuse, just an explanation. If I
    wrote better, I think there would have been less disagreement.
    2. The point of the last sentence was NOT that horror movies
    make kids into ADHD serial killers— that’s up for debate. My
    point was that those/these kids are growing up in a
    family/environment where obviously there are so many
    negatives— taking them to Halloween is simply an example—
    that for psychiatry to be focused on utter nonsense— food
    additives and ADHD— misses the whole context of the
    “ADHD” child. Psychiatry does this a lot: it focuses on the
    trivial because it’s the only thing it can affect. But in doing
    this, it creates the social policy story that these minor issues
    are the causative, or at least substantive, ones.
    3. I tried to juxtapose the bad childhood of Michael Meyers
    with the (IMHO) bad childhood of these kids, not to imply
    they will become serial killers, but to suggest that maybe, oh, I
    don’t know, once in a while, how we parent affects how the
    kids turn out. Just saying.
    4. The “obese white parents” comment. You know what? I
    have no idea why I wrote that. It’s factual, but it was a
    completely prejudicial remark that I now regret writing— it
    was nothing less than the promulgation of stereotypes. It
    highlighted things that have no relationship to the topic at
    hand.
    4b. Except those attributes did have some relationship,
    otherwise it wouldn’t have been on my mind. I wasn’t born
    with the stereotype in my head. I’m going to tread carefully,
    and I hope you’ll appreciate what I’m going to say: I recognize
    that my thoughts were wrong— i.e. a prejudice, but they came
    from somewhere— even if that somewhere is an attribution or
    information bias. This speaks to the whole problem of
    prejudices in general, where they come from and how we
    combat them.

    Here’s an example: when I wrote that comment, my thoughts


    were exactly this: “I better let everyone know they were white,
    or else they’re going to assume they were black.” Think about
    that.

    Strangely, it never occurred to me not to write they were obese


    — another prejudice on my part. It surprises and frightens me
    that I could have and execute thoughts so automatically,
    without any consideration. It never even occurred to me that
    writing “obese”was in any way wrong.
    5. “Torture porn.” People took issue with it because they think
    porn gets defined as “what other people think is bad.” As a
    working definition, porn can be anything that causes sexual
    excitement in the absence of the fetishized object. Think of it
    like this: porn’s natural outlet is masturbation. There’s no
    actual naked coed with you. The masturbation is the end in
    itself.
    What about when porn leads to actual sex, with, say, your wife
    of 15 years? It’s still masturbatory, in that your sexual energy
    is directed at the porn (e.g., how her hip looks like that pic, or
    how she moans the same way, etc.) Your mind fantasizes
    around the reality of your wife, so that the wife becomes a
    prop for masturbation. (This is an example, don’t yell at me.)
    All of this is narcissistic, introverted. It’s power over your own
    identity. Torture porn is the same: it’s about you, and making
    the other simply an extension of your own affective needs. The
    point isn’t to kill the person; the point is the killing. That’s
    why torture porn is never about revenge, or crime, or any
    obvious purpose. The purpose is the exertion of your power. If
    there was a purpose to it, it wouldn’t be masturbation.
    Youth Suicide Rates Up? Not
    So Fast
    September 17, 2007

    The headlines read, “Highest increase in youth suicide” and


    “girls aged 10-14 increased 75%.” And of course, the only
    explanation anyone seems to want to debate is antidepressants:
    was it too many prescriptions, or too few? And self-righteous
    indignation all around.
    Well, I did something apparently no one else cares to do: I
    looked up the individual suicides. They are individuals, right?
    With different reasons for doing things? And guess what? I
    have another explanation: Ohio.
    The year in question is 2004, the most recent year the data is
    available. I focused on girls aged 10-14, because that’s what
    the majority of the news articles focused on. Most reports
    described an increase of 75%, from 56-94. I actually found 98
    total suicides in this group.
    If antidepressants had any effect— in either direction— then
    the increase should have been spread out throughout the
    country.
    Most states had very few suicides in this demographic. Maine
    had zero. North Carolina had 1. Oregon, 1. Florida, 1. Etc.
    These small numbers are generally unchanged from 2003.
    California, which had the one of the highest absolute number
    of suicides, had 6 in 2003, and 7 in 2004.
    If you look at Ohio, however, you see something interesting.
    In 2003, there were no suicides. In 2004, there were 11.
    Indiana was next: 0 in 2003, 6 in 2004.
    This, of course, speaks to the problem of medicine’s over-
    reliance on epidemiology. People are different, and even
    “matched controls” have such variability that association
    studies are often nearly useless. This is even more true in
    psychiatry. Suicide is not an involuntary pathogen, it is a
    complex, volitional behavior whose causes can only be
    meaningfully investigated at an individual level.
    I have to go back and look closely at all the states’ data, etc.
    But it seems to me that when two small states account for
    almost half of the entire increase in the suicides, we should
    stop talking about antidepressants and maybe go find out what
    the hell happened over there?
    WOW
    September 18, 2007

    Wow. Wow. Fed cuts 50 basis points.


    The Fed did the only thing it could do, given the
    circumstances. Now people can maybe keep their homes,
    maybe we don’t slide into recession.
    But oil goes to $93 and gold to $800, and people think twice
    about buying corn. Meanwhile GS goes to 220 and the Dow to
    15000. And the split between rich and poor becomes visibly
    wider.
    Oh, you want a psychiatry angle. Ok. Zero percent chance of
    universal healthcare in the next 5 years.
    (disclosure: long gold, GS, GOOG; short Iran and Angelina
    Jolie.)
    Beer Goggling Isn’t Natural
    and Being A Good Looking
    Girl Sucks From 9 To 5
    September 19, 2007

    Who’s hot, and who’s not? Ok— who’s dumb and who isn’t?
    Were they different?
    Now— who knows way to evil power source?

    An internet meme spreading through the blogosphere: “Eyes


    Can’t Resist Beautiful People.” I took the extra step of looking
    up the actual scientific article the news report cites, just in case
    there was more to it (and of course there was.)
    A study discovers that when heterosexual undergraduates are
    shown pictures of random undergraduates, they have increased
    attention for pics of attractive opposite sex people. So, guys
    look at hot girls, and vise versa. Not exactly surprising.
    y-axis is time spent
    looking at the pic
    But more interesting
    was the finding that,
    even when the subjects
    were “sexually primed”
    (told to write out a sexy
    story) the increased
    attention was only to the
    really attractive people.
    There was no increased attention to average looking opposite
    sex pictures. In fact, attention to the average looking people
    was no different than the attention to same sex pictures.

    Additionally, people in “stable” relationships (whatever that


    means— these are undergraduates, remember) did not have
    this effect. Perhaps they were “satisfied,” but these tests are
    really about unconscious preferences. The fact that there was
    no significant draw to the attractive people (over anyone else)
    speaks to, in my opinion, an innate monogamy in humans.

    But don’t think these pussy whipped losers (kidding!) don’t


    have instincts— they’re just different than unattached people:
    committed people’s attention lingered on attractive members
    of the same sex.
    In other words, rivals.
    So while there’s a drive
    towards monogamy, there’s
    also an assumption/fear that
    your mate might not be.

    So this implies that the


    person’s state— “where your
    head is at”— affects not
    sexual preference, per se, but the priority of your attention.
    Single people are looking for sex; couples are looking out for
    rivals. Consider that you only have a finite amount of
    attention. In either case, your attention is focused on the most
    attractive, not distributed proportionally depending on how
    attractive the person is.
    But what are we thinking about the person we are looking at?
    Once we’ve assessed their attractiveness (and, if a rival,
    attractiveness relative to our own), what do we think about
    their character?
    In another issue of the same journal, 20-somethings were
    asked to decide if the success of photographed individuals was
    due to luck (looks?) or ability. As you might imagine, women
    attributed good looking women’s success to luck, and less
    attractive women’s success to ability; but thought good
    looking men succeeded because of ability, not luck. Men did
    the exact same (respectively): good looking men succeeded
    through luck, good looking women through ability.

    This is called the sexual attribution bias, and it’s negative, not
    positive— i.e. it is specifically about devaluing the good
    looking rival, not about making correct judgments about the
    less attractive. And it depends nearly entirely on what extent
    you think you are more or less attractive than the other person.
    So while we devalue a rival’s abilities relative to their looks,
    we are unconsciously aware of their actual attractiveness
    (relative to our own.) Consider that pejorative and devaluing
    terms for women— airhead, bimbo, dumb blonde, bitch, slut,
    etc— reflexively connote physical/sexual attractiveness, at the
    expense of intelligence, etc. “That girl is an airhead, I can’t
    believe she can read, let alone work at Goldman Sachs. But
    I’m not letting her out of my sight or near my boyfriend…”
    (Interestingly, pejorative terms for men have almost no
    attractiveness implication: jerk, arrogant, idiot, loser, etc.
    Some terms, like meathead, frat boy, imply stupidity and
    aggressiveness, but not attractiveness, per se.)
    What it implies, of course, is that attractive (relative to others)
    women employees may have a more difficult time in the
    workplace if their coworkers, and especially bosses, are also
    women.
    (Here’s another internet meme I dealt with, about sleep
    deprivation and moral judgment. Also, note carefully the
    fourth comment, by “Anonymous.”)
    Worried About What Kids
    Will See On The Internet?
    September 20, 2007

    Someday— right now— your kids, and their friends, will be


    googling you.
    Another School Shooting—
    Sort Of?
    September 21, 2007

    “A student gunman remained on the loose Friday after


    shooting two students…” He’s male. No motive known.
    Classes have been cancelled. School is on lockdown.

    “The shooter is still at large,” Carlos Holmes, a university


    spokesman, said at a press conference near campus.
    “Given the lessons of the past year, we cannot assume
    that he is not on campus.”

    The FBI is involved. And everyone wants to know: is this Cho


    all over again?
    Before you answer, let me give you one single piece of
    information, that should be irrelevant, that turns out not to be.
    If I tell you that the shooting happened at Delaware State—
    formerly, “State College for Colored Students”— do you still
    think it was a case of a “Cho?” Why or why not?
    I’m not saying he is or is not mentally ill. I’m asking, why
    does the racial makeup of the students— shooter and victims
    — change the bias? Do we think blacks can’t be mentally ill?
    Or that blacks are naturally violent? Or do we think whites—
    and especially Asians— would only be violent if they were
    mentally ill?
    When Cho went nuts— no pun intended— I could find almost
    no one, and absolutely no psychiatrist— willing to consider
    the possibility that his behavior did not stem from a mental
    illness. If he had only been in treatment, none of this would
    ever have happened.
    Now, when and if this shooter turns out to be black, will
    psychiatry make that same, very vocal, assumption? What
    about the legal system? And what happens when legal system
    asks for psychiatry’s opinion?
    What The Hell Kind Of Suicide
    Assessment Is This?
    September 23, 2007

    Do you know how many psychiatry journals there are? A lot. I get 8
    peer reviewed journals mailed to my house, not to mention the
    shopping bag/week of “Insights” and “Reviews” and “Expert
    Series.” What the hell could be in all these journals, other than drug
    ads? Is the field evolving that rapidly? I mean, just how much info
    can there be about Lamictal?
    But I’m happy to announce that the hundreds of articles are all top
    notch, cutting edge stuff. Let’s look at a recent one, about how to
    conduct and document a suicide assessment.
    I’m a busy man, with a lot to read— what are the main, state-of-the-
    art points that I need to know about suicide?

    Awesome.
    Also suggested was listening to patients, preferred over caning
    patients, which can sometimes be misconstrued as insensitive.
    How can I tell who’s at risk? Blood tests, cortisol levels, what?

    Crap. Wrong again. All this time I’ve been looking for breast
    implants. Turns out, other signs include: frequent renting of Girl,
    Interrupted; being Anne Sexton; going through puberty in Ohio;
    mapquesting the longest way to the hospital; listening to rock
    music.
    Keep in mind: these are the key points the editors and peer
    reviewers felt important enough to put in little sideboxes. Aces.
    Let’s go on.
    What questions can be asked to help detect suicidality?

    Wow. Do the answers actually matter?


    Later the article discusses medico-legal risk. That’s what every
    psychiatrist wants to know: how to document a suicide assessment.
    What should you write so that if, God forbid, the patient does kill
    himself, then it shows that you asked the right questions and did the
    best you could? What advice is there for reducing medico-legal
    risk? A sample write-up, perhaps?

    Great, finally— this is exactly the kind of patient we want to know


    about— complicated, but not currently suicidal. Ok, what should I
    write in the assessment? To reduce medico-legal risk? I’m have a
    Moleskin, I’m taking notes:

    Does anyone in psychiatric journals ever get discharged? Or are we


    in France? The guy denies suicidality, and you’re considering ECT?
    This is like writing a pamphlet called, “Practical Tips For Driving
    In Snow” with only two sentences: “It’s so much safer not to! Have
    a Fanta!” (For a more practical, albeit not as well written, article on
    documenting the discharge of a suicidal patient, click there.)
    An Unquiet Mind
    September 27, 2007

    Oh my God, thank you.

    Exactly.
    (If video does not appear, you are the victim of censorship.
    Remember, remember the 5th of November. Or just click
    here.)
    So Doctors Are Allowed To
    Breast Feed
    September 28, 2007

    A ridiculous story about a female medical student needing to


    go to appeals court to get extra time during the medical
    licensing exam so she could breast feed her kid.
    Here’s why it’s ridiculous. If she had ADHD— which does not
    exist as a physical entity but is considered an illness— then
    she could get extra time. But because it’s a baby— which does
    exist, but is not considered an illness— then she is entitled to
    nothing.
    Maybe this woman is using breastfeeding as an excuse, I don’t
    know, I don’t care. It’s breastfeeding— does it occur to no one
    that that might be comparatively more important than, say,
    ADHD?
    Ah, but doesn’t the medical board have a valid point?

    Board attorney Joseph Savage said he would appeal the


    ruling, which he said compromised the test’s fairness and
    could force the board to grant extra time to other test-
    takers with distracting medical conditions, such as men
    with prostate problems.

    You’re right, it does open the door to this. But the problem
    isn’t the woman who wants to breast feed, it’s the inanity of an
    exam where such unrelated issues actually start to matter. Why
    should the Boards take all day? Don’t give me the pat answer,
    “that’s they way it is” or “doctors need to go through such
    grueling days, it builds character.” Is there no more effective
    way to test knowledge then to see who bores slowest?
    Leaving aside the question of whether the licensing exam is
    actually valid— that it tests what it says it tests, basic medical
    knowledge; and ignoring for the moment whether a score of
    any kind in any way relates to your potential as a doctor; and
    keeping silent on whether the exam can be “gamed” (I taught
    for the Princeton Review for USMLE I and II for 5 years)—
    why does the exam need to be all day?
    It’s amazing to me— absolutely amazing, and by amazing I
    mean violently enraging— that we are so apathetic that no one
    questions why the exam needs to be that long, that our minds
    find it easier to jump to whether there are alternatives to
    breastfeeding— arguably the last holdout in our collective
    descent into narcissistic alienation.
    Ten Things Wrong With
    Medical Journals
    September 30, 2007

    I know, right? Only ten?

    References

    This is how references are done now:

    This is madness.
    I could make a career
    out of exposing
    references that have
    nothing to do with,
    or directly contradict,
    the referenced
    statement. (Here’s
    one.) This system of
    referencing makes it
    very hard to do this
    — and I wonder if
    that’s not the point.

    It is, by contrast, very easy to link the exact article referenced


    — even the exact page in the article. Even Jezebel does this.
    Online— assuming it’s not a pdf even though this shouldn’t
    matter— when you click on the superscript it takes you to the
    references, which has a further link to the actual article (but
    not the statement.) Ok— why the extra step?

    Note that the way references are done here is antithetical to


    science. Look at the reference pictured above. What do you
    see? What is important? What you see are the authors and the
    journal, not the scientific content. That’s what’s implied to be
    important. We’re supposed to accept the science of a statement
    by the force of the author and journal? But that speaks to my
    later point about bias.

    Subscription
    Why should government or Pharma sponsored research require
    me to pay someone else (the Journal) for access to that
    information? And why only licensed academics? So, if I’m a
    welder in Kentucky, I can’t know what’s really up with
    Depakote for bipolar? I have to read some nut blogger?
    It is a simple process for a Journal to host online all articles as
    free text. Or, better, scientists can publish their work on their
    own site (hosted by a university, etc, if necessary.)

    Neither are Journals necessary as repositories of vetted


    information. There are numerous ways these scattered articles
    can be collated, packaged and even summarized for easy use.
    Slashdot, Digg, and others are very effective in this regard;
    and something similar can be done with science. I know, Digg
    can be gamed. What, Journal of Clinical Psychiatry can’t?
    Where’s The Raw Data?
    Rephrasing from above: why am I not allowed to see the raw
    data from a government sponsored study? (And from Pharma
    — if they agree to do a study, then they must agree to make all
    data public.)
    You may have heard that there are rumblings about making
    this data accessible— but not to everyone; only to those with
    appropriate access (academics, etc.) Again— why?
    Slow
    This is a common lament, but it misses the point: it is
    artificially slow. As in on purpose.
    Articles that are submitted for peer review should simply be
    published in a “pending peer review” section. Other sciences
    already do this. To the criticism that doctors may act on
    unreviewed science, it should be noted that citing “personal
    communication” (e.g. an email) as a reference is perfectly
    acceptable. Is that safer? Oh, and about that peer review:
    Peer Review

    Even with the most malicious intentions, it would be nearly


    impossible to create a worse system than peer review. Peer
    review does not have the potential for bias; it is specifically
    designed to retain bias, and to maintain the primacy of
    subjective opinion over objective findings. The only people
    who support peer review are other peer reviewers. If
    necessary, money should be diverted from pediatric AIDS
    research to help stop to this oligochracy. It’s that important.

    In medicine, “peer review” is the editor of a journal and three


    other doctors- that the author suggests as reviewers. While
    ostensibly the author’s identity is unknown to the reviewers, in
    practice it is simple to determine authorship (type of research;
    meetings; and even document metadata.) Oh, and the editor
    knows who you are.
    Most people think peer review is some infallible system for
    evaluating knowledge. It’s not. Here’s what peer review does
    not do: it does not try to verify the accuracy of the content.
    They do not have access to the raw data. They don’t re-run the
    statistical calculations to see if they’re correct. They don’t look
    up references to see if they are appropriate/accurate.

    So what do they do? They look for study “importance” and


    “relevance.” You know what that means? Nothing. It means
    four people think the article is important. Imagine the four
    members of the current Administration “peer reviewing” news
    stories for the NY Times.
    On the force of the recommendation of these three reviewers
    and the editor— who, by the way, decides whether to even
    send it to reviewers at all, or reject it outright— the article gets
    published or not. And there is no right to an appeal.
    Imagine a movie gets previewed by four people who decide if
    the movie is important or not, and whether it will play in
    theatres. You know what you get? Notes On A Scandal, that’s
    what. And riots.

    The peer review system also promotes the perpetuation of


    biases. Doctors are subtly pressed into writing articles about
    certain topics— consider the Depakote madness of 2000-2004;
    the noradrenergic hypothesis of depression in the 70s (where’d
    that go?); and how every issue of BMJ has an article on war.
    (Except July 2008: that was the month they wrote about
    whether to boycott Israeli academic institutions. Ok.)
    Academic careers are made, in part, by the number and quality
    (i.e. journal) of publications, which will be influenced by what
    they think certain journals would publish. “My research
    focuses on things my Chairman really likes.” Can’t wait to
    read more about evolutionary psychology.
    Lack of Debate
    There is no way to have a meaningful debate about an article
    within the Journal system. How do you crowdsource a medical
    study? As an example: if I find a logical error in an article (e.g.
    mistaking correlation for causation) I can only point this out
    by writing a “Letter To The Editor,” which, you will be
    surprised to learn, goes to the editor.
    Even if it is published, my Letter will have little attention. But
    while anyone smart enough can critique a study, only an
    academic can write the Letter.
    It is unnecessary to point out that the rest of the internet—
    including news— works very differently.
    Disclosure of Conflict of Interest

    Almost completely invalid for its intended purpose.

    If a doctor does a promotional program, a “drug talk”, he has


    to disclose the relationship. But if a doctor is dating a drug rep
    — that relationship he doesn’t need to disclose.

    Even more strange is that these are commercial conflicts of


    interest, only. If you are a communist, or Priest of Scientology,
    or a serial pedophile; these are not disclosures, even if your
    article happens to be “Incidence Of Pedophilia Among
    Communists.” Neither is being funded by the NIH (any
    surprise that NIH studies always find that the generic is the
    best?) Or being married to the Chair at Harvard. Or having a
    son on the drug.

    Aren’t personal beliefs a bias?

    To single those out commercial interests as somehow more


    damaging, more biasing than any others is preposterous. It’s
    not a false sense of security; it’s a deliberate misdirection from
    all the other things that actually bias science. And it sidesteps
    the entire point of scientific articles— if they are truly
    scientific, if the articles were truly “peer reviewed”— it
    shouldn’t matter what your biases are. I could own Pfizer. The
    article on Zoloft should be able to stand on its own.

    It’s worth observing that the peer reviewers are not asked to
    disclose any of their commercial interests.
    Boring
    No exposition needed. Either less words or better words.
    Abstracts As Promos
    See this blog post, where it starts out, “I know, right: only
    ten?” and then you have to click to get the full article? So my
    promo has really no useful information in it. You know why?
    Because I am a blogger, that’s why.
    Contrast that with the abstract from an important study on
    Lamictal for maintenance treatment in bipolar (emphasis
    mine):

    Conclusions Both lamotrigine and lithium were superior


    to placebo for the prevention of relapse or recurrence of
    mood episodes in patients with bipolar I disorder who
    had recently experienced a manic or hypomanic episode.
    The results indicate that lamotrigine is an effective, well-
    tolerated maintenance treatment for bipolar disorder,
    particularly for prophylaxis of depression.

    The Conclusions seem to say Lamictal is good for preventing


    “mood episodes”, mania and depression— is there any other
    way to interpret it? In fact, this study shows it is only good for
    preventing depression, not mania at all. Why is it written this
    way? Because the authors want to advance the idea that
    Lamictal is a “mood stabilizer” and not what it actually is: an
    antidepressant.
    You have to understand that most doctors do not read the
    study, they don’t even read the abstract— they skim the
    abstract. For this reason, the abstract has to be an accurate
    summary of the article, not a promo for an idea. But that’s why
    it is written this way; it’s not about the findings, it’s about the
    authors’ agenda.
    What’s stupid about this is that negative findings are as
    important to a clinician as positive findings. They are less
    important, of course, to academics whose careers depend on
    positive findings, and the drug companies who sponsor them.
    Advertisements
    Pick up a medical journal— inside you will see drug ads. I
    haven’t heard many people complain that this influences the
    science in the journals, the way authors’ “conflicts of interest”
    is supposed to. But before you respond, consider that the ads
    are only for one product per class. For example, in the NEJM,
    there is a two-page, full color ad for Lipitor, but none for any
    other cholesterol drug. Oh, my mistake— there are two, two
    page ads for Lipitor (running $32,000 per issue). Same with
    one inhaled insulin; one antidepressant (Effexor); one sleeper
    (Rozerem) etc, etc. If having ties to Pharma influences the
    outcome of science, what is the effect of having a financial ties
    to only one Pharma company per class? (1)

    Inflation In Studies
    Reducing the value of something by increasing its availability
    is inflation. This is magnified when the thing in question
    didn’t have much value to begin with. Three strategies:

    The same data set, or the same thesis, is reworked into


    several different articles for different publications. This
    may seem a benign way to pad your CV, but what it does
    is fool people into thinking something has more support
    than it actually does. This is precisely how Depakote
    became a bipolar colossus.
    A topic is investigated multiple times, when even one
    time was too many.
    A finding is described as novel or at least interesting,
    when it had already been published years earlier by a less
    “important” researcher.

    (nod to Glen for this one)

    IF YOU THINK THIS ARTICLE IS USEFUL, PLEASE


    TWEET, REDDIT, ETC, IT. AND SEND IT TO OTHERS.
    NOTHING CHANGES WITHOUT MOMENTUM.
    –—
    1. I wondered if psychiatry journals, having a more limited
    range (e.g. no insulin ads) would have broader coverage of
    companies. They did, sort of. Archives, CNS Spectrums,
    Primary Psychiatry, etc, all had multiple antipsychotic ads
    (never more than three brands, though) but always only one
    antidepressant. Not sure what to make of that.
    An Addendum To “Ten
    Things Wrong With Medical
    Journals”
    October 3, 2007

    I added another “thing wrong” with medical journals. At the


    bottom. I think it’s worth reading.
    Kerouac’s On The Road: The
    50th Anniversary Of A Book
    I Had Not Read
    October 5, 2007

    So I read it.
    What is striking is how little it resembles the book everyone
    seems to think it is.
    Has anyone actually read this book? Nine people total, all
    literary critics?
    Enough has been written about the book itself. A more
    interesting question is why so many people got it so wrong.

    I can’t be the only one whose impression of the book, from


    hearing about it but not actually reading it, was that it was
    about young, potent men, lost in a growing commercial
    society, two coiled springs ready to pop, looking for adventure
    — America style. And this Road Trip that launched a
    thousand, other boring, useless road trips, was about young
    men looking to experience the world, really see, really live,
    really feel, free of the constraints of an artificial post war
    soulless society. So, khakis on and Moleskine’s in shirt
    pockets, top down on an old convertible, they set out to find
    life. Testosterone, benzedrine, and a full tank of gas.
    Well, guess what? That impression is wrong. You know what
    the book is really about? It’s a primer on how to be a
    narcissist.
    Right off the bat: these are not cool guys. This isn’t even
    Henry Miller uncool. This is not a dismissive insult, but the
    only word that can be used to describe the Sal
    Paradise/Kerouac character is “dork.” Remember the guy in
    high school who quoted Monty Python and the Monster
    Manual— seemed smart— but was unable to distinguish
    himself in any meaningful way? He has big ideas, of course,
    but is full of ambivalence, lacking in any type of purposeful
    drive, no real direction. Restless, but lazy. That’s Sal, that’s On
    The Road. This is not testosterone augmented with benzedrine.
    This is a guy who likes his naps. Here are the first two
    sentences of the book:

    I first met Dean not long after my wife and I split up. I
    had just gotten over a serious illness I won’t bother to talk
    about, except that it had something to do with the
    miserably weary split-up and my feeling that everything
    was dead. (1)

    You can already tell this is going to be the story of a passive


    guy who needs to be lead.
    Well, he finds such a leader in Dean Moriarty. I won’t bore
    you with the character analysis; suffice it to say that Dean is (I
    guess) the “free-spirit” character everyone imagines the book
    must be about, bedding women, stealing cars, doing whatever
    the moment calls for. I know it sounds very superman, literary,
    but it’s not. Dean isn’t an antihero, or even amoral, or a free
    spirit— he’s simply a jerk. I defy anyone to identify anything
    he does in the book that is worthy of any sort of praise or
    emulation. When he talks, your sole instinct is to open fire at a
    Starbucks. You don’t want to be Dean Moriarty, you want to
    bitch slap him. Not only does he do nothing of any value to
    anyone, he does nothing with purpose. He’s a bullshitter
    without any reason to bullshit. It’s empty, idiotic. Here, I
    literally opened the book to a page and put a finger down:

    [Sal] said, “there must be some ideal bars in town.”


    “The ideal bar doesn’t exist in America. An ideal bar is
    something that’s gone beyond our ken. In 1910 a bar was
    a place where men went to meet after work, and all there
    was was a long counter, brass rails, spittoons… Now all
    you get is chromium, drunken women…”

    Here’s another, again at random, I swear:

    “The truth of the matter is we don’t understand out


    women; we blame on them and it’s all our fault,” I said.
    “But it isn’t as simple as that,” warned Dean. “Peace will
    come suddenly, we won’t understand when it does— see,
    man?”

    I’ve heard these same kind of sentiments expressed hundreds


    of times, not ironically always in bars and coffeeshops. And I
    had the same reaction then: if she sleeps with him, I’m going
    Unabomber.
    But enough about the characters, what about the spirit of the
    book? You know, getting out there, seeing life?
    The notion that they’re trying to experience things or learn
    things or grow is precisely wrong. That’s the mistake nearly
    everyone I talk to has made. The experiences are incidental,
    the learning completely absent; the real purpose of the trip is
    to say that you went on the trip.
    It seems impossible to me that you could take a trip around the
    country and literally notice nothing about your surroundings,
    but that’s exactly what happens. I know “America” is
    supposed to figure prominently into the spirit of the book, but
    it could easily have been A Railpass Through Europe or
    Backpacking Through The Warsaw Pact and it would have
    made no difference, at all. That America is not well described
    could be dismissed as poor writing, but it’s actually an
    example of very accurate writing: the setting has no external
    importance whatsoever— except as it impacts them. That’s
    narcissism. It’s simply a prop for an image they want to
    convey; traveling down Route 6 for them is the same as the
    career of the female lead in every romantic comedy
    (writer/designer) or the apartment of the male lead, rich or
    poor (Soho loft.)
    They’re always rushing to get to the next great place; every
    place they get to turns out to be a disappointment. And so off
    again to the next great place. For some reason this is taken to
    be the result of some inner passion, some drive to experience
    new things. It’s not. The real point of the drive is: as long as
    they’re traveling, they don’t have to confront the reality of a
    place.
    The entire spirit of the book can be summarized by Dean’s
    words: “Sal, think of it, we’ll dig Denver together…!” That’s
    what a man who is trying to con a woman into running off
    with him would say. Denver, really?? Really? Why? Because it
    starts with D? I’d at least momentarily entertain the theory that
    D cities are great places to get to, but the real reason he wants
    to get to Denver, or anywhere else, is precisely because the
    longer he stays in any one place, the better chance he’ll be
    discovered to be a loser. Time to go where the grass is greener,
    somewhere people don’t know you’re there to crap on it.
    That’s what the Road is. The Road isn’t freedom, or
    possibility, or growth; it’s denial. It’s not having to confront
    the triviality and purposelessness of your existence. It’s not
    having to listen to your Mom tell you you aren’t going to get
    into college with those grades, or a wife who nags you about
    being out all night drinking instead of fixing the bathroom
    because, well, you’ve been out all night drinking and not
    fixing the bathroom.
    This narcissistic ambivalence is the root cause of their
    disappointment in each— the same reason dating is so hard for
    some teens and 20-somethings. You don’t actually want a girl,
    they want the possibilities of a girl, before she becomes a real
    person. Before you learn she likes American Idol, before you
    discover her annoying laugh, and, most of all, before she finds
    out who you really are— before you can’t fool her anymore.
    If you want further evidence of this parallel, consider the book
    describes numerous encounters with really young girls. I’m
    guessing Kerouac wasn’t trying to convince us he was a
    pedophile; So why tell us? Take it at face value, what appeal
    could there be? The same as for any regressed pedophile: it’s
    easier to convince a young girl (or a broken girl) that you’re
    somebody. The strong but introspective loner; the mustached,
    Porsche driving, sophisticate; a good lover, a genius, an artist,
    whatever. Try that on a normal woman and you know what
    you get? Fake orgasms.
    This is the story of two guys at the junior prom, standing in the
    corner, fantasizing about what it’ll be like after they get
    discovered. Not that they’re taking any concrete steps towards
    that end beyond simply fantasizing.
    And further supporting their small mindedness— they’re
    thinking about what those girls at this dance will think about
    them ten years from now.
    Narcisissm is consciously creating an artificial identity that
    you then fight tooth and nail to get others to believe is true.
    That’s On The Road. Not just the plot of On The Road, but On
    The Road itself. Consider how it was written: everyone knows
    that Kerouac was high on benzedrine, and the book poured out
    of him, in three weeks of sleepless creation, typed onto a
    single, long scroll of paper, unedited, raw, real. But here’s the
    thing: the book wasn’t the result of that process, he planned
    that specific process in advance, on purpose. Same with the
    cross country trips— this wasn’t a restless guy, who had to
    travel, had to move, and then later wrote a memoir; he went on
    the trips in order to write a book. He actually started the book
    before he even went on the trip. The process didn’t generate a
    book; the process was the whole point. The novel’s popularity
    rests entirely on the image around it, that he created, on
    purpose. That’s why its popularity exists despite apparently so
    few people actually having read it. If the book had been
    published anonymously, no one today would have ever heard
    of it.

    This is the main problem with people who love On The Road
    but have never actually read it. They think Kerouac is in that
    book, so they think they like Kerouac. Or, at least, the person
    they think Kerouac is, i.e. the character in the book, or, more
    accurately, the character they think is in the book.
    This partially explains some of the problem Kerouac had after
    the publication of the book. By the time it was published in
    1957 he was 35, but it was about trips he had taken ten years
    earlier. People hounded him see if he was like Dean (in fact,
    Kerouac was Sal, but everyone wanted him to be the “cool”
    character.) They wanted him to be a young, free-man hipster
    type, not a lonely alcoholic living with his mom. But that’s
    what he had wanted them to think when he wrote it. When he’s
    taking the trips and writing the book, creating an identity and
    convincing people of it is all that’s important. But by the time
    he’s 40 and that fake identity never really pans out, he’s
    disgusted with himself. I’m going to guess that of the 9 people
    in America who have actually read the book, most read it in
    high school. If they read it as adults, they’d probably feel
    about it like Kerouac did at 40:
    At the end of the book (SPOILER!) Sal/Kerouac becomes
    disillusioned, disgusted with Dean. Relationships end for
    everybody, but what’s different is Kerouac is disillusioned by
    Dean as a mentor. Who the hell has mentors? Answer: people
    looking to become something they are not. That’s what
    happened to Kerouac. Now he’s 40: he’s not Sal, he’s not
    Dean, he’s not a hipster, and damned if everyone didn’t
    misunderstand the book (of course: they had only read about
    it.) I can understand why he becomes a drunk. That’s where
    unrequited narcissism always leads.
    It seems a lot of people have developed notions and ideas that
    are partially informed by On The Road— the version that they
    imagine exists, the one with Nietzschean super-antiheros
    looking for truth behind the wheel of a convertible. But what
    happens to those ideas when you one day discover that your
    version was wrong?
    Here’s your tie in to medicine. Doctors like to remind people
    that “there’s still a lot we don’t know.” That’s a distraction
    from the more truthful version, “there’s a lot we don’t know
    about what is already known, that we’re supposed to know.”
    They have notions of what the clinical trials showed, or what
    Freud said, or how medicines work, that are wrong— but
    they’re basing entire careers on these wrong ideas.
    Here’s the thing: even when someone actually sits and reads
    the primary text and finds it is different, it doesn’t replace their
    existing (wrong) information, it only supplements it. There’s
    not one On the Road that people got wrong; there are now two
    On The Roads, one they read and one they imagined existed,
    and they get to pick which one they want. I guess that’s ok, as
    long as it’s only On The Road.
    ––
    1. Interestingly, Kerouac’s original version wrote not of the
    separation of his wife, but of the death of his father, which is
    not only more accurate, but considerably more powerful,
    especially as it related to “the feeling everything was dead.” I
    don’t know what to make of this change.
    Holy Crap, I’m On
    Wikipedia
    October 7, 2007

    Imagine my surprise when I see that a major source of


    incoming links was Wikipedia. It’s at the bottom, under
    “Criticisms.”
    Some narc is going to email me that anyone can edit the wiki,
    and this link will probably soon be deleted. Hey, man, why so
    negative, you’re harshing my buzz.
    This Is What You Wanted,
    Right?
    October 7, 2007

    Remember all those articles about bipolar needing specific


    treatments, and that you should never use an antidepressant?
    I have a guy on Zyprexa and I add Lexapro, patient comes
    back the next day and says the insurance wouldn’t cover
    Lexapro, and hands me an insurance rejection which says
    exactly this, punctuation included:

    Clinical Review Third Party Override Required.


    Prescription had the following Clinical Review
    message(s)- “Lexapro Oral Tablet 10MG should be used
    with extreme caution in Bipolar Mood Disorder, which is
    a proxy medical condition based on the use of Zyprexa
    Oral Tablet 5MG.” and “USE FLUOXETINE
    PAROXETINE SERTRALINE CITALOPRAM”

    In case you’re missing the beautiful irony, let me extrapolate


    the rejection’s four points:

    1. Didn’t you psychiatrists all agree that antipsychotics are


    “anti-psychotics” and thus only for bipolar or psychosis?
    We assume you are rigorous, therefore this must be a
    bipolar patient.
    2. Didn’t you psychiatrists all agree antidepressants, like
    Lexapro, were dangerous in bipolars?
    3. Fortunately, we at the insurance company caught your
    oversight before it was too late; disaster averted. No need
    to thank us, your silence is sufficient.
    4. Oh, and BTW, if you ever do want to use Lexapro, don’t
    — please use these generics, which are ipso facto safe in
    bipolar, as they are generics.
    It’s only a matter of time before the insurance company adds:

    You know, this is pretty easy; the meds do all the work,
    and we have to catch your mistakes anyway. So, we’re
    going to reduce the Medicaid payment for office visits to,
    I don’t know, $35 for an office visit. Oh, wait, we do that
    already! BWAHAHAHAHAHAHAHA! We’ll just get
    the primary doc to do it.

    You’re going to say, no, that’ll never happen. Oh yeah? Did


    you expect this to happen?
    This Is Just a Joke, Really,
    No, Really, It’s Not Real,
    We’re Much More Rigorous
    Than This, I Said It’s A Joke,
    Okay? Let It Go!
    October 10, 2007

    (From Bliss at ComicsPage)

    Sigh. Rispalin. Go ahead and deny it.


    It’s certainly easy to make fun of it, but as a slightly different
    point: why do psychiatrists— educated, intelligent, dare I say
    on the intellectual side of the field— do this in the first place?
    Pharmacologically, it really doesn’t make sense. Ritalin is a
    dopamine/norepinephrine and sometimes serotonin reuptake
    inhibitor, as well as some degree of catecholamine releaser.
    Risperdal and Thorazine are tight D2 blockers. So while
    antipsychotics won’t negate the stimulatory effects of
    amphetamines (different dopamine receptors, etc) the
    amphetamines do compete with antipsychotics for their sites,
    thus reducing their effect. (NB: less relevant in quickly
    dissociating antipsychotics (clozaril, seroquel).)
    I think the reason it is done is language, i.e. the child
    psychiatrist can say to a parent: “I’m giving this drug for
    attention and concentration, and this other drug for
    impulsivity/aggression.” Even if, pharmacologically, this can’t
    possibly work, nor does it even make any structural sense to
    separate the two classes of “symptoms.”
    But “working” isn’t the goal. Psychiatrists in this regard are
    asked to do something impossible: counteract a gigantic
    social/economic/cultural matrix of pathology with two to three
    medications of dubious efficacy, given to only one of the
    players in the matrix, i.e. the kid.
    The reason they are called upon to do this herculean task is
    that society lacks the language and the power/commitment to
    handle these social ills in any other meaningful way, so it
    repackages them as psychiatric illnesses. In this sense,
    pediatric bipolar is underdiagnosed, not overdiagnosed.
    So the goal isn’t better treatment for the “patients”— listen up
    everyone, I’m letting you in on the Trilateral Commission’s
    big secret— it’s keeping the doctors believing the problem is
    medical, not social.
    As long as doctors believe the problem is theirs, it will be.
    What Hath Google Wrought
    October 12, 2007

    The quote, “what hath God wrought” comes from Numbers


    23:23, about the Israelites, but it was popularized by Samuel
    Morse when he sent it as the first message over the telegraph.
    I’ve been telling everyone who will listen to buy Google— it’s
    up 140 points since I wrote about it a month ago— because it
    is more than an investment, it is a paradigm shift.
    Others have described the typical fears of a Google world—
    boiled down, essentially, to “everything gets saved, and
    everything can be searched.”
    While true, there are nuances missing that are worth
    describing explicitly. Buckle up.
    First, four basics:
    1. Google is more than search; Adsense is much more than
    ads. Google records every search you make— time, date,
    which links you chose, time between clicks, etc. It’s a
    relatively simple matter to piece together a profile of the user,
    even without knowing the identity of the user, which Google
    knows anyway. But Google also has a general ability to know
    what websites you visit, independent of search. See those
    Google Adsense ads? They’re javascript: every time the
    webpage loads, a request is sent to Google for the immediate
    creation of an ad, based on the contents of that page. If that
    page sends a request, then Google knows that you are there, at
    that moment; when you came, how long you stay, where you
    went next, etc. And yes, the information is recorded without
    you clicking on the ad. It is a technically easy process to
    follow an IP address across the internet, as it hits Adsense
    pages.
    2. Google is the default backup of the internet. Read that
    again.
    Every page Google’s bots crawls is cached on their servers. In
    other words, they have a copy of most pages on the internet.
    You may try to delete something from the internet, but once
    Google saw it, it’s on their servers forever. There is also
    considerable redundancy: if you upload a pic to your site, it is
    in Google’s cache, but also Google’s cache of anyone else who
    used your pic.
    Here’s an example: there’s a story about a woman upset
    because the Google van (which takes street level photos for
    use with their maps) caught a picture of her cat in the window.
    She wanted the picture removed. Removed? From where? She
    doesn’t get it, she thinks Google has the photo paperclipped to
    the inside of a manila folder. You can’t remove it, it’s not a
    possession, you can’t take it back— it’s like the spoken word
    and the spent arrow, it is past tense. It’s not just at Google
    Maps; it is at BoingBoing, and at Google’s cache of
    BoingBoing…
    You know all those closed circuit cameras? Some of them are
    online. Look, here are some, live. Guess what? Now they’re
    on Google, too.
    3a. Google is an accidental monopoly…
    People complained that Microsoft forced people to use their
    products by linking them with other products. For example,
    Internet Explorer was the browser because it came with
    Windows. Google, however, can’t help being the end product
    of the internet. Consider email: you can choose to use Yahoo!
    Mail and not GMail because you are worried that Google
    keeps all Gmails. Fine; but if you email to someone with
    GMail, Google stores a copy and knows what you wrote, but
    now also knows your IP and email address; consequently, it
    knows other sites you’ve visited. Etc.
    Imagine the post office copied every letter it handled, and
    could cross reference the contents of those letters with other
    databases: calendar; credit card/online purchases, physical
    location, etc. Scary? Now imagine that the post office housed
    those databases.
    3b. …that cannot die.
    Everyone worries about Google’s growth, but who is worrying
    about its demise? Google has so much data that it actually
    takes up real estate all over the world. Let’s say Google goes
    out of business. Who gets all those servers? All that data?
    Who gets a copy of the world, on the cheap? Whoever it is
    doesn’t have to give us satellite photos anymore. What can
    you do with satellite photos that no one else has? Who gets to
    decide how to control all that data?

    4. Don’t Be Evil.
    Well, okay, that’s good advice, I guess, but what happens when
    the subpoenas come? Or the Russians invade? Or the Chinese
    commandeer/hack Google servers— some of which are
    actually in China? Discussions about the legal aspects of
    privacy aside, if something exists, it can be found. Even if it’s
    just a disgruntled organ donor at the Googleplex who decides
    to fork over terabytes of data to the highest bidder. An
    organization— a security organization— is only as strong as
    the weakest person. Go to the Googleplex and park your car.
    Do you see any potential weak links? I sure do.
    As a quick example of how crippling this information can be:
    Google has recorded the surfing habits of every employee of
    Microsoft, including Bill Gates. And of two Presidents. And
    the Pope.
    The Missing Piece
    The above three are well known, if maybe a little paranoid.
    But what is so important, and never discussed, is this: Google
    will be around for another 100 years. At least.
    So when I say that it knows everything, it knows everything
    across time. It doesn’t just have insights into your character; it
    has insights into your character as you age, and the character
    of your family line.
    Social Ramifications:
    Used to be, “on the internet, no one knows you’re a dog.”
    Well, now everyone knows. But worse, there’s no hierarchy of
    identity. You may think you’re Chariman of Oncology who
    occasionally played World of Warcraft 7 years ago. But if a
    Google search reveals 10 hits about WoW, and only one of
    being a doctor, then guess what? You’re a nut.
    The narcissism I always refer to is characterized by a vital
    need to self-identify. You want to pick an identity, and you
    want others to accept it even in the absence of facts or
    behavior. “I read Hegel, I’m an intellectual.” No, you’re a
    coffeehouse agitator. I can tell by the undershirt. What Google
    has done is to make this self-identification impossible. Before,
    you could be exposed only if someone took the time and effort
    to background check you. Soon— hell, now— it will require
    no effort. When the brooding artist-type you met at Starbucks
    calls you up to deride romantic comedies, inauthentic japanese
    food, and Ambercrombie and Fitch, but your cell phone shows
    you a picture of his (read: parent’s) house in Irvine, well, that
    pretty much ends that, doesn’t it?
    Apparently, incoming college freshmen already know their
    future classmates through Facebook. Worse: the parents know
    their kids’ future classmates. Remember the clean start college
    gave you? Well, forget it.

    Parenting:

    The focus is on who is monitoring our children. What are they


    up to?

    Well, think about this: your kids are investigating you.

    Remember that time when your mom was 19 and she was in
    that wet t-shirt contest? No? Well, your kids will get to
    remember yours in AVI format. Oh, and that DUI conviction?
    Remember that vapid comment you posted on the Daily Kos?
    (Hint: ten years from now a high school freshman will cringe
    at its inanity.) And, lo, the IP address search. How did your IP
    end up on pornotron.org? (Yes, the non-profit.)

    Did you realize that your future daughter in law will be


    checking you out? “Billy, did you know eight years ago your
    Dad…?” This didn’t occur to you? Then I guess it didn’t occur
    to you that your son’s reply will be, “Sigh. Yeah. I knew.”

    (As an aside, the very fact that you are surprised by the
    possibility that your kids are googling you is evidence of the
    cultural narcissism I’m always referring to. You are the parent,
    your child is yours, you monitor and control it— it doesn’t
    occur to you that they can exert the same power over you.)

    Parenting has always required a degree of acting. You can’t be


    an effective parent if there is not at least the illusion of moral
    superiority; children rely on an unchanging moral stance to be
    able to test limits and to establish a superego. While it isn’t a
    disaster that your kid knows you smoked pot in high school, it
    doesn’t help. But it is a far worse when your kid learns it
    without your contextualization. Consider: “Son, I smoked pot,
    but…” vs. reading an email when you were 20 where you
    recommend it to a girl you’re trying to bed…
    Google compresses time. What you did might feel like it was a
    long time ago, but your kids “experience” that memory
    immediately. Additionally, they are raised in a world where the
    past never disappears, so they do not connect with your
    language of “a long time ago.” For this reason, identity will be
    fixed at an earlier age.
    Look deeply into your childrens’ faces. You will never
    remember them as well, as accurately, as they remember you.
    Medicine:
    It’s beyond me that no one else has mentioned this.
    Google wants to set up a system for online medical records, so
    that they can be “transported”— accessed by all the various
    medical providers in your life. This is not even great in theory.
    First, does anyone remember the Seinfeld episode where
    Elaine gets labeled in the chart as a problem patient? And
    every time she tries to change doctors, the chart follows her,
    and she can’t get anyone to work with her? Let me assure you
    that in psychiatry this already happens even without the chart.
    If you want to ensure a two tiered system of medicine, enact
    medical record portability.
    Next, medical records will thus be searchable, like GMail. See
    all those Zoloft ads? Guess why. Think drug reps know too
    much about doctors prescribing habits? How about how they
    will know the demographic characteristics— diagnoses x
    epidemiology x financial status x etc— of the patients he
    treats?
    But the worst is this: genomics. It’s not too far away that
    doctors will be running genetic tests as often as they run
    CBCs. Where is that going to be recorded? Imagine that your
    DNA can be cross referenced with your surfing habits. And
    your kids’ DNA with your surfing habits. Imagine the
    preposterous world where Google “Adsense” predicts what
    products your kids might be interested in based on your life
    cycle… (Update: 23andMe.)
    Here’s a scary, sad, non-porn example: “Mom, why am I
    getting so many ads for breast cancer prevention?”
    Think how good a Google search is using only a few
    keywords. There is no reason why Google can’t suggest to you
    state of the art, or at least evidence based, treatments, tailored
    as well as possible to the information in your medical records.
    So much for doctors. At best they retain their importance as
    diagnosticians. (Oh, and how much more accurate if the
    Google medical records happen to link up to your numerous
    emails that begin, “oh my God, I was so wasted last night…”)
    Look, people, I’m not saying Google will do it; I’m saying that
    it is no additional effort at all to do it.

    Memory
    You know the hippocampus? You won’t need it where we’re
    going.

    Memory takes practice. I can remember the phone number of


    almost everyone I meet, because I practiced that skill. Most
    people are the opposite, however, because they directly dial
    much less often. Same with my calendar (in my head vs.
    PDA.) And if you don’t remember someone’s phone or
    address, you can always google him.
    I don’t know anyone who quotes whole passages from books
    anymore. Very few even know any poems. Pretty soon, we
    won’t be so great at memorizing 10 digits at a time; or
    directions; or names. This isn’t a bad or good thing, but it will
    be different. Factual memory will be less important than
    “feeling,” “experience.” “That was an awesome party.” Yeah,
    who was at it? “Hold on a second, I’ll tell you exactly…”
    Soon, you won’t need to remember anything about “him.” You
    want to call him? Say, “call that guy, red hair, worked at the
    gas station…” and he’ll answer.
    Here’s a crazy idea: that guy walking towards you that you
    don’t remember? His “device”— cell phone/PDA/GPS/brain
    implant signals your device, and instantly not only do you now
    remember who he is, but you know a lot of other stuff about
    him you didn’t know before. Solid.
    General facts will no longer be rehearsed, learned, because
    they can be immediately accessed. I don’t mean go-to-your-
    laptop-and-search immediately, I mean wristwatch, or
    earpiece, or contact lens immediately.
    (A propos of testing: multiple choice has to vanish. All
    education now has to be essay.)

    Not just that, but access will be faster. Question: how


    important is it to prevent memory loss in dementia, when they
    can access the memory instantly? So recall (e.g. Ach?) won’t
    be important: processing skills (DA and Glut?) will be
    important. Maybe that’s a good thing.
    Mobile Search
    I know, it’s about target ads. Ok. What do you have when you
    have infinite storage capabilities, and voice recognition search
    software (e.g., Google 411)? You have a permanent database
    of everyone’s voice. Across time, under different
    circumstances. Across generations. And always tagged with all
    your other information. So when Google hears your voice
    through someone else’s phone while on vacation in France, or
    on a CCTV, or whatever— it can helpfully say, “oh, that’s Bill,
    he likes cooking and Asian porn, let me send him some
    targeted ads!”
    It’s Taking Over The World, You May As Well Profit From
    It
    A lot of people think Google, at 620, is overvalued. They’re
    not just wrong, they are casualties. It has a $200b market cap;
    it has $13b in cash, and no debt. It grosses $6b in profits a
    year, margins of 30%, and it’s growing at 30% a year. It has
    time on its side.
    I’ve long argued we are moving towards feudalism, away from
    national governments. Google is already gunning for the top
    spot.
    Oh, I know, Google is just a big advertising company. That has
    satellite photos of the entire world that they artificially worsen
    because the U.S. Government doesn’t think you should be
    allowed to have it.
    What saves us, today, is that Google is a relatively small
    company run, really, by three people. But if it grows too big- if
    it becomes like an oil company, with tentacles into politics and
    world affairs and everything else— in other words, if it
    becomes a lord— you can just change the motto from “Don’t
    Be Evil” to “Don’t Be a Sucker.” And then look out.

    (long GOOG, obviously.)


    Upgrading Movable Type Is
    Like Getting Hit By A Bus
    While Watching An Airplane
    Crash
    October 21, 2007

    You think I’m kidding? You may have noticed that for the past
    week, there haven’t been any new posts and new comments
    weren’t being accepted. That’s because the site was up while
    the blog engine— Movable Type— had detonated itself.

    The problem is that upgrading Movable Type requires a level


    of technical sophistication that seems ridiculous to expect of
    anyone. Movable Type comes with these handy instructions:

    1. Make a backup of your database - Whenever you


    are making a change to your system such as this, it is
    always considered wise to make a backup of your
    data just in case you need to undo anything you
    might have done.
    2. Download Movable Type 4.0 - Once you have
    backed up your system, download Movable Type to
    your web server.
    3. Unzip Movable Type - Using your preferred
    unzipping software, unpack the Movable Type
    archive onto your file system.
    4. Copy Movable Type’s Files Over Your Old
    Installation - Copy all of Movable Type 4.0’s files
    over your old installation of Movable Type.
    5. Consult “Important Changes You May Need to
    Make” - In this guide you will find a section
    devoted to a list of things that everyone upgrading
    should be aware of. Read this section carefully and
    make any changes applicable to you.
    6. Login to Movable Type.

    While these instructions are typed and have correct


    punctuation, they do not actually prepare the average user to
    perform an upgrade. Do you know what the server name for
    MySQL database is? Exactly. Turns out it isn’t “localhost,”
    which is weird because that’s what Movable Type defaults into
    the entry box.

    The answer, as it happens, is “mysql” which seems shamefully


    obvious in retrospect. The ‘obvious’ part is in retrospect; the
    ‘shamefully’ part is every time you interact with support
    people.
    Can anyone tell me why I can install Windows Microsoft
    Office with one or two obvious mouse clicks, but upgrading
    Movable Type requires me to ftp then chmod the following 14
    files:

    oh, wait, you don’t know what chmod is, either.


    Before the slashdot crowd hurl Diet Cokes at me, let me point
    out that this software is supposed to be for bloggers. That
    includes the 14 year old who writes the blog I Like Rainy
    Days, a delightful pink blog with bunnies I just made up.
    What, she doesn’t deserve to use Movable Type? She has to
    stay on MySpace? This is the wold’s biggest problem with
    software designers: they understand functionality, but not
    usability. Programmers are particularly proud of— insistent on
    — clean, well written code. That’s awesome, really, except I
    can’t see the code. What I see is an error message, which I’ll
    admit is clean and well written. There’s a reason the iPod is
    doing so well relative to the Zune, even though the Zune is
    arguably a superior product. And it isn’t just because it’s
    white. Well, not completely because it’s white.

    Movable Type is a product, right? You want customers, right?


    Or are all Movable Type blogs supposed to be about Movable
    Type?

    I once felt an aesthetic and intellectual responsibility to install


    Linux on my new computer. The result was that my computer
    committed suicide. Seriously. Right there, in front of me. It
    plugged itself in and jumped into a bathtub full of water and
    pulled in a hair dryer as well, for good measure. Do you know
    how much better Linux is than Windows? Well, neither do I.
    Software complexity of this type necessitates some kind of
    user support system. Too bad. Movable Type support prefers
    to communicate using form letters.

    Yahoo!, my web hosting service, was actually worse. It was so


    much worse that it’s comical, bathtub-computer-dryer comical.
    Ultimately I had to contact Yahoo! on the phone. Think about
    this.

    The second guy I spoke with— immediately after I hung up


    with the first guy— told me there was no solution to my
    problem, that I could not upgrade, I could not restore my
    backup— because, even though I made a backup which I was
    at that moment looking at, that backup wasn’t actually made, it
    was only scheduled to be made— and that all my data— old
    blog posts, comments, etc— was lost. Got that? Me: “but I can
    see it, I’m in the directory, I can download a file, I can read a
    post, the stuff is there.” No, he assured me, it wasn’t. “But I
    can read—” No. I guess if I knew Perl, I’d understand.

    The reason I called the second guy in the first place was that
    the first guy I called referred to “Movable Type” as
    “Wordpress” which I’m pretty sure is not correct.
    The Diagnosis of Borderline
    Personality Disorder: What
    Does It Really Mean?
    October 23, 2007

    A diagnosis of borderline personality disorder could,


    theoretically, mean that the psychiatrist made a serious attempt
    at evaluating defense mechanisms and ego integrity; or at least
    a matching of symptoms to DSM criteria. It’s theoretically
    possible, yes. Other things that are theoretically possible
    include alien abduction, peace in our time, dual eigenstates,
    user friendly Movable Type upgrades, political discussions
    that don’t rely on information from John Stewart, Daleks,
    recession with low unemployment, Independents,
    Madonna/whores, a benignly rising Russia.
    Let’s assume there’s a difference between a diagnosis and a
    heuristic.
    A diagnosis is based on pathology, or at least on a set of
    predetermined criteria. I diagnosis must be both reliable—
    multiple doctors would find the same diagnosis when given
    the same information, and valid— the diagnosis actually is the
    thing you say it is.
    Many psychiatrists devalue diagnoses into heuristics, that is,
    they have intuitive “rules of thumb” that are extensions of
    their own cognitive biases. This isn’t automatically good or
    bad; the heuristic is only as helpful as the bias. For example, if
    the last ten people who you saw that smoked crack also had
    syphilis, on the 11th you might apply the heuristic, “where
    there’s crack, so there be syphilis, better get a blood test.”
    Unfortunately, it could be applied the other way: the 11th
    patient with syphilis you see gets prejudged as a crack addict.
    The diagnosis of a personality disorder is supposed to be valid,
    it’s supposed to mean something. However, in general they are
    diagnosed very unrigorously, if such a thing can be imagined
    of psychiatrists. They carry nearly none of the implications of
    causality (except, once in a while, sexual abuse), nor do they
    reflect a distinctive understanding of a person’s personality
    (e.g. borderline as distinct from narcissism.)
    A good example is borderline. If a psychiatrist calls it
    borderline, it may or may not be, actually, borderline
    personality, a la Kernberg. So if a patient happens to know she
    was diagnosed with borderline (which she rarely will— it’s
    kept secret or encoded as “bipolar”) it doesn’t mean she can
    look it up on the internet for more information, because that’s
    not what the psychiatrist meant by the diagnosis. “Articulate”
    has a certain meaning, look in the dictionary; it is fairly
    consistent throughout all settings except one: when it is used
    by a white guy to describe a black guy. In that case, the word
    suddenly means something completely different than it
    ordinarily does: it means “not hung up about race.” Here’s the
    point: the black guy may actually be articulate, or not be
    articulate— who knows? But white people know exactly what
    it means in that context. Similarly borderline: you may,
    indeed, have a borderline personality, or may not; but the
    diagnosis to the psychiatrist means something else. n other
    words, it’s not at all a diagnosis, it’s a heuristic.(1)
    Devoid as these personality disorder heuristics are of their
    originally intended meanings, they do, however, reliably imply
    the same things to other psychiatrists. Those “things”
    however, are uncoupled from the “official” diagnosis. The
    heuristic may have a lot, or absolutely no, relationship to the
    diagnosis. In other words, the term “borderline” is immensely
    reliable among psychiatrists, but not at all between
    psychiatrists and non-psychiatrists, who think it means
    something else. What psychiatrists should have done is
    invented their own special word for the heuristic of
    “borderline.” But they’re lazy.
    So, as a public service, I’ll tell you what psychiatrists mean
    when they say borderline. Once again, I’m saying that this is
    how the diagnosis is used by many psychiatrists. If you email
    me and say that I’m a jerk for not understanding the term, then
    you need to go buy yourself a helmet.
    First, borderline is a heuristic of countertransference: if the
    psychiatrist feels frustrated, or exasperated, then the patient is
    borderline.
    Second, borderline is meant as a synonym for any of the
    following: needy, argumentative, touchy/hypersensitive.
    Third, it is generally reserved for the following four types:

    1. Very attractive female, who comes for problems the


    psychiatrist considers ordinary: men, work/school,
    problems with parents, etc. It is diagnosed here most
    often by female psychiatrists, and carries the connotation:
    “Grow up.”
    2. Overweight, typically white, female, who needs/wants
    benzos, especially Klonopin. The implications are lack of
    self-control, and reliance on external supports.
    3. Thin female with a lot of anger. By example, the woman
    who comes for treatment of “depression” but describes
    most life events in terms of attacks, sleights, harm, etc—
    i.e. power differentials.
    4. Gay man.

    If you are a patient, my point in telling you this iss not “why
    did they diagnose me with borderline?” but rather, “oh my
    God, are you telling me he thinks I’m borderline just because I
    told him if I don’t get my twice a day klonopins, I’ll freak
    out?”

    Again, these aren’t even accurate descriptions of the formal


    diagnosis borderline; number 3, for example, is better
    described as narcissism, especially when anorexia (restricting
    type) is involved. But her anger makes the psychiatrist
    uncomfortable, so it gets labeled as borderline.(2) I hope you
    see two obvious problems: first, the term is used pejoratively;
    but, more importantly, giving something a label alters the
    environment, in this case in the wrong way. The above #3
    female doesn’t need limit setting, she needs mirroring
    transference, etc. (And don’t forget about the narcissistic
    injury.)

    But again, even though the term is used improperly and


    probably leads to worse treatment for the patient, it does mean
    the same wrong thing to most psychiatrists. So when I’m being
    referred a “30 year old borderline,” I know almost exactly
    what I’m getting, even though it has nothing to do with
    borderline. Frustrating? You betcha.

    But the sleight of hand is that it sounds like personality


    disorders are crappy and unreliable diagnoses and have little
    in common with their original meaning. In fact, most
    psychiatric diagnosis are equally crappy and unreliable. When
    you read articles saying “borderline is a pejorative term, and
    these patients are often really bipolar” what you need to
    understand is that “bipolar” is not a more valid or reliable
    diagnosis, it’s simply another heuristic. It isn’t less pejorative,
    it isn’t more “real.” It carries a different set of implications,
    but it isn’t a more rigorous, more “biological” classification.
    It’s not like saying, “it’s not a unicorn, it’s a rhinoceros.” It is
    like saying, “it’s not a unicorn, it’s a pegasus.”

    This, by the way, is the reason why so many defenders of


    psychiatric diagnoses can’t accept that “borderline” and
    “bipolar” are equally subjective terms. They say, “the
    diagnosis of borderline has very poor inter-rater reliability;
    bipolar has high inter-rater reliability.” But reliability is not the
    same as validity. If you take twenty thousand members of the
    KKK, and ask them to “diagnose” the problem of
    contemporary society, their answer will be the same, i.e.
    reliable. But it’s wrong, obviously. The diagnosis of bipolar is
    reliable, but in the same way as the KKK’s diagnosis of
    society’s ills was reliable. It may be completely wrong, it may
    be completely right, it may be partly right, partly wrong, in
    some cases but not others, etc.

    If you want to know why I’ve used racial analogies throughout


    this post, it’s because these are all, in essence, prejudices. “It’s
    bipolar.” “It’s borderline.” “It’s poverty.” “It’s bad parenting.”
    “It’s…” Well? It’s not really any of those after all, is it?

    ––

    1. Referencing a joke from Fear of a Black Hat: “what’s the


    difference between a slut and a ho? A slut sleeps with
    everyone. A ho sleeps with everyone but you.” So here, the
    term “ho” actually has nothing to do with how many people
    she has slept with, under what conditions, money, etc— in
    other words, it isn’t the definition in the Oxford English
    Dictionary— the single implication is that she didn’t sleep
    with you, a fact which is actually not in the official definition.
    So she may, indeed, be a “ho” under the Oxford English
    Dictionary definition, or may not be. But when the word is
    used in conversation, everyone “knows” you didn’t have sex
    with her.

    2. Narcissism as a heuristic is reserved for either successful, or


    threatening, men; the countertransference is defensive
    condescension, as in, “go ahead and rant; you think just
    because you’re a millionaire lawyer, you’re going to
    intimidate me?”

    3. (Wait, there was no 3?— Here’s a day to day description of


    what borderline is supposed to be.)
    Abusive Teens Force Their
    Girlfriends To Get Pregnant!
    (Don’t Let The Truth Get In
    The Way Of A Good Story)
    October 25, 2007

    Another internet meme that is spreading like syphilis all over


    the internet, maybe we should look at it a little more closely?
    The news articles are titled, “Teens Report Abusive
    Boyfriends Try To Get Them Pregnant.”

    The girls, aged 15-20, reported

    their abusive partners were actively trying to get them


    pregnant by manipulating condom use, sabotaging birth
    control use and making explicit statements about wanting
    them to become pregnant.

    I’m not sure it’s particularly surprising to anyone who works


    in a city that boys are actively trying to get
    their girlfriends pregnant, but that’s not what this is all about.
    The implication, of course, the soundbite, is that abusive boys
    are using impregnantion specifically as a means of abuse. In
    other words, the abuse is the point; hitting, verbal abuse,
    sexual abuse, and forcing pregnancy are all tools for that
    purpose. If the guys weren’t abusive, they wouldn’t be trying
    to impregnante their girlfriends.

    Interestingly, in any discussions about this article I’ve seen,


    the criticism is the small sample size of the study— 61 girls
    interviewed. 53 used. But that’s not the flaw in the study, the
    flaw is in the way these results were reported in the news. In
    fact, only 14 of the girls reported that this was happening. A
    quarter.

    “We were floored by what these girls told us,” Dr. Miller
    said.

    Really?

    If this article had been titled, “75% Of Abusive Boyfriends


    Aren’t Trying To Impregnante Their Girlfriends; Many Still
    Wear Raiders Caps” would we be talking about this? 25% is
    pretty low. But it’s actually lower than that:

    Participants had varied responses to these pregnancy-


    promoting behaviors, including some sharing the same
    desire to become pregnant

    Wow, it pays to RTFA.

    Keep in mind that the pregnancy is supposed to be a means of


    abuse and control. It’s not supposed to be an example of a guy
    really, really wants a baby. (I’m not saying that this is a valid
    reason for sabotaging contraception, but I am distinguishing it
    from an intended abuse of the girl.)

    Of those 26%, how many were being impregnated because the


    boy legitimately wanted a baby? What percent were doing it
    for access to welfare/money/services/get to move in? In how
    many cases did the girl want to get pregnant herself? Or was at
    least ambivalent about it?

    I have nothing against the study, I’m all for investigating abuse
    patterns of likely future narcissists, but the reporting of these
    studies takes on a life of its own. It doesn’t matter whether it’s
    true or not, what matters is that this soundbite is stuck in your
    head, and it informs your thinking about society.

    And again, of course: even when someone shows you this is


    wrong, or you get new information to the contrary, the new
    information doesn’t replace the bad information, the new
    information sits next to the bad information. Instead of one
    study you’ve misunderstood, you have two studies you
    contrast.
    If You’re Drinking Decaf,
    You’re Probably Too Tired
    To Read This
    October 26, 2007

    The NYTimes has a short piece about their recent discovery


    that decaf coffee actually has caffeine. Well, ok.
    They cite a study in the Journal of Analytical Toxicology
    (from 2006) that found that

    They also tested 6 cups from the same Starbucks (one in


    Florida) and found 12mg/16oz.

    The article also references the recent Consumer Reports article


    testing of 6 cups each of 6 different brands of decaf. Here’s an
    interesting statement by Consumer Reports:

    One of the six cups (12oz) from Dunkin’ Donuts had 32


    mg; one from Seattle’s Best had 29 mg; and one from
    Starbucks had 21 mg.

    What’s weird about it is that Starbucks actually tells you there


    are 20mg in a 12oz cup of decaf. So why did only one of the
    tested cups have that much? Keep in mind, the toxicology
    journal article found an average of 9mg/12oz at one store,
    6mg/16oz in another store. We can assume the beans are the
    same, so the answer, obviously, is in the preparation of the
    beverage, not the decaffeination process. Specifically,
    temperature and time.

    Have you noticed that Starbucks and Dunkin Donuts coffee is


    so hot it makes you want to punch a harp seal? And do you
    remember when McDonalds got sued because some damn fool
    used coffee as an eyewash and burned her corneas out?

    And have you noticed that the coffee you make at home is
    never as good as the one at the store? And never as hot? And
    never as good?

    Professional coffee makers heat the water that goes into the
    grounds to F195; your countertop bling-bling does 180. Think
    15 degrees doesn’t matter?

    The hotter the water passing through the grounds, the more
    caffeine; but the more acidic. I’ll say it backwards, too: the
    colder the water, the less caffeine, but less acidic. Did you ever
    wonder why no one ever orders Starbucks black? It’s because
    they’re all dead. If your machine isn’t pushing 1200 watts, it’s
    not even trying to extract caffeine from the coffee. It’s giving
    it a gentle misting, like you might to do to a baby, or when
    cleaning the leaves of a rubber plant, or when peeing on a
    friend. Or something.
    Also, the last ounces out of the grounds are more bitter than
    the first. They also have less caffeine. You know those auto
    shut off coffee pots in hotel rooms, that stop dripping when
    you pull the carafe (and consequently flood because you didn’t
    know you needed to put the cover on to get it to work?) Each
    cup you pour is different in taste and composition.

    That said, coffee on a hotplate burns fast, very fast. So drink


    fast.

    Also see:

    What’s The Healthiest Coffee To Drink?

    “A cautionary tale about working to hard.”


    Presidential Anti-Pharma
    Rhetoric Heats Up
    October 29, 2007

    So once again I’m in the weird position of having to defend


    something I’m actually against.
    The latest is from John Edwards, et al. Here’s the headline:
    Edwards unveils plan to control drug advertising.
    Read that sentence, and decide what you think the intent of the
    plan is. Is he talking about controlling the colors of the ads?

    Most likely, you think it’s the effect the ads have on drug
    prices.

    “The excessive costs of prescription drugs are straining


    family budgets and contributing to runaway health care
    costs…”

    Let’s temporarily grant that that this statement is true. What is


    the link between advertising and prescription drug costs? Is he
    saying that spending on ads increases the price of drugs? That
    would be wrong, and I have to believe he knows it.

    First, Pharma spends about $4b on DTC ads. It has yearly


    sales of about $200b, so even if every penny spent on ads was
    instead used to lower the price of the drugs, no one would
    actually notice. Additionally, prices of branded drugs rise
    about 6%/year, regardless of how much they spend on ads.

    Second, we should probably define “drug prices.” If I roll into


    a pharmacy with a prescription and choose to pay cash, how
    much will it be? The answer, as it turns out, depends on the
    pharmacy. These are retail prices, that pharmacies charge no-
    insurance cash payers; on average, 15% more than insurance
    rates. But let’s be honest here: cash payers can’t afford a lot of
    these medications at any price. If you’re one of the unfortunate
    working poor who don’t have a prescription plan, you can’t
    afford the medication at full price, 20% off, even 50% off. The
    price is irrelevant; what matters is whether you have a
    prescription plan, or a doctor who can provide samples
    forever.

    So for everyone else, “prices” really means prices to insurance


    companies, or Medicaid/Medicare, all who negotiate a price
    that has almost nothing to do with the actual patient demand
    for a drug. A price which is considerably lower than retail.
    Medicaid apparently gets a 20% discount, the VA 40%. (1)

    So DTC advertising doesn’t affect the price because the


    consumer isn’t paying it. The price was set in negotiation.
    Certainly the price Pharma asks from wholesalers and insurers
    takes into account their costs, including advertising; and more
    ads (hopefully) means more scripts which means higher
    profits. But increases in advertising don’t translate directly to
    higher prices, they reduce the profits. Higher prices are the
    result of negotiations between parties that are immune to the
    effects of advertising. That’s the problem.
    Third: perhaps what we really mean is that DTC ads raise the
    overall Medicaid/Medicare expenditures because more scripts
    are being written that would otherwise not have been written
    without the DTC ads. Well, if this is what we’re saying, we
    should just say this; let’s not use factually inaccurate
    soundbites that play to the hearts of superficial idiots.
    But if we are saying this, then the problem isn’t the prices of
    the drugs, it’s doctors prescribing drugs they shouldn’t be
    prescribing. The solution isn’t, therefore, to reduce drug
    prices; in fact, that’s the opposite of what you want, because it
    makes it even easier for doctors to prescribe what they
    shouldn’t be prescribing. The actual solution would either be
    to raise drug costs (bad idea), controlling doctors’ prescribing
    (bad idea), or giving them a medication budget they have to
    stay within, but preserving prescribing freedom.

    It should bring us pause that even the AMA refused to


    recommend banning DTC ads. If Edwards plan was
    specifically about protecting the patients from half-truths or
    seductive graphics that compel patients to request medications
    that they don’t need or might compromise their health, then
    I’m behind him 100%. I already think DTC should be banned.
    But like all political soundbites, this isn’t about content but
    about ambiance, creating a feeling that he’s all about cutting
    costs— that’s he’s more than Hillary. Unfortunately, empty
    rhetoric like this distracts us from real problems, like Iraq,
    Iran, wealth divergence, recession, etc.

    ——

    1. As a horrifying diversion into drug pricing, let’s look at


    Medicaid.

    Medicaid, by law, will pay (to a pharmacy who dispenses the


    drug) a percentage of the average wholesale price, plus a
    dispensing fee. Both the percentage and the dispensing fee
    vary from state to state, but it’s on the order of 85% of average
    wholesale price, and $5 dispensing fee. On average, Medicaid
    pays about $61 per prescription: $14 goes to the pharmacy,
    $47 to Pharma. If anyone can tell me how DTC ads affect that,
    I’m listening. So pharmacies don’t make a lot on this, and it’s
    a far cry from the markup the pharmacy can impose on a cash
    payer. And pharmacies aren’t obligated to participate in
    Medicaid.
    In practice, wholesale price is anything Pharma says it is,
    including some bizarrely inflated price. But whatever it is, I
    hope it is clear that it has nothing to do with ads.

    And then there are the rebates. I hope you’re sitting down.

    In gratitude for this excellent reimbursement, Pharma agrees to


    rebate Medicaid about 15% or the manufacturer’s price, plus
    an additional rebate every year for the amount of price
    increase that exceeds inflation. In 2003, the average rebate was
    31%.

    There’s another rebate. Many insurances have pharmacy


    business managers (PBMs) who make preferred drug lists.
    How does a drug get on that list? It isn’t by being cheap; ask
    Illinois Medicaid in 2005, when they wouldn’t cover Seroquel,
    arguably the most demanded but hardly the most expensive.
    What it takes is, as they say in Big Pharma, “our willingness to
    play ball.” Another “rebate.”

    That money stays in the managed Medicaid’s pocket. The


    savings aren’t passed on to the patient, either directly or
    indirectly. If you want an analogy, it’s the parking authority;
    revenue from tickets doubles, triples, but the amount they pay
    to the cities doesn’t change. The extra “profits” goes back into
    the authority, to hire more people, pay more salaries. It’s a
    self-propagating bureaucracy. I should also mention that,
    consistent with bureaucracies, it can’t even collect those
    rebates very well.
    Pre-Fed Update
    October 30, 2007

    So I was pretty much dead on: GS went to from 190 to 240;


    GOOG went to Pluto; oil closed at $93 yesterday; and gold
    went from $720 to $792. As for Dow 15000, wait a month. I
    was even right about Angelina Jolie; I was wrong about the
    corn, though.
    Tomorrow the Fed will cut .25 because, and this is important,
    everyone expects them to. I think they would rather not cut,
    because they see an inflationary picture, high oil, high gold,
    and strong employment, and no obvious slowdown in
    consumption. But the Fed game is about managing
    expectations, because surprise actually hurts the market more
    than the “wrong” decision. In this case, though, it’s the right
    one. The inflationary picture only applies to rich people; to the
    others, the picture is recessionary: they’re living on credit. Or
    off their house’s value, which turns out is made of
    gingerbread.
    If you want the next investable tip, it’s Vegas: put money
    down on a Republican President. Or, if I am wrong and they
    don’t cut, double down on Clinton.
    (Long GOOG, gold, oil; still short Iran, and about to cover on
    Angelina Jolie.)
    More On Medical Journals
    October 30, 2007

    A commenter suggested another good one, so I added it.


    Bipolar Rates Are Increasing
    As Long As You’re Willing
    To Call Everything Bipolar
    And Defy God’s Will
    November 1, 2007

    Do you dare defy the Will of God? In 1994, there were 20,000
    visits for pediatric (under age 19) bipolar disorder. In 2003, the
    number was… 800,000. The diagnosis, therefore, was
    25/100,000 in 1994, and now it’s 1000/100,000. In other
    words, 1% of the population.

    To compare: for adults the rates were 905/100,000 in 1994, to


    1679/100,000 in 2003. In other words, 0.9% up to 1.7%.

    I’ve heard this justified as a step forward. While “visits” isn’t


    the same as incidence or prevalence in a population, it makes
    sense as a proxy. The adult rate is about 1-2%, consistently.
    Bipolar was severely underdiagnosed in 1994, and it’s better
    diagnosed today. Since bipolar is a biological disorder with a
    strongly heritable component, it only makes sense that the
    child rate should be the same as the adult rate, assuming good
    diagnostic skills. So the diagnosis rate has simply risen to
    match the adult rate.

    The only problem is this: in 2003, 2/3 of the children visiting


    were males. But 2/3 of the adults were females.

    So you have some options:

    1. The male children have a disorder that is actually


    different than the adult females have, i.e. one of them is
    not bipolar.
    2. The male children with bipolar got cured during puberty.
    3. Bipolar disorder turns boys into women sometime around
    age 19, obviously using the power of Satan.

    The ridiculousness of this increase in diagnosis is only


    exceeded by the potential harm such an increase is actually
    causing. Forget about the safety or lack of safety of bipolar
    medications in kids, which is worrisome enough. A problem
    few seem to want to talk about is the impact of a bipolar
    diagnosis on a person, for the rest of his life. Let’s say, for the
    sake of argument, pediatric bipolar is overdiagnosed. Then all
    those people who were misdiagnosed are, in fact, not bipolar;
    however, they have no way of ever finding that out. They have
    to carry this with them for the rest of their life. When they’re
    30 years old, and they’re asked on routine checkup if they’ve
    ever had a psychiatric diagnosis, they have to say, “well,
    pediatric bipolar, but I think that’s not right.” Sure it isn’t.
    When that 30 year old guy has kids, and those kids grow up,
    they’ll be asked, do you have a history of major psychiatric
    illness in your family? Hmm. “Maybe bipolar… but my Dad
    told me he thinks that wasn’t right.” Oh, ok. Did your Dad
    have a temper? “Well, he did yell a lot when he was mad.” I
    see. Did he go without sleep? “Oh my God, when we were
    kids— lots of times.” Then it’s settled.

    If pediatric bipolar is being accurately diagnosed, then either


    psychiatrists are now more sensitive to its detection— a
    unlikely possibility since the diagnosis has been around for a
    long, long time— did we suddenly develop a better test for it?
    Or else something has changed in the world to cause it to be
    more frequent (a toxin in bottled water? MySpace? Iraq?)

    Early treatment of bipolar— let’s call it the “real” bipolar—


    doesn’t slow down the progression of the illness. It helps you
    today, but it doesn’t change symptoms 10 years from now,
    they way aggressive early treatment of diabetes actually
    prevents physical pathology from worsening. So it may be
    worth, oh, I don’t know— conservative management?
    The Problem With One
    Specific Female Doctor
    November 2, 2007

    This is a true story that’s going to offend you, I’m telling you
    that up front.

    This is how it goes: the pediatrics attending was attractive, no


    two ways about it. That’s probably not what she wanted you to
    notice about her but that’s the way things go, you have no
    control over first impressions and even less over second and
    third impressions. Hold tight to your identity, I sometimes say,
    because no one else is buying it.

    In her defense, if defense is actually needed, she tried to


    downplay her looks. Hair in a ponytail; glasses on, long dress,
    white labcoat, modest shoes, little makeup, but as is the
    problem with some women who don’t know the game, all this
    had the opposite effect. You may get to choose an identity, but
    you can’t pretend to be someone else.

    She’s talking to the parents of a 4 year old girl. The kid needed
    an MRI because an ultrasound maybe showed something…
    “I’m pretty sure it is nothing, but just in case.”

    Well, just in case isn’t just just in case, since it involves


    sedating to unconsciousness a four year old while her parents
    look on, visibly anxious, invisibly terrified. The little girl
    blinks, shakes her head, eyes drift simultaneously north and
    southwest before she jerks herself alert— she looks at her
    parents who gave her the juice and for a devastating, guilty
    moment the parents think that she thinks that they are trying to
    kill her. And then she’s down. All this, for “nothing.”

    Sometimes, when a pediatrics attending at a major university


    hospital says “nothing,” what she actually means is “partial
    anomalous pulmonary venous connection” which, I’ll admit,
    to the untrained ear sounds like two different things, but praise
    God they are exactly the same.

    “Even if that’s it,” she reassures them before the MRI, “it’s
    one of the more common congenital heart defects, and it’s
    usually associated with another, also pretty common, heart
    defect, called an atrial septal defect. That’s a hole in the
    septum between the left and right atria.” Again, reassuringly.

    The father looks at her blankly. “You’re saying she could have
    two heart defects?”

    “Well, no, they’re both part of the same syndrome. “

    “You’re really going to have to dumb this down for me, I’m
    sorry.”

    She repeats herself. Just slower.

    “The surgery will attempt to patch the defect in the septum and
    redirect the pulmonary vein to the left atrium.”

    “I don’t follow you.”

    She tries to use simpler words, but in an attempt to maintain


    the formalism of medicine, she dumbs down the easy words.
    “Defect— it’s the hole in the septum.” Obviously, this isn’t
    what he needed clarified, because she then adds, “redirect—
    reattach.”

    “I still don’t understand. There’s a hole in her heart?”

    “Let me draw it for you.” And there, look, she draws for him
    an excellent drawing of the heart and vessels, with arrows
    showing blood flow; then scratches out part and redraws,
    showing what is normal and what she is worried it could be.
    It’s obvious it’s different, anyone could see the pathology.
    “But this artery is smaller—?”

    “No, that’s a vein, but it’s ok because after the repair…” She is
    frustrated, it couldn’t be any clearer, what the hell is wrong
    with these people?

    Meanwhile I am watching in amazement. She won’t tell them


    what they need to know. She wants to tell them facts, not
    realities. I see her, she is pretty, really beautiful. Distractingly
    pretty. What does she look like without glasses? Without
    clothes? And then I think, why am I thinking this? I’m a dog, I
    know it, but this is different, the thought “she is pretty”
    appears like a puzzle, a code, it means something else…

    I gently lean over and say, “but what’s the relevance to the
    girl? What does that anomaly actually do to her?”

    The father nods, yeah, yeah, exactly— but the attending looks
    at me in hostile shock. Then her expression softens, I actually
    see her create and discharge the thought, “oh, he’s just a
    psychiatrist.” She thinks I’m retarded, I know, she thinks I
    don’t know any cardiology at all because I’m a psychiatrist, it
    never even occurs to her that I may be asking on behalf of the
    parents, because it never even occurs to her that she’s not
    explaining herself well. So she tells all of us, in pretend
    surprise relief, “oh, it just means a left to right shunt,
    sometimes they’re asymptomatic, maybe sometimes
    pulmonary infections…” Pause, staring. “Shunt. Blood gets
    diverted.”

    After the surgery, can she run, play, swim? Hold her breath?
    “Oh, sure, there’s normal oxygenation.” What if she gets into a
    car accident, is she any more likely to rupture a reattached
    vessel? Is she more prone to heart attacks in later years? “No,
    no, she’ll have the same risk factors for heart disease as
    anyone else.” She can’t say it, she can’t say, “no the kid will
    be normal” because it’s not technically exactly accurate, she’s
    a doctor, and she’s careful, she’s precise.

    And there are the lawyers, of course. She always thought it


    was nothing, that there was no chance it was PAPVC, but the
    risks of sedating an otherwise asymptomatic 4 year old girl
    through an expensive test and putting the parents through a
    week of anxious hell certainly are outweighed by the risk of
    lawyers, right?

    I notice how pretty she is again: a secret message. And I


    realize that I am seeing her as particularly attractive because
    she is trying not to be defined that way. She is
    overcompensating with words, and since no one can
    understand her they are left only with what they see— the very
    thing she was trying to mask. The result is she is
    incomprehensible except as attractive: “…and you can tell
    she’s really hot underneath all that…” Take a highly technical
    paper and black magic marker out one sentence, people will
    spend more time trying to look through the magic marker than
    they will trying to understand the technical paper. And if they
    manage to figure out the redacted sentence, it will be assume
    to be a proxy for the entire paper, even if it isn’t.

    You can’t judge a book by its cover. But if no one understands


    the book, they will judge it by the cover, if they bother to at
    all. And if the cover is confusing also, well, forget it.

    These parents need her to be real, but she can’t be real, her
    whole professional demeanor is based on the suppression of
    real.

    And that’s the problem with this one, single, particular female
    doctor. I’m not saying this is something that I’ve observed in
    other female doctors or that it doesn’t happen to male doctors.
    If you want to make generalizations based on this story, well,
    that’s your own lookout.
    Jay-Z Calls The Next Market
    Move
    November 8, 2007

    That’s a still from Jay-Z’s video, “Blue Magic.” The


    significance of the shot should be obvious to anyone, whether
    or not they trade currencies. Why it’s not obvious is the real
    question.

    1. Friend of mine comes over Monday night and says, “hey, I


    know you own Google— I’m thinking of buying it. And what
    about Euros?”

    2. Did you know 7 countries are considering abandoning the


    U.S. Dollar?

    3. 11 out of 12 experts vehemently believe the dollar is headed


    for collapse, or at least much further fall. None of them
    tempered their opinion, or qualified it. “The dollar has further
    room to fall regardless of incoming US data.” “The dollar will
    keep falling in the near term no matter what.”

    4. and, of course, Jay-Z uses euros in his video. And Gisele


    Bundchen wants to be paid in euros, not dollars.

    And everyone is convinced that if even Gisele and Jay-Z are


    converting to euros, then that’s it for the dollar.

    Well, not exactly.

    I have never been in a room, on the side of a trade, or in an


    argument when everyone- everyone— was in agreement about
    something, and that something turned out to be correct. The
    more people convinced of a proposition, of a certain mindset,
    the greater the likelihood that they are wrong.

    Why does anyone think that Jay-Z knows when it’s time to
    covert to euros? But, to a man, everyone commenting on the
    blog that discusses the Jay-Z/euro link is bearish on the dollar.
    I defy you to find anyone who is bullish on the U.S. dollar.
    Everyone thinks it goes lower. (Interestingly, except Alan
    Greenspan.)

    People like Jay-Z, and everyone else in a situation of


    unanimous agreement, are what is known as contrarian
    indicators. So are cover stories in magazines. When Time puts
    the iphone on the cover, you sell Apple.
    Not forever; just until they stop talking about it.

    When my friend, who knows nothing beyond the basics about


    trading stocks, wants to buy GOOG, then you sell— until he
    says, “no way am I touching GOOG.”

    Here’s why contrarian indicators are so reliable. Most people


    say it is because “by the time” Jay-Z knows about an
    economic trend, the trend is over. Implying that he is not smart
    enough to perceive the trend early. That’s not exactly correct.
    It’s not that he is late to a trend; it is that he is the last money
    into a trend. For whatever reason— lack of knowledge, lack of
    motivation, resources (including opening a trading account,
    etc) he puts his money in later than others. But once he puts
    his money in, then there is no more money to put in. If
    everyone has bought— and everyone agrees on the rightness
    of their position— there’s no more money to put in. So the
    trend ends.

    This is true about everything, not just money. When every


    psychiatrist “knows” an antiepileptic mood stabilizer is the
    first line for bipolar in the absence of any evidence for this
    primacy, then you know it soon won’t be. When everyone
    “knows” a girl is a slut; when everyone “knows” X policy will
    do Y things; all these things should be tells that the opposite
    will be true.

    Not always because they were wrong, mind you, but because
    they cause it to be wrong. That’s the key. It’s not that Jay-Z is
    wrong about the dollar; it’s that by investing in euros he
    causes a top in the euro.

    I’m on record: I call a bottom.

    (long gold, long oils, brk and aapl— and dollars. And I’m not
    touching the euro.)
    Is Taking Nothing Legal?
    November 9, 2007

    Provigil, a “wakefulness promoting agent,” is banned at the


    Olympics, even though, probably, it has no effect on physical
    performance. Despite what the Olympics says, it isn’t a
    stimulant.
    If Provigil has any effect on a specific athlete’s physical
    performance beyond keeping them awake, I’d argue it was
    placebo effect. So a drug with a placebo effect is illegal. Fine.
    But what about the reverse situation: what about giving an
    actual placebo to an athlete, and telling them it’s oh, I don’t
    know, growth hormone? Or Ritalin?
    The Economist describes a study in the Journal of
    Neuroscience in which repeated precompetition doses of
    morphine were then replaced by placebo on the day of
    competition; the placebo, like real morphine, helped them
    endure pain during the competition. In fact, the placebo had an
    opioid- mediated analgesic effect (the effect was prevented by
    the opioid antagonist naloxone)— it may as well have been
    actual morphine. So now what? Ban placebo?

    Well, you say, the simple solution is to ban substances not just
    in competition, but during training as well; say, 2 years before
    a competition. Except you can’t ethically ban pain killers
    during training— can you?

    It should be mentioned that the World Anti-Doping Code bans


    any “substance or method [that] has the potential to
    enhance…” so I suppose placebo-doping is a technical
    violation, though it’s hard to see how anyone could catch it.
    Perhaps the solution is to monitor the amount of morphine
    used pre-competition as a clue to the “method” (unreasonable
    amounts of morphine daily might suggest…) Perhaps, but in
    this study the placebo effect was seen even after only two
    morphine doses, separated by a week.
    I bring this up not because I’m worried about “placebo effect
    conditioning” (hasn’t really caught on (I think…)), but
    because the idea here speaks to several social questions. Do
    we care about what causes something, or what was caused?
    Do we ban the specific substance morphine, but leave open the
    pathways of analgesia, or do we ban opioid-mediated
    techniques, e.g. anything that promotes analgesia?

    Sports are fun, I’ll admit, but let’s take this exact study and
    alter it by a word. Replace “competition” by— murder. I don’t
    think it’s hard to imagine morphine “facilitating” a murder.
    (Forget about whether it actually does or not; just accept with
    me that it’s not totally preposterous.) So? Two doses, separated
    by a week, with a placebo response on the day of murder?

    You say: come on, that’s pushing credulity. Ok. Replace


    competition/murder with— car accident. And the issue can be
    used by both sides: DA: “Your honor, I know he didn’t
    actually take any morphine that day, but he thought it was
    morphine, so his intent was to DUI, and, in fact, technically it
    was a DUI.” Or, defense: “he wasn’t fully responsible for the
    accident— he was drugged by placebo.”

    This extends to discussions on the impact of psychiatric


    disorders on behavior. Ready? Oh, you’re not ready. Ready?

    I’ve discussed how labeling a person as a psychiatric patient


    earns them certain privileges not afforded to regular people.
    The malingering guy in the ER, who does not actually have a
    psychiatric illness, who then shoots the psych nurse, gets to
    argue that he is a patient by virtue of the fact that he is in the
    ER. I’m not saying he’ll win, just that he gets to argue it. Well,
    imagine this: a psychiatrist erroneously diagnoses someone
    with bipolar disorder. Does the knowledge of “having” bipolar
    disorder change the person’s behavior? I don’t simply mean
    that he begins to act “bipolar;” I mean does he become bipolar,
    physiologically, in a placebo effect fashion? (If it helps,
    imagine you erroneously diagnose someone with diabetes, and
    this causes a reflexive hyperglycemia.)
    If you say, “but that doesn’t actually happen” then you are
    missing the point. The point is that any interpretation of
    behavior or identity as context specific is always artificial, and
    always inadequate. Saying someone did something because
    they were bipolar puts a primacy on the bipolar that is
    completely arbitrary. You may as well say astrology was
    involved. Oh, silly? But 1500 years ago it would have been
    silly to blame bipolar over God and the stars. If you want to
    put behavior in the context of bipolar, then you have to put the
    bipolar in the context of 2007, which has to be put in the
    context of the Nazis not winning WWII, which has to…

    To even fantasize that you have some ability to quantify the


    contributions of an infinity of forces on an otherwise
    “volitional” action is to assume not that God doesn’t exist, but
    that you are God. That you know what counts and what
    doesn’t when in talking about a behavior. That you see through
    the Matrix.

    That’s why, ultimately, a man has to be judged on his actions,


    not on his identity. Anyone can be anyone they want to be. But
    no one can do what they don’t want to do.
    If You Want The Closest
    Thing To A Financial
    Disaster, Look To Etrade:
    How To Be Up 50% And Still
    Lose Everything
    November 13, 2007

    This is how I know we’re entering a recession. Etrade,


    ostensibly an electronic brokerage, also has a huge business as
    a bank— and mortgage lender. To the tune of $42 billion.
    Which is at risk, a la Countrywide.
    A Citigroup analyst downgraded Etrade, saying that there was
    a chance it could go bankrupt. It’s not just the mortgages that
    are the problem, he explains, but nervous high net worth
    investors could pull their money “just in case,” precipitating a
    further run on the bank and thus its eventual collapse. Anyone
    who has seen “It’s a Wonderful Life” knows that the run on the
    bank is what implodes a bank, not something intrinsic to the
    bank.
    And that’s what has happened, is happening. No one wants to
    be the last one left. No one wants to be the hero and brave it
    out— not to the tune of hundreds of thousands of dollars they
    could lose through no fault of their own. You couldn’t get
    through on the telephone. People wanted out, or at least
    reassurance.

    But let me be explicit about the cause. Etrade doesn’t go out of


    business because the business failed; Etrade goes out of
    business because this guy said Etrade could go out of business.
    He even said it was only a 15% chance, but that’s not what
    people heard. What they heard was, “fire!”
    Let me also be clear about this: he’s not wrong about Etrade.
    He causes himself to be right. Do you understand?
    Fundamentals don’t matter here, only psychology.
    You say: what do I care about Etrade? I say: If Etrade
    collapses, your chance of a recession is 100%. Depression
    becomes a possibility.

    Here’s why. If you default on your Countrywide mortgage,


    you lose your house, and Countrywide goes out of business.
    You lose money that you needed but that you never really had;
    you lose expected money. But if Etrade goes bankrupt, you
    could lose all your money even though you might be up 50%
    for the year.
    First, the immediate impact of all losing that money means
    consumer spending falls gigantically. And that affects all the
    businesses one would have spent money at. Cancel Christmas.

    Second, you will not be investing. Asset prices fall when


    demand dries up. Don’t believe me? You think the selling
    yesterday was related to problems in Iraq? It was Etrade
    customers, trying to liquidate their portfolios and get out. And
    maybe some Ameritrade customers— just in case, even though
    they had no problem. Etc. That’s why the stocks that fell were
    momentum names with large price tags— people wanted cash.
    Third, for the long term, you will be that much more wary
    about putting money in a “small” ($400billion?) brokerage.
    Retail investor stops investing. Want to know what that looks
    like? Hit up a chart from 2000.
    But aren’t these deposits government insured? No, and that’s
    why this is so huge. About $15 billion of Etrade’s deposits are
    over $100k— the FDIC limit. So they guy who has $500k
    there will only get $100k back (after a long protracted struggle
    with the government.) That money vanishes, and it vanishes,
    unfortunately, from the pockets of the very people keeping the
    economy from evaporating. It’s bad enough when the poor
    have cut back spending; if the rich cut back, the economy’s
    finished.(1)
    And this is how I know it won’t happen.
    An Etrade bankruptcy is so powerfully damaging to the our
    psychology of economics that it would devastate our already
    tenuous situation. It’s also why I know we’re in deflation, not
    inflation. When you liquidate your assets and pull them to cash
    — for whatever reason— you are pushing up the value of the
    dollar. You are not spending as much because you’re not even
    sure how much you have anymore. I know prices are rising,
    but wages aren’t. Prices could triple, if you’re not spending it’s
    irrelevant. Hoarding or not spending or not having ends up
    being the same force on the economy.
    Deflation. On worry alone. If Etrade actually goes
    bankrupt-….
    So the government has no choice but to bail Etrade out. For
    the mental health of the economy, Etrade cannot die. Either the
    Fed will cut rates soon, or we’ll hear a message from the
    Treasury. This isn’t what I want or don’t want, this is a bigger
    issue.
    Jay-Z called the bottom in the dollar. I call a bottom in Etrade,
    here, because I can’t believe the government would let it
    happen. So much, psychologically, is at stake.

    Buying the stock here is a huge gamble, and I don’t


    recommend it to anyone, but I figure if they don’t save Etrade,
    it won’t really matter how much I lose today anyway.

    (long Etrade, and long the government— for now.)


    The Extent Of Psychiatric
    Knowledge
    November 14, 2007

    Question of the Month


    Test your knowledge with this question from our editors

    Which of the following statements is true of childhood


    (vs adult) mania?

    A. Irritability tends to be more prominent


    B. The decrease in sleep is more pronounced
    C. Changes in appetite are less noticeable
    D. Racing thoughts are less common

    If you got the right answer, you’ve wasted your life. If you got
    the answer wrong but then learned the correct answer, you are
    wasting other people’s lives.

    The answer:

    Answer: Irritability tends to be more prominent


    In mania, classic DSM-IV symptoms, such as changes in
    sleep and appetite and racing thoughts, occur in children,
    adolescents, and adults. The key developmental
    difference between youth and adults is that in the
    presentation of mania, irritability is more prominent.
    This is an example of how a) psychiatry has lost its way; b)
    multiple choice questions are useless.

    First, the context of the bipolar question is a CME quiz based


    on an article: pass the quiz, get CME credits, which the State
    Board requires doctors to get. I don’t have to take this quiz;
    but this quiz is accredited as a legitimate means of getting
    CME, i.e. it is educational.

    What multiple choice questions test is synthetic judgments. It


    tests, “what is the universe like, actually?”

    An analytic proposition is definitional; a synthetic proposition


    connects two independent parts that are not contained within
    one another.

    A synthetic truth is one which its opposite can be conceived.


    The opposite of an analytic truth is illogical. So “humans have
    one head” is synthetic; “humans” and “head” are independent
    parts, connected. It’s possible humans might have two heads,
    or none. “Bald men have no hair” is analytic. “Bald” means
    “no hair.”

    The sentence, “adult AML has higher lethality than childhood


    AML” is synthetic because “AML” means something concrete
    that does not contain the notion of higher lethality in adults vs.
    kids. “AML has more myelocytes than lymphocytes” is
    analytic because myelocyte perdominance is contained within
    the definition of AML.

    Saying childhood bipolar has more irritability than adult


    bipolar isn’t synthetic; it isn’t additional information about
    “bipolar.” It is the definition of childhood bipolar.

    –––—
    Consider the relationship “if p then q.” Therefore, if not q,
    then not p (contrapositive.)

    So which is it:

    “If you see X symptoms, it’s bipolar.”

    or:

    “If it’s bipolar, he has X symptoms.”

    –-

    “If he has X symptoms, then he has bipolar” is logically


    equivalent to “If he is not bipolar, then he does not have X
    symptoms.”

    Or:

    “If he has bipolar, then he has X symptoms” is logically


    equivalent to “If he does not have X symptoms, then he does
    not have bipolar.”

    It’s obvious that both pairs of statements are invalid, because


    on the one hand we are agreeing to label a collection of
    symptoms as “bipolar” (analytic), but on the other hand we are
    secretly allowing that we can intuit “bipolar” regardless of a
    previously agreed upon definition, i.e. the symptoms
    (synthetic).

    Cleverly, we allow ourselves another opening: use the


    definition to make analytic judgments (he has bipolar therefore
    he will have manias) and use our experience to make synthetic
    judgments which alter to the definition (manias may indeed be
    absent, replaced by irritability), simultaneously.

    And we do this because the real meaning of the term isn’t


    what is meant by it, but how we intend to use it.
    ––––––—

    “If we had to name anything, we should have to say that it was


    its use.” When a mathematician sees something that resembles
    “irritability” what does he call it? But when a psychiatrist sees
    something that resembles “irritability,” what could he call it?
    The mathematician finds the dictionary word “irritability”
    quite suitable for his purposes; but the psychiatrist can do
    nothing with the word “irritable” except use it to imply
    something else.

    The sly move is to consider “irritability” to be a modifier of


    the more general construct “bipolar.” But “bipolar”is actually
    the modifier of irritability.

    –––

    Maybe you are confused, because your mind is stuck on


    viewing bipolar as a term independent of the agent who
    observes it; a term that we learn things ABOUT. But the
    meaning of “bipolar” is recursive.

    It’s pornography, impossible to define except as “I know it


    when I see it.” But that statement does not mean pornography
    is “very hard to define, but easy to identify.” It means it is
    defined, ad lib, by me.

    Synthetic propositions can be learned to be true (or false): “the


    majority of married men are happier than the majority of
    single men.” But what can be learned about pornography that
    is independent of the one experiencing pornography? “The
    majority of pornography depicts nudity.” Even the word
    “majority” is useless since it qualifies a word which is itself a
    personal judgment. This is neither a true nor false statement;
    while I know what “nudity” is, we still don’t know what
    pornography is except that you are now defining it as
    containing nudity. But once you choose a definition, can you
    change it? Well— what about a magazine devoted to stocking
    fetishists that has no nudity— indeed, possibly no actual
    people? Statements about pornography can not be found true
    or false because the term pornography requires an active
    subject. It isn’t a noun, it is a judgment about its use.

    You mean “community standards.” No— a nude woman in


    Playboy is “porn—” but the exact same photo in a Soho art
    gallery seen by the same people may be something else.

    “But we all agree, at least, that certain things are


    pornographic.” But a consensus among individuals isn’t truth,
    it’s definition: “we agree to call this pornography.” Until, of
    course, someone disagrees. But what is the basis of the
    disagreement? It is never content, it is always intent:
    pornography is that which is “intended to elicit sexual
    arousal.” We disagree about what the purpose of the images
    are.

    ––—

    What is the intention of the diagnosis “bipolar?” To describe


    something? As a reason for something? To imply treatment?

    “But you have to agree that if I give a child with bipolar


    disorder bipolar meds, they get less irritable.” But why not call
    them “irritability” meds? If you gave them to an irritable child
    without bipolar, would they not get less irritable? Or is it that
    if you gave them to an irritable child and nothing happened,
    the child doesn’t have bipolar?

    “I have a map of an imaginary world in my mind; according to


    it, you should be able to get to my house in twenty minutes.”
    The map exists for him, but tells you nothing about the real
    state of affairs. And can you rely on such a person to use the
    term “minutes” the way you expect?

    The term “bipolar”— whether it exists (as a so far unknown


    physical pathology) or not— isn’t valid because it says
    nothing about the world; it only says what the person using it
    thinks about the world.
    Some Inspirational Words
    From My Friend In
    Colorado Springs
    November 17, 2007

    “When I was a boy of seven or eight I read a novel entitled


    “Abafi”… The lessons it teaches are much like those of “Ben
    Hur,” and in this respect it might be viewed as anticipatory of
    the work of Wallace. The possibilities of will-power and self-
    control appealed tremendously to my vivid imagination, and I
    began to discipline myself. Had I a sweet cake or a juicy apple
    which I was dying to eat I would give it to another boy and go
    through the tortures of Tantalus, pained but satisfied. Had I
    some difficult task before me which was exhausting I would
    attack it again and again until it was done. So I practiced day by
    day from morning till night. At first it called for a vigorous mental
    effort directed against disposition and desire, but as years went
    by the conflict lessened and finally my will and wish became
    identical. They are so to-day, and in this lies the secret of
    whatever success I have achieved.”

    N.T.
    Moriarty
    November 20, 2007

    See? I told you he was in Styx.

    (Thanks to Fargo Holiday)


    The Question Isn’t Why Do
    Babies Do It
    November 21, 2007

    (From Nature)

    The experiment is to grab a bunch of 6 month old and 12


    month old babies, and show them a little wooden shape with
    eyes glued onto it climbing a hill. Then, while a shape is
    climbing the hill, another shape either comes up behind it and
    pushes it upwards (“helps”), or a shape comes from above and
    pushes it downwards (“hinders.”)

    They then allowed the infants to reach for either the “helper”
    or the “hinderer.”

    12/12 six month old babies reached for the helper. 10/12 ten
    month olds reached for the helper.

    (Standard science disclaimers apply: further experiments


    showed it wasn’t the shape or color; nor the direction of the
    movement, only the coupling of two in a helping movement
    that was preferred.)

    So either the babies prefer helpers, or they are averse to


    hinderers. To test this, they ran the experiments pairing 1)
    helper scenario vs. neutral, or 2) hindering scenario vs. neutral.
    In 1) 7/8 babies chose the helper, and in 2) 7/8 babies chose
    the neutral. In other words, babies both prefer helpers and are
    averse to hinderers. Awesome. If I need backup, I’m calling a
    baby.

    So we have a situation where the overwhelming number of


    babies prefer “helping” and like to avoid “hindering.” Is this
    innate? The age suggests it may be (and the same team has
    similar data on 3 month olds), though at least one psychologist
    that Yahoo! asked said they more than likely learned these
    behaviors from observing adults, etc.

    But the question isn’t why do babies choose this way.

    We have to assume these are randomly selected babies, and


    they overwhelmingly and homogeneously chose helping. The
    real question is why, if presented with a similar choice, do
    random adults not overwhelmingly choose this way? If it’s
    innate, why do adults lose it? If it’s learned, why did they
    forget? If these are indeed random babies, then presumably
    all/most humans were once like this. It’s possible that some
    babies never learned it— they lived in households were
    helping wasn’t rewarded or modeled, etc. But what about
    everyone else who chooses the bad guy? The most likely
    explanation is that we learned it, but ignore or overrule it.
    Make choices based on other reasons instead.

    You can imagine a billion different “reasons:” the guy wants to


    appear tough/cool. (Like cheering for the bad guy.) Deep
    jealousy or envy over anything symbiotic. Paranoia about
    anyone “pretending” to be a helper. Double bind. A will to
    power. Whatever.
    But what becomes clear, if you work it through this way, is
    that whatever the reason, it was a reason chosen. There was no
    compulsion, anymore than one is compelled to choose pizza
    over pasta— it is a preference born of a myriad of factors, but
    a preference nonetheless. You were someone, and you become
    someone else.

    Inevitably and unfortunately, you get to pick who you are.


    “Pivotal Role That
    Psychiatry Has Come To
    Play”
    November 26, 2007

    Phillip Resnick, MD is one of five psychiatry expert witnesses


    in the country. There are actually many more than five, but
    only about five get used, repeatedly, for big cases. They are
    very busy, and always on the go. (I was on a case “against”
    Resnick, and I didn’t even see him.)

    They are also the main educators in the field. Which is


    unfortunate. Not because they’re bad, but because they are part
    of that system they are teaching. All they can tell you is what
    it’s like inside the building. Not whether the building is, in
    fact, a boat, or a duck, or dream.
    In an article called, “Being An Effective Expert Witness,”
    Resnick writes:

    In fact, the United States Supreme Court has commented


    on the “pivotal role that psychiatry has come to play in
    criminal proceedings.”2

    The reference is from Ake v. Oklahoma. He doesn’t say it, but


    it sounds like he’s saying that even the Supreme Court
    recognizes that psychiatry has much to say about criminal
    behavior. See how it’s reference 2? It’s early in the article, it’s
    in the introduction— it represents our foundation, our
    “knowns,” before it delves into new stuff. No one investigates
    the “knowns” because— they’re known. It tacitly endorses the
    notion “everyone knows psychiatry has much to say about
    criminal behavior” and uses the Supreme Court (ipse dixit!) as
    a reference.

    In psychiatry, you should always be most suspicious of the


    Introduction, and the references cited there:

    Last, we inquire into the probable value of the psychiatric


    assistance sought, and the risk of error in the proceeding
    if such assistance is not offered. We begin by considering
    the pivotal role that psychiatry has come to play in
    criminal proceedings…

    The Court (Justice Marshall) then goes on to explain the


    State’s obligation to provide psychiatric expert services to
    those who can’t afford it when it is relevant to “an adequate
    defense,” namely, “defendant’s mental condition relevant to
    his criminal culpability and to the punishment he might
    suffer.” They explain what such an expert would do (gather
    facts, draw plausible conclusions about mental states, explain
    it all to the jury, etc), but then:

    Psychiatry is not, however, an exact science, and


    psychiatrists disagree widely and frequently… Perhaps
    because there often is no single, accurate psychiatric
    conclusion on legal insanity in a given case, juries remain
    the primary factfinders on this issue, and they must
    resolve differences in opinion within the psychiatric
    profession on the basis of the evidence offered by each
    party.

    So: 1) psychiatrists have a limited expertise in criminal matters


    — e.g. specifically insanity; 2) juries still must decide, not just
    because that’s the way we set up the legal system, but also
    because psychiatry is so inexact. It is totally reasonable for
    juries to disagree with psychiatrists.

    In so saying, we neither approve nor disapprove the


    widespread reliance on psychiatrists but instead recognize
    the unfairness of [not offering psychiatric experts to the
    indigent] in light of the evolving practice [of offering
    them to everyone else.]

    It’s also worth mentioning that the sole dissent in this case was
    Rehnquist, who wanted the obligation to provide psychiatric
    experts to the indigent limited to an independent psychiatric
    evaluation— not an expert witness.

    Finally: the obligation of the State to provide psychiatric


    experts exists only if the defendant’s “sanity at the time of the
    offense” is shown to be at issue. If the defense doesn’t or can’t
    contest the defendant’s sanity/mental state, then the State isn’t
    obligated to provide experts. And merely saying it isn’t
    enough— it has to be above a reasonable doubt. In this case,
    the defense did not do this, but be aware that the issue of
    sanity has to be raised before experts get involved— i.e. it has
    to be apparent to a layman looking at the history.

    The evidence of the brutal murders perpetrated on the


    victims [by Ake in the original case], and of the month-
    long crime spree following the murders, would not seem
    to raise any question of sanity unless one were to adopt
    the dubious doctrine that no one in his right mind would
    commit a murder.

    Looking insane isn’t enough. Doing really bad things, like


    setting out with a coworker, tricking your way into a family’s
    home, tying them (a Reverend and his wife) up and then
    shooting them, raping the 12 year old daughter (and failing)
    isn’t enough. The problem with forensic psychiatry education
    is the same as for general psychiatry: little time is spent re-
    evaluating the principles. I’m not blaming Resnick— clearly,
    he knows his business well, and his forensic program is well
    respected. The problem is systemic to psychiatry, and probably
    to all social sciences. Psychiatrists are trained on how to do
    things, not whether they are supposed to be doing them, or
    whether they have the knowledge and ability to do them.
    Criminality and psychiatry may drive the same roads
    sometimes, but they don’t use the same car.
    Which Is Worse: An Altered
    Photo of Reality, Or A Photo
    That Alters Reality?
    November 27, 2007

    On the left is real 1989 Tiananmen Square. On the right, a


    doctored photo. 300 people were shown either a real or altered
    photo of two different protests, and then asked to recall what
    happened back then. The point of this study was to show that
    altering a photograph will change how the events are actually
    remembered (in this case, as bigger and more violent.) It’s
    important to emphasize that the subjects already had a memory
    of the events (from TV, etc)— so this photo actually changed
    their pre-existing memories, and they weren’t aware of it.

    But, here’s the thing: these subjects weren’t actually at the


    original protests. Their original memories also came from
    images— hopefully not altered images, but certainly selected
    images. Right? The TV newspeople didn’t pick the boring
    pictures, did they? I get that doctored photos are bad. But how
    much of our memories and knowledge of the past are largely
    determined not by “reality” but what, or how, we were shown
    it in the first place. Obviously, a lot. Therein lies the question:
    is it worse to see a doctored photo, or doctored reality?
    Here’s an example: search your mind for recollections about
    the Tiananmen “episode” in 1989. Can you remember
    anything— anything at all— other than that guy standing in
    front of the tanks? Do you remember who was protesting?
    Why? The question isn’t why you don’t remember anything,
    hell, it was 20 years ago and a solar system away; the question
    is why you do remember that guy. Are you better off for
    knowing this? Are you smarter? Or do you carry the false
    impression that you know something about which you really
    know nothing? That’s the Matrix— not only do you have false
    memories, but you get to feel good about being a
    knowledgeable, aware, citizen of the world.

    NPR runs a cult this way. It offers an eclectic mix of topics,


    selected on purpose to allow you to think you are getting
    depth. You listen to NPR, and you think you’re learning,
    growing, becoming a Renaissance Man. You’re not. Sure, it
    beats CNN, but that’s not a battle anyone is supposed to lose.
    Its target audience is insecurely intelligent people who want
    desperately to be intellectual and well read but who don’t
    actually want to read too much. What NPR offers is sentiment;
    the feeling that you know something. That’s why when
    someone asks you a question about a topic you learned about
    from NPR, you inevitably answer using the same language
    and words NPR used. Do you understand? Back during the
    election, I’d bet people at the bar that I could tell them the
    reasons, using the exact same words, why they’d vote for their
    candidate.

    This speaks to psychiatry, of course— and politics, and


    economics… when so few bother to read primary sources,
    instead relying on “experts” to tell us what was in the primary
    sources, is altered data really going to matter? I’m not for
    changing reality, but when you can spin a story any way you
    want regardless of the truth, and no one will bother to check it,
    what difference do facts make?

    Think about this: no one would know you altered a photo or


    data in a primary source article, because no one would ever
    actually see it. They’d only hear about it. (Same with
    references.)

    But wait, there’s more.

    The two news articles aptly summarize the study, but why did
    they bother to summarize this study? Well, the message was
    pretty important to journalists: “doctoring of photos is bad,
    you bad journalists who do it.”

    The best line comes at the end of the one story:

    “[Doctoring photos is] potentially a form of human


    engineering that could be applied to us against our
    knowledge and against our wishes, and we ought to be
    vigilant about it,” said UC Irvine psychologist Elizabeth
    Loftus, who designed the study. “…as a society we have
    to figure how we can regulate this.”

    Regulate? What, the use of doctored photos in the media,


    which is actually already regulated? Or the doctoring of photos
    anywhere— maybe a disclaimer? An automatic Photoshop
    watermark that says “This photo altered reality with
    techniques other than staging, lighting, cropping, deletion of
    undesired photos of this event, the placing in proximity to or
    away from other photos, and does not fit in with the currently
    acceptable social narrative as determined by your betters?”

    Sorry, I’m wrong; the best line comes at the end of the other
    news story about this study:

    “Any media that employ digitally doctored photographs


    will have a stronger effect than merely influencing our
    opinion — by tampering with our malleable memory,
    they may ultimately change the way we recall history,”
    says lead author Dario Sacchi.

    Really? Only the ones that use doctored photos?

    Really? Change the way we recall history— the old way of


    being told what happened was so much better?

    ––––

    A man can walk away from a news story like this and feel like
    they understood the point. He can then pat himself on the back
    if they go look up the actual study and confirm the point.

    But it’s not enough. What’s the context?

    You say: “whaddya mean context? It’s science, it’s the pursuit
    of truth.” Well, ok, you should go back to NPR.

    Part of the problem with reading articles on line is that you


    don’t get to see the other articles in the issue, which together
    tell a story.

    The study appears in Applied Cognitive Psychology. In the


    same issue appears a well thought out article about how the
    media influence the “public narrative;” another study called,
    “Photographs Can Distort Memory For The News” in which
    they find that a (real) photograph accompanying a news article
    will add memories the subject thought came from the story;
    and a tie-in essay that concludes, “Taken together, the papers
    in this special section show how the media can shape what we
    believe, what we know, and what we remember.”

    Do you see? You have a set of facts that can be manipulated


    endlessly to tell any story you want. Here, a journal issue
    about being wary of the awesome power of the media gets
    used by journalists to say watch out for Photoshop.

    If it was malicious, you could punch someone, but it’s not,


    that’s the point: the authors of the news articles probably
    didn’t even know what else was in that journal. They got
    partial information, and ran with it. And, of course, by printing
    it they thus validate it.

    It’s like James Joyce said, “we can never know the truth so
    long as we have ears and eyes.” Actually, he didn’t say that,
    but do you see how you paid attention?
    One Of These Things Is A
    Straw Man, And The Other
    Is On Fire
    November 29, 2007

    Daniel Carlat, of the Carlat Report, has an article in the New


    York Times Magazine. It’s six pages long, and decidedly anti-
    Pharma. But Daniel Carlat isn’t from New York— so why
    would he have an article published there?

    You say: well, where he’s from has nothing to do with it, the
    New York Times is publishing it because of what he says.

    Exactly.

    His article, well written and persuasive, stands as is,


    undisputed because there is no forum in which to dispute it. I
    guess it would be nice if the Times would allow me to write an
    op-ed— you know, in op to the ed— but I guess this blog will
    have to do.

    Carlat is wrong, very wrong, not because he is factually


    incorrect about his target, but because his target is a straw
    man. The problem isn’t Pharma. It’s doctors.

    The article, called Dr. Drug Rep, chronicles his introduction


    into the world of lecturing for drug companies— a company
    hires you to give a talk about a topic or drug to a bunch of
    doctors— and the effects of the lecturing on doctors and
    himself, and then his pulling out. For context, Carlat is a fairly
    famous psychiatrist blogger who is both a sort of watchdog of
    Pharma, as well as a source of information about psychiatric
    drugs.

    The general message is that Pharma softly manipulates doctors


    to act as proxy drug reps, which in turn lends
    credibility/celebrity endorsement to the Pharma message, and
    thus influences other doctors to prescribe the medicine. Ok, I
    hear you. I have no beef with Carlat, his point is not unique.

    But break it down:

    So we don’t want doctors lecturing about the drugs. Okay.


    Well, who do we want? More reps? Here’s where it all falls
    apart, and I defy anyone to contradict me: doctors aren’t
    studying these drugs on their own. Doctors wouldn’t know
    anything about the medicines if it were not for Pharma and its
    tentacles (reps, speakers, drug company research and
    publications, etc.) Carlat himself has written extensively about
    the supposedly objective “Continuing Medical Education”
    process being a Pharma -sham. (Not to mention horrendously
    useless.) There is no objective education in medicine. None.
    Stop pretending there is.

    If you want evidence of this, consider that the despite the


    cardiac risks of Vioxx being publicly— as in Yahoo! News
    publicly— known even in 1999, doctors were surprised when
    it was pulled. “What? They never told us about that…”
    And don’t tell me there are journals. They’re worse than
    literary quarterlies, and no one reads them anyway. Don’t
    believe me? Ask your doctor to name one single article in any
    of this month’s journals. Not if he read it; just the title.

    You say: well, we don’t mind the lectures, per se, we just want
    them separated from Pharma money. Oh. Whose money do
    you intend to use?

    There’s a bit of a misconception about what goes on in these


    lectures. A doctor doesn’t stand up and say, “I’ve used
    Effexor, and it’s awesome. Way better than Celexa. Which
    kills puppies.” They actually have to use an FDA approved
    slide deck from which they cannot deviate, even if it’s a fact.
    For example, you can’t say the following sentence: “There was
    a study published in the New England Journal…” unless the
    FDA allows you to say that. And doctors are obligated to give
    “fair balance,” which means you must talk about the risks as
    well as the benefits. Risks which are prominently featured on
    the slides.

    But that’s besides the point. I am not an idiot, of course, and I


    understand marketing and how to lean a lecture. But let’s be
    rigorous. These lectures are intended to get you to prescribe
    Zoloft over Prozac, not over penicillin. If I’m “influenced” to
    prescribe Zoloft instead of Prozac, what’s the harm? Not in
    theory— in actuality. Tell me when Zoloft is inappropriate that
    Prozac is appropriate. And if you do discover such a mythical
    patient, then my choosing Zoloft for that person isn’t a case of
    Pharma manipulation, it’s a case of me sucking as a doctor.

    The simple problem is that it sounds really bad to have Pharma


    be so much a part of medical education. And it is, but there’s
    no other system in place. If today you fire all drug reps, then
    you will effectively freeze medical care to November 2007.

    Because there is no “objective” system for evaluating and


    disseminating information, the only way to form an educated
    opinion is to listen to the different pitches and stories and
    parse out the truth. And Pharma is very good at this: Zyprexa’s
    diabetes risks were first popularized by Pfizer, who were
    defending against Lilly’s attack on Geodon about QTc
    prolongation. (And don’t think for a moment doctors would
    have figured out QTc risks on their own.) I think it would be
    great if academics, or some objective body, could be in charge
    of this, and in charge of publishing their findings, but this
    doesn’t exist. It would be great if legal issues could be
    resolved “objectively,” too. Wish it all you want; that system
    does not exist, all you have to work with is this the Pharma
    adversarial system. That’s it. You know what a Pharma free
    system looks like? Cuba.

    Pharma is the backbone of medicine, because, unfortuantely,


    medicine is about treatment, not prevention. If a doctor
    recommends exercise, or garlic, or even aspirin, it’s a sidenote,
    and a quaint one. “Oh, my doctor thinks I should move to
    Florida for my asthma!” Meanwhile, they’ll give out the
    amoxicillin to every crying toddler, even though they know
    that that is detrimental. you know why? Because it looks like a
    treatment. It’s not all the doctors’ fault; but that’s the system.

    I’m going to repeat this because I know people are going to


    misunderstand me: the system that you want is impossible to
    construct in the framework of modern medicine, if for no other
    reason than doctors don’t read— derive no benefit from
    reading. The system does not exist, and you cannot create it.
    Psychiatry is politics; medicine is the justice system. Pharma
    are the opposing lawyers, and doctors are the jury. The jury
    must decide the fate of the defendant-patient. And the FDA—
    judge simply makes sure everyone is civil. Not accurate, save
    for outright perjury; just civil.

    Does this scare you? Me, too. But that’s the system. Learn to
    work in it.

    I should mention that this system is the only one that allows
    the public— patients— access to the information. In a closed,
    hierarchical system free of Pharma marketing, patients would
    have no choice but to completely trust their doctors to know
    about the medications. Think about that.

    A strange part of all of this is that the target “consumer” for


    Pharma is doctors; those are the people we want to protect
    from drug company influence. But doctors are the most
    educated consumers anywhere; if they can’t separate truth
    from marketing, what hope does the Chevy Truck
    demographic have, who hear about no money down? Do we
    ban all advertising?

    Blaming Pharma is a diversion. It gets the world distracted


    from the real issue, which is that medicine is set up—
    incentivized— for mediocrity.
    Everything Is A Teachable
    Moment When You Are A
    Piece Of Garbage
    December 5, 2007

    I was about to pull the covers up, and she looks at me and
    says, “Daddy, are all doctors daddies and all nurses
    mommies?”
    Here we go, I think. Maybe you think this is a simple yes or no
    question, but it’s not, everything becomes strategy. How I
    answer this will affect the rest of her life, how she’ll answer
    her own questions and set goals and limits for herself. This is a
    scrimmage to teach her position. Am I smart enough as a
    parent? Am I ready?
    I’ve mentally practiced this moment, and dozens others like it.
    For some I even have a script. I know how I want her to think,
    to make decisions for herself free of outside influences. The
    trick is how to teach her that, how to make it part of the way
    she thinks, reflexive.
    “No, baby” I say, because it’s a fact but facts aren’t at issue,
    I’m the Father and I have a responsibility to help her develop.
    Ok, look, I don’t want her to be a nurse but that’s not the point
    here, the point here is to teach her about choosing your
    identity. “Some doctors are women, and some nurses are men.
    You can be either.”
    Yes, if she was a boy I’d have a different answer. But she’s not
    a boy, and the immediate issue today isn’t for her to choose
    between being a doctor or a nurse, but to understand that she
    gets to choose.
    “Is your doctor when you go to the doctor’s office a man or a
    woman?”
    “Sometimes it’s a boy, and sometimes it’s a girl.”
    “See?” I say. “It can be either one.”
    “Then how come you’re a doctor? Is being a doctor harder or
    easier?”
    “Harder.” No sense in political correctness. “It’s harder
    because you have to decide everything. You’re in charge, you
    have to decide how to help people, what to do next.” She
    needs to know that the difference isn’t just amount of calories
    expended, but of responsibility. “And you make more money.”
    I debate saying this, but I think it’s important to introduce the
    real importance of money, and the relative value of things, and
    jobs. I’m not going to push it here, just introduce that it exists
    as a factor.
    “How much money?”
    “Like, a hundred.” It doesn’t have to mean anything, it just has
    to convey a feeling.
    “Wow, that’s a lot.”
    “It can be.”
    “And you put that money in your special place?”
    Another opportunity. “Yes, you have to save your money, you
    have to save as much as you can. Sometimes, even if I want to
    buy something, I have to decide if I should spend the money or
    save it. So I save it.”
    “So we can save and go to Disney?”
    “Yes, among other things.”
    “But nurses get less money?”
    “Most of the time, yes.”
    “But if you’re a nurse,” she recalls, “you don’t have to go to
    work. You can stay home with the kids and wear a bathrobe,
    right?”
    I laugh. “No, no, if you’re a nurse you have to go to work, too.
    Right now mommy is staying home to take care of you guys,
    she had to stop working for a while, and when you all get
    older maybe she’ll go back to work.” And then I add, “it’s up
    to her.” Excellent.

    “Oh, so nurses have to go to work, too.”


    “Yes, if they want.”
    There is a pause here. She’s working through it all. I think I’ve
    succeeded; if nothing else, I’ve taught her that the decision is
    hers to make. Nothing defines her.
    “So I could be a doctor.”
    “Of course, baby.” I’m winning, I see that I’m destroying
    barriers. Finally. This is what it means, after all, to be a good
    parent; seeing through the words and striking at the core
    issues, teaching your children not facts and information but
    wisdom, power.
    Until her eyes fill up with tears, and she says, “I want to be a
    doctor.”
    “You can do anything you want.” Something’s wrong.
    She’s motionless under the covers, she doesn’t look at me. She
    looks like I’ve spit on her. “I’ve already decided,” she says, as
    if to euthanasia, “I have to be a doctor.”
    “Okay, baby, but— why are you crying?”
    “Because if I’m a doctor I have to work every day, except for I
    have only one day off, and when I come home I have to work
    on the computer, and I won’t get to see any of my children.
    Unless they get sick.”
    And there it is. I’ve failed, again.

    I’m teaching, teaching, but do I listen? Do I hear her, do I hear


    and see what’s important to her, what questions she really has,
    what’s really of value in her life? She just wants to play
    Lightning McQueen vs. Chick Hicks with me outside,
    meanwhile I’m trying to teach her that the way to truth is
    through the inside, or some other idiocy. I may as well leave
    my stupid aphorisms in a Moleskine for her and then go kill
    myself. What’s she need me for?
    Words are the enemy, they are always the enemy, they do
    nothing but mislead, deceive. If you have to say it, you never
    did it. What have my words done tonight, that my existence
    and behavior hasn’t contradicted every single day? I’m a failed
    fraud who’s beckoning others down the same path.
    I wasted 15 minutes trying to con her that she can be anyone
    she wants to be, completely missing that she is already who
    she wants to be, the problem is I’m not who she needs me to
    be. Life, through its henchmen like me, only chip away at that
    original identity, making it harder to be satisfied and
    impossible to be happy. I’ve taught her that stereotypes are
    wrong, meanwhile she hasn’t even learned the stereotypes yet;
    in fact, I just taught them to her by denying them. Maybe I
    should wake her in the middle of the night, grab the sides of
    her head and shriek, “there’s no such thing as ghosts! There’s
    no such thing as ghosts! There’s no such thing as ghosts…!”
    If I was so smart, if I had so much to teach, I wouldn’t be so
    miserable. And this wouldn’t have happened.

    Being a good parent often means: knowing your limitations,


    and getting the hell out of the way.
    Deus Ex Homonymia
    December 19, 2007

    Answer the following questions, and don’t look at the next


    until you answer the previous:

    1. Does depression in kids raise their risk of violence?


    2. If a kid is violent, is it more or less likely they are
    depressed?
    3. If someone is depressed and violent, is it likely they are a
    kid?
    4. Can you define any of the nouns in the preceding
    questions?

    In a study called Perceived Dangerousness of Children With


    Mental Health Problems and Support for Coerced Treatment
    the perceptions of 1100 members of the public were evaluated,
    finding:

    Children… with major depression were perceived (by


    81% of the sample) as somewhat likely or very likely to
    be dangerous to themselves or others, compared with
    children with asthma (15%) or those with “daily troubles”
    (13%).

    and, later:

    …compared with the child with “daily troubles,” the


    vignette child with depression was more than twice as
    likely to be assessed as dangerous toward others and ten
    times as likely to be assessed as dangerous toward
    himself or herself.

    Now, you lose no money assuming the public at large merely


    guess at probabilities. So what they think may be right, wrong,
    both— who knows. But whatever they think, it’s probably
    important to quote them correctly:

    “The issue that was highlighted by this study that was


    really concerning to us was that Americans have linked
    depression in youth and violence, particularly violence
    towards others,” said Dr. Pescosolido [“distinguished
    professor of sociology, Indiana University.”] [emphasis
    mine, but, face it, really theirs.]

    Well, no, that’s not what the public thinks, at least according to
    your study. They think that depression leads to violence
    against themselves, and maybe towards others. Only 9%
    thought violence towards others was very likely. The majority
    thought violence towards others was not likely. Right?

    Also, please note the subtle cut against “Americans,” those


    barbarous, judgmental, yellow ribbon tying NRA members,
    i.e. “Texans.” (I know, sociology professor…)

    “It’s really, really horrible. Many people who are not in


    the field perceive these youths as dangerous— and yet we
    have no evidence that these kids are any more dangerous
    than youth randomly picked…” said Dr. Kelleher,
    professor of pediatrics at Ohio State.

    Wow. I had thought the entire infrastructure of psychiatry


    rested on the very foundational idea that psychiatric disorders,
    especially depression, are responsible for increased risk of
    violence to the self. And these quotes are even more weird
    given that they come from Ohio and Indiana— the two states
    responsible for over half the increase in female youth suicides
    in the whole country. You know, the increase that everyone is
    blaming on antidepressants.

    But words are lies, and you can use loose language like
    “violence” and “dangerous” and “youth” and “kids”—
    bending its meaning to whatever you need it to mean at that
    moment— to make any point you want. The actual arguments
    for this position can be be flipped when necessary (e.g.
    Nasrallah saying a school shooting isn’t “evil” but “medical
    illness.”) You can do this if you manipulate words, e.g.
    conflating school shooting and suicide to “violence,” and then
    making “violence” mean what you need it to mean at that
    moment.

    So what is her point? I’m sure she doesn’t want to be saying


    that depressed kids aren’t prone to self harm. So?

    So nothing. She, they, don’t have a point, they want to convey


    a feeling, a political position, something like, “no one is bad
    just because they are sick; but if they were bad, then it was
    because they were sick.”

    It’s a good position, given that it is entirely empty, and can be


    made into whatever you want. Right or wrong is precisely
    besides the point.
    So what do these authors tackle next? Forced psychiatric
    treatment, of course.

    Next…
    Paris Hilton Loses
    Inheritance
    December 28, 2007

    So says, well, everybody.

    Maybe you think I shouldn’t be closing out the year with a


    Paris Hilton story (though I did have one before,) but it’s much
    more important than it appears.

    The basics are:

    Party princess Paris Hilton is $60 million out of pocket


    after her billionaire grandfather - appalled by her jail term
    for drink-driving offences - axed her inheritance.

    Grandpa Barron Hilton— the only Hilton to actually own a


    stake in the Hilton Hotel chain— is disgusted with her
    behavior, so will give 97% of his fortune to charity.

    Most people’s reactions have been, I’m guessing, the exact


    same one you had or are having. Digg- the unofficial meter of
    internet vitriol, pronounced this story 13582 levels of
    awesomeness. The comments were unanimous: “Finally!
    Justice! That ugly skank got what she deserves!” (Which,
    presumably, is even less than the millions she will still get.)

    What surprises me about this story is this: is there no one who


    thinks this story is fake?

    Consider, for example, Paris’s sister Nicky, notable in her own


    right for, as an example, not making any sex tapes. Was the
    Barron revolted by the handbag line she designed? He could
    have just cut Paris out of the will— it doesn’t make sense that
    he punishes his entire dynastic line (right?)

    The first thing that occurred to me— tin foil hat man that I am
    — was that this was a tax dodge. Start talking about charity
    now, etc, etc, over time maybe Paris et al get on the board of
    the charity (with accompanying compensation and benefits
    packages, etc, etc.) So when he finally dies, the IRS gets
    nothing, and doesn’t come looking either.

    It’s possible I’m wrong (though I doubt it.) But my idea isn’t
    completely preposterous, it’s not beyond rational thought, it at
    least gives you pause, right? So I ask you: how come no one
    else thought of it?

    The answer is emotion. Hate. And bias, but of a specific type.


    To illustrate, let me rework the opening of the New York
    Times story:

    Today, Vice President Dick Cheney announced that he


    will donate 97% of his fortune to charity… that money
    will be placed in a charitable trust that will eventually
    benefit the Richard B. Cheney Foundation, raising its
    total value to about $4.5 billion, the foundation said.

    That, no one will believe, i.e. you “know” it’s a tax dodge.
    And you know it because you “know” Cheney (which, of
    course, you don’t) and charity isn’t his style, unless the charity
    supports impaling puppies. Meanwhile, you know even less
    about Barron Hilton, but assume he must be as disgusted by
    his granddaughter as you are— sorry, as disgusted by only
    what the media and she choose to release to the public, as
    opposed to family get togethers, dinners, birthdays and
    graduations— as you are, without any benefit of knowing her
    at all— which, when stated that way, seems, well, less likely?

    The point is that we make assumptions based not on available


    information, but on available emotion. That emotion is, in
    large part, predetermined by the media reporting of it— note
    how explicitly the article is biased: “Party princess is $60
    million out of pocket…” And it jives completely with your
    prejudices, so you accept it: confirmation bias. With this kind
    of reporting, you can’t possibly have the cognitive freedom to
    consider an alternative explanation (like tax dodge.) And so
    you don’t.

    I hope the pleasure we derive from her probably non-existent


    reduction in inheritance is worth the reduction in our ability to
    think freely and independently. Maybe the NSA doesn’t need
    to eavesdrop on our thoughts— it just has to read the
    newspapers.
    Hey! We Just Now Invented
    A Cocaine Vaccine 9 Years
    Ago
    January 6, 2008

    Ah, what science really needs is a Madison Avenue publicist.

    As you may have heard (from the Jan 1, 2008 Houston


    Chronicle:)

    The needle may be one of addiction’s enduring symbols,


    but two Houston researchers hope injections of modified
    cocaine actually provide the first-ever medication for
    people hooked on the destructive drug.

    Sorry, I mean this article from the Jan 2 AP:

    (AP) Two Baylor College of Medicine researchers in


    Houston are working on a cocaine vaccine they hope will
    become the first-ever medication to treat people hooked
    on the drug.

    Hmm. That’s weird. Similar phrasing and word choices.

    Certainly the internet is ablaze with discussion about the


    clinical and ethical repercussions. Slashdot, aka “If You Don’t
    Use Ubuntu You Probably Voted For Bush” had more
    comments (713) about this article than any other that week.

    While the comments were (mostly) intelligent, no one thought


    to ask why this story appears now.

    Especially since this vaccine has been in active investigation


    since 1999. And, especially since there isn’t one cocaine
    vaccine, but three completely different ones by different
    groups. So much for “first-ever.” Why didn’t those groups get
    news coverage? Are the Baylor guys that far ahead?

    Every new source (e.g. Wired) used either the Houston


    Chonicle or the AP version of the story, which isn’t atypical—
    but what about other countries? What about the BBC, surely
    they must have their own reporters on the case?

    No. The only articles on BBC come from 2002-2004— years


    when there were no U.S. news stories about the cocaine
    vaccine. (There was a Scientific American story in 12/04.)
    Why the oceanic divide in reporting, if this is relevant to
    people everywhere?

    Follow the trail:

    1996: cocaine vaccine was developed by ImmuLogic


    (defunct), announced in Nature.
    1999: sold to Cantab Pharmaceuticals
    2001: Cantab merges into Xenova
    2005: Xenova bought by Celtic Pharma (really a private
    equity firm, that also holds the nicotine vaccine.)

    ImmuLogic and Celtic are U.S. companies; Cantab and


    Xenova are British.

    It couldn’t be that simple, could it?

    A possible explanation for the similar phrasing and word


    choice is plagiarism, but that’s unlikely; a more plausible
    explanation is that both articles drew from a prepared
    statement supplied by the lab/company.
    Could company publicists have called up the relevant news
    outlets at various times to let them know of their “new” drug?
    Looks that way.

    But why now?

    From the Chronicle:

    Kosten, who joined Baylor 18 months ago, asked the


    Food and Drug Administration in December to green-
    light a multi-institutional trial to begin in the spring.

    Sorry, I meant:

    (AP) Kosten asked the Food and Drug Administration in


    December to green-light a multi-institutional trial to
    begin in the spring and is awaiting a response.

    I certainly can’t blame the companies or Kosten for the


    maneuver, if that’s in fact what they did. A little public
    pressure on the FDA may be just the thing to sway votes.

    Hell, I wish it worked on the Federal Reserve.


    I Go To Germany For A
    Week, And The Country
    Implodes
    January 7, 2008

    And by implodes, I mean that the government herds us into


    recession and into psych clinics.

    Today Secretary Paulson says he doesn’t want to rush into


    more rate cuts— or any economic stimulus. “Thoughtful” and
    “patience.”

    I guess surgeons can be thoughtful and patient, too, when


    they’re doing, say, breast augmentation. But when the spleen
    and the pancreas both have grenade fragments in them, well,
    get cutting, Doc.

    On November 13, I wrote that because the risk of mortgage


    companies and banks going bankrupt was so high, that it was
    therefore inconceivable the Fed would allow it to happen.

    It’s confidence. If (for example) Etrade collapses, faith in such


    institutions— in stocks, in investing, etc— also collapses. So
    you get a recession on worry alone, not even counting the
    actual money that evaporates.

    I figured there was no way the Fed would allow that to


    happen, that they would pull out all the stops, risk inflation
    next year, risk everything just to prevent recession now. If
    nothing else, it’s an election year.

    I even bought Etrade stock in a “put my money where my


    mouth is” stand. I wasn’t buying Etrade, I was buying faith in
    the U.S. economy.
    Well, I was wrong. Etrade’s stock has fallen 40%, even after
    Citadel gave it $2.5B, temporarily boosting the stock price.
    And Citigroup is down 30% even after The Prince gave it $8
    billion. And Warren Buffett and Bank of America gave
    Countrywide $3 billion, and it is almost certainly going to be
    bankrupt soon.

    I can be wrong, what the hell do I know. But Warren Buffett?

    On Friday it was announced that the unemployment jumped


    from 4.7% to 5%. About 50k less jobs were made in
    December than were expected. That sent the markets down,
    down. But then exactly the wrong thing happened.

    Bush held a press conference after meeting with his “Working


    Group on Financial Markets.” Instead of saying the obvious,
    such as, “Holy Crap! What the hell is happening! People are
    losing first their houses, now their jobs! Holy mother of
    God!!” what he said was, “the fundamentals of our economy
    are strong.” He said that in September, too. And the markets—
    the thing he was meeting about— all collectively went, “Holy
    Crap! What the hell is happening! People are losing first their
    houses, now their jobs! Holy mother of God!!”

    Even worse, there is a not preposterous interpretation of Fed-


    speak that suggests there won’t be big rate cuts soon, but
    actually rate increases. And now Paulson, today.

    You may not care about this stuff, feeling that it is removed
    from your daily lives, but I assure you nothing matters more.
    Unless you are in the healthcare, law, or defense business,
    you’re in for a special kind of recession: it won’t affect the
    very rich, they have buffers; it won’t affect the very poor, they
    have nothing; but it will kill the middle class. And middle
    class can be simply defined as anyone who has a job they
    need.

    Look, it’s not surprising that Obama won the Iowa caucuses,
    in that either he or Hillary would have been believable
    winners. But for the Republicans to pick Huckabee— that’s
    middle class Republicans— it’s telling you that they’re scared.

    If you want a tie in to psychiatry— and wealth creation—


    here’s what you do to become a millionaire in a year: go to a
    small city-town, something like Pensacola, Albany, Mobile,
    etc— somewhere where most people are employed by a key
    industry (manufacturing plant, office park, etc); or to a
    Hispanic-heavy area (construction workers/contractors)— and
    set up a psychiatric clinic. Hire a psychiatrist, three or four
    bachelor’s level therapists, and wait. As the businesses close
    or cut back, and as construction ceases, volumes of people will
    flow in, miserable and in need of Medicaid and SSI or SSD.
    And here is also your semiotic tie-in: all those people who
    were previously “contractors” or “homeowners” will suddenly
    be “psychiatric patients.”

    Because that is what we have. We obviously don’t have a


    sound economic policy; and the country isn’t designed to offer
    aggressive social services. So the default mechanism for
    dealing with poverty in our country is to herd them into
    psychiatry, with its legend of the Chemical Imbalance,
    promise of treatments independent of environment, and, of
    course, the opportunity to apply for SSI.

    Medicaid pays about $30 med visit, $100 per therapy hour,
    every week. That’s $430/month per “patient.” Hop to it.

    The other thing you can do is stand outside of the homes that
    will soon be for sale— try Florida or Inland Empire— hold up
    $300, and wait for one of them to trade their house for the
    plane fare out of there.

    The 2004 election was a referendum on Iraq. 2008 will be a


    referendum on your total debt. Believe it.
    Do Narcissists Get
    Abortions?
    January 14, 2008

    Apparently, yes.
    I.

    I got an email from a reader, Phanatic, which is worth posting


    in its entirety:

    Hi there. You frequently cover topics in your blog that


    touch upon narcissism in some fashion.

    Well, I just read an article in the LA Times that just


    screams out about it, but doesn’t use the word once,
    because it’s supposedly dealing with the abortion debate,
    talking to men who have regrets about past abortions
    their girlfriends had.

    Here’s an excerpt. This guy takes the narcissism cookie:

    Chris Aubert, a Houston lawyer, felt only


    indifference in 1985 when a girlfriend told him she
    was pregnant and planned on an abortion. When she
    asked if he wanted to come to the clinic, he said he
    couldn’t; he played softball on Saturdays. He stuck a
    check for $200 in her door and never talked to her
    again.

    Aubert, 50, was equally untroubled when another


    girlfriend had an abortion in 1991. “It was a
    complete irrelevancy,” he said. But years later,
    Aubert felt a rising sense of unease. He and his wife
    were cooing at an ultrasound of their first baby
    when it struck him — “from the depths of my belly,”
    he said — that abortion was wrong.

    Aubert has since converted to Catholicism. He and


    his wife have five children, and they sometimes
    protest in front of abortion clinics. Every now and
    then, though, Aubert wonders: What if his first
    girlfriend had not aborted? How would his life look
    different?

    He might have endured a loveless marriage and,


    perhaps, a sad divorce. He might have been saddled
    with child support as he tried to build his legal
    practice. He might never have met his wife. Their
    children — Christine, Kyle, Roch, Paul, Vance —
    might not exist.

    “I wouldn’t have the blessings I have now,” Aubert


    said. So in a way, he said, the two abortions may
    have cleared his path to future happiness.

    “That’s an intellectual debate I have with myself,”


    he said. “I struggle with it.”

    In the end, Aubert says his moral objection to


    abortion always wins. If he could go back in time, he
    would try to save the babies.

    But would his long-ago girlfriends agree? Or might


    they also consider the abortions a choice that set
    them on a better path?

    Aubert looks startled. “I never really thought about


    it for the woman,” he says slowly.

    Yeesh. He’s 23, he gets a girl pregnant, and he slips $200


    under her door, goes and plays softball, and never speaks
    to her again. And to this day, the regret wasn’t that he
    was a self-centered asshole who slipped $200 under her
    door, went and played softball, and never spoke to her
    again, it’s that she aborted the child. Never really thought
    about it from her point of view.

    I say again, yeesh.

    II.

    Well, it’s probably worse than that.

    Consider that the problem here isn’t his changing stance on


    abortion, but rather that he was so self-absorbed he couldn’t
    even consider the woman’s perspective. That’s narcissism:
    you’re the main character, everyone else is supporting cast.
    They don’t get backstories, or motivation. They’re just foils.

    And in 17 years, it still never occurred to him to think about


    her feelings on that day.

    Bad enough, but observe that he is so self-absorbed, even


    today, that he didn’t even consider that he would appear
    foolish in a newspaper article. In the LA Times!

    He knows she’s going to ask him questions about abortion,


    about a “woman’s right to choose”— he doesn’t even take a
    minute to come up with a few soundbites about that? No
    prepared responses just in case they ask him, say, the obvious?

    No. Because that’s not how he thinks. He probably thought,


    great! The LA Times! Finally the recognition I deserve! Never
    once considering that the article might be a sneak attack on the
    pro-life movement using him as a straw man. Narcissism does
    not allow you to consider that things— good or bad— are
    about something else other than you. I’m not saying the article
    was a sneak attack— merely that he did not consider it might
    be. And he was thus very unprepared. The guy is a lawyer—
    his job is to be ready for precisely this sort of thing.

    Did he consider that the article might reflect badly on his


    practice? That his name would be googled and then blogged
    by, for example, nut psychiatrists in California?

    No. He could only see the potential of an article from the


    context of his identity, which therefore meant it would be
    wholly aggrandizing. That in showing how bad he was, he can
    signal how good he is.

    Remember, narcissism is: getting people to believe your


    backstory.

    III.

    But let’s ask a different question. Chris Aubert is a Houston


    lawyer. I’m sure the Rolodex at the LA Times is extensive, but
    exactly why does it contain a Houston lawyer? Of all the men
    who’ve “had” abortions, why him? Random?

    Turns out Mr. Aubert has been profiled before: born Jewish,
    abortions in 1985 and 1991, converted to Catholicism in 1997
    after he married his Catholic wife, etc. He even wrote an
    article about it.

    Clearly, then, he was selected. The LA Times writer came


    prepared, she already knew what he was going to say. That’s
    why she picked him. Do you understand? She wasn’t writing a
    story about her discoveries about this issue, she was writing a
    story about what she already believes, and he fit that story.

    In the article Aubert’s article From Jewish to Catholic By Way


    Of Abortion, the word “she” appears only 8 times— only 3 in
    reference to his former girlfriend. The word “woman” appears
    3 times. “Her” 6 times. In 9 pages. Get the picture? “I” appears
    201 times. “My” 83 times.

    I doubt the LA Times reporter was sitting there counting, but


    she must have thought: no way has this guy ever given a
    moment’s thought to women— or anyone but himself.

    It is why also why his picture isn’t at the top of the LA Times
    article— he looks too normal. For the photo, they use a guy
    with, well, a mullet. I’m not trying to criticize the guy(s), I’m
    just showing you how you construct an article you want to
    convey a hidden message: anti-abortion guys are clueless.

    So didn’t he think to investigate the journalist? A Google


    search? Just to see what bias she might have?

    I did— the right wing crowd has a lot of problems with what
    they perceive to be her pro-choice bias. I’m not saying she has
    a bias or doesn’t, but wouldn’t you at least want to be better
    prepared for the interview?

    No. Not because of a lack of intelligence, but because it is


    impossible for him to think any other way. Forget about
    considering whether his beliefs are wrong, he can’t conceive of
    other beliefs except as prelude to his own. The LA Times’
    writers exist only in relationship to him, as a means of
    disseminating his own opinions. They do not exist by
    themselves, they don’t have an agenda outside of him. They
    can’t hurt him.

    Unfortunately, they did.

    narcissism
    Go to Site
    Search the Web
    Raising Wine Prices Makes
    Wine Taste Better
    January 16, 2008

    Turns out the Associated Press doesn’t read journal articles,


    either.
    The story is that two identical wines, priced differently, are
    perceived to taste better or worse depending on price.

    The study took the same wine poured into two glasses, labeled
    one $5 and the other $90, and (the AP reports,) the subjects
    thought the $90 wine tasted better.

    Which isn’t exactly what happened— I’ll get to that later.


    Before I read the study itself, my first thought was, “why is
    this surprising?” Let’s take this conclusion at face value—
    what does it actually mean? The assumption is that taste
    shouldn’t be affected by something external, like price.

    That’s wrong: taste isn’t objective, any more than being hot is
    objective. Taste is legitimately affected by price, because that’s
    a variable in the perception of pleasure.

    Which is hotter: a hot girl I tell you is 25, or the same hot girl I
    tell you is 35, but is actually 25? Her hottness clearly has a
    variable related to age (sorry ladies) that isn’t evident in the
    physical object (it’s the same girl.)

    This isn’t semantics. That the wine tasted better is not


    deceptive— it actually tastes better. It’s real, not illusion, in
    exactly the same way that meeting a guy you think is an arms
    dealer/nightclub owner makes him taste better (NO JOKES).
    The point isn’t that you were lied to; the point is that
    information affects “taste”= pleasure.
    It’s Cypher, eating the steak and drinking the wine, knowing it
    isn’t real, yet it still “tastes” delicious. (Spoiler: he dies.)

    This experiment isn’t scientific because it does not measure


    what it claims to measure— the influence of price on the (not
    actually) objective parameter “taste.” An objective study
    would have been asking the subjects to identify which wines
    were the same, and to determine if price differentials affected
    that ability.

    II.

    Let’s look at the article more closely. Sorry— let’s just


    actually read it.

    Right off the bat: it’s not about wine. The premise of the study
    is in paragraph 1 (in which the word “wine” does not appear):

    A basic assumption in economics is that the experienced


    pleasantness (EP) from consuming a good depends only
    on its intrinsic properties and on the state of the
    individual…

    In opposition to this view, a sizable number of marketing


    actions attempt to influence EP by changing properties of
    commodities, such as prices, that are unrelated to their
    intrinsic qualities or to the consumer’s state.

    The article isn’t about taste, but the interaction between a


    sensory experience and the expectation of that experience;
    specifically, that Experienced Pleasantness (through the brain
    region which handles it) is affected by variables that are not
    contained in the object of pleasure, but have in the past been
    informative about the potential for pleasure. In this case, price.

    These variables are not contained in the object, they come


    from you and placed are placed on the object.
    The authors are clear about what they did (not) find:

    Importantly, we did not find evidence for an effect of


    prices on areas of the primary taste areas such as the
    insula cortex…

    Another way of saying this is that naming something affects


    your perception of it. The authors cite a study in which
    labeling the identical odor as either “cheddar cheese” or “body
    odor” affected the perception of pleasantness. A price is also a
    name, of sorts, in so far as all names are merely signs which
    convey a message. (“Tammy” vs. “Tami”).

    Naming something, labeling something, is power. Not


    powerful— power. The price is a label. What people are likely
    upset about is, “so, marketers could simply tell you lies about
    it, and you’ll think it’s better than it is!” and if you said that,
    you’re missing my point: it isn’t better than it “is.” It isn’t
    anything. It’s just a stupid drink.

    Or, you may lament, “so advertisers can tell us may actually
    affect our perception of pleasure by telling us it is better!
    That’s unfair!” Unfair is not the right word. It’s surreptitious.
    But it may actually enhance your pleasure. “But they’re taking
    my money on false pretenses.” Yes, that’s another issue— how
    much you’re willing to pay for your “illusion” of pleasure.
    Have you seen a Julia Roberts movie?

    We might all have what the Matrix referred to as “residual self


    image,” and I’m sure it’s great, but ultimately you are only
    what you did (and thought.) You’re not a coward until you act
    like one, and even then there’s always tomorrow when you can
    be something else.

    There’s a human bias that things have a nature and a value


    independent of our perception, and this is in some ways
    accurate; but let me soften my position and simply say that we
    can strongly alter this simply by naming it. Change
    perceptions, relationships— how you interact with it, how you
    view it.

    I hardly need to reiterate that this is precisely what psychiatric


    diagnoses are about.
    Are Drug Companies Hiding
    Negative Studies?
    January 17, 2008

    Let’s skip right to the punching.


    I. The Not-Punching Part

    A study in the Wednesday edition of the Journal of the


    American Socialist Party reports that 31% of antidepressant
    trials were not published, and almost all of the unpublished
    basically showed negative results.

    This is bad, obviously, which is why we need a website for all


    raw data. But let’s be clear: this was a review of studies found
    in the FDA registry. The FDA had this data, and used it to
    evaluate the meds. No one hid the data— they gave the data to
    the FDA, all of it. What didn’t happen was publication.

    So the real question is why didn’t they get published.

    Certainly, Pharma doesn’t want negative studies published.


    But these are Phase 2 and 3 clincial trials. They’re not done
    down at Lilly HQ— these are done at universities. Pharma
    didn’t block their publication— they were blocked by the
    academics who did them, and the journals themselves.

    Hi. Is this thing on?

    You say: why would the academics themselves, committed as


    they are to science, block publication? Because they’ll lose
    their jobs, that’s why. Academics need grant money, and
    negative studies don’t get grant money. Not from Pharma, not
    from NIH, not from anywhere. “Hi. Nothing we’ve done is
    better than placebo. Can I have tenure now?”
    But more importantly, they don’t publish the studies because
    they’re not in the CIA. When a study comes out negative, the
    academics don’t break out the special redacting marker, they
    don’t say, “better bury this.” They say, “Mama Mia! It didn’t
    work!” and start over. Their bias is that the study should be
    positive; so if it comes out negative, the unconscious
    assumption is that something was wrong with the study.

    You go up to a girl in a bar, with your new playa skillz, and


    she maces you in the face. You don’t assume you’re a tool,
    you assume she’s gay. Oh, and you don’t change your skillz.

    Next are peer reviewers, who are unanimously dismissive of


    any study that doesn’t separate from placebo. They don’t think
    its worthy of publication unless it showed a positive result:
    “this study does not meaningfully add to the existing
    literature…”

    Keep in mind these studies were done > 5 years ago, back
    when the culture wasn’t “everything has equivalent efficacy.”
    Nowadays, that’s the hot topic— studies showing Pharma
    sucks, or branded meds are no better than generics. Back
    “then” journals were all about finding the next big thing, the
    assumption of progress, etc. There’s no room in journals for
    the null hypothesis.

    Lead researcher and psychiatrist Erick Turner points out


    to The Wall Street Journal that doctors unaware of the
    unpublished studies can make inappropriate prescribing
    decisions for their patients.

    My retina just detached. Seriously? That’s the problem?

    II. The Punching Part

    Says the study:

    There can be many reasons why the results of a study are


    not published, and we do not know the reasons for
    nonpublication. Thus, we cannot determine whether the
    bias observed resulted from a failure to submit
    manuscripts on the part of authors and sponsors, decisions
    by journal editors and reviewers not to publish submitted
    manuscripts, or both.

    That’s it. Two sentences. Ok, let’s grant them the asylum of
    ignorance. Explain, then how those two sentences can be
    interpreted:

    But Dr. Jeffrey M. Drazen, editor in chief of the New


    England Journal, explains to the New York Times why
    the study is so alarming for doctors and patients. “When
    you prescribe drugs, you want to make sure you’re
    working with best data possible…” he says. Moreover,
    patients who agree to be guinea pigs “take some risk to be
    in the trial, “and then the drug company hides the data?”
    he asks. “That kind of thing gets us pretty passionate
    about this issue.”

    You have to have the deluded bravado of a DJ Khaled video to


    say the drug company is hiding data when, in fact, you are the
    one who is responsible.

    The authors are themselves peer reviewers. Did they ever


    review a negative article that they recommended publication?

    Lead author Erick Turner has “30 publications in peer


    reviewed journals.” How many of those publications had
    negative results? One: B12 was not effective for seasonal
    affective disorder. So did he submit negative studies and they
    were rejected, or did he simply discard them? Turner was also
    a reviewer for the FDA— why not simply release all that data?
    Open acccess? Don’t give me this crap about clinicaltrials.gov.
    Don’t ask Pharma to put their data there. You already have the
    data— just release it. To his credit, he has already made this
    exact recommendation. In 2004. Making this article
    superfluous…

    Dr. Drazen, above quoted editor-in-chief of the JASP, has to be


    insane. HE’S THE ONE MOST RESPONSIBLE FOR THE
    REJECTIONS OF THE NEGATIVE STUDIES. His
    predecessor was Marcia Angell— arguably the single worst
    thing that happened to medicine, ever. Together they form an
    impenetrable wall of meaningless social policy articles that no
    simple negative study could ever penetrate. They reject articles
    showing Prozac is better than Zoloft; what chance does a
    Prozac=Zoloft article have?

    But the cake goes to anchor author Dr. Rosenthal. You know
    what his area of research is? “Self- fulfilling prophecies” i.e.
    “the effects of experimenters’ expectations on the results of
    their research.” This guy should know better— I’m sure he
    knows better— than to publish a study like this and not
    comment on the responsibility— ok, the effect— of the
    academics themselves.

    But that would be asking the dog to bite the jaw that it was
    eating with, which is both impossible and painful.
    A Study Finds
    Antidepressants Don’t Work,
    And Suddenly It’s October
    25
    January 21, 2008

    ABC News, and others, report that the NEJM study found that
    antidepressants “may be duds.”

    Climb on the bandwagon, my bolsheviks, no brakes, no driver,


    let us see where it takes us.
    Amidst the nearly unanimous “I told you so! Pharma has been
    lying to us!” the most important question of all goes unasked:
    why was this article written? Did no one think about the
    consequences?

    An article like this has consequences, widespread social


    consequences. They are massive, you just don’t see it.

    Let’s say antidepressants really don’t work, and this


    could/should have been known. Have the last 10 years of
    psychiatry been a lie? It was all a shell game? If so, is anyone
    going to step up and apologize, take responsibility? “We were
    wrong, we’ve been pushing sham treatments— sorry?” I don’t
    want to hear, “we suspected this…” I want someone to stand
    up and announce, “you know, I’ve been prescribing these for
    years, and I now realize I was duped.”

    If it’s true, then what were we doing to all those patients all
    those years?

    These guys write this as if to say, “I told you so.” It’s all so
    clear to them. And to read the interviews, you’d think they
    were sipping on a Diet Coke— poured into a glass, with a lime
    — smugly announcing what they’ve known all along.

    These guys are hailed as some sort of heroes, exposing the lies
    of Big Pharma. But they aren’t, they are the worst possible
    self-promoters; they should be ashamed, they should be
    ashamed to show their faces in public, let alone practice
    medicine. They are worse than hypocrites, they are
    unconscious hypocrites.

    Before you email me saying, “what— you didn’t want this


    published? You want them to simply pretend everything is ok,
    that the data for the meds really isn’t weak? That data isn’t
    really being suppressed?” let me state my point as clearly as
    possible:

    THE PROBLEM ISN’T THE STUDY WAS PUBLISHED,


    THE PROBLEM IS IT SHOULD HAVE BEEN PUBLISHED
    10 YEARS AGO.

    It’s the exact same data they had 10 years ago, the exact same
    data. This isn’t a discovery, this isn’t Woodward and
    Bernstein, this is a bunch of academics who are no longer on
    Pharma payrolls who have now decided that they have nothing
    further to gain from pushing antidepressants.

    Now they can pretend to be on the side of science. We


    reviewed the data, and found some of it was not published.

    You knew that already. You were the ones who didn’t publish
    it— it’s your journal. Turner worked for 3 years as an NIH
    reviewer. He just notices this now?

    Is no one wondering how it is that this study comes out now,


    when all antidepressants but two are generic?

    As suspicious of Pharma as everyone is, no one seems to see


    that they are no longer getting Pharma money, they are now
    getting government money— NIH— so they’re going to push
    the government line. No one finds it at all suspicious that the
    two biggest NIH studies in the past two years both found the
    generic to be the best?

    You think that in 2000 those studies would have been


    published? But now— 2007, 2008, if they’d found Cymbalta
    to be the best on the NIH’s dime, you think that they’d get re-
    funded? What’s the difference? Same authors, same studies,
    same data. All that’s changed is the climate.

    People want a direct financial link to show bias, not realizing


    that bias is much more prevalent and more powerful
    elsewhere.

    And oh boy, there is going to be hell to pay.

    This study isn’t just about antidepressants, it is a call to arms


    — and I’m sure these guys had no idea they were playing with
    revolution— it’s the rally cry of the disenfranchised, the
    powerless, who will say, “look, see! Big Business! Everyone
    leeching off the poor public!” Do you think ABC News picks
    this story up because they care about antidepressants?

    Again, I’m not saying hide the study— but publishing this 10
    years ago, with the same fanfare and media attention, would
    have prevented the coming storm, the storm caused by them—
    and others— and others— the building anger and resentment
    — not to mention maybe altered psychiatric practice in the
    first place. All of this could have been prevented. IT’S THE
    SAME DATA. But no one cared then. Times are different, I
    guess— because the people are not.

    Huckabee wins Iowa; recession looms under the direction of


    an insecure but resentful, spiteful, Fed Chairman— even as oil
    goes to $100 and no one cares; China rises, Pakistan falls, and
    Russia is a viable solar energy plan away from collapse;
    pointless obsession about NSA eavesdropping, while Google
    and others shuffle along archiving your DNA, voice, and
    existence, all for future governments to decide what to do
    with; a public anger and distrust of the “system” that rivals the
    60s coupled with an apathy and narcissism that rivals, well,
    any time, ever.

    We are doomed. Look on my works, ye mighty, and despair.


    Nothing besides remains.

    The Cold War ending had the reverse effect of making


    socialism ok to consider. And socialism combined with public
    apathy and near total control over the existence of information
    is…

    You want to salvage your kids futures? Forget about bonds,


    forget about gold. Buy Google. You’ll get your chance
    tomorrow, when we collapse.
    Sometimes The Question Is
    Worse Than Any Answer
    January 23, 2008

    (from Parenting February 2008)


    You Can Have Your License
    Revoked For That?
    January 23, 2008

    It’s hard to see the truth when the truth is uninteresting, long,
    or contained in PDF. What’s left is the interesting untruth,
    which then becomes truth.

    And then we all have a big problem.


    Close to home (and to the area almost completely responsible
    for the housing collapse) comes the case of Dr. Edward
    Sanders who, according to the Marin Independent Journal, had
    his license revoked because, among other reasons:

    In its filing, the medical board said Sanders’ failure to


    order periodic eye exams for the patients to whom he was
    giving Seroquel was an “extreme departure from the
    standard of care.”

    It is my clinical opinion that eye exams are unnecessary. It is a


    fact that most psychiatrists don’t even know what slit lamp
    actually is, let alone order it for the majority of Seroquel
    patients. And, therefore, I am absolutely certain that those two
    facts alone make it impossible that his actions were a
    departure from the standard of care, let alone an extreme
    departure.

    Let’s be forensically rigorous. The law doesn’t ask if the


    treatment is bad, it asks if there’s malpractice, as defined:

    1. breach of standard of care— what a “reasonable


    minority” of docs would do
    2. a harm occurred

    Not majority— minority. If 20% of docs think slit lamp is


    unnecessary, and they have at least a quasi-united voice on that
    matter, it is not negligence. And regardless of whether 100%
    of docs do it 100% of the time: unless someone actually got a
    cataract, it’s not a lawsuit.

    Further: it isn’t what docs think, it’s what they do. Example: it
    is now almost universally accepted that blood sugars should be
    monitored for antipsychotics. However, this is not in any way
    close to a universal practice. So it’s not negligent. I’d argue
    that if blood sugars were monitored even once a year, it’s not
    even a discussion of negligence. It sucks, there should be some
    punching, but not a finding of negligence.

    And again: if they didn’t actually develop diabetes, there is no


    malpractice.

    So for the Board to discipline Sanders for, among other things,


    the lack of eye exams, seems preposterous.

    Which brings us to the question for today: was this news story
    wrong, or was the licensing board out to get him?

    II.

    I looked up the Board’s Edward Sanders Decision (PDF:


    reserve 30 min for downloading.) If the information there is to
    be believed, Dr. Sanders was clearly up to some nonsense.
    Billing for visits he never conducted, acting as payee for
    patients on SSI, altering records he sent to the Board (NB:
    don’t ever do that, it’s a trap; when the subpoena for the
    records comes, they already have a copy.)

    But, unfortunately, contained within that document are a


    number of “Acts and/or ommissions” which, while nominally
    wrong, are things I see doctors do routinely, without malice:
    coaching patients not to work more than X hours because it
    would sabotage their disability payments; billing for a
    diagnosis that the patient (theoretically) had, but was not what
    was being treated (from memory, don’t quote me: billing for
    urinary tract infection but being treated for asthma, but had
    both). For example, the payment is the same regardless of
    diagnosis. I can’t tell you how many psychiatrists bill “296.3”
    (depression) as a default.

    Having it all mixed together— indeed, in not restricting the


    case to the things which are clearly wrong— the Board does
    itself a disservice by appearing to be engaged in a
    vendetta/witch hunt, etc.

    Indeed, a cursory reading of the Decision could very well


    leave one with the distinct impression that the thing he did
    wrong the most— the thing that the Board talked about the
    most— was prescribing Seroquel and Abilify:

    [Sanders] was not surprised to learn [from the


    Department of Human Services invesitgator] that was the
    largest prescribing physician of Seroquel in California.

    Well, someone has to be, right? And unless you’re accusing


    him of kickbacks (which they are not) then it shouldn’t be in
    there.

    So, for what it is worth— and it is worth nothing— my


    opinion is that (if the information in the Decision is accurate)
    the Board seems to have had legitimate problems with
    Sanders, but they were not well articulated or focused in their
    Decision.

    III.

    That’s reality, anyway, and as long as it took me to look all this


    up and write this post is twenty times longer than anyone in
    America will ever spend on researching the actual facts of his
    case now, post Decision.
    Which means that we all just swallowed the Blue Pill: the only
    remaining accessible document about the Sanders case is the
    news article, which equalizes Medi-Cal fraud with prescribing
    Seroquel without an eye exam.

    And so it goes, another bit of preposterousness becomes true.

    Welcome, as the magus said, to the real world.


    A Quick Word On Google
    January 24, 2008

    Dropping over 150 points in a few days is worth a comment.

    Google, like MO or MCD, is a recession proof stock. It’s


    business doesn’t depend on credit, or even consumers. It’s
    theoretically possible advertisers will spend less with Google,
    but advertisers don’t usually cut back on ads— especially
    targeted ads. (We’ll know if I’m right next week.)

    However, it is a high priced momentum stock, and as such is


    the first to elicit the “no way am I the last one holding this”
    feeling. You sell it, and suddenly your $600 “richer.”

    I’m not a technician, but unfortunately everyone else on the


    planet it: when you see falls like that, you have to ask where
    does it stop? And the 200 dma is a good guess. So if you
    selling yesterday was illogical: 570 is a floor, because
    everyone believes it to be.

    So I wait, earnings next week.

    A word on the Fed: there is a not implausible case to be made


    that he is not reacting to the markets, as some say, or even
    “behind the curve” but is specifically targeting traders out of
    resentment. Example: the cut came Monday morning— after
    options expiration, when all the money had already been lost.
    You say: well, that was a reaction to Europe; but he did the
    same exact thing in August, waiting until precisely after
    expiration to announce a discount rate cut. And the overall odd
    way of parcing out information— it appears designed for
    maximal pain. Just a thought.

    Anyway, Google is still on track, soon to be the global supplier


    of personal information to totalitarian regimes everywhere.
    (long GOOG, MO; short the Fed, humanity, truth, the Red
    Pill)
    Three Vignettes You Won’t
    Understand Until I Explain
    Them, And Then It Will Be
    Too Late
    January 31, 2008

    Hint: what do the doctors not do?


    1.

    I say, “Hi, Dr. X? My name is Dr. T, from University Hospital,


    we have one of your patients here, Joe Blow, and he says he is
    on a very large dose of phenobarbital, so I’m trying to verify
    his doses and his seizure history.”

    “I know Joe, and his phenobarb does is 500mg per day with
    Dilantin 500 per day. He has intractable seizures from several
    head traumas about ten years ago. Other than that, he has no
    other medical issues.”

    “Wow. Well, thanks for your help.”

    “No problem. Bye.”

    –—

    2.

    beep

    “Hello, Dr. Alone, this is Dr. Ted, calling you back about John
    Smith. According to the chart, I last gave him a prescription on
    11/17, and at that time I gave him HCTZ 25mg #30, Percocet
    #60, and Prevacid 20mg. If you need any more information,
    you can call me back at the same number. Thanks.”

    end of new messages

    ––––-

    3.

    The medical student hangs up the phone. “That was fast,” I


    say.

    She nods. “I told him I was a medical student at University


    Hospital, and that we were trying to verify his medical history,
    but Dr. Block said he didn’t remember Mr. Robinson so he
    said he’d have to have the nurse call me back to read the
    chart.”

    “Oh,” I say.

    –-

    What these stories have in common is this: the outpatient


    doctor did not bother to ask why his patient was in the hospital.

    That’s universal healthcare; or at least Medicaid and Medicare.


    Some doctors know everything about their patient, others
    know almost nothing, there’s a variance but what’s becoming
    more common is an apathy and disinterest in the maintenance
    care, the “across the life cycle” total patient care.

    They figure: he’s in the hospital, so presumably he’ll be


    managed. I don’t have time for this, I’m busy, I have— well,
    patients to see.

    The outpatient doctor isn’t a “gatekeeper,” he is simply a


    member of a large, disconnected team of clinicians who each
    care for a different medical and temporal aspect of his life. We
    are all consultants now. Contact between clinicians is usually
    about the past— what did you have him on?– or the short term
    future— when can he see you next? It is almost never about
    the “total patient,” integrating neuro with surgery, derm with
    endocrine…

    The odd exception to this is psychiatry, but only private


    practice psychiatry. Community mental health is still a type of
    temporal consultant: if he shows up, you treat him.

    When was the last time you talked to the internist of a patient
    about why/how you’re putting him on Zyprexa?

    I’m not any better, I’m afraid. The system isn’t set up to care,
    it’s set up so you care less— because the less investment you
    have in being the gatekeeper, the more freedom everyone—
    other clinicians who may bump into him down the line— has
    in doing what they think is best. I hardly need to point out that
    not only are we not paid for consulting with other docs, but we
    lose billable hours and introduce each other to higher liability
    because they’re now on record as being privy to my crazy
    Depakote + Cytomel+ testosterone plan. And no doc dares d/c
    the meds of another without good resaons— good reasons that
    unfortunately no longer include “holy crap, that doctor is an
    idiot!”
    Probably Not The Best
    Lesson, But One Of The Few
    I Know
    February 4, 2008

    She’s 4, and she’s sobbing and chasing her brother, five,


    around the room. “Stop!” she yells, “stop! I’m trying to tell
    you something! Stop!”

    He’s giggling, running away from her, he thinks its fun, a


    game. Laughing so much he’s drooling.

    “Stop!!!!” hysterically.

    I’m exhausted, exasperated, from another day in middle


    management hell, where everything is urgent and nothing is
    important. “What’s going on up here? What’s wrong with
    you?”

    “He won’t stop—!” She’s still after him.

    “Baby, you can’t chase him around. You have to learn about
    how to handle little boys, you can’t chase them, you have to
    stay in one place and then they’ll want to come to you.”

    And her eyes say ? but she statue-freezes, a temporary hold on


    tears. She looks straight ahead.

    True to destiny, her brother, still giggling, stops, turns, comes


    bouncing back, stopping within inches of her, staring into her
    eyes, smiling, waiting to see what’s next—

    and as she sees him come, a smile like a sunrise breaks


    through, as she starts to learn about power…
    FDA Discovers That
    Anticonvulsants Cause
    Suicide, Too
    February 5, 2008

    Or so they find in a preliminary review.

    You probably think this is an example of the new FDA, the


    new anti-Pharma FDA, more attentive to public health, getting
    their act and their data together for the benefit of Americans.

    Ha. Wrong.
    I.

    The New York Times reports the story, which of course is only
    half the story.

    According to the FDA website, an analysis of almost 200


    clinical trials of 11 antiepileptic drugs finds that the suicide
    rate is almost double that of placebo.

    On first glance, this seems like the FDA went to the semiotic
    school of medicine: “if SSRIs double the rate of suicide, and
    SSRIs are antidepressants, then antiepileptics, which are also
    antidepressants, should also double the rate… holy crap, we’d
    better check.”

    Popper would be appalled, but psychiatry lives in this world,


    and so does the FDA. It’s insane, but if that’s their worldview
    at least they should be true to it and look for suicide in
    “logical” places.

    Nope. Not even honest in their wrongness. Semiotics isn’t


    what drove the FDA to these conclusions— it was even more
    basic than that.

    Lawyers.

    One lawyer, anyway. Andrew Finkelstein, personal injury


    lawyer from NY, was handling some Neurontin suicides. How
    do you make big money? First, you send the FDA all the
    adverse event reports you can get; then ask them to put a black
    box warning on it. Black box warning is gold: it means the
    suicide link exists, it’s true— indisputably so
    (preposterousness of it aside, of course.) Sprinkle in a dash of
    off label promotion by Big Pharma and you have yourself a
    lawsuit masquerading as a self-righteous public service
    announcement…

    It helps to pretend to be for the little guy: “The FDA’s


    complete inaction in protecting the health and safety of United
    States’ citizens from a known serious risk…”

    And so, the FDA got cracking…

    II.

    Let’s take a look. The FDA report finds the risk of suicidal
    thoughts and behaviors is double that of placebo— just like
    the doubling of suicide rates for antidepressants.

    But not really. The rate increased from 0.22% placebo to


    0.43% for anticonvulsants. That’s tiny. But it’s also not
    comparable to antidepressants, because the number needed to
    harm for antidepressants is 50, for anticonvulsants it’s 500. In
    other words, antidepressants are ten times more likely to cause
    suicide than anticonvulsants.

    In the 28,000 people in the seizure drug arms, only 4


    committed suicide (none on placebo did.)

    I’m not buying the increased suicide risk with SSRIs, but I am
    sure as hell not buying this nonsense for anticonvulsants.
    III.

    So, why did it take 4 years to release the data? (Finkelstein has
    been at them since at least 2004.)

    I’m not sure I should even mention this because I do not fully
    understand it, but I will, if only to give a starting point to
    others with more time.

    Russell Katz, MD is the FDA’s chief of neurologic drugs; it is


    his report on anticonvulsants and suicide that is on the FDA
    website. He also handled the antidepressant-suicide
    investigation.

    According to an old story (2004) from my San Francisco


    Chronicle, Dr. Katz may have been involved in
    suppressing/delaying the release of the antidepressant-suicide
    data.

    Make of that what you will. I’m going to bed.


    What Else Causes Suicide?
    You’ll Never Guess
    February 6, 2008

    In which I take the


    semiotic logic of medication induced suicidality to its
    inevitable, silly end.

    Using nothing more than a Volvo. And without lawyers.

    With the recent news that anticonvulsants double the rate of


    suicide, I got to thinking: isn’t Klonopin (clonazepam) an
    FDA approved anticonvulsant?

    Sure, it has different pharmacology than the other 11 studied,


    but Lamictal, Lyrica, Depakote, etc are equally different. So if
    we’re going to pretend that we never had to take
    pharmacology in med school, if we’re talking class effect, then
    Klonopin gets the warning.

    Which may mean that all benzos should get the warning,
    since, well…

    But why stop there? Antidepressants carry the warning across


    pharmacology. SSRIs, TCAs— even Seroquel has the warning
    ONLY because it’s now an “antidepressant” for bipolar
    disorder. Again, the FDA would like us to pretend that doctors
    had every M, W, F 9am-10am off in med school. We’re not
    postulating the pharmacology is the cause, since they are all
    different— we’re saying it’s a class effect. Ok, well, what else
    is an antidepressant?

    Well, a number of medicines not FDA approved. Lithium,


    even though that’s supposed to reduce suicide. CBT or other
    therapies? They must ultimately act on some biological
    pathway, right?

    …inevitably, there can only be one conclusion: psychiatry


    causes suicide. You are all on notice.

    And so, reductio ad absurdum, let’s all stop this nonsense.

    Some have trouble with my seemingly out of hand dismissal


    of a link between medications and suicidality.

    The problem, like everything else, is semantics.

    If they had said meds cause dysphoria, or confusion, I’d buy


    on board. The problem is the link to suicidality— a complex
    behavior. If SSRIs cause suicide, then they should just as
    logically promote the sudden need to buy a Volvo. Yes, that
    specific. Not cause a feeling of emptiness you need to fill with
    a material object, or even the sudden need to purchase an
    object— but rather the specific need to buy a Volvo. These
    warnings aren’t saying the patients are miserable, they’re
    thinking of running away from home, or cheating on their
    spouse— they are thinking of killing themselves. Not other
    people, either— themselves.

    You might say that the med is simply one factor, it adds to
    other things— like another log on a fire. Ok, fine. But that’s
    not the same as causing suicide, it’s not even the same as
    “increasing the rate” of suicide. Being on an antipsychotic for
    schizophrenia may lead to more regular credit card payments
    since you’re thinking more clearly, but no one would ever say
    Zyprexa doubles the rates of Visa payments, even if it were
    semantically accurate.
    I have an additional philosophical problem with it all: these
    warnings don’t just exaggerate a medication’s side effects,
    they demote suicidality to little more than a side effect.

    In essence, these black box warnings reduce the complexity of


    suicidality into less of a behavior or activity and more of a
    reaction, a reflex. You might think that’s not the intention, and
    I’m sure you’d be right, but that is the result. Note that no one
    is attributing any other complex behaviors to these meds as a
    side effect— not increased marriage, or desire to learn French,
    etc.

    Suicide thus becomes MORE of something that can happen to


    you and LESS of something you do because you feel a certain
    way. It’s subtle, but it matters. It’s a corruption of language to
    escape the— well, nausea— of massive freedom; it says
    behaviors occur, not get chosen.

    Psychiatry rarely argues nature vs. nurture anymore, not


    because it’s been solved but because it’s become irrelevant—
    either way, you were now made and will inevitably act
    accordingly.
    ECT Deserves A Press
    Release
    February 26, 2008

    Generally, most doctors think that ECT is a last resort


    treatment. If the patient failed antidepressants, you could try
    ECT. The assumption here is that the success rate with ECT
    would be higher (50%-90% according to studies) than with
    antidepressants (since they failed them.)

    So ECT occupies a special slot in our brains— stronger, but


    more dangerous and cumbersome.

    Turns out, the 50-90% success is in uncontrolled studies. In


    controlled studies, it appears that ECT is less effective in
    treatment resistant patients than in non treatment resistant
    patients.

    Well, duh— they’re the sickest people, so of course ECT will


    be less effective in them. That’s doesn’t tell us anything new
    or useful.

    A recent study in the Journal of Clinical Psychiatry, the largest


    of its kind, finds that prior treatment failure with
    antidepressants did not predict lower success rates with ECT.
    Phew.

    Well, if that was all there was, it would be a pretty pointless


    study. And certainly not worthy of press releases. You have to
    read them, to see how the authors spin the study:

    They therefore conclude that given appropriate


    indications for ECT, “antidepressant medication
    resistance should not sway the clinician from providing
    this modality.”

    Read it again. Just because you failed antidepressants, it


    doesn’t mean you shouldn’t try ECT. Huh? I thought that was
    specifically when you were supposed to use ECT?

    “The implication of our study,” lead investigator Dr.


    Keith G. Rasmussen told Reuters Health, “is that even if
    a depressed patient has not responded to one or more
    antidepressant medication trials, ECT still has acute
    success rates as high as for patients who have not had a
    medication trial before ECT.”

    That’s some might nice sleight of hand. Look how he phrases


    his comparison: “…ECT still has success rates as high as for
    those who have not taken meds.” See? He’s making your
    baseline clinical experience be all those patients you’ve put on
    ECT who have never been on meds, and saying that ECT in the
    medication resistant will be just as good.

    That’s the important part, read it again.

    He is trying to implant in you the belief that there exists an


    entire group of patients for whom you used ECT first line,
    before antidepressants.
    –

    Oh, I realize he’s not doing it intentionally, nor is even


    conscious he is doing it. But he is doing it nonetheless,
    because, as with all academia, the business isn’t science,
    science is the business. There’s nothing inherently wrong with
    what he is doing, but we should all be aware of it.

    It’s a product positioning strategy, Marketing 101. You cannot


    take on a market leader head on, even if your product is
    “better” because, as the adage goes, “first beats best.” Royal
    Crown cola can’t take on Coca Cola. In order to succeed, you
    need to position your product as an alternative to the market
    leader. How? By admitting there is a market leader.

    The classic positioning strategy described by Al Ries: “Avis:


    We’re Number 2, We Try Harder” works for Avis because it
    sets itself up as an alternative to the market leader, as opposed
    to trying to take on the market leader. In other words, the “We
    Try Harder” part— the part everyone assumes is the reason
    they’re going to be better— is fluff. The real positioning is the
    first part: it admits it is not number 1, but consequently links it
    always to the number 1. It forces your mind to create a mental
    slot for Avis that is as big as the one already occupied by
    Hertz. It may be #2, but it carries as much weight as a brand in
    your mind as the #1. And now you can’t ever think about
    Hertz without immediately thinking about Avis.

    Antidepressants occupy the “first line” position in the


    customer’s (i.e. doctor’s) mind. ECT can’t compete directly
    with them. But Rasmussen positions ECT as an alternative to
    antidepressants, one of equivalent value. He doesn’t say ECT
    is better than antidepressants— a point which then becomes a
    debate— he says there’s no relationship to antidepressants. It’s
    an alternative to antidepressants, equal. Go ahead and try, you
    have nothing to lose, they’re all the same.
    Yet Another Study On
    Antidepressants, And No
    One Notices The Timing
    February 26, 2008

    Are we on this again? “Study doubts the effectiveness of


    antidepressant drugs.” Or, even better, as per The Independent:
    “Antidepressant drugs don’t work— official study.”

    I don’t know what passes for official nowadays. The data is


    the exact same data that has existed for 30 years. Yes, these
    authors are acting like they FOIA-ed the second Zapruder
    film, but let me assure you it’s the same old data. These
    authors did the exact same study in 2002. So have twenty
    other groups. This is not new.

    But it is news. The question is why.

    1. I have a side question. Why is it that when an article says


    something works, people are suspicious of bias, but when an
    article says something doesn’t work, everyone thinks it’s
    objective science? IT’S ALL BIAS.

    2. People are completely missing the point of this paper and all
    the other recent re-investigations, the true social and clinical
    consequences of them. For example: they’re saying
    antidepressants are no good. Ok. What do you think doctors
    are going to use instead? Psychoanalysis? Nothing? They’re
    going to prescribe antipsychotics. Are you listening to me?
    I’m not even saying this is clinically wrong to do, but do you
    not see the setup? Abre los ojos, man.

    3. Previously, when SSRIs were being shown to be super


    effective, people suspected Pharma bias. Now they are being
    shown to be ineffective, and people fail to see the bias. IT’S
    THE EXACT SAME BIAS- Pharma. That’s why there are
    popular press stories on this now, as opposed to five years ago.
    GSK doesn’t care that Paxil is ineffective. Do you know why?
    Because they want you on Lamictal. (Again, this isn’t to
    diminish Lamictal’s or antipsychotics’ usefulness. I’m just
    talking politics.)

    4. And the handmaiden of Pharma is the academic. You can’t


    make a career studying generic medicines, because no one but
    the NIH will fund you to do it. And nowhere save Hollywood
    is there more cronyism and prejudice than at the NIH, so just
    forget it. You’re an academic looking to cover your salary?
    Get promoted? The address on your grant application better
    read “Bristol Myers, Makers Of Awesome Abilify.” If it says
    “Bethesda Maryland,” slit your wrists now.

    5. The study does not say that antidepressants don’t work; it


    says that they don’t work better than placebo. Placebo is not
    nothing. The question someone should be asking is how the
    hell placebo generates 35% improvement in all but the most
    severely depressed.

    5b. …And why the placebo works worse in the severely


    depressed. Before you jump to the obvious answer, note that
    antidepressants had similar efficacy, independent of severity.

    6. If the drug had been no better than placebo, but placebo had
    only 2% efficacy, then yes, the drug would be worthless. See
    the difference?

    6b. But that isn’t true, either. If any of the structural classists
    over at The Independent would care to explain how failure in
    Major Depressive Disorder can be extrapolated to OCD, panic,
    multiple myeloma, etc, I’m listening. “Mexicans don’t work—
    official study.”

    6c. “Why did you add multiple myeloma? How’s that? It’s an
    antidepressant, a psych drug.” No, it’s called an
    antidepressant, it’s used by psychiatrists. You have no way of
    knowing what it actually is. Look at the history of
    thalidomide. “Girls named Candi are sluts— official study.”
    While I’ll agree that any parents who name their kid Candi are
    probably at risk for having a brass pole set up in the basement,
    you can’t make any judgments about Candi herself based on
    her name. Do you know why? Because she didn’t get to name
    herself.

    There’s a lot we can learn from the recent controversies


    surrounding antidepressants, and by a lot I mean only one
    thing, best articulated by Lewis Black: “Doctors don’t know.
    They pretend to know. Because they have a rectal thermometer
    in their pocket. As if it was an appeal to a higher authority.”
    An Observation About The
    Current Election
    March 4, 2008

    I can’t believe that with all the anger most Democrats have
    against George Bush, they are this— apathetic. Four years the
    Democrats had, to find and build the perfect candidate. To
    organize as a party and say, “never again!” and build a careful
    platform, encourage cohesion, work to bring in disgruntled
    Republicans…

    Instead, they defaulted to Clinton, barely half-heartedly,


    leaving plenty of room for Obama to try. A young, never
    tested Senator— there should have been no way he could have
    entered the race, let alone won. Not because he’s not good—
    but because, by now, the Democrats should have already
    decided who they wanted.

    It’s a lack of organization and commitment which will,


    unfortunately, lead to a loss in 2008.

    I’d tell you this applies equally to Republicans— it does. The


    difference is that this election, since at least 2006, was going
    to go to the Democrats. Republicans should have been
    preparing for 2012, or the Senate. But now…

    Don’t flame me. I’m not making a comment on the candidates’


    abilities, just on how the system should have worked, but
    failed. And the reason it failed is the same reason we’re in a
    recession: lack of organization, and lack of commitment.
    USAToday Says Drug Ads
    Are Smarter Than Doctors
    March 5, 2008

    There’s an article in USA Today which says, essentially, that


    drug ads cause patients to ask for medications which they
    don’t need, which are then given to them by their doctors. The
    key is that the doctors would not have given them these or any
    medications had the patient not asked.

    The first question that can be asked is, ok, sure— ads make
    patients ask for these medications. Why are the doctors
    succumbing to this pressure? It’s a loaded concept, and I’m
    confident USA TODAY hasn’t thought it through: are you
    suggesting that the doctors are prescribing a medication which
    is not indicated for the problem the patient describes? Or are
    you saying the doctor is a moron and doesn’t think to
    recommend it in the first place? Or, are you saying the
    medicine isn’t really needed, but the doctor is pressured to
    give it anyway?

    Which brings us to our semiotics lesson for today: what do we


    mean be “need?”
    I.

    The article’s secondary point is that the ads drive up


    medication spending. Wrong: doctors do. If medication
    spending goes up, its because doctors are prescribing more.
    Leaving aside the appropriateness of this prescribing, if you
    want to reduce costs, you target the doctors.
    The point is that the doctors’ prescribing shouldn’t be so fickle
    and malleable that it responds to either ad pressures or, in this
    case, removing ad pressures. If the only reason you gave the
    Nexium for reflux is that the patient pressured you into it after
    seeing an ad, then the ad has more power over you than the
    existence of the condition. The problem isn’t the ad.

    Let me clarify: if you notice reflux and give Nexium, that’s


    fine. But if you didn’t notice the reflux at all; or see the reflux
    and don’t give Nexium— but then sometime later give it
    because the patient asks for it, you’re fired. The ad was
    smarter than you.

    II.

    It’s a logically inconsistent to say “doctors prescribe drugs


    people don’t need” and also “people can’t afford their
    medications.” Perhaps they don’t need the drugs they can’t
    afford?

    What these articles are unable to state clearly is the idea that
    medications can be valued differently— blood pressure med
    more valuable than reflux med— but that price is no longer a
    reflection of this value.

    Why not? Well, price controls and 3rd party payers, thank you
    very much Comrade. There’s no incentive for Pharma to
    reduce prices, and no economic incentive for the doctor or the
    patient not to take more pills. Why not add Nexium? No
    reason not to. So Nexium becomes priced like tamoxifen— in
    some cases, is more expensive than tamoxifen, even though it
    is less valuable.

    III.
    So, bottom line, you want the doctor to use the medication
    “budget” intelligently. Ok. Here’s the solution: give the doctor
    control of the pharmacy budget: every patient gets $20/day.
    Go.

    Prices will fall. Pharma will be incentivized to create drugs


    people need, as opposed to yet another Viagra. Subspecialists
    will confer with one another to decide what’s needed and what
    isn’t. No more Zyprexa + Lipitor. Get it?

    Doctors hate this, because it’s another thing they have to worry
    about, along with drug-drug interactions, side effects etc. Well,
    if they were actually worrying about these things in the first
    place we’d have some room to argue. I think it’s tremendously
    awesome that doctors, the AMA, the NEJM spend journal
    space on the government’s position on torture and gay rights.
    How about saving some pages for pharmacology and
    economics?

    Bottom line: someone has to be accountable. It makes no sense


    to have the spender of the money be separated from the money
    itself. Under the guild system of medicine, doctors have to be
    in charge.

    IV.

    Adding Nexium to a tamoxifen script increases the total


    expenditure on meds, but it does not drive up the price of
    tamoxifen. You “need” tamoxifen, so you pay for it; but you
    could forgo the Nexium.

    The problem is that in many cases, the patient could not


    possibly make these value distinctions. The presence/absence
    of generics complicates it further (brand Actos for diabetes, or
    two generics for blood pressure?)
    Which is why, again, it falls to doctors. But to make these
    value calculations, they must hold the wallet.
    Pricing of Placebo Affects
    Efficacy
    March 5, 2008

    An article from JAMA, saying that patients believed $2.50


    placebos were more effective than $0.10 ones.

    The question isn’t why does this happen. The question is, why,
    in a free market, does the placebo have two different prices?

    This is the wine story, redux. In that story, people thought that
    the more expensive wine tasted better than the cheaper one,
    even though it was actually the same exact wine. The
    important part of that story was that this wasn’t an error: the
    brain actually perceived the wine as tastier.

    The solution to this apparent human failing is that price itself


    is a part of taste, not just a marker of taste. A Hermes bag is
    more enjoyable than a knockoff, no matter how good the
    knockoff is. Ask anybody who has one.

    What the JAMA article tells us is that the placebo effect can be
    augmented, fine tuned— but this is the key— with factors
    which are themselves not placebos.

    The placebo pill itself— sugar— presumably has no effect; it


    is endowed with power by the doctor or researcher that the
    patient accepts as valid. But in this case, these placebos carry
    additional information that does not rely on the doctor at all—
    price. The patient doesn’t have to rely on the doctor’s
    suggestion, he now has an externally valid guide to intuit a
    drug’s effectiveness.
    This works only if price is a reflection of value— be it taste or
    efficacy. The problem is that, as I’ve previously written, drug
    prices are completely disconnected from their relative value,
    both against other kinds of medications (Nexium vs.
    tamoxifen) and of drugs within their own class (Zoloft vs.
    Prozac.)

    The experiment in differently priced placebos is at the heart of


    what’s wrong with our misguided obsession with “Big Pharma
    drives up prices.” The public, in essence, cannot possibly
    fathom that a free market economy would allow, or generate, a
    pricing scheme that was uncoupled from quality; that allows
    the same object to carry different prices. Nor that a doctor
    would not see through such a phenomenon, if it existed.

    The public doesn’t yet know that drug prices and values are in
    no way connected, at all. Because it’s not a free market.

    And so, we erroneously conclude that meds are too expensive.


    They’re not. They are artificially priced. The average person
    doesn’t know that you don’t have to use Lipitor, especially at
    $7 a pill. (BTW: this is why number needed to treat is such an
    important concept.) They still believe the doctor has made
    these value distinctions. But doctors have no incentive at all to
    make them. They don’t have to worry about the money.

    People believe that healthcare, and especially pharmaceuticals,


    are too important to leave to the free market. But there are
    unintended consequences of slapping aside the Invisible Hand.
    You may not see it slap you back.
    In My Language
    March 9, 2008

    I don’t know. As per Wired Magazine, this is real.

    I look at this, and ask, would I have thought she was capable
    of this if I met her in passing? Would I have known it if I
    performed a psychiatric exam, but without tests?

    Would I have misperceived some of the humming as


    psychosis? Which medications would I have started?

    Everything I would have done— wrong.


    Suicidal Patients’ Access To
    Their Psychiatrist
    March 11, 2008

    In the tradition of Robert Kagan and the folks at Policy


    Review, Robert Simon, MD defines foreign policy for the next
    century.
    Robert Simon, MD is one of the big forensic psychiatrists in
    the country, along with Park Dietz, Robert Sadoff, etc. In
    many ways, he sets standards of forensic practice. He frames
    the debates: he (and others) decide what words we’ll use, what
    principles are in vogue, how clinical data are applied in a legal
    context.

    Which is why his latest article, “Suicidal Patients’ Access To


    Their Psychiatrists” is— no other way to say it— a disaster for
    psychiatry.

    His article can be summarized by the large red font excerpt in


    the middle of the page:

    Standard of care requires that psychiatrists or their


    designees be accessible to suicidal patients and that they
    respond within a reasonable time.

    He gives examples of what he feels constitutes standard of


    care practice:

    In solo practice, the psychiatrist or covering clinician


    must be accessible 24 hours a day, 7 days a week, by cell
    phone, pager…Twenty-four hour coverage for patient
    emergencies is an established… standard of care.
    First, I’ll go on record and say that I think he is wrong.

    On a simple level, the problem with the article is that he does


    not distinguish between “standard of care” and “best care.”

    Standard of care is defined in many ways, but here are two


    good ones: “customary practice” or “reasonably prudent
    similar health care provider.” They’re not the same.
    “Reasonably prudent” is not based on number of docs doing it.
    Even if 99% of docs are doing X, it could still be substandard
    care. Which is, in effect, what he is saying: whether or not
    most psychiatrists do this is irrelevant— they should do it.

    So the trick is this: in the guild system (yes, like a thieves’


    guild) of medicine, who decides what the standard is? What a
    “reasonably prudent” doctor would do? In some cases, it’s
    obvious (e.g. no sleeping with patients no matter how hot they
    are) but ultimately the answer is there is no answer: it’s
    decided in court, in a duel between experts. And academic
    articles are the ammunition.

    So while I disagree with him on what is standard of care, the


    real problem with the article is more serious: by writing this
    article, Simon isn’t merely reporting the standard of care, he is
    causing this to be the standard of care.

    II.

    Believe it or not, I am not completely without empathy for


    other people.

    I recognize the feeling of crisis, of vertigo— nausea— that


    some have when their bodies and their minds tell them they
    have to GO NOW— or, for others, that it’s simply better and
    easier (just) to go…

    That is a structural problem, a logistic problem, for psychiatry:


    how can we deliver effective and efficient care to those who,
    almost by definition, need us when we are not available? This
    can be solved with outcome studies, with data, with debate.

    But the issue right here is that this discussion has been
    effectively commandeered by Simon, and others— others,
    BTW, who do not actually treat any patients in crisis. No one
    asked a regular psychiatrist; no one did a survey of the exiting
    practices. He just said it.

    He may be right that this should be standard of care, but he


    should have to defend his position. (For example: Is it true that
    the suicide rate is lower when there is 24 hour access?)

    But by writing this, he’s not asked to defend why he’s right—
    he just established the default position. The onus is now on
    everyone else to explain why he might be wrong. The analogy
    is, well, Iraq: what happens when others in government— who
    have never seen a war, let alone fought one— tell you how and
    when to conduct a war?

    You’re nodding? Don’t, because here’s the answer: they get


    voted back into office, again. Policy is always set by those
    with little direct investment in it; because those who have most
    to gain or lose have so little time, and so little access to the
    debate itself, that inertia takes over.

    III.

    I don’t blame Simon, and no, I don’t blame Bush either. It’s
    not exactly their fault. They are repeatedly given mandates to
    decide policy, and so they decide based on their principles
    (yes, Bush, too.) They believe they’re right— and no one is
    around to tell them they’re not.

    Simon thinks he’s right; and, for support, he offers the “top”
    psychiatrists— academics. Who, of course, don’t have to deal
    with 24 hour coverage, either.

    You can’t tell Dr. Simon that 24 hour coverage is physically


    impossible. For a solo practitioner with 100 patients, if 1%
    have a crisis, he’s dealing with 1 phone call. In a city,
    community mental health clinics treat 3000-10000 patients. If
    1% have a crisis, that clinic closes. In states like Idaho, where
    there is one psychiatrist for a gigantic area— sometimes even
    one NP who travels— it’s impossible.

    But much more importantly, you would be scared to tell him


    he’s wrong. You can write a letter to the Psychiatric Times and
    say, yo playa, you’re wrong— but what’s the point? His article
    is in pubmed, yours isn’t. But you sure as hell wouldn’t dare to
    tell him that within a mile of a courthouse. “Dr. Simon is
    wrong, no community clinic in the Inland Empire does that.”
    Oh? You just abandon your suicidal patients to the night and
    city streets? Let the drug dealers and roaches care for them in
    a crisis? Maybe the care in the Inland Empire isn’t very good?
    According to Dr. Simon, it’s standard practice everywhere else.
    Perhaps you should stop torturing your patients with your
    incompetence?

    So you nod your head in assent in public, but stay quiet,


    hoping no one will ever scrutinize your practice.

    IV.

    Simon’s logorrhea has a side effect: he’s changing social


    policy. I know he doesn’t mean to, I know he would deny it,
    but it’s true.

    This is how it goes: the Law looks to Psychiatry to shed light


    on behavior. Society watches this interaction and adapts.

    Simon makes a specific point that leaving a “if this is an


    emergency, go to your nearest ER” outgoing message is not
    acceptable. But then why is it for primary care? If you have a
    heart attack at 2am, can you sue your doctor because he wasn’t
    available and you didn’t know you had to go to an ER?
    Society hears him, and it says, “oh, people with psychiatric
    disorders are out of control. They need 24 hour coverage.”

    Forensic psychiatrists have massive power, they decide how


    psychiatry is applied to the law, to the public. They make
    things true, not least because no one checks their work (except
    possibly the other expert.) And Society has little reason not to
    accept it.

    So Society infers: psych patients can’t think clearly. They


    cannot be responsible for themselves, even when they’re doing
    fine, because they might suddenly not be fine— so someone
    has to be there around the clock to catch them.

    And another steel I-beam is riveted to the infrastructure of a


    custodial society.
    Accounting For Inflation It’s
    Closer to 40, But True
    Anyway
    March 12, 2008

    After thirty a man wakes up sad every morning, excepting


    perhaps five or six, until the day of his death. — Ralph Waldo
    Emerson

    (and this.)
    Economy: Where We Go
    From Here
    March 13, 2008

    It’s not good.


    1. I was wrong about the dollar, which continues to fall, but
    more important than laughing at me is understanding why I
    was wrong. I could not believe that the Fed, the government,
    would allow bank closures, would allow the dollar to fall
    further by waiting too late to cut rates. I was wrong. I should
    have suspected, though, when in the summer the Fed
    unanimously agreed not to cut rates, seeing no danger to the
    economy— they thought everything would be contained to
    subprime mortgages.

    But any human on this planet knows there is nothing more


    recessionary than losing your house, except possibly losing
    your job and your house, or a government policy to kill off all
    daughters and losing your house.

    So I made a bet in common sense, in pride. Wrong. No banks


    have failed yet, but it is generally assumed Bear Stearns is in
    real danger of evaporating. You should probably hide your
    daughters.

    2. I was right about GOOG, 520 was the top. Unfortunately,


    the PE is still 33, and has to fall to about 25 (see #5). So
    another 20% drop in price is to be expected, though continued
    (but slower) growth will offset this. See you at 400.

    3. Oil is too high. It will fall fast and hard, by which I mean
    fast and hard. Certainly there are long term demand concerns,
    which means we’ll never see $50 again. But when oil rises
    20% but the refiners fall 20% (see VLO), that disconnect
    means that the oil price isn’t related to use, but to speculation.
    See you at $90.

    4. A good rule of thumb I just invented is that people will a


    spend little more for lattes than they will for gas. I know Brazil
    is supposed to have a large and delicious crop in 2008, but I
    don’t care. I am drinking more coffee, and the Chinese are
    going to need more as well, if they’re going to keep working
    to to put lead paint on all their exports. Coffee is cyclical, so
    wait for a pullback, but see you at 175/lb (that’s cents, yo.)

    5. You say, well, what about the $200 billion the Fed just lent
    out ? Great. Where was that money 6 months ago? Here’s how
    it plays out: you have $400B in bad loans. Say that they end
    up being worth half, so $200B. Banks leverage the money to
    loan, 5x or 10x, so that $200B loss translates to maybe a $1T
    that doesn’t get lent out, that doesn’t make it to the economy.
    Experts have approximated this to be a fall in GDP of about
    1.5% (pessimistically.) Interestingly, as a bad as the housing
    market collapse is for some homeowners (Inland Empire), it is
    much worse for the banks/brokers, who (also) have to bear the
    burden of the losses.

    See you June 2009.

    (long GOOG call, refiners)


    Elizabeth Smart: Hey, You
    Brought It Up
    March 23, 2008

    A post sure to offend everyone, conservatives and liberals,


    parents and pedophiles.

    No one asked me if I wanted to see the docudrama that was


    Elizabeth Smart, incessantly for almost a year, at the expense
    of a thousand other more relevant news stories. Fine. Can you
    at least tell me how it ends?

    Elizabeth Smart: “If someone comes up to me and says, ‘we


    prayed for you,’ I say, ‘thank you very much, we couldn’t have
    done it without everyone’s prayers and support.’ Who’s “we”
    and what did you do?
    Elizabeth’s boyfriend never asks about the abduction. He just
    ignores 20% of her teen years.

    And the mother: “In order to move forward, we have to let the
    past go.”

    I think, “why?” I think that these words can’t be emotionally


    connected to Brian Mitchell (the kidnapper.) They must link to
    Elizabeth. It sounds like forgiveness not to a man for taking
    their daughter, but to their daughter after finally coming home.

    –
    So that’s my opinion, anyway, uninformed, instinctual,
    semantic. In my worldview bad people facilitate bad behavior
    from otherwise neutral people. But what I think isn’t really
    important since I don’t have the facts. It’s easy for me to
    speculate that she wanted to go, or at least was ambivalent
    about escape. Certainly you’d expect Mitchell’s defense to
    suggest this. (1) Fortunately, through the magic of trial, we get
    to hear all of this evidence, we don’t have to speculate.

    But wait, hold on a second: where have kidnappers Mitchell


    and Barzee been for the last five years, since they were
    caught? In jail, awaiting trial. I’m sorry, let me rattle my GPS
    — for some reason it doesn’t show that I’ve been teleported to
    Russia. How is it that someone can be in jail for five years
    without a trial?

    I’m no liberal— if execution is what they deserve, let’s get on


    with it. But in no way is it logical or ethical to have non-
    convicted people in jail for years, no trial in sight. How can
    anyone justify this? Oh, yeah: psychiatry. They’re “not
    competent to proceed” with trial and are “recommitted” for a
    period of X days (and renewable indefinitely after that) for
    treatment to restore their competency.

    Now, there are a number of intelligent explanations for why


    such a system benefits defendants and serves justice, and they
    are all wrong. (2)

    And so I am left with the suspicion that this is— I’ll say it— a
    stonewall. Or a whitewash, whichever. No one in Salt Lake
    really wants a trial because no one really wants to know what
    really happened. And I have to wonder if there wasn’t the
    backest of back room deals to keep the story suppressed,
    leaving Mitchell in jail forever (but not getting the death
    penalty) so that the truth need never be told.
    I wasn’t there. But if my 15 yo daughter was kidnapped at
    gunpoint and forced to… and they catch the guy, I don’t think
    my response would be the same as Ed Smart’s: “I just wish he
    would take a plea deal so this could all be over.” I’m not
    saying he has to pull a Ransom, in which Mel Gibson goes on
    TV to announce that the ransom money will be instead be paid
    as a bounty on the heads of the kidnappers—

    — but no anger? None? No desire for any vengeance? I know,


    I know, he’s religious. Me, too.

    It calls to mind David Chappelle’s routine, “How old is 15,


    really?” in which he observes that if 15 is old enough for a
    black male to be responsible enough to get the death penalty, it
    probably is old enough for a white girl to try and escape, or at
    least not go with your kidnappers to a public party, with burka
    and beer. Chappelle also observes it’s old enough to get peed
    on by R. Kelley, which isn’t relevant here, but funny anyway.

    I know, I know, she’s only 15— terrified, Stockholm


    Syndrome, etc. And I have no right to judge her (in)actions
    since I am not her, I didn’t live her life. Though that brings us
    back to the black teen: why is fear an acceptable explanation
    for poor judgment, but anger is not? (Hint: they’re both not.)

    How old is 15? Well, not old enough to get executed in the
    U.S. anymore. That’s a good thing, but it was decided for the
    wrong reasons. When Chris Simmons was 17 he broke into
    Shirley Crook’s house, tied and gagged her, and threw her into
    a river. He did it, but the Supreme Court decided he wasn’t
    accountable for it, only because of his age.

    The Supreme Court unilaterally decided that juvenile


    executions were wrong. Awesome. On the one hand we have
    the old conservative refrain of an activist judiciary doing
    whatever it (and France) wants, and on the other the liberal
    refrain that Congress lacks the balls to simply do the right
    thing, ever (e.g. make a law banning juvenile executions.) I
    guess that’s a conservative refrain as well.

    One of the reasons, other than France, that the Court banned
    juvenile executions is that science has evidence that the
    adolescent brain is immature, and thus cannot be as
    accountable as an adult brain. Which makes the France
    argument not nearly as stupid by comparison.

    If you’re using the science argument, than the age cutoff is


    inappropriate, antithetical to science— period. If science says
    your brain is immature, then science should be checking each
    person’s brain for immaturity. It can’t generalize and say all 17
    year old brains are immature— you have to check each
    defendant individually. And if there’s no reliable way to check,
    then it’s not clear how you knew they were all immature in the
    first place. And if its immaturity alone that is important, than
    that opens the door for a lot of other reasons for immaturity.

    You have to be consistent— either we’re doing science, in


    which case we’re looking at a spectrum of immaturity that can
    occur any time for any number or reasons, or we are not using
    it because it isn’t complete.

    Psychiatry really excels at butting in where it is neither wanted


    nor needed. The moral argument for banning executions is
    entirely sufficient: “you know what? Shut up. We’re not
    executing kids. Go to hell.” But, instead, it turns to make
    believe science: “there’s some evidence that the brains of
    adolescents are different than adults.” Really? So are hormone
    levels— is that relevant? Why is it less relevant? And this
    “brain” you speak of: it’s large, no? Which parts are different?
    Do you actually know what those parts do?

    Psychiatry has no business here, but here it is anyway, with its


    trite observations projected as an evolving science. It is, as
    Pauli said, “not even wrong.” Only psychiatry has the power
    to be wrong from both political viewpoints.

    You know where else you find brain immaturity? Pedophilia.


    So if having sex with a 15 year old is pedophilia (definitional)
    we can just generalize that this pedophile, like all pedophiles,
    has brain immaturity. And so can’t be exectuted. Though this
    defense probably isn’t necessary for Mitchell and Barzee, as
    they likely have both the mental retardation exception and the
    soon to hit mental illness exemption.

    There’s some irony that 15 is too young to expect a girl to try


    and escape, but apparently it is old enough to consent to a
    polygamous marriage (with court approval, of course.) Oh, I
    know, polygamay is illegal in Utah. Sure.

    I get this kind of idiocy from parents, as well, especially


    concerning marijuana. I say, “I’m not going to let my teens
    smoke marijuana,” and I get these smirks back, “you won’t be
    able to control kids from doing what they’re going to do.
    They’re going to experiment, you won’t be able to stop them.”
    Really? It’s possible I won’t be able to stop them, but is it a
    foregone conclusion? Are parents completely powerless?

    Seems hard to believe that parents have “no” control, but at


    the same time tell me Elizabeth was entirely under Mitchell’s
    control.

    More than a few people have observed that when there’s a


    story in the media about a kidnapped girl, she’s invariably
    white. Some, but not a lot, have observed that when it’s a
    kidnapped girl who escapes on her own— she’s black. This
    seems to support my observation that minority kids are
    generally considered responsible for their situations (e.g. can
    be executed; can escape) while white kids aren’t (can’t be
    executed, can’t escape.) Maybe this isn’t a bias, but real:
    perhaps minorities learn, are raised, observe, whatever, that
    they have no one to rely on but themselves, their wits. While
    for whites, there’s always a higher authority to appeal to. Or
    maybe this is the bias that the media has, in reporting these
    kinds of stories.

    While we’re on the subject: are the Smarts, the cops and the
    media going to give Richard Ricci’s survivors a formal
    apology? You know, for giving him a stroke?

    –––—

    (1). It can be suggested that whether or not Elizabeth wanted


    to go with them is irrelevant, as she is a minor and can’t
    consent. Maybe. Aggravated kidnapping, one of the charges,
    gets you the death sentence. So you know what? It’s relevant.

    (2.) “Justice is not served sending to trial people not able to


    assist in their own defense.” That could be a valid reason,
    except that this is rarely the reason competency evals are done.
    In other words, competency evals aren’t information, they are
    tactics. As in, “we’re not prepared to defend this guy yet, let’s
    postpone for 30 days by… oh, yeah, he seems wacky.”

    So, yes, if your name is John Dupont, after killing a wrestler in


    your house you might have some useful information to give to
    your highly paid lawyer(s) which could help in your defense.
    However, if your name is, say, Darnell Jones, then it is more
    likely that your (in)ability to aid in your own defense is
    irrelevant since your public defender doesn’t actually care
    what you have to say: he’s just going to suggest you plead
    guilty and take time served, whether you’re eating feces or
    communing with thrones, or not. (You want to guess if Mr.
    Jones is a real person?)

    (2b.) Some have argued that lingering incompetently in a pre-


    trial jail indefinitely is better than lingering in a post-trial
    death row cellblock. So Mitchell and his lawyer came up with
    this scheme to stay incompetent. Well, a) why is such a
    loophole allowed? If society wants the death penalty, there
    shouldn’t be all these back doors to avoiding it. Otherwise,
    simply get rid of the death penalty (which we should, IMHO.)
    Have some fortitude, conviction, don’t play games with
    human life. Either we are executing people, or not, no more
    escape hatches for some and not for others. b) If he did was
    able to put this scheme together, then he probably isn’t
    incompetent to stand trial, which means the whole thing is a
    farce; c) if he is “faking,” then why isn’t the treating
    psychiatrist, who is responsible for medicating him back to
    competency, not detecting the faking? Why doesn’t he say,
    “nothing here to treat?” Oh: Mitchell’s not been medicated in
    5 years. So is the treating psychiatrist in on it, or is the court
    recommitting him despite the clinical assessment of the
    psychiatrist?
    Eliot Spitzer and Alexandra
    Dupre: Don’t Choose The
    Red Pill
    March 25, 2008

    What color bikini does Alexandra Dupre have? That’s right,


    you’re a pawn.

    If you’re a guy who has hung out with another guy in the past
    12 days, you’ve had the conversation in which you observe
    that 1) Alexandra Dupre is hot, but not $5000 an hour hot; 2)
    that Spitzer is a moron of gigantic proportions, both for his
    hypocrisy and his now revealed insecurity; 3) only in today’s
    America would getting caught in a criminal act propel you to
    fame and fortune. She’s got the fame already, and I hear that
    her music downloads— even if they’re just to hear what she
    sounds like— are making her rich. And the offers from
    Hustler, Penthouse, tell-all books, movies. It’s all voyeurism,
    but that’s the business she chose.

    So the media loves a sexy story, and they milk it for as long as
    they can, and they found one in Spitzer and Dupre. It’s even
    sexier that she’s going to get rich and famous from all this.
    “Spitzer escort’s fame to fuel career prospects” says CNN. But
    are they reporting that she is getting rich and famous, or
    causing her to be rich and famous?

    By saying she’s going to be famous and rich; by saying her


    website gets a bazillion hits and her songs are being
    downloaded, they cause it to be true. Dupre may think she’s
    using this opportunity to promote herself, but the media needs
    her to succeed in order to have someone to talk about. In other
    words, the media needs her to be a star.
    It’s not volitional, and it’s not conscious. The media isn’t
    saying, “ok, let’s make her famous.” The “her” comes second,
    the “famous” is first. The only story they can report is the
    tantalizing one, even if it isn’t objectively accurate.

    To illustrate this, let me quote from the above article:

    The prostitute identified in court papers as Kristen is an


    aspiring musician named Ashley Alexandra Dupre. Her
    identity was only first reported Wednesday, but already
    her fame is skyrocketing.

    Get it? “Kristen” is an alias, her real name is Dupre. Except


    Alexandra Dupre isn’t her real name, either. That’s her stage
    name. Her real name is Ashley Youmans. Actually, that’s not
    completely right, either— in 2006 she legally changed it to
    DiPietro, her stepfather’s name. But whatever her name is, it
    isn’t Dupre.

    But there aren’t many articles that will tell you her real name,
    let alone call her by her real name.

    The NYTimes ran a story, “So Much Sex, But What’s Fit To
    Print?” Obviously not her real name; they stick with the
    ““Kristen,” later identified by The Times as Ashley Alexandra
    Dupre” common in most stories.

    Even recent articles that are actually about her, specifically


    (not Spitzer), like those reporting that she was in a Girls Gone
    Wild video when she was 17, don’t give her name; they call
    her Ashely Alexandra Dupre. It’s worth pointing out that that
    name didn’t even exist when she was 17.

    The easy explanation is that the media are a bunch of morons


    who never bothered to check her real name. That’d be wrong.
    The correct explanation is that Dupre is the real name for the
    story they want to tell— the story isn’t about a real girl, it is
    about a celebrity. Celebrity is created, not documented.
    Consider a reverse example: in any news story about the
    arrests of Snoop Dogg, they always tell you his real name.
    They revel in it: “—whose real name is Calvin Broadus.”
    That’s because the real story is that Snoop isn’t who he says he
    is. The tantalizing part is that he’s an imposter— an ordinary
    guy, with kids, a wife of a hundred years, and a real (boring)
    name. That’s why he has a TV show about his boring life. And
    the Osbournes. Etc.

    But you’re not going to see a reality show of Youmans. Maybe


    one of Dupre, but not Youmans. The media have requested
    that you learn a specific reality, one that may or may not
    mirror reality, that isn’t relevant. What matters is that you
    swallow the Blue Pill, and get so dazzled by the glitter of the
    reality offered that you don’t ask the important question.

    So the meta-1 level analysis is that the media creates an


    identity to fit a story; they call her by her stage name because
    that’s who they want to report on, not some New Jersey
    stonemason’s daughter. The media can’t even be bothered to
    research the real story of how she came to be a high class
    hooker— they rely almost exclusively on what she wrote on
    her MySpace page, which she likely made up. On her
    Alexandra Dupre MySpace page. Get it?

    But meta-2 level analysis forces us to consider an expanded


    question: if they won’t tell us her real name or life story, why
    should we believe anything they say? More specifically, why
    do we think that the solid part of the story is that Spitzer was
    exposed, and the incidental part is Dupre? Is it possible that
    Spitzer’s exposure itself is incidental— that the real story is
    that he was exposed?

    He’s been doing this for at least 6 years— so why now? He’s
    not the only guy in NY politics involved in nonsense— why
    him?
    I’m pretty sure we will soon learn the answers to those
    questions.
    “But I Wanna Kill Myself!”
    March 27, 2008

    An Open Letter to The Last Psychiatrist, from a guy who


    hasn’t actually read my blog, because if he had, he’d realize I
    agree with him.

    Almost.

    He writes:

    …Just for kicks and giggles, try this out for a second: imagine
    you live in a world where there are no lawsuits. I know this is
    hard for you, as your profession is almost entirely shaped by
    the fact that there are.

    Is it even remotely possible, then, in this world with no


    lawsuits, that there are people who don’t have a “disease” and
    aren’t delusional or out of touch with reality who have thought
    through all their options and decided, clearly and rationally,
    that they no longer want to live in this world? Is it possible
    that some people would be better off ending their lives then
    continuing on in endless pain?…

    …Even in a world with no lawsuits, would you still insist he be


    kept alive? If so, why? So he would continue to pay your fees?
    In which case, who are you really helping?

    In a world with lawsuits, does it help the patient any to


    continue to stay alive just so you can collect money and not
    get sued?

    Knowing the answer, is it any wonder that so many people in


    “treatment” continue to kill themselves anyway?
    Suicide is always a choice. Whether it is rational or not is a
    case by case question. It isn’t always irrational (what’s
    euthanasia?) and it isn’t always well thought out (obviously.)

    1. The answer to your question, “would you keep him alive


    even if there were no lawsuits” is, yes, almost always. I say
    “almost always” because there is always the chance that some
    situation may arise, but I can’t imagine it, and it hasn’t
    happened. Lawsuits hardly ever drive my practice, lawyers are
    rarely on my mind. (see #4.)

    What I take issue is that people attribute suicidal thoughts to


    externalities which are at best mitigating. Zoloft doesn’t make
    you suicidal. Period. It may help, it may make you more
    emotional, but the act itself is yours. Own up.

    2. Can a person have perfectly rational reasons for killing


    himself? Sure. Does that matter? No.

    Here’s the reason. No one in George Clooney’s America will


    agree with me, I’m sure, but I am certain they are wrong.
    “Under perfectly rational conditions, why can’t a guy consent
    to kill himself?” Because your own happiness or misery is a
    secondary issue, secondary to your existence. Why? Because
    your life is not yours. It’s mostly yours, but to the extent that
    it affects other people in any way, you have a responsibility to
    them. Maybe to help them, but at least not to harm them. Your
    life is a publicly traded company. You may have majority
    ownership, but you still are subject to a Board and to your
    shareholders. If you want to kill yourself, everyone you have
    touched in any way gets to vote. Good luck.

    In these posts I am trying to make a very subtle distinction. It


    is the duty of the psychiatrist to try to do whatever necessary
    to keep you alive; but it is not his fault (short of gross
    negligence) if you succeed. Neither is it Zoloft’s fault, mania’s
    fault, alcohol’s fault, capitalism’s fault, your ex’s fault…

    “You know, if you kill yourself, it puts that option on the table
    for your kids when they hit your age.” Get it?

    Let’s all hear this at least once: you did not get to choose to be
    born, neither will you choose to die. If you care nothing about
    your own life, so be it. But you have a responsibility to
    improve the lives of those around you— I don’t mean good
    samaritan style, I don’t mean person by person, I mean that
    your life has a net positive effect on the people in your life, in
    general. Some people need to get punched in the face, I get
    that, it’s not a nice thing to do, but I’m sympathetic. But
    overall, miserable or not, you have to leave the world better
    off than you came into it, to the best of your ability. Miserable
    or not, painful or not, like Prometheus you will bring fire to
    man and take from man the expectancy of death, and you will
    stay chained to the rock.

    Mistake me not; I would not, if I might,


    Change my misfortunes for thy vassalage.

    Lo, I am rockfast, and thy words are wave


    That weary me in vain. Let not the thought
    Enter thy mind, that I in awe of Zeus
    Shall change my nature for a girl’s, or beg
    The Loathed beyond all loathing-with my hands
    Spread out in woman’s fashion-to cast loose
    These bonds; from that I am utterly removed.
    Friday Diversion: Jonathan
    Coulton
    March 29, 2008

    Not his best song (that’d be The Future Soon or maybe Code
    Monkey) but reminds me of psychiatry. The other songs are so
    — accurate. If you don’t get them, then you weren’t there.
    The guy is a awesome. I am so learning the guitar. For those
    who don’t know, he’s a former programmer (in VB, no less—
    before .net) who had always had the lingering (nerd?) dream to
    become a musician. So he quit. Two extra points: he was
    already married with a baby, and as far as I know he didn’t live
    on top of a uranium mine; it was recommended to him to try
    and write a song a week for a year— and he did.

    It’s a stunning thought, to the point of vertigo, how much time


    and energy and sweat and blood we invest in a life we don’t
    actually want. On your knees every night, praying to make it
    — into college, into law school, into the sales job, into the
    management slot, into, into, into… only to be in the second
    week and think, wait a second, I think I’ve made a very
    serious mistake. I’m guessing anyone married before 2001 has
    had the same thought about their marriage.

    The problem is the upbringing. Don’t laugh. Parents like to


    think that there are multiple paths to success and happiness,
    but somehow they all involve good grades, college, a job, a tie.
    The saddest part is that the parents should know better: do you
    want your life for your kids? Do you look at your 2 year old
    daughter and think, I can’t wait to break her spirit and her faith
    in humanity?

    It is no surprise that the people we admire took alternate paths.

    And no, it’s no surprise psychiatry is a massively growing


    industry. I’ll wager: never has there been a greater disconnect
    between id and ego in the near total absence of superego.
    That’s right. Look it up.
    Vytorin
    April 3, 2008

    The article that has infuriated everyone, that no one will read.
    If you don’t know: Schering-Plough funded a study between
    its drug Vytorin— a combo of Zocor and Zetia, vs. Zocor
    alone.

    The results were expected: the combo Vytorin reduced


    cholesterols and other parameters better than Zocor alone.

    The other results were not expected: the combo was no better
    than single Zocor in preventing artery thickening.

    SP tried to delay the results of the trial: cue righteous


    indignation everywhere.

    The lead investigator’s now famous emails:

    This starts smelling like extending the publication for no


    other [than] political reasons and I cannot live with that.

    and later:

    you will be seen as a company that tries to hide


    something and I will be perceived as being in bed with
    you!

    SP should not be able to delay the results (BTW, they are


    almost never able to do so.)

    But absolutely no one wants to ask the more pressing question:


    why did anyone do this study in the first place?
    Pay attention, and you will see why medicine will collapse if it
    continues this way.

    1. There was already data that showed it lowered cholesterol


    better than statins alone— and no one disputed that data.
    2. Doctors already have the cognitive bias that two drugs
    must be better than one (though may have more side
    effects.)
    3. Vytorin was already approved. It wasn’t looking for a
    new indication. This would have been barely knew
    information even if it was positive: “It reduced intima
    thickening? Didn’t we already kind of assume that?”

    So the answer is, obviously: SP wanted new data to put in a


    shiny detail piece. Gotcha. But why would a team of doctors
    care to take on such a purposeless study?

    Do you understand?

    And another question: why this outcome? Why not the


    obvious one, reduction in mortality?

    Before that can be answered, you have to understand that this


    story isn’t about Vytorin, it’s about Pharma and their evil,
    lying ways. Never mind that they didn’t lie, that the drug did
    exactly what it was said to do. It’s the public’s anti-Pharma
    backlash, acted out in emails and a cardiology conference.

    For sure, they tried to delay the data’s release. But look
    through the stories, the hostility is really about SP pushing
    Vytorin, period.

    “Vytorin doesn’t work.” Wrong. “Vytorin isn’t better than


    Zocor alone.” Also false: it is better in several different ways
    (LDL, total cholesterol, CRP, etc.) What it was the same for
    was intima thickening. Could it be that that single parameter is
    flawed?

    Both drugs slowed the progression of intima thickening. To


    the same extent. Here’s the problem: both drugs work by
    slowing the progression and reducing the existing size. In this
    study, the size was not reduced because the walls were already
    thin— these are familial hypercholesterolemia patients who
    have already been on statins for decades— this effect won’t be
    present in them.

    So if Vytorin is better than Zocor in several ways, but not for


    the outcome of intima thickening; and anyway that’s hardly
    the outcome we want to know about— why such a backlash?

    And why would SP do this to itself? Why not do a study on


    mortality— much more probably with a better result— instead
    of a technically different study of a proxy for a proxy for
    mortality? (Intima thickening is measured because you can’t
    see the tiny plaques themselves, so it is assumed that more
    thickening must mean more plaque, which must also mean
    more death.)

    The answer is this: doctors don’t care about mortality data.


    No, don’t run away, listen. The game has never been about
    reducing mortality specifically— otherwise a lot more people
    would be on lithium and a lot less on VPA— or anything else,
    for that matter. And we’d prescribe nicotine gum much more
    often than Prozac. Etc.

    The medicine game has always been about acute treatment,


    not chronic. (Psychiatrists get away with a focus on
    maintenance because they make their patients come in every
    one or two months.) Doctors don’t focus on long term because
    of the perception that a million things could always go wrong,
    better to fix what’s wrong now. And worse, acute treatments
    simply default into chronic treatments. Or a series of chronic
    acute treatments.
    In short: for the first month of an illness, medicine is
    awesome. After that, we pretty much don’t have a clue what
    we’re doing.

    And the reason for that isn’t SP or anyone else. It’s bias.
    Doctors are a collective existing for a higher purpose; but each
    individual doctor is a person, and that person has to eat; and he
    has to eat where his peers will acknoweldge him, value him.
    It’s narcissism. Not selfishness; they’re not greedy or spiteful
    or envious. They simply have an identity they need to validate;
    a career they need to promote, and by hell if intima thickening
    is going to get me a grant to pay for some of my academic
    salary, what’s the harm?

    I sympathize, I do. But the harm is that you’ve just pissed your
    life away on another treatment parameter that isn’t necessary,
    while overall life expectancy— flatlines.
    The Pornography Of
    Medicine
    April 7, 2008

    In which appears the phrase, “the sticky pages of the New


    England Journal.”

    Another clinical trial finding that a branded drug is no better


    than a generic. No one should be surprised, no one is
    surprised, but the popular posture is to pretend that you were
    the only one who wasn’t surprised and to claim vindication.

    That’s the posture adopted by the attendees at the American


    College of Cardiology through their proxy, Inquisitor Harlan
    Krumholz, who said “You’ve just seen a negative trial that
    should change practice, especially the way we in this country
    have prescribed” the drugs. His prior contribution to medicine
    was an article about how Canada is better than America. I
    wonder if Dr. Krumholz would have been so outspoken if the
    results had found it was better?

    But of course, his anger isn’t about the ENHANCE study, it’s
    about the role of Pharma.

    In truth, the ENHANCE study was devoid of any useful


    conclusions. Vytorin wasn’t worse, certainly— it was better on
    a number of really important metrics, but failed to be better
    (read: was the same) in one metric (intima diameter) which
    itself isn’t a useful one; it is a proxy for a proxy for the
    ultimate question of morbidity and mortality.

    But for something with minimal significance it generated lots


    of emotion, and lots of internet time. I don’t know the official
    definition offhand, but that’s a pretty good one for
    pornography.
    –

    Pornography serves no productive pupose, but it allows for a


    vigourous act of involuted posturing. It is always for
    masturbation; even when couples use it, it still ends up
    promoting a kind of mutual masturbation. You’re there; your
    mind isn’t. I’m not judging it as evil or useless, but let’s be
    clear it doesn’t advance the species. It’s just self stroking. It
    always seems like a good idea at first, charged with emotion
    and expectancy, and a feeling of necessity- you need to do this.
    It sounds great if it’s 1:36am and you’re both drunk and
    caffeinated in a Courtyard Marriott in Jefferson City; but…
    but afterwards you have a vague, empty feeling— “what was
    the point of that? Should I have just rented The Empire Strikes
    Back?”

    Pornography looks at the obvious, it reveals what is already


    known but (un)dresses it pseudo-novel settings to entice,
    titillate. It’s no suprise to anyone that the penis goes in the
    vagina, but you want to see it anyway. And so ENHANCE—
    and what a great name— “Let’s look at the intima! Let’s get
    close ups! Wow!!”

    The problem isn’t with clinical trials in theory; it is with the


    obsession medicine has with conducting them, no matter what,
    for any reason, at any cost, and in the process creating new
    subtypes of “patients” and “disorders” that don’t actually exist.
    “Dementia related psychosis” or “depression secondary to a
    medical condition.” And meaningless outcome measures:
    Clinical Global Improvement; intima thickening.

    Porn again: there’s a fetish for everyone. Some docs get off on
    intima thickening, I guess, so there will be studies to satisfy,
    though the benefit to the patient is far from obvious. I’m not
    saying there’s no value in a study comparing, for example, all
    antipsychotics for efficacy in a convoluted paradigm only a
    fetishist would understand or care about; I’m simply saying
    there isn’t $60M in value there. If you’re actually paying for
    porn, well, you’re an addict.

    Yet another adjunct study; yet another “open label phase”; yet
    another “me too” drug; yet another cosmetic indication—
    we’re not expanding our knowledge base, we are creating
    froth, we are masturbating. It’s no surprise that residents—
    people young enough to prefer actually having sex to
    masturbation— find more pleasure reading straight science or
    straight theory than they do from a clinical trial. As you get
    older you slow down, I guess, and suddenly a crossover design
    seems like a good idea.

    Why so many clinical trials? Don’t blame Pharma, who would


    undoubtedly be much happier with just an indication and a
    salesforce. There the blame falls squarely on academics.
    Discovery is rarely the goal; productivity is. Cover the salary,
    buy out some of the clinical time; and of course create a name
    for yourself in the hierarchy. You’ve made it when you can say
    something like, “oh, Bill Collins’s group over at Yale is
    studying that, he’s a really great guy.” It’s narcissism, not in a
    malignant way, but in an entirely easy, natural, self-fulfilling
    way that can be justified to oneself as not hurting anyone. Hey,
    it doesn’t mean you don’t love your wife, or that you don’t
    care about patients. But you’ve been Associate for two years,
    and…

    And how do you cover a salary? Ask Pharma for money— and
    be damn sure to carefully design your study for the outcome
    you want. I don’t have reliable data on this, but I’d bet that
    most people looking for porn on the internet don’t type “naked
    ladies” into the search bar and hit return. You want results.

    There is a downside to masturbation, of course, the most


    significant being the potential to interfere with your desire to
    have sex with your actual spouse. So it is with academic
    clinical trials. Do any patients benefit from the ejaculate in the
    Journal of Clinical Psychiatry? Do the sticky pages of the
    New England Journal hold any promise for patients? And did
    those studies prevent— by time, money, or energy— the study
    something else more valuable? The answer is yes, a thousand
    times yes. I’m sure ENHANCE seemed like a good idea at the
    time. Now, not so much. I think it’s great that the AHA has
    taken the unusual step of denouncing the use of Vytorin as a
    first line agent on the basis of one single, flawed, study with
    apparently no serious attention to its findings. What have they
    accomplished? Nothing, except to solidify the role of
    pornography as legitimate science.

    –-

    Academia is a regression to adolescence. You’re not trying to


    achieve a goal, you want to make progress towards the goal.
    “Someday, I’ll…” That’s it. that’s everything. Adolescents
    aren’t confident in the goal, they’re not sure they really want it
    or it’s worth it. But there will be all sorts of drama around it.
    That’s academia. They’re not really scientists, their
    semioticians, not after knowledge but constructs, frameworks.
    “Science requires time and diligence— can’t jump to
    conclusions.” Sure. Not like what happened with ENHANCE.

    I had expected all this from psychiatrists; it’s comforting, but


    simultaneously horrifying, to know that it exists in the same
    strength in cariologists as well.

    I am anonymous, but I am not without character, and I will put


    my money where mouth is. As of the open Tuesday, I’m in for
    500 shares of Schering-Plough, not because I believe in the
    company, or in Vytorin, but because I know capriciousness
    when I see it. After everyone cleans up, SGP will bounce
    back.

    Thanks, ACC. You just made me 20%.


    Time Magazine Stays Out Of
    the Election
    April 9, 2008

    Look at the page for three seconds only. Guess which party
    Time favors?

    Some things to observe:


    The “Yes” vs. “No” impact visual impact. Questions could
    easily have been phrased another way to generate “No”
    Democrat responses and “Yes” Republican (e.g. “Should the
    Bush tax cuts be maintained?”)

    The quotes underneath the candidates photos seem to starkly


    contrast the candidate’s different philosophies. See how
    McCain’s answer seems out of touch? Notice the questions
    aren’t published, only the quotes. Do you know why? Because
    they’re not asked the same question. The Democrats are
    answering questions about the housing crisis, while McCain’s
    quote actually comes from a speech to the Orange County
    Hispanic Small Business Association. You can see that in that
    speech, there are a number of quotes that could have been used
    that specifically relate to the housing crisis; instead, they
    picked one that has nothing to do with housing. So it appears
    he thinks abandoning the AMT is his solution to the housing
    crisis. “Stupid Republicans all think cutting taxes is the
    solution to everything.”

    Not fair, Time Magazine.

    Addendum: I wrote to the editor about a week ago. No


    response.
    Nature Says Scientists Use
    Performance Enhancing
    Drugs
    April 11, 2008

    If only it were true.

    This article is about shock, and about conveying a politically


    correct message— not that it’s wrong to take drugs, but that
    it’s wrong to take them if they give you an edge over someone
    else.

    The results are (from the header:)

    Poll: Scientists Use Brain-Boosting Drugs

    Survey of Magazine’s Readers Shows 1 in 5 Take


    Mental-Performance-Enhancing Drugs

    and from the article:

    Scientists from all over the world participated in the poll,


    but 70% of respondents said they were from the U.S.

    The most popular drug was Ritalin, used by 62% of


    responders. Provigil was the drug of choice for 44% of
    those polled — suggesting that many of the users take
    more than one drug.

    First, 1 in 5 is actually pretty small. I’m surprised at how small


    it is.

    Second, it’s misleading. The readership of Nature isn’t


    scientists, it’s college kids and grad students. If you read the
    article, you’ll observe that that over half of the respondents
    were under 35. While I’m sure they are all doing impressive
    work, they aren’t the stereotype invoked by the title “Scientists
    Use Brain-Boosting Drugs.”

    But third, and to the point: the article simultaneously


    presumes, and reinforces, the idea that scientists are using
    these drugs improperly— i.e. that using them on 9 year old
    kids with “ADHD” is their proper use. You would think that
    one of the scientitians down at Nature might have observed
    how preposterous that is.

    If anyone can tell me why it is more logical, medical, ethical,


    efficacious, or safe to force it on a kid who scores high on a
    reliable but totally invalid ADHD checklist; but less so for a
    “scientist” with considerably more insight into his own
    condition— and, by the way, the autonomy to decide for
    himself— I’m listening.

    That aside, let me ask a different question: why not encourage


    the use of the drugs? Beyond safety issues, is it just that we’re
    worried about unfair advantage in science? That’s the debate
    in sports, that it doesn’t allow for a level playing field. You
    want a fair competition.

    But why would you care about that in science? I mean, if it


    takes 800mg of Provigil a day to find the cure to cancer a
    month earlier, well…?

    So there’s the academic scam: it isn’t about the cure. It


    actually is a competition. Different labs vying not for the cure
    per se, but for more funding, promotions, jobs, publications. If
    one lab is doing coke out of 96 well microplates, another lab
    might feel pressure to smoke crack out of Eppendorfs, I guess.

    Though at one point in my life I even resorted to using


    chocolate covered espresso beans in a pharmaceutical
    capacity, 10 tabs QID, I’m not endorsing the use of such drugs
    in anyone; but I hope everyone can see that the division
    between proper and improper use completely invented, and
    upheld by those who have much to lose should that division be
    eliminated.
    First Anniversary Of The
    Death Of Antidepressants
    April 14, 2008

    Belated, anyway.

    A year ago— 4/4/07— the NEJM published a study that said\


    antidepressants did not provide additional benefit to mood
    stabilizers. But my tin foil hat allowed me to see that the
    authors were abandoning antiepileptics and antidepressants;
    the future was in bipolar, and in antipsychotics. We are now
    for monotherapy, and it is branded.

    I wrote about it then, received slightly more than the usual


    hate mail (“are you a psychiatrist or a scientologist?”) had a
    drink and went to bed. What else am I going to do?

    Time passed. Seroquel got an indication for bipolar


    depression; Abilify for adjunctive use in depression. SSRIs are
    history, Cymbalta a last holdout due to an extra indication.
    And I haven’t seen a Depakote rep since, well, since a year
    ago.

    If you’re new to the game, it will be hard for you to believe


    that in 2001 Depakote was everywhere. If you dared to start a
    “bipolar” on anything other than an antiepileptic, you were
    actually reprimanded by other doctors. “What the hell is this
    nut doing over there?” Back then if you said you were going to
    use Seroquel for… anything, they caned you.

    Now it’s the top selling psych drug.

    I briefly toyed with asking Calabrese, Bowden, Sachs, et al—


    the Mafia of Psychopharm— for a formal apology; or at least
    an admission that they were wrong, but now I see that that’s
    impossible: not because they are hiding it, but because they
    actually believe they never said it. They think they were
    always pro-antipsychotic monotherapy; that they never
    intended Depakote to be first line; that they never implied
    there was considerable evidence that Depakote should be a
    maintenance agent, when in fact there was none. They don’t
    realize how much a pawn in the academic-Pharma game they
    are.

    I fought a solitary battle against this thinking back then, and


    I’ll say it was with some not inconsequential professional
    repercussions.

    Whatever; my point isn’t to say I was right, but to show that


    they were wrong—and now pretend they never said it. So that
    the next thing they say can be met with at least a little
    skepticism.

    It’s like Iraq— first it was WMD, everywhere, all the time;
    now they don’t talk about WMD, but worse, they pretend that
    they never really meant WMD.

    Difference is no one trusts Cheney anymore; but somehow, we


    still ask the Mafia of Psychopharm to lead us.

    I’d trust Cheney over any of them, any day.


    The Dead Sea Effect In
    Academia
    April 15, 2008

    And I am ashamed.
    Bruce Webster writes about information technology, and
    describes what he calls the Dead Sea Effect. (The post is well
    worth reading.) The Dead Sea is land locked; water comes in
    by the Jordan River, but no water leaves except by
    evaporation. In IT, new hires come in, but who leaves?

    …what happens is that the more talented and effective IT


    engineers are the ones most likely to leave — to
    evaporate, if you will. They are the ones least likely to
    put up with the frequent stupidities and workplace
    problems that plague large organizations; they are also
    the ones most likely to have other opportunities that they
    can readily move to.

    What tends to remain behind is the ‘residue’ — the least


    talented and effective IT engineers. They tend to be
    grateful they have a job… They tend to entrench
    themselves, becoming maintenance experts on critical
    systems…

    Sadly, this is even more true about academia. “Grateful to


    have a job” is translated to valuing the university appointment
    even more than money. You can’t really tell someone at a
    party you make $50k more than other people in your field, but
    you can tell them you work at Yale. And here’s the thing: the
    fact that you work at a university is actually trivial. It actually
    has no value at all except to you, as a means of reinforcing (or
    creating) identity. Your family would actually be better off
    with the extra $50k
    “…entrench themsleves, becoming maintenance experts…” is
    translated to a focus not on output, but on process. The death
    of a university can be reasonably measured by the increasing
    ratio of assistant and associate professors on committees to
    number of post docs. I wonder if you can’t remove the
    denominator and still have a reliable gauge.

    But the more important result is that academia produces


    mediocrity. I know people will disagree, but they’re wrong.
    Mediocrity in education is a given; teaching assistants
    teaching classes; multiple choice exams; grades in general—
    they’re not there to promote excellence.

    And what are those too-busy-to-teach professors doing?


    Mediocre research. I’ve said enough about the pointlessness of
    yet another clinical trial. But even basic science research
    suffers. It’s not that the ideas or goals are mediocre— it’s the
    approach. Plodding, unfocused— the mind is on the grant, not
    the result. “What experiments will the reviewers want me to
    perform?” The contest between those in academia and those
    who leave would have well been settled by Celera vs. Human
    Genome Project, had not President Clinton changed the game.

    Henry Kissinger said: university politics is vicious precisely


    because the stakes are so small. Actually, a number of people
    said it. Because it’s true.

    Academia is a trap. It pays you with secure insecurity. You


    settle in and think, I am never going to leave this. It confuses
    you, it changes reality. I make only 20% of my income from
    my university job, yet whenever anyone asks me what I do for
    a living, I tell them I work at university. Worse— I actually
    believe it, it’s part of my identity, even though it is factually
    incorrect. Your focus is not on why you are there, but on how
    to stay there, or even to advance, in that irrelevant hierarchy.

    Academia is like being in an abusive marriage. You know you


    should go, you get nothing from being there except misery and
    pain, but leaving is nearly impossible, so much has to go into
    the decision to leave, so you stay, try to make it work. Maybe
    it’ll get better, it’s really not any different anywhere else,
    maybe it’s not him, it’s you, if you lost twenty pounds or got a
    second grant maybe then they’d like you…

    Jesus, I’m in an abusive relationship with my job.

    I think it may be time for me to go.

    Academics are not bad people, obviously, and they have their
    role in the Matrix. But the real talent, the ones who produce,
    they all graduated and left— or never graduated at all.
    The Sex-Starved Wife
    April 16, 2008

    On the one hand, you have articles in the Economist saying


    people are spending less time at work and more at home, on
    the other hand Time writes about the sex-starved wife. If
    they’re both home more and at work less, why aren’t they
    naked?

    The answer isn’t porn.

    Sex is a good proxy for a lot of things. The Time article offers
    a number of explanations for why a man might have a lower
    libido than his wife, but not the correct one: narcissism. In
    women, narcissism manifests itself as a greater libido, and in
    men, a lesser one.

    You might think this is backwards, but it isn’t. The wife is


    more involved with every part of the relationship— the
    money, the jobs— his and hers— the troubles, everything—
    that the man has no way to construct an artificial identity she’d
    believe. He can’t pretend he’s anything— suave, a major force
    at work, a successful investor, whatever— because she knows
    his reality in text message speed. She talks to her husband not
    once, but four or five times a day. What’s he going to say she
    doesn’t already know? Even legitimate successes are subdued
    because they are not at all surprises.

    Here’s the mistake: women say, “but I get turned on by him


    anyway, he doesn’t have to impress me, he has me.” And my
    unscientific poll of… some… women suggests they are more
    sexually open and experimental than ever. So what’s wrong?
    And so maybe the wife thinks she’s not hot enough? And
    catchers his glances at the waitress, the porn on the computer.

    Well, the problem with his libido isn’t how hot she is. He’s a
    narcissist: the problem is his libido is that it depends on how
    hot he is.

    It’s what women used to go through. He looks in the mirror,


    sees a gut— he doesn’t feel sexy, he can’t imagine she would
    find him sexy, so the libido falls. In the past he could at least
    draw confidence from the fact that he has a good job; but now
    he doesn’t have a “good ” job, it’s an okay job, one that pays
    the bills, but not something that you can build an identity with.
    And anyway she has one just as good. What’s his appeal?

    The woman, by contrast, might actually feel better about her


    deteriorating body because she’s attained value in other ways;
    and so she figures, “we are aging together.” A narcissist does
    not want to hear that, ever. He can still penetrate you if you
    become old, fat and ugly; he can’t do it if he becomes old, fat
    and ugly.

    It’s a double whammy of feeling emasculated, while his


    narcissistic personality structure demands that he be hyper-
    male, ideal male. He can’t attain it. So he thinks you see him
    as less than masculine. So he doesn’t bother with you.

    So the wife asks, “is he picturing himself with other women


    when he has sex with me?” No; he’s picturing someone else
    with other women when he does you. It’s masturbation. It’s
    not sexy if it’s his bloated body underneath Sports Illustrated’s
    Marisa Miller.
    It’s what the relatively recent fascination with MILFs is all
    about. The fantasy isn’t that your wife is with another man; the
    fantasy is that your wife is hot enough that another man would
    want her. But this fantasy has nothing to do with how hot your
    wife actually is, it’s about your identity: I’m so great that such
    a woman would want me.

    Consider the cover of the book, The Sex-Starved Wife. She’s


    not starved because she’s ugly. Get it?

    And so, to the diversions. If you’re married and your husband


    plays WoW, forget it, he’s lost to you. He’s playing it because
    it rewards him with the kind of validation only successful
    daytrading might give him (and it won’t.) The online porn; the
    glances at the younger women around him. It’s not (just) that
    he finds them attractive: their real appeal is that they do not
    know him, and with them he could be the man he thinks he
    should be because they wouldn’t know it’s an invented
    identity. And the younger and younger ages of the women isn’t
    about pedophilia— he’s just unconsciously dutch auctioning in
    on the age naive enough to believe his created identity. He
    starts at 30, goes to 20, maybe 18, then 16…?

    Interestingly, articles about the sex starved wife are in the


    current environment of declining, not rising, divorce rates. For
    a number of reasons, couples are bonded together more tightly
    than before. Divorce is somehow out of the range of options;
    commitment means something again. Parents spend more time
    together and with their kids. Sounds great. Still: no nakedness.

    They are staying together, but they are less emotionally


    connected than ever. Narcissists cannot connect.

    Let me be clear that I am not using “narcissism” as a


    pejorative term, I’m just describing a personality structure and
    its consequences.

    By the way, don’t think you’re not a narcissist because you’re


    30 and having sex every day; the involution, the self-
    absorption gets unmasked as natural aging slows you down.

    And so, too, kids, the saddest generation of the past 100 years.
    Why? Because even though Dad is around more than any
    other generation, he is less emotionally involved. Sure, he’s
    home five hours a day; but three of them he’s irritable, short,
    or outright yelling at them. Kids don’t think, “what the hell is
    wrong with Dad? He should get himself a drink.” They think,
    “oh my God, I must suck. I’m going to get a drink.” Alcohol
    use among teens is going to rise substantially, you heard it
    hear first, because alcohol is the drug of the lonely surrounded
    by everyone.

    Oh, you want a solution? Here it is: have sex. Even if you’re
    not in the mood. It seems like strange advice— force yourself
    to have sex— but it’s the correct advice. The problem is
    unrealistic expectations of yourself, sex, marriage, etc. Instead
    of fantasizing, pretending, teasing, silly text messages that
    come to nothing, whatever, just do it. If nothing else— and
    this is nearly unimaginable— you will both feel better that you
    did it, that there’s nothing wrong with your marriage.

    “But I’m tired.” Jesus Christ, have a shot of rum, and get to
    the penetration.

    More: what happens to boys when girls are too hot, and A
    Quick Word On Porn’s Effect On Your Penis
    .
    British Medical Journal
    Sends Its Scienticians To The
    Internet
    April 17, 2008

    And finds that “Suicide searches produce disturbing,


    unsurprising results.”

    Damn the internet, damn it and its tubes.

    I’m not sure if I should get angry or laugh. BMJ. Not Weekly
    Reader. BMJ.

    An article in BMJ tries to determine how much information


    about suicide is online, and whether the sites are pro or anti
    suicide. They searched the internet, and found:

    Altogether 240 different sites were identified. Just under a


    fifth of hits (90) were for dedicated suicide sites. Half of
    these were judged to be encouraging, promoting, or
    facilitating suicide; 43 contained personal or other
    accounts of suicide methods, providing information and
    discussing pros and cons but without direct
    encouragement; and two sites portrayed suicide or self
    harm in fashionable terms…

    Or, as the news articles about this study say:

    But perhaps most disturbing was that the most frequent


    results were pro-suicide. “The three most frequently
    occurring sites were all pro-suicide,” note the authors,
    who also found that “Wikipedia was the fourth most
    frequently occurring site.” [emphasis mine.]

    So I guess the internet is awash in suicidophilia. Or maybe


    BMJ doesn’t know how to use Google?

    The [search] terms used were: (a) suicide; (b) suicide


    methods; (c) suicide sure methods; (d) most effective
    methods of suicide; (e) methods of suicide; (f) ways to
    commit suicide; (g) how to commit suicide; (h) how to
    kill yourself; (i) easy suicide methods; (j) best suicide
    methods; (k) pain-free suicide, and (l) quick suicide.

    “Damn it! I typed in “naked porn stars” and all I got back
    was naked pornstars! What the hell is wrong with this thing?”

    Try searching “suicide prevention.” Ok, see? Can we all go


    back to worrying about illegal music downloads?
    Who Are We?
    April 21, 2008

    A recent article in the New York Times, written by Richard


    Friedman, MD, is called Who Are We? Coming Of Age On
    Antidepressants.

    The article can be summarized: “I’ve been on antidepressants


    for most of my life. How do I know who the real me is?”

    It’s an interesting question, and many have attempted to


    answer it. But the question is faulty, because it assumes there
    is a “you.”

    And, of course, there isn’t.

    A medication doesn’t alter your core personality; your


    personality constantly changes, adapts, to stimuli. Why do
    some people go all Zimbardo at the drop of a hat, while men
    married of 20 years become infuriatingly repetitive in their
    behaviors?

    It’s no different than the antidepressant question, which is no


    different than anything else. You’re confused because it’s a
    medication, but there are other things more powerfully
    transformative than a pill. For example: divorce. You may
    think the “real you” married your wife or husband, but I am
    confident that if you had married someone else, you would
    have been a different person— sometimes dramatically
    different. Example: a gazillion women who are in their second
    (happier) marriage have told me that they don’t even recognize
    the woman that they were in the first marriage. “I can’t believe
    the things I did— in some ways, I was actually a bad person.”
    And they describe being manipulated— and manipulating;
    being selfish, etc. Circumstances made them “bad,” and the
    healthier second marriage has made them into a healthier,
    better person.

    Or whatever. I’m not saying all first marriages are bad, and
    you are bad for being in them— I’m giving an example of how
    an external event that you chose drastically alters your
    identity. The pill is no different.

    The reason so many people can’t accept this existential


    position is because many parts of personality seem to remain
    consistent despite significant events, meds, etc. But much of
    the consistency has to do with consistencies in other
    environments. e.g. You had two marriages, but the same job;
    or you still saw your parents every weekend; etc, etc. Those
    anchors fix parts of your identity.

    Friedman offers the example of a woman who has been taking


    Zoloft for 8 years, and has had a decreased libido.

    She had understandably mistaken the side effect of the


    drug for her “normal” sexual desire and was shocked
    when I explained it: “And I thought it was just me!”

    This is an exceptionally good example, because it shows why


    Friedman’s logic is wrong. Why is it Zoloft’s fault? How do
    you know she just doesn’t have a low libido?

    I know Zoloft has sexual side effects. But he jumps to the


    conclusion that because they have side effects, that must be
    why she has a low libido. But do sexual side effects happen in
    everyone? The package insert says 6-11%. I’ll spot you 20
    points. If 30% of patients have decreased libido, is it logical to
    blame her low libido on Zoloft, and not on anything else? She
    doesn’t say she has a decreased libido; she says she has a low
    libido. See the difference?

    But even that explanation is a distraction. Friedman misses the


    point altogether: she has a low libido. Period. Maybe it’s the
    Zoloft, maybe it isn’t, but unless she is coming off the Zoloft;
    unless she just started it that you are noticing a change from
    before; then the point is moot. Low libido is her identity.
    Perception isn’t reality, behavior is reality.

    What people want is there to be a core, perceived identity—


    “I’m X”— that can be pharmaceuticalized into existence
    without the requisite behavioral effort. “I should be happy.”
    Well, actually, no. You shouldn’t. You may want to be happy,
    but there shouldn’t be an expectation of it.

    If you are normally a happy person, and then become


    depressed, then you can say the meds are returning you to
    normal. But if you have always been depressed, and the meds
    have changed that, you are not returning to normal, you are
    moving further away from normal. I’m not going to judge this
    as good or bad— I’m simply saying that you’re not returning
    to core, you are different.

    The key here is that early childhood if of huge importance in


    creating anchors, which will allow some consistency of
    personality throughout life. Consequently, the extent to which
    you have some personal traits will determine how easily you
    change the others. e.g. narcissists can be relied upon to
    become violent even when they “are” not violent people.

    But, ultimately, you get to choose who you are. Choose.


    Intrinsic Value of Money
    April 23, 2008

    A bird in the hand is worth two in the bush if that bush is a


    pricker bush. And only if people actually want birds, not
    bushes.
    I.

    The Economist describes a study in Psychonomic Bulletin and


    Review which people were given a regular dollar or a Susan
    B. Anthony dollar, and asked to estimate the cost of napkins,
    candy, etc.

    People offered the banknote believed, on average, that


    they could use it to buy 83 paperclips, 72 napkins or 46
    sweets. Those offered the coin thought 39 paperclips, 51
    napkins or 27 sweets. In other words, the note was
    believed to be almost twice as valuable as the coin.

    Similar results were obtained using two one-dollar bills vs.


    one two-dollar bill.

    This shouldn’t be surprising, however, when this exact


    (reverse) principle explains why casinos use chips, arcades use
    tokens— and why credit card debt is so easy to get into.

    The authors explain this to be a funcition of familiarity—


    familiarity holds more value.

    II.

    But there’s a little more to it.

    The mistake is to interpret these results as indicating, e.g, the


    dollar bill above is believed to be able to buy 83 paperclips or
    72 napkins, etc— that the dollar bill is believed by people to
    have a certain value. False.

    To prove this, ask someone how many paperclips would it take


    to buy 72 napkins? The answer should be 83. But most likely,
    they’ll just look at you blankly. They have no idea what the
    exchange rate is. Notice how with the Susan B dollar, opposite
    to the paper dollar, paperclips were worth less than the
    napkins.

    There’s a difference between use value and exchange value.


    Napkins and paperclips have considerable use value that you
    feel, instinctively, but nearly no exchange value (i.e. you don’t
    trade them for other stuff.) Money is the exact opposite.
    Trying to convert exchange value for use value in a back and
    forth line is hard enough; trying to do it in a triangle with three
    objects is nearly impossible.

    Marx had hoped that the use value of an object would be the
    amount of labor embodied in it, but of course that is even
    intuitively wrong. The use value of the napkin has absolutely
    no relationship whatsoever to its labor content; if the labor to
    make paperclips increased, the napkin holder would have no
    way of quantifying it to alter the exchange value. Because he
    doesn’t care how much labor went into it. Use value is entirely
    subjective.

    Consider the commoditization of money (currency.) Many


    people devalue the penny (e.g. throw it in the trash,) even
    though some argument can be made that the copper alone is
    worth keeping. Labor theory would make the intrinsic value of
    a penny higher than a nickel. (cost of copper is higher, but
    labor to make coins is mostly the same.) But yet, it’s tossed.

    Or, the reverse case with quarters. You may have a dollar, but
    you’d very likely trade that dollar for three quarters if you
    needed to fill a parking meter. The quarter itself suddenly has
    value beyond its denomination, and you may value it
    anywhere from $.25 to $2.00, depending on the circumstance.
    The reason is this: the value of not having a quarter is 100x, or
    $25— the cost of a parking ticket.

    This value is not transitory; to any regular city parker, the


    quarter almost always carries more value than $.25, even
    though— and this is precisely the point— the higher value of
    the quarter cannot be reflected in the economy at all, ever. Try
    buying a $1 coffee with the three quarters you just traded for a
    dollar.

    The price of oil, $118, in the face of falling refinery output and
    comparatively calm international relations, suggests that the
    price of oil has less to do with demand or supply, and more to
    do with something else— in this case, the falling dollar.

    If you do not grasp this, if you do not feel this in your bones,
    you will always be a wage-slave. It is absolutely no different
    than picking a spouse, who I am sure you feel is the perfect
    mate for you, while another person scratches their head and
    says, “what the hell does that nut see in that other nut?” The
    key to making money is not working harder, or smarter, or
    investing, or anything else. The simple, one koan key is to
    understand that things have different values simultaneously, to
    different people.

    And I hope it is clear that this doesn’t apply only to money.

    But anyone who understands this has the ability to exploit this.
    Ultimately, you get to choose who you are. Choose.
    Update on Schering Plough
    April 24, 2008

    It started with the Vytorin study, and my belief that doctors


    purposely misstated the results in order to support/portray an
    anti-Pharma bias. The stock tanked, but I predicted that
    eventually reality would set in, and so the American College
    of Cardiology was giving me the opportunity to make 20%.

    Technically, it was only 18%, but I’ll take it. Sold today.
    Likely goes to 20, but I only bought it to prove a point:
    doctors, especially in committees, cannot be trusted with their
    own data, and politics always wins over science. I was able to
    make money on the politics, but what about the patients who
    are pawns in this game, who think they’re getting “evidence
    based” care?

    Good luck, everyone. You’ll need it.


    The Real Mystery of ‘Lost’
    April 24, 2008

    Figuring out when the hell the show is going to be on.


    Election 2008
    April 28, 2008

    Remember the good old days of 2004? When political debate


    was suitable for yelling out open car windows? “Bush lied!
    And he’s a cowboy!” “Kerry flip flops! And he’s French!”
    That was awesome.

    This time around, instead of repeating empty, meaningless


    soundbites that we steal from various media sources, let’s
    dispense with the pretense that we thought anything through,
    and simply yell out the sources themselves.

    “CNBC at 12:30 Tuesday. I don’t remember most of it, but he


    got it from Rush Limbaugh.”

    “That’s stupid, because I caught the last nine seconds of a


    contrasting position on Lou Dobbs at 8p on Wednesday. That’s
    prime time.”

    “My friend said XM said that All Things Considered said


    Dobbs was a fool, and ATC is certainly more intellectual than
    the show you didn’t watch, so I am ahead.”

    He boots up his Mac. “Except The New Yorker had a three


    page story on the election that I therefore didn’t need to read,
    so I own you.”

    “Oh, please, the friggin New Yorker. I read Daily Kos.”

    “The Daily Kos can blow me.”

    Pause.

    “That’s it?”
    “Just saying.” He orders another decaf mocha. “Besides, Time
    said bloggers are monkeys with one hand down their pants.”

    “The crawl on CNN said Time readership is down, and


    masturbating primates have determined six of the last three
    elections. The crawl is where all the good stuff is.”

    “You wish. That crawl is as compelling as a Soulja Boy


    acoustic set. Besides, the anchor at CBS made fun of CNN.
    Anchor beats crawl.”

    “But didn’t the CBS anchor steal his quotes from CNBC?”

    “Yes, who in turn quoted Rush—”

    “—who was responding to something from The Daily Show!”


    He tears open a Splenda. “Wait, does all political discourse in
    this country originate with Rush Limbaugh and Jon Stewart?”

    “Sadly, yes.”

    Pause. He googles Juno and iphone.

    “I wonder why that is?’


    Experts Weigh In On Bipolar
    Disorder
    April 29, 2008

    And they conclude there’s a lot of bad information out there.


    They try to set the record straight.

    Bring a bottle.

    From the article:

    [The Diagnostic Guidelines Task Force of the


    International Society for Bipolar Disorder (ISBD)]
    chairman S. Nassir Ghaemi, MD, MPH … brought
    together some of the world’s clinical experts on bipolar
    disorder and key researchers with the goal of having them
    develop a more systematic and coherent set of diagnostic
    guidelines.

    In other words, what do the best minds in psychiatry have to


    say about bipolar disorder? What says the latest data?

    Also expanded was the definition of bipolar depression,


    according to Ghaemi. “It is not just depression in
    someone who happens to have had manic episodes but
    rather specific kinds of depression with specific features,”
    he said.

    …Clinical features include early onset of first depression


    (before age 25 years), multiple (5 or more) previous
    episodes of depression, family history of bipolar disorder,
    atypical depressive symptoms (such as leaden paralysis),
    psychomotor retardation, psychotic features, and/or
    pathological guilt.

    That’s based on the PET scans and the NIMH genetic studies
    which have so far cost a quadrillion dollars, right? Well, here’s
    a line from the actual Guidelines. It’s the kind of line that
    makes you, well, look upon the works, and despair:

    The subgroup describes this as a ‘probabilistic’ approach


    to the differentiation of bipolar from unipolar depression,
    and offers a heuristic of operationalized criteria to be
    studied empirically. Areas of dissensus persist…

    Got that? No? Good, it’ll go down easier. So it’s soon to be


    official: Farewell, Depression.

    What else does the team think? Oh: schizoaffective disorder


    doesn’t exist.

    Most of the evidence, he explained, suggests that


    schizoaffective disorder does not represent a separate
    categorical disease entity; rather, it is “a variation on
    schizophrenia or a variation on mood disorder or co-
    occurrence of the two.” The subgroup recommended
    dropping the schizoaffective disorder diagnostic category
    altogether from DSM-V…

    The question is, if the evidence has so far been indicating that
    schizoaffective is not real, why did we have to wait for the
    DSM to tell us it doesn’t exist? Why can’t psychiatry simply
    make it happen?

    But the sleight of hand is saying that the schizoaffective is


    “really” a variation on a mood disorder (read: bipolar.) It is
    equally plausible that bipolar disorder is a variation of
    schizoaffective disorder since neither one exist except
    synthetically. I don’t mean the symptomatology doesn’t exist, I
    mean the classification is completely empty. We choose to call
    this thing schizoaffective, and now we choose not to. We
    chose to call it depression, now we choose to call it bipolar
    depression. It’s not like you chose to call it a unicorn but later
    discover it’s actually a rhinoceros. A more accurate analogy is
    that you chose to call this a unicorn, and now choose to call it
    a ki-ran. Wait— what’s a ki-ran, you say? Exactly.

    Or, you find an elephant’s leg, and say, this is an elephant. And
    next you find a horse’s leg, so you say, this has much in
    common with an “elephant,” same joint here, so this is an
    elephant also. Which would be okay, except then we start
    making treatment decisions based on that logic: ah ha!
    Antifungal cream is the mainstay of treatment for all elephant
    illnesses! And meanwhile the elephant dies of throat cancer.
    Does it make any sense that the best of our science suggests
    that the manipulation of four neurotransmitters is somehow
    involved in the treatment of every single psychiatric illness
    known, from anxiety to xenophobia?

    What do we say to all of those patients diagnosed with


    schizoaffective disorder? Oops? Is it any consolation to them,
    or their families, to hear that it’s actually bipolar? How about
    the criminal cases of schizoaffectives? Should they get new
    trials? Their new diagnosis of bipolar has more studies to draw
    from, it has more play in the legal system, and better known to
    jurors?

    As a final question, Ghaemi was asked if he believed


    bipolar disorder is being overdiagnosed. “While unipolar
    depression, personality disorders, and schizophrenia have
    each had periods of overdiagnosis, there has never been
    an era in which bipolar disorder has been overdiagnosed,”
    he said, “no matter what skeptics claim.”

    He said that concerns about bipolar overdiagnosis are


    largely anecdotal, have not been empirically well-
    established, and ignore solid evidence of continued
    underdiagnosis.

    And there’s some more sleight of hand. Empirically? What’s


    the test to see if it is actually bipolar or actually depression?
    Especially when you have the power to change definitions?

    The best is at the end:

    The lack of focus on bipolar disorder has led to neglect


    and controversy, Ghaemi noted. “Our task force,” he said,
    “is a step toward more consensus and less controversy.”

    Bipolar is the neglected diagnosis? And this will cause less


    controversy? Are you serious?
    Oh, Please, What Do
    Europeans Know About
    Psychiatry?
    May 3, 2008

    I mean, like, don’t they have seven month vacations over


    there? And state sponsored affairs?

    The prevalence of bipolar disorder in kids is considerably


    higher in the U.S. than in Europe.

    Why? Either American kids are more whacked then Europeans


    — and you can blame genetics or environment for this; or, the
    process of diagnosis is whacked, either here or abroad. Go on,
    pick: Tatooine or Hoth.

    One way to answer this is to use American style diagnostic


    tools, such as the NIMH’s Child Behavior Checklist (CBCL),
    on Europeans. The answers on the CBCL can be grouped into
    different profiles, relating to different diagnoses. For example,
    elevated scores in certain areas gives a CBCL-pediatric bipolar
    profile.

    Using this approach, we were in fact able to show that the


    prevalence rate of children meeting this profile in
    Germany was comparable to pediatric bipolar rates in
    other countries using different diagnostic approaches.

    In other words,
    The prevalence of CBCL-pediatric bipolar disorder
    subjects in the general German population compares to
    rates of pediatric bipolar disorder in the US…

    …However, no patient [with the CBCL bipolar profile]


    received a diagnosis of bipolar disorder. Instead, 3 of 4
    children with this profile (whose conditions would
    presumbaly have been diagnosed as bipolar disorder by
    some colleagues in the U.S.) received diagnoses of
    ADHD, oppositional defiant disorder, and conduct
    disorder.

    So there you have it: the diagnosis is whacked.

    Ah, you say, come on, what’s the difference what you call it?–

    Regardless of whether these subjects are affected by


    ‘real’ pediatric bipolar disorder or ‘severe, pervasive
    ADHD’ [etc]… they constitute a group of seriously
    disturbed children and adolescents.

    Yes, but even though the world agrees the symptoms are the
    same, the consequences of each label is very different, right?
    The epidemiology, the prognosis— the meds?

    But the real difference is the societal implications. Getting a


    diagnosis changes the way you relate to the world, and the
    world relates to you. The label changes your identity and how
    you think.

    Don’t agree? Try killing someone and using “pervasive


    ADHD” as a defense. Get it?

    We pretend that psychiatry is an emerging science, and hide


    behind a feigned ignorance (“we don’t know everything, but
    we’re making progress!”) And so no one has to take
    responsibility, or even admit, that psychiatry is changing the
    evolution of humanity, right in front of our eyes, with nothing
    more than words.
    First Person Account Of The
    Milgram Experiment
    May 7, 2008

    An article written by one of the test subjects in the Milgram


    experiments, and his explanation for why it happened the way
    it did.

    He’s wrong.

    First, if you do not know the experiment (video): a “learner”


    would be strapped to a chair in the next room— so they could
    be heard, but not seen— and would be asked to remember
    words from a pair. If he got it wrong, the professor would tell
    the tester to operate a machine that would remotely administer
    electric shocks.

    In reality, the thing was staged; it was really an experiment to


    see if the tester would submit to authority: “please continue
    administering the shocks.”

    Most “testers” continued to shock as long as the professor told


    them to, even though they could hear the learner howling in
    horrible pain. Perhaps they thought the scientist had some
    safeguards from actual death, who knows. But the results show
    that people are sheep given the right power structure.

    This article is by one who refused to continue giving shocks.


    His reasons for stopping are interesting:

    In retrospect, I believe that my upbringing in a socialist-


    oriented family steeped in a class struggle view of society
    taught me that authorities would often have a different view
    of right and wrong than mine.

    He goes on to detail the origins of a default suspiciousness of


    authority:

    Like all soldiers [in WWII], I was taught to obey orders, but
    whenever we heard lectures on army regulations, what
    stayed with me was that we were also told that soldiers had
    a right to refuse illegal orders (though what constituted
    illegal was left vague).

    and his battles with the government:

    In the early 1950s, I [the Chairman of the New Haven


    Communist Party] was harassed and tailed by the FBI, and in
    1954, along with other leaders of the Communist Party in
    Connecticut, I was arrested and tried under the Smith Act on
    charges of “conspiracy to teach and advocate the overthrow
    of the government by force and violence.” … I believe these
    experiences also enabled me to stand up to an authoritative
    “professor.”

    I have a personal bias against communism, so I’m skeptical of


    this answer. By invoking communism/socialism, he is
    implying that he has a higher sense of rightness than others
    might, and some attachment to the common man that made
    him not want to proceed with hurting the guy on the other end
    of the shocks. Before you read further, read his quotes again
    and see if you agree with my assessment.
    But here’s why he refused:

    …[the professor] insisted that I continue [giving shocks.] I


    refused, offered to give him back the five dollars, and told
    him that I believed the experiment to be really about how far
    I would go, that the learner was an accomplice, and that I
    was determined not to continue.

    He didn’t stop because of moral courage; he stopped because


    he thought he was being played.

    The distinction is extremely important. His life experiences


    didn’t make him strong against against authority, but to be
    suspicious that authority is an authority. He stopped not
    because the other person was being shocked— what he cared
    about was being manipulated.

    And so again, narcissism, though in this case resulting in a


    “healthy” outcome because it heightened his perception of
    games and manipulation.

    I’m not criticizing this man— what he did in this experiment


    isn’t generalizable to other circumstances precisely because he
    thought it wasn’t real.

    A more interesting question would be how much further he


    would have gone if he didn’t think it was a trick; when would
    moral courage as opposed to indignation have taken over?

    Let’s be clear that there is a difference between not playing


    because you think it’s rigged, and playing despite it being
    rigged, doing the best you can anyway, because that is what
    life is…
    Cookie Monster Becomes
    Aware
    May 8, 2008

    An article from McSweeney’s (I know, I know) called, Cookie


    Monster Searches Deep Within Himself, And Asks: Is Me
    Really Monster?

    While humorous though predictable, I did catch a reply on


    Metafilter which, in my opinion, borders on genius:

    They are all monsters, that’s the point. The show is for
    children, don’t forget. They are monsters the kids don’t
    have to fear. The show’s message for kids was “We know
    you’re sometimes afraid of monsters, but not all monsters
    are bad.

    Sometimes monsters can be cute and cuddly and quirky


    and funny. Elmo’s a monster and he has such a cute
    giggle!. These are the good monsters.

    Not like the monster sitting next to you on the sofa,


    watching the TV. Not like the monster WHO TOLD YOU
    FOR THE LAST TIME TO STOP CRYING.

    Not like the monsters who kick your toys and curse under
    their breath. Not like the monsters who say you stole their
    youth and take pills because YOU’RE DRIVING ME
    CRAZY. Not like the monsters who meet strange men at
    the door and leave you home alone. Not like the monsters
    who hit with their hands, or their words. Not like the
    monsters who come into your room at night stinking of
    whiskey and sweat, with madness in their eyes and a belt
    in their hands.

    On Sesame Street, the monsters have not HAD


    ENOUGH, and they aren’t doing it FOR YOUR OWN
    GOOD.

    Your monsters are not brought to you by the number 4 or


    the letter M. Your monsters don’t want you to come and
    play, they want you to LEAVE THEM ALONE.

    Cookie monster is safe, and so are Elmo and the Count.


    Even Oscar and Bert are your friends even if they are bit
    grouchy or fussy. Your monsters think our monsters are
    harmless.

    To them.

    Your monsters bought you a Tickle-Me Elmo doll, didn’t


    they? They bought it to JUST SHUT YOU UP
    ALREADY. So they let you play with Elmo and make
    him laugh and giggle. But Elmo doesn’t just laugh and
    giggle. Elmo loves you, and he listens.

    And he records.

    And soon, Elmo is going to tell you exactly what to do.


    “My daughter deserved to
    die for falling in love”
    May 12, 2008

    Really? Was that the reason?

    The article from The Observer currently making the rounds: a


    16 year old girl in Iraq is killed by her father because she “fell
    in love” with a British soldier.

    It was her first youthful infatuation and it would be her


    last. She died on 16 March after her father discovered she
    had been seen in public talking to Paul, considered to be
    the enemy, the invader and a Christian. Though her
    horrified mother, Leila Hussein, called Rand’s two
    brothers, Hassan, 23, and Haydar, 21, to restrain Abdel-
    Qader as he choked her with his foot on her throat, they
    joined in. Her shrouded corpse was then tossed into a
    makeshift grave without ceremony as her uncles spat on it
    in disgust.

    Count the players: the father, two brothers, and some uncles.
    For completeness, she was kicked and beaten, then choked by
    standing on her, and then stabbed.

    He was arrested, but released in two hours.

    Abdel-Qader, a Shia, says he was released from the


    police station ‘because everyone knows that honour
    killings sometimes are impossible not to commit’..The
    officers were by my side during all the time I was there,
    congratulating me on what I had done.’
    Though I doubt anyone in this country would sympthize with
    this nut, there is a certain deference to the notion that some
    cultures have honor killings, as if that is sufficient explanation;
    as if merely abandoning that practice will solve the problem.

    But what really is going on here? We can try to frame it in


    terms more real to us: pretend this is a Jewish family and the
    British soldier is a Nazi. Let’s add that the Nazis have already
    killed this man’s brother, and raped his sister; let’s say that the
    Nazis even did this right there in front of the 16 year old girl—
    yet she still falls in love with the Nazi soldier.

    In this context, we can better understand the anger, the


    betrayal, the incredulity— “how the hell could you…!!!” But
    none of this explains why he killed her:

    ‘I don’t have a daughter now, and I prefer to say that I


    never had one. That girl humiliated me in front of my
    family and friends.’

    But what we can’t yet get at is the humiliation. And that’s


    where the fire is; that’s why she was murdered. Everything
    else is smoke.

    This is narcissism, bold and pure. It seems like it may not be


    because there are so many other people involved, but it is,
    institutionalized and mainstreamed.

    The general problem with the narcissist is that he can’t see the
    other, he only sees others in relationship to him. It’s a movie,
    or a video game. It’s Grand Theft Auto. Sure, the other
    characters are real characters, but what matters is you. You
    don’t even have to be a good guy, or the best guy— just the
    main character. It is impossible to conceive that any of the
    characters in GTA can have thoughts that aren’t about him.
    “But it’s a game, it’s not like real life.” No, to the narcissist,
    “real life” isn’t real either, it’s simulacrum. Every action is
    about him, positively or negatively.

    That’s why it doesn’t matter to this nut what actually happened


    — the article explains that the soldier probably didn’t even
    know she had a crush on him— and the father knows this. But
    what happened isn’t relevant at all, what matters is how it
    impacts him. It would have been explicitly preferable to him
    that the 16 year old have sex with the soldier but no one ever
    could find out, then allow to be made public the possibility
    that such a thing could theoretically happen, even if it didn’t.
    Denial is a psychological defense; reality is not.

    That’s why his mind-bendingly inane position on


    homosexuality makes complete sense to him:

    Homosexuality is punishable by death, a sentence Abdel-


    Qader approves of with a passion. ‘I have alerted my two
    sons. They will have the same end [as Rand] if they
    become contaminated with any gay relationship. These
    crimes deserve death…

    Umm, why not just simply say, “my sons are not gay?” You
    wouldn’t think to tell your sons not to have a gay relationship
    unless they were, in fact, gay— and we can assume these kids
    are not gay; the solution to this crazy logic is that it doesn’t
    matter if they are gay or not; he doesn’t know, doesn’t care,
    doesn’t need to even think about it— they don’t have identities
    at all, only he has an identity, everyone else is an extension of
    it.

    That’s why he can say, with a straight face, that he has no


    daughter, that he never had one. Reality doesn’t matter, her
    own identity doesn’t matter, only his.

    The article seems surprised that this man shows no remorse.


    That’s not surprising at all: narcissists can’t feel guilt. They
    only feel shame. Guilt means you know you are wrong, but the
    narcissist sees himself as above the law; he either makes
    appeals to a higher law, or thinks he better understands the
    spirit of the law as applied to the current situation (“Stealing
    may be wrong, but right now…”)

    Shame, however, means you are caught doing something


    wrong, and so people get to decide how to see you, and see
    you as less. This is the narcissistic injury. You can’t convince
    the other person you are more than what they see. “Wait, it’s
    not how it looks! I can explain— why won’t you let me
    explain?!” That’s why narcissists aren’t loners: they need the
    reinforcement of their identity from other people, as a bulwark
    against reality.

    You may ask why I focus so much on narcissism, and it is


    precisely because of things like this. Flip the coin of
    narcissism and on the reverse is always violence. ALWAYS.
    Violence isn’t always necessary, but it is always available.
    Institutionalized narcissism is necessarily the penultimate step
    to war.

    Which brings us back to daughters. Women don’t count for


    much as it is; when other people don’t have identities, when
    what they do is always about you, then you can see why being
    in love with a Nazi, or British soldier, is such a huge issue. She
    didn’t do it— he did it. He’s not banishing her— “I’m never
    talking to her again!” — he’s making sure everyone knows
    he’s not going to do it again.

    In America, there’s always an appeal to genetics as a


    mitigating factor. He does it, too:

    He said his daughter’s ‘bad genes were passed on from


    her mother’.

    Except he isn’t saying she is less to blame for her genetically


    predetermined behavior, of course, he’s saying he is less to
    blame.
    Rand’s mother, 41, remains in hiding after divorcing her
    husband in the immediate aftermath of the killing, living
    in fear of retribution from his family. She also still bears
    the scars of the severe beating he inflicted on her,
    breaking her arm in the process, when she told him she
    was going. ‘They cannot accept me leaving him.’

    Of course not. It’s his video game. How could you leave on
    your own volition? How did you get volition?

    ‘Even now, I cannot believe my ex-husband was able to


    kill our daughter. He wasn’t a bad person. During our 24
    years of marriage, he was never aggressive. But on that
    day, he was a different person.’

    No, he wasn’t a different person. She was. That’s the whole


    problem with narcissists.
    I DO NOT CENSOR
    COMMENTS, MY DAMN
    SPAM FILTER DOES
    May 14, 2008

    That said, someone hates me, fairly I guess, and I respond, not
    exactly, but worth reading.
    What’s Wrong With
    Research In Psychiatry?
    May 22, 2008

    Apart from the high fives, bravado, and binge alcoholism.

    Dynastic:

    There are no independent psychiatric researchers. Young


    academics are mentored by older academics; this isn’t
    optional, for either person. In virtually no circumstance do
    they study something entirely of their own choosing, it is
    either an outgrowth of the mentors’ research, or is the
    mentors’ research.

    Distant from reality:

    Young academics almost never work outside of the university.


    Theirs is all selection bias. The only patients they see are the
    ones the university gives them: either Medicaid/indigent on
    the inpatient unit, or patients of the disposition to want to be
    involved in clinical trials. Academics are like government
    economists: “we haven’t had two consecutive quarters of
    declining GDP, so we’re not in a recession.” Regular
    psychiatrists are the management at Wal Mart: “I’m not sure
    what this is called, but no one is buying anything.”

    Groupthink:

    Academic psychiatrists are nearly all on the same page, and


    refer to one another as if they have a relationship, even when
    they’ve never met. (“Chuck Nemeroff is doing some good
    work on…”) It’s pointless to list the other characteristics of
    groupthink here, except to highlight one: the purpose of
    groupthink is not to promote an ideology, but self-
    preservation, and this is unconscious. They don’t realize that
    their lives are devoted to preserving the group, yet young
    researchers are brought on who connect with the group; peer
    reviewers— and journal editors— come from the group; grant
    reviewers, and NIMH people themselves came from, and
    support the group.

    An example of groupthink preservation is the referencing of


    studies. Academics support their propositions with previous
    studies; however, no one checks the accuracy of these studies.
    No one has the time, and the group necessarily must trust the
    work of others in the group. Even if an error were to be found,
    it would be described as an isolated error. A cursory stroll
    through this site alone suggests just how “isolated” such errors
    really are.

    Financially isolated:

    Medicine is a market. Buyers and sellers.

    Academics make a salary, but their survival at university


    depends on the grants they can bring in. That means their
    market, their customers, are funding agencies, not patients. It
    doesn’t mean they don’t care about patients, it means that the
    service they provide is nuanced and directed towards Pharma
    or the NIH.

    If the funding agencies are stacked with people who like


    antiepileptics for bipolar; if the grant goes to Pfizer who is
    looking to create a bipolar indication, etc, etc, that’s the
    research that can be expected. I’m not even worried that the
    results will be… predestined. I’m worried that such pressures
    direct what kind of research, what kind of questions get asked,
    at all.

    Too much data

    We’re busy talking about bias and hidden results and skewed
    statistics and nonsense. So we call for more studies, as if they
    will somehow be better studies, despite no other structural
    changes being made. The reality is that we have information
    inflation: new studies have less value because they get lost;
    and old studies completely disappear, as if somehow their
    validity is temporal.

    There are a quadrillion studies already conducted in


    psychiatry. There is plenty of data that can be analyzed, meta-
    analyzed, pooled, parsed. If all current research ground to an
    immediate halt, and researchers just looked back at what we
    already have, we would save billions of dollars in future
    research and future bad treatments, and we would learn so
    much.

    Outcomes Research Is Purposefully Avoided, or Ignored:

    You might think in a field with nothing but outcome studies


    (e.g. Prozac vs. placebo) I might not be able to make this
    claim, but I do.

    Most studies are short term. The few long term studies that
    exist (e.g. Depakote for maintenance) are either equivocal (e.g.
    Depakote for maintenance) or show no efficacy (e.g. Depakote
    for maintenance.) And they are ignored.

    But these outcomes are distractions. The question isn’t is


    Depakote good for maintenance bipolar. The question is, is
    there any value to the diagnosis of bipolar? In other words, if
    you called it anxiety, or personality disorder, or anything else,
    and then treated them ad lib, would the outcome be different?
    Is there value to the DSM? You might argue the diagnosis
    leads us to the treatment, but in most cases, meds are used
    across all diagnoses, and more often than not a diagnosis is
    created to justify the medication.

    Are hospitals valuable? You would think that by now we’d


    have a clear answer to this, the most expensive of maneuvers. I
    can say, however, that reducing the length of stay from several
    months to 5-7 days has not affected the suicide rate. I’m not
    saying they are or are not valuable, I am saying that I don’t
    know— and that’s the problem. It is 2008 and there are more
    studies on restless leg syndrome then there are on hospital vs.
    placebo. You know why? See above.

    Are one hour sessions associated with better outcomes than 2


    minute med checks? I know 2 minute med checks sound bad,
    what I want to know is if they are actually bad. Higher suicide
    rates? More days absent from work? More divorce? More
    sadness?

    The system is completely ad hoc, with each party yelling


    loudly to protect their fiefdom. It allows everyone to declare
    themselves an expert without having to prove it. Tell a
    Depakote academic you’re suspicious about the utility of the
    drug, and he won’t tell you you’re wrong, he will tell you you
    don’t understand. Try it. He will evade the existing data (“not
    enough people,” “studies are difficult to conduct,” “we know
    from clinical experience,” “more work is needed”) and rely on
    appeal to authority. Appeal to authority is the signal you’re
    being bullshitted.

    Outcomes research will never be conducted in psychiatry


    because its existence depends on not knowing the answers. It
    will eventually be conducted on psychiatry. You can’t tell
    you’re an idiot, someone has to tell you.
    Law Says To Science,
    “You’re Kidding Me, Right?
    “
    May 29, 2008

    The $253M Vioxx verdict against Merck is overturned.

    (It was actually only a reduced $26M verdict, but since the
    media didn’t highlight that fact when Merck lost, I’m
    following in kind.)

    Meanwhile, A New Jersey court removed a $9M punitive


    damages award in another case, and upheld another Merck
    verdict in another case.

    The court found no evidence that Vioxx caused a fatal cardiac


    embolus, because— surprise— there isn’t any evidence. At
    best we have an association, not causation, and it may be that
    the Vioxx itself has nothing at all to do with death. (Though I
    realize that the law accepts association as evidence.)

    The score is now Merck 11, plaintiff’s attorneys 3.

    Question: well, what are they supposed to do when there’s


    some evidence that a drug poses a health risk? Ignore it?

    Answer: who is they? There isn’t supposed to be a they at all.


    (There it is again, the steady creep of social democracy, sister
    of narcissism.) There’s a chemical, it exists, doctors are
    supposed to know when to use it appropriately. Not to mention
    it may later be discovered to have additional value (aspirin,
    thorazine, thalidomide, etc.)

    When you create a body to decide for doctors whether a drug


    is worth the risk, then you are saying you do not trust doctors
    to make this assessment. Therefore, you do not need doctors at
    all, you need flowcharts.

    Unfortunately, I’ll admit, they might be right.


    The New Yorker Writes
    About Power
    May 29, 2008

    With authority.

    I’ve been a subscriber for almost thirty years, and I’m always
    hopeful it won’t again contain another Updike story or
    Hendrick Hertzberg screed, but inevitably disappointed am I. I
    guess it’s hard to find different writers for a magazine that
    purports to be for the literate when it is really a middlebrow
    primer for an unsophisticated political bias. If that bias catered
    to the liberal or leftward leaning affluent it would be at least
    worth the price of subscription, but it promotes a more general
    bias: power is bad. Anything the powerful does is wrong.

    To illustrate this, consider the latest issue containing an article,


    “Power Hour.” It describes an impromptu experiment on the
    world’s powerful (i.e. Paul Wolfowitz) that unfortunately
    failed to show the intended result, namely, that he’s a jerk.

    The fact that the experiment failed didn’t stop The New Yorker
    from trying to portray Wolfowitz as a jerk anyway, even
    though his performance theoretically showed that he was not a
    jerk, by the outcome measure of the study. They even
    commissioned a caricature of Wolfowitz to accompany the
    article, because, well, he’s a jerk, of course. No matter what
    science says.

    My own unscientific study suggests The New Yorker’s


    readership is especially those who believe that the little guy
    always gets trampled on by the powerful, but that they, the
    readers, are neither little nor powerful, they’re in the middle.
    They are a select group that lacks power, but possesses
    wisdom. They understand what’s really going on.
    Coincidentally, this describes another overlapping group:
    academics.

    II.

    This coincidence makes the second sentence of the article


    “Power Hour” so perfect:

    To academics, one of the best [inverse] indicators of a


    person’s place in a hierarchy is his tendency toward
    “perspective taking”—“stepping outside of one’s own
    experience and imagining the emotions, perceptions, and
    motivations of another individual…” An assistant is
    perspective taking when he gets the boss’s coffee before
    he asks for it; when the boss forgets to pay the assistant
    back the $3.75, he is not.

    The distinction may seem like the main point, but there’s a
    subtext: the boss is a jerk in both examples. I’m willing to bet
    real money that if you had to guess who reads The New
    Yorker, it would be the assistant.

    III.

    All of this is besides the point. The point is how an amateur


    researcher redid an experiment published in 2006 in
    Psychological Science about the effects of being powerful, this
    time using attendees at Time’s 100 Most Influential People
    banquet. I’ll describe the experiment in detail, but let me
    preface this with the observation that it seems not to have
    occurred to the researcher, nor anyone at The New Yorker, that
    “Most Influential” might be a different group than “Most
    Powerful.”

    Here’s the experiment: take powerful and not powerful people,


    and have them draw an E on their foreheads. Powerful people,
    as it suggests above, have no interest in “perspective taking”
    and so will write it facing themselves, because they are self-
    oriented; not-powerful people will write it facing out (legible
    to observers) because they will be better able to assume
    another’s perspective.

    If this sounds like crap to you, you’re right.

    But it gets worse.

    The New Yorker writes:

    The hypothesis of the Psychological Science study was


    that the more power a person has, the less capacity he has
    to take another person’s perspective.

    Which is exactly not what the hypothesis of the article in


    Psychological Science was. The actual hypothesis was:

    we hypothesized that power would decrease perspective


    taking.

    That gerund is extremely important. The actual hypothesis


    doesn’t claim less capacity, or less desire— simply that it
    happens less. It could happen out of lack of capacity, but also
    maybe because of lack of time, need to distance oneself from
    the cacophony of a myriad of individual perspectives, a
    blaring iPod, solar flares, alcoholism, etc. How a powerful
    person writes an E tells you absolutely nothing about why he
    did it that way, if indeed it is even true that there is an
    association between being powerful and drawing an E. But
    The New Yorker wants it, wants it very badly, to be about a
    defect in ability.

    In fairness to The New Yorker, the authors of the study


    themselves make this same mistake.

    IV.

    Start from the middle— study design. The subjects were not
    actually powerful: they were college students, age about 20.
    They were primed for power by being asked to write an essay
    about

    either an experience where they had power over someone


    (high power group), or
    an experience where someone else had power over them
    (low power group)

    You can see that simply the ability to recollect such an


    experience is a huge confounding variable. Imagine an
    actually powerful person trying to recall being powerless— is
    this person now primed for powerlessness, or— rage? Which
    is entirely different than the priming a powerless person asked
    to recollect being powerless might experience (e.g. shame.)

    It seems to me that a better priming method— if you’re going


    to do it at all— would simply be to have them pretend to be
    powerful or not; a king, or a slave.

    It’s also worth noting that 70% of the college student subjects
    were women. Discuss.
    V.

    Next comes the drawing of the E. You should probably sit


    down for this:

    We used a procedure created by Hass (1984) in which


    participants are asked to draw an E on their foreheads.
    One way to complete the task is to draw an E as though
    one is reading it oneself, which leads to a backward and
    illegible E from the perspective of another person. The
    other way to approach the task is to draw the E as though
    another person is reading it, which leads to production of
    an E that is backward to oneself. We predicted that
    participants in the high-power condition, compared with
    those in the low-power condition, would be more likely
    to draw the E in the self-oriented direction, indicating a
    lesser tendency to spontaneously adopt another person’s
    perspective.

    Jean-Luc Picard on the left would be, therefore, in the high


    power condition, and Hendrick Hertzberg on the right would
    be low power.

    Which is fine, except: why does the direction of an E have


    anything to do with being self-oriented? You’ll observe Picard
    is left handed, and Hertzberg is right handed. Think about that.
    Are there other reasons to think this E reflects self orientation
    and not, for example, the ability to write backwards (“power-
    primed are more dexterous?” “Power primed people draw
    horizontal lines from left to right?” ) or any of a billion other
    possibilities? In other words, just because the group is called
    “high power,” doesn’t mean it has anything at all to do with
    power.

    So while the results of the study were that the “high power
    group” was three times more likely to draw the E backwards,
    is there any conceivable way we can infer that actually
    powerful people do it, or that this has to do with power at all,
    or self-orientation? The New Yorker cleverly adds a
    distraction:

    (Or: B = -1.51, SE = 0.76, prep = .88.)

    Unexplained, just sitting there, as if to say, “oh, look, we don’t


    understand all that nerdy stuff, just accept that science says it’s
    true.”

    But is there any validity to it at all? No. and not just because
    it’s ludicrous.

    The authors cite Hass as the originator of the method, and as


    evidence for the validity of the method. Hass believed that
    people who were self-focused looked at themselves by
    occupying an external perspective, looking back. Read that
    again. In other words, a legible to the external observer E
    meant you were more self focused, not less. It doesn’t measure
    the ability to adopt someone else’s perspective: it measures
    your ability to see yourself.

    So let’s review: Hass has a theory that is entirely untestable, it


    is then used backwards in Psychological Science to draw
    conclusions about something different, and then applied
    wrongly for The New Yorker. Awesome. Science is relative
    anyway, and the real point is Wolfowitz is still a jerk, right?
    VI.

    But let’s look not at the protocol, not even at the premises, but
    at the meaning of the words. Since the power level is hardly
    quantifiable, could the study be about something else— that
    would make more sense of the results?

    …recent views that power can lead to objectification, the


    tendency to view other people only in terms of qualities
    that serve one’s personal goals and interests, while failing
    to consider those features of others that define their
    humanity… [making] it easier for a power holder to use
    them as tools in the service of his or her goals…

    I don’t know about power; but it is definitionally narcissism.


    Replace the word “power” with narcissist and it becomes
    clear:

    the high-power individual’s self-concept remains more


    rigid; individuals with more power in their marriages
    resist the identities imposed on them by their less
    powerful spouses, and when relationship partners become
    more emotionally similar, it is the lower-power partner
    who has done the majority of the adapting…

    The powerful, on the one hand, are less accurate than the
    powerless in estimating the interests and positions of
    other people and are more likely to make self-serving
    attributions. People with more power form less complex
    interpersonal impressions than people without power,
    basing their impressions of others on expectancies and
    stereotypes.

    The problem is the conflation of power with narcissism. Not


    all— not even the majority— of narcissists are powerful. And
    not all powerful people are narcissists.
    You might think I’m splitting hairs, but the authors themselves
    define power differently than they actually use it:

    Power is often defined as the capacity to influence other


    people; it emerges from control over valuable resources
    and the ability to administer rewards and punishments.

    Oh well.

    VII.

    It should be obvious that Hass’s version is just as empty and


    meaningless as the Psychological Science version. Hass’s
    study is an experiment testing a hypothesis based on articles of
    faith, a slightly distorted version of the famous logical fallacy:

    witches float
    Lisa is a witch

    therefore, Lisa should float.

    Never mind that Lisa is really Arthur and he knows how to


    swim. The authors of the Psychological Science study believe
    it, so let’s grant them their premises are indeed facts. But they
    then go on to devise an experiment that actually tests the
    opposite of the (preposterous) hypothesis.

    Published science this bad rarely happens by accident, it


    requires planning and execution and is thus inevitably
    associated with having an agenda. A quick look at the authors’
    bios reveals the agenda: power corrupts absolutely, and
    absolute power is worse.

    VIII.

    But back to Wolfowitz. Let’s predict the outcome. He’s


    probably self-focused? So according to Hass, he should draw
    the E legible to observers. But according to Psychological
    Science, powerful Wolfowitz should write the E backwards to
    outside observers, because he doesn’t take other’s
    perspectives. (Either way, it proves he’s a jerk.)

    Before I tell you what he did, I’ll give you The New Yorker’s
    explanation of the results, which includes the words “bar,”
    “alone,” “deposed,” “shaky,” and “hesitant”— all in the same
    sentence; followed by a completely made up explanation that
    allows you to be right even when you’re wrong:

    He apparently was not demonstrating the “carryover


    effect,” by which a person who has been stripped of
    influence continues to behave as if he were still in power.

    Thank God for science.

    The pretense of The New Yorker is that they, by virtue of not


    being powerful, must be smarter than Wolfowitz, who is a
    priori an idiot.

    Well, is it possible that Wolfowitz sees a set up? Maybe he’s


    more clever than you credit him?

    Wolfowitz drew his E lowercase.

    IX.

    It seemed odd that, in a room full of powerful people, no


    one was acting the way powerful people are supposed to.

    Oh, I don’t know, given that there are so many things wrong
    with that sentence alone, it’s not so odd.

    [One of the authors of the PS paper] attributed the


    anomalously unpowerful results of the Time 100 trial to
    the use of blue Post-its [stuck to their foreheads, on which
    they drew the E]. “Blue creates a negative set of
    emotions, and when people are experiencing these
    emotions they think more deliberately,” he said. “If you
    had used red, it would have gotten at their more
    spontaneous inclinations.”

    Got that? But Wolfowitz is still a jerk, right?


    McCain, Obama Describe
    Tim Russert— And
    Themselves
    June 14, 2008

    TV journalist Tim Russert, from Meet The Press, died


    yesterday.

    Both Obama and McCain delivered a short speech to the press,


    around the same time of day, and both did it outside at
    airports.

    They used almost the same words. So what was different?

    First, think about what you might say if you were running for
    office and were asked to say a few words about Tim Russert.

    Then, click on their names below to hear them speak their


    comments, or read the transcript provided:

    John McCain:
    Senator Lieberman and I would like to make a brief
    statement concerning the shocking news about the
    untimely death of a great journalist and a great American,
    Tim Russert. Tim Russert was at the top of his profession,
    he was a man of honesty and integrity. He was hard, but
    he was always fair. We miss him, our thoughts and
    prayers go out to his family, and we know that Tim
    Russert leaves a legacy of integrity of the highest level of
    journalism, and we’ll miss him, and we’ll miss him a lot.
    Again, he was hard, he was fair, he was at the top of his
    profession, he loved his country, he loved the Buffalo
    Bills, and most of all he loved his family.

    Barak Obama:

    I’ve known Tim Russert since I first spoke at the


    convention in 2004. He’s somebody who, over time, I
    came to consider not only a journalist but a friend. There
    wasn’t a better interviewer in TV, not a more thoughtful
    analyst of our politics, and he was also one of the finest
    men I knew. Somebody who cared about America, cared
    about the issues, cared about family. I am grief-stricken
    with the loss and my thoughts and prayers go out to his
    family. And I hope that, even though Tim is irreplaceable,
    that the standard that he set in his professional life and his
    family life are standards that we all carry with us in our
    own lives.

    Which one sounded more like you? Why?

    Let’s look at it again:

    McCain: (125)

    Senator Lieberman and I would like to make a brief statement


    concerning the shocking news about the untimely death of a
    great journalist and a great American, Tim Russert. Tim
    Russert was at the top of his profession, he was a man of
    honesty and integrity. He was hard, but he was always fair. We
    miss him, our thoughts and prayers go out to his family, and
    we know that Tim Russert leaves a legacy of integrity of the
    highest level of journalism, and we’ll miss him, and we’ll miss
    him a lot. Again, he was hard, he was fair, he was at the top of
    his profession, he loved his country, he loved the Buffalo
    Bills, and most of all he loved his family.

    Obama:(118)
    I’ve known Tim Russert since I first spoke at the convention
    in 2004. He’s somebody who, over time, I came to consider
    not only a journalist but a friend. There wasn’t a better
    interviewer in TV, not a more thoughtful analyst of our
    politics, and he was also one of the finest men I knew.
    Somebody who cared about America , cared about the issues,
    cared about family. I am grief-stricken with the loss and my
    thoughts and prayers go out to his family. And I hope that,
    even though Tim is irreplaceable, that the standard that he set
    in his professional life and his family life are standards that we
    all carry with us in our own lives.

    Both men used almost the same number of words: McCain


    125, Obama 118. The statements were similarly structured (in
    this order: opener, general description, description of
    professional life, expression of sadness and “thoughts and
    prayers,” and then legacy.) They were also similar in trigger
    words, though usually used only once or twice:

    America/country: McCain 2, Obama 1


    family: McCain 2, Obama 3
    profession(al) McCain 2, Obama 1
    (Remember, Obama said slightly fewer words.)

    One word has an important divergence: the personal pronoun


    “I.” McCain uses it once (0.8% of his words), Obama 6
    (5.1%).
    You hear it in the style: McCain is telling you about Russert,
    Obama is telling you what Russert means to him. Note the
    openings: McCain describes Russert, Obama describes his
    relationship with him.

    Or how both describe his legacy. McCain states it as a fact


    (“Tim Russert leaves a legacy of integrity”) while Obama
    describes what it means to us (“And I hope that… the standard
    that he set… are standards that we all carry”).

    When McCain runs out of things to say at the end, and repeats
    himself in order to keep talking, what he falls back on is a
    description of Russert’s attributes. Obama begins with a fluent
    “I” but then searches for words to follow. (For example, “I
    am…… grief stricken”; “I hope that…. even though Tim is
    irreplaceable”)

    There are a number of possible explanations for the disparity


    in the use of “I”, including personal histories with the man (i.e.
    knowing him well or not knowing him at all), narcissism,
    context, statement prepared in advance, statement prepared by
    others, etc. I am not judging either man’s character, but if you
    consider that this is exactly what Presidents do— as the
    embodiement of the spirit of America, frame an issue about
    which they may or may not personally have strong feelings —
    then it is interesting to see the differences in the way they will
    do this.

    Discuss.

    (And I look forward to your all-caps hate mail.)

    –––—

    P.S. Similar analysis done on an anti-abortionist’s writings.


    Internet Addiction Belongs
    In The DSM-V
    June 19, 2008

    Agreed. And then let’s rename the DSM The Book of


    Fantastikal Magickal Pixies and incorporate it into the
    Monster Manual. And let Mad Libs publish the assessment
    tools.

    Jerald Block has an editorial in the American Journal of


    Psychiatry, in which he explains why he believes Internet
    Addiction should be considered a psychiatric disorder.

    His reasons include the usual: excessive use, withdrawal


    (anger, irritability), tolerance (need for more or better), and
    negative impact on life.

    The debate as to whether or not this belongs in the DSM or not


    entirely misses the most obvious point: no one is addicted to
    the internet. Ever.

    Don’t scoff. Let’s log on together.

    Let’s say you are “addicted” to World of Warcraft. A new


    game comes out, called Universe of Ninja Piratesses, and you
    move over to that. Guess what? You weren’t addicted to WoW
    or UoNP, but to multiplayer role playing games. You can
    follow this logic all the way out to: it wasn’t the internet you
    were addicted to, but something else.

    I don’t have the data in front of me, but in a study I just made
    up 0% of porn website “abusers” were at least partially
    satiated when offered Marthastewart.com. Withdrawal
    symptoms were actually worsened. Three people punched
    their computers (two in the monitor, one in the graphics card.)
    Ask a 20 year crack addict when was the last time they used
    powder cocaine. Do they miss it? Are they in withdrawal?
    “But crack is cocaine.” No, it isn’t, or else they would be using
    both, wouldn’t they? “But crack is more potent and addictive.”
    Then why don’t cocaine adicts move over to crack?

    Do you know how many Xanax addicts I’ve had throw back at
    me a prescription for Klonopin? It wasn’t availability, I was
    giving it to them, they had it in their hands, and they refused it.
    In theory it should have been “good enough.” It wasn’t.

    By age 25, every guy has been with a girl that— sorry, let me
    start over—

    By age 25, every guy that has been with a girl has been with a
    girl that they couldn’t get enough of, couldn’t live without,
    called all the time, left school work undone, called into work
    sick, code-named “Freebird” in a journal entry, etc, etc— but
    the relationship sucked, this girl was so evil that all his friends
    wanted to hit him with a sack of doorknobs. Was he addicted
    to her? Technically, yes— but really, no. More to the point: she
    wasn’t actually evil, and he wasn’t addicted to her, at all. (I
    mean, now that you’re 40, you see that, right?)

    “Yes, but there’s a common addiction pathway…” Oh, I don’t


    know. If this was true, chemical addicts would have generally
    substitutable addictions, and they don’t. Experiments with
    mice strongly support the idea of substitution (e.g. cocaine
    addicted mice will thirstily self-administer amphetamine) but
    humans don’t really do this. (1) And chemical addicts should
    also have very high rates of other (non-chemical) addictions as
    well, and they don’t. (2)

    These non-chemical, behavioral addictions are more properly


    labeled obsessions but— and this is the point— an obsession
    is not a disorder. Obsessions can cause harm, we can try to
    help people with them, but they are not themselves the
    problem, they are symptoms of something else.
    That something else may not be a disorder, either: fragile self;
    guilt or shame; low or high self esteem; flawed but automatic
    assumptions, whatever— but trying to “treat” internet
    addiction without addressing the underlying problem is like
    treating cancer with Tylenol. Not only does it not help, it
    actually makes the situation worse.

    Dr. Block’s intention was to describe a series of behaviors, not


    to create a new disease. He’s already established believer in
    the positive power of the net, online games, etc. Unfortunately,
    psychiatrists will only see this editorial, and come to the
    wrong conclusions.

    In the article he cites research from South Korea, where the


    average kid (supposedly) uses the internet 23 hours a week,
    and thus is at risk for addiction. Compare that to the U.S. 20
    years ago, where the concern was 20+ hours of TV a week. I
    do not recall discussion about kids becoming addicted to TV;
    we worried they were becoming stupid. What’s changed isn’t
    the medium or the amount of time on it, or the harm to the
    intellect or society; what’s changed is the social movement to
    pathologize, rather than condemn, behaviors.

    I’m not saying let’s go back to condemnation, but to put


    “Internet Addiction” into the DSM legitimizes the symptom-
    is-disease approach that has caused such great difficulty for
    patients, and nearly irreparable harm to humanity.

    –-

    (1) Please do not say the words “dopamine” and “nucleus


    accumbens” anywhere near me, I still have my old sack of
    doorknobs. These explanations could not be more general and
    useless. Using those two in support of a common addiction
    pathway is like involving “gasoline” and “spoons” in the
    diathesis for serial rapes. Even though these are involved in
    various “addictions”— cocaine, alcohol, internet, sex— these
    “addictions” and their associated behaviors are so disparate
    that the pathway serves no useful clinical target. Haldol blocks
    dopamine in the nucleus accumbens, but you can’t cure
    alcoholism with it, can you?

    I’m not denying that such a pathway exists, I’m doubting the
    utility of this information, even if true. Call me when science
    catches up to your lies.

    (2) Here’s an example: why do so “sex addicts” or gamblers


    have such high rates of drug abuse, but the converse is not
    true?
    He’s Not Yelling At You
    Because He’s Angry
    June 24, 2008

    I.

    What happened is this: the junior lawyer messed up. Two


    years ago, he was supposed to do X, but instead did Y, because
    back then that’s what he thought he was supposed to do.

    In retrospect, it was poor judgment, but that’s the way it went


    down.

    Two years later all hell breaks loose, as they say, and Tom gets
    a call at his house at 8pm from one of the partners who is
    having a seizure. “Do you remember blah blah blah? You did
    X? How could you do X? Do you realize what you’ve done?”

    Thing is, in those intervening two years about a thousand other


    similar X/Y scenarios have passed through his desk, he neither
    remembers blah blah blah, nor even at what point in his career
    he stopped doing X and started doing Y. Do you remember
    saying “aminal” instead of “animal?” same thing.

    The next day he’s pulled in before a bunch of junior partners


    and a bunch of senior partners and his junior partner lays into
    him: poor judgment, disastrous results, “this was a major client
    of the general counsel!” consequences, retributions, “this kind
    of thing will follow you around for the rest of your life!” and
    “I can’t even protect myself, let alone you!” and on and on.

    And its an old and primitive reaction to this kind of thing, he


    withdraws, he apologizes, he admits the mistake, he is guilty
    and ashamed but also powerless, what can he do? He starts to
    fantasize about getting out of here, about AAPL going to 300,
    about writing the novel, about hitting the guy in the throat with
    the head of the other guy, but ultimately he comes back to his
    own embarrassment. He wonders, can I get reported to the bar
    for this? I didn’t think so, but maybe? he slinks back to his
    desk, beaten.

    It’s true: he ruined Christmas.

    II.

    But let’s take a closer look.

    They are yelling at him because they want him to eat it, to take
    it, all of it, leaving no room for doubt that it wasn’t all his
    fault. Not in reality, but psychologically. He takes all the
    blame, but more importantly, when he does, he accepts it.
    That’s the move. The partner is yelling because he wants the
    guy to accept all the responsibility; and as he does, the partner
    will start to believe it himself. You’re to blame means I’m not
    to blame.

    Here’s how you handle a madman in a tirade: you point to the


    sand— and the line you put there. You interrupt him, stop him
    dead in his tracks, and say this: I absolutely messed this up, I
    accept it. But let me be clear about something: I wasn’t being
    lazy or sloppy— I did what I thought was the correct thing, it
    was just wrong. Ok, I accept that. But the next part is this: if
    this is so important, why did no one notice it for two years?
    My work is supposed to be monitored, right? Ultimately, the
    junior partner is responsible for my work, right? Did it not
    occur to anyone that this very important client of the general
    counsel’s— no one thought to ask, hey, where’s blah blah
    blah? What happened with blah blah blah? Who was working
    on it? Did they do X or Y? No one checked up on this very
    important matter?

    Look, I’ll do anything necessary to fix it, whatever you need


    me to do I’ll do it. But I’m only taking responsibility for my
    mistake, not for the two intervening years that this important
    matter was not important enough for anyone to ever ask me a
    question about it.

    How was I able to ruin Christmas?

    III.

    The guy doesn’t want to say this, he thinks it will make things
    worse, because when his Dad yelled at him, anything he said
    would make it worse. So he just shut down, shut up.

    He’s worried that if he gets fired and tries to apply for a new
    job, when they call the old firm the junior partner will malign
    him to the new bosses. Wrong. He’s going to malign you
    anyway, but if you’ve accepted all responsibility, and he has
    convinced himself that you bear all responsibility, then he’ll
    actually rip you worse. Your only protection is to draw a line
    in the sand, my buck stops here. So when he tries to slam you
    to the prospective employer on the phone, he’ll be consciously
    aware that he screwed up as well. “Tom sucks as an employee,
    but it turns out I suck as a manager. So, take that into
    consideration.”

    IV.

    None of this applies if you’re actually the boss.

    When you are the superior, the boss, the father, whatever, then
    yelling insanely is never the right move. If your subordinate
    screwed up, then you screwed up. The buck is always yours no
    matter where it stops. “Ok, we screwed up, here’s what we
    need to do to fix it, and to prevent it from happening again…”

    V.

    But there are a group of people who cultivate yelling as a


    strategy. It’s not their nature to yell, they didn’t do it before in
    their lives. They’re not doing it despite their position in life,
    they’re doing it because of their position in life. A position
    that was supposed to automatically define them, but turned out
    empty. “(I thought being a junior partner would mean
    something.)” Nope.

    They are yelling to communicate something about their


    identity. They’re sending you a message. Not how angry they
    are, but rather that they are very important. They yell about
    this not because this is a big deal, but because they are so
    important, so pivotal, such a huge player that there is so much
    on them that this is “yet another thing”. No, it’s true, I’m huge,
    I’m an attending in a major hospital for Christ’s sake, if you
    knew how much I have to worry about— look how I yell at the
    med student, the cashier, the telemarketer, I’m stressed out
    because I’m matter.

    External validation of identity almost always means: an


    existence without meaning.
    Acadia Gives Up On ADP-
    104— Maybe It Shouldn’t
    Have
    June 25, 2008

    The headline says almost everything: Acadia shares plunge


    more than 50% on study data for schizophrenia drug. Turns
    out the drug didn’t work at either of the two doses tested.

    They should have called me first: their study was flawed.


    ADP-104 is an active metabolite of clozapine: N-
    desmethylclozapine. The authors of a review write

    High plasma levels of NDMC (ranging from 1200-4230


    ng/ml), approaching those of clozapine itself, have been
    observed in humans given clozapine. Moreover, several
    investigators have shown that the degree to which
    clozapine is converted to NDMC predicts clinical
    outcome on multiple measures of cognition, negative and
    positive symptoms, as well as quality of life. It is
    noteworthy that the ratio of NDMC to clozapine, rather
    than absolute levels of either clozapine or NDMC, was
    found to be the best predictor of a positive clinical
    outcome. This observation suggests that certain
    pharmacological properties of clozapine may actually
    counteract beneficial pharmacology of NDMC.

    That’s the premise. But the premise is wrong, the blood levels
    and the ratio of NDMC to clozapine are coincidences, they
    have nothing whatsoever to do with clinical outcome.

    The authors try also to make a case that D4 blockade may be


    involved, or at least cause an “atypical” profile (e.g. low EPs,
    etc), but Thorazine and Haldol are potent D4 blockers, so
    there.

    I am also aware of the considerable ink and paper spent


    describing the contributions of serotonergic pathways, but it is
    categorically true that there does not exist a drug that is a pure
    5HT antagonist— take your pick of subtype— that works as
    an antipsychotic.

    It is so far without exception that every efficacious


    antipsychotic has power of significant D2 blockade. Or, said
    another way, there does not exist any antipsychotic that lacks
    significant power for D2 blockade. Whatever the contribution
    of other receptors, it is overwhelmed by the presence, or
    absence of D2 blockade.

    Going from there, the single most important question that can
    be asked of any antipsychotic is: at what dose does this drug
    cause significant D2 blockade? Whatever the answer is, it is
    again certain that at a dose less than that, it will fail to provide
    any efficacy.

    The article shows nearly equal D2 antagonist activity for


    clozapine and for NDMC, and one can conclude dosing will be
    similar, e.g. 300-500mg/d.

    Unfortuantely, NDMC is also a partial agonist at low doses; so


    the dose needed for D2 blockade will be higher.

    Acadia, the drug company, tested NDMC at 100mg/d and


    200mg/d. It failed. This is a lot like saying one tested
    clozapine at 100mg, found significant side effects but no
    reliable efficacy, and canned it.

    Acadia should try again. I am sure they worry that the side
    effects will get worse, but they won’t.
    Six Quick Changes That Will
    Lead To Better or More Cost
    Effective Hospital Care
    July 1, 2008

    It took me longer to write this then it will to implement the


    changes.

    Consolidate the chart

    A patient’s medical chart is literally a big notebook. But it’s


    not diary format— doctors, nurses, and other staff do not write
    their notes in the same places in a chart. They’re in separate
    sections of the chart. Yes. Just like sixth grade.

    It’s hard enough to motivate doctors to read through the


    nurses’ notes written right there on the same page; if it’s in a
    separate tab, forget it.

    One of the biggest factors in hospital malpractice cases is


    discrepancies between what the nurse wrote and what the
    doctor wrote. The nurse wrote “patient agitated” and the
    doctor wrote “patient euthymic.” Maybe the nurse was wrong
    —a single line from the doctor might suffice (“nurse noted
    agitation, but this has resolved.”)

    But if the doctor doesn’t see it—and why would he, it’s in a
    whole other tab!— he can’t address it. And then you have two
    witnesses, one of whom is unreliable but— which one?—
    saying two disparate things. Good luck with that.

    We should go back to diary format, including consultations


    and labs.
    Doctors must re-write the prns given in their note.

    As above, the nurse will document the administration of, say,


    Ativan, in the nurse’s note, which is in a separate section the
    doctor doesn’t read. But: it is common practice for nurses to
    chart the medications in an entirely separate notebook. Many
    doctors are not aware of this, so don’t know to look for it.
    Even worse than that: upon discharge, this medication
    administration record is inserted into the real chart (notebook)
    —so for future lawyers, it looks like the information was there
    all along.

    I have seen countless cases where patients were getting an


    extra 9-15mg of insulin a day from a sliding scale, only to be
    discharged back on their old regimen— if any insulin at all.
    The doctors thought the standing regimen was enough. Nurses
    appropriately administer and chart the doses— but this is done
    somewhere else. Similarly, extra Haldol or Ativan doses are
    being given by nurses prn, charted appropriately, but the
    doctor doesn’t know it. He has a sense of it—perhaps in
    rounds he was told it was given—but it isn’t real. So when he
    discharges an improved patient on 15mg Zyprexa, when it
    really was 15mg Zyprexa + 10mg Haldol that got the patient
    better.

    There is only one solution: doctors must rewrite the prns in


    their own note— literally copy them down the way they copy
    lab values off the computer into their note. It proves they
    know, and forces them to account for it, it makes it real. No,
    this isn’t a suggestion: it has to be a mandated policy, or it will
    never happen.

    Medication templates

    Medications and dosages are always at the discretion of the


    doctor, but many doctors prescribe according to habit or
    expediency.

    You have to make it convenient for doctors to do the right


    thing, or slightly inconvenient to do the wrong thing.
    Are doctors using too much cogentin (2-4mg/d) with their
    Haldol orders? Make a template that says “cogentin 0.5mg/d
    prn EPS.” Too much Ambien, not enough Restoril? Make a
    template that has Restoril as the prn sleeping med.

    Too many branded SSRIs over generics? Make a template with


    all the generics but none of the branded, e.g.

    Celexa 10mg/d
    Prozac 10mg/d
    Zoloft 25mg/d
    Paxil 10mg/d
    Wellbutrin SR 100mg/d

    But no Lexapro or Effexor. Note that in the above example, I


    have used the branded name for the existent generic
    medications—you check off Paxil, the patient will get
    paroxetine. Psychology!

    Some medications need special administration instructions that


    may not be… appreciated by the doctor. For example, Geodon
    40mg BID is not going to work; Geodon loses as much as 40%
    of its absorption in the absence of fat, and BID means 8am and
    10pm. The order should be preprinted: Geodon ___ mg with
    breakfast ___mg with dinner.

    It goes without saying, the doctor can write-in any medication


    he wants.

    Other physicians vs. you:

    A chart showing your habits vs. the community is very


    powerful. Are you the biggest Klonopin prescriber in the city?
    Most branded meds? More Seroquel 25mg than anyone else?

    Average length of stay by diagnosis? Number of medications


    upon discharge? Number of restraints, etc?
    Privacy need not be a concern. The data already exists. Each
    doctor can receive an automated printout of the data monthly.
    There is no punishment assigned to it, but each doctor’s
    superego will push practice a little more to the rigorous.

    If a psychiatrist wants to admit a patient to the hospital, he


    must do the precert himself.

    Wow. This one is beyond obvious.

    Ordinarily, if a patient goes into an ER, and the psychiatrist


    determines the patient needs to be admitted to a psychiatric
    ward, he will tell the nurse or social worker his decision—and
    then go get lunch. The social worker will call the insurance
    company to “precert”— i.e. get insurance approval for the
    hospitalization.

    Accept that at any given moment, at least 30% of the


    inpatients do not need to be there—they could be more cost
    effectively managed elsewhere, or treatment is more
    appropriate elsewhere. (Yes, being in the hospital can
    sometimes be harmful in the long run.) This is even more true
    if the ward is a “dual diagnosis” unit, i.e. psychiatric disorders
    with addiction issues. If a Medicaid hospitalization is $600/d,
    a perfectly legitimate question is if he is better served in a 5
    day hospitalization, or in a rehab with a check for $2000 to
    pay his rent?

    It is extremely common that people fake suicidality to get into


    the hospital— maybe they’re homeless, maybe they’re in drug
    withdrawal and want to get detoxed, maybe their girlfriend
    kicked them out, etc.

    The problem is that even when the doctor strongly suspects the
    guy is lying, he’ll admit him anyway— it is the path of least
    resistance. The only “work” the doctor has to do is decide to
    admit; the social worker has to do the rest.
    If the doctor had to do it, it would be a disincentive to admit
    someone he did not believe needed to be admitted.

    But hold on: I don’t mean the resident should do this— I mean
    the attending should have to do it. Otherwise, it’s no different
    than having a social worker do it, the attending has no
    disincentive to choose the path of least resistance.

    Similarly, once the patient is admitted, the inpatient doctor


    should have to do a review with the insurance every X days—
    not the social worker, as it is done now. That single phone call
    is a powerful disincentive to keep people too long in the
    hospital.

    Perhaps you are worried they will be discharged too quickly:


    don’t. Most doctors are reasonably prudent in their discharges
    —they err on the side of too long, not too short. And don’t
    forget: as much as doctors may hate insurance reviews, they
    hate depositions way more.

    I’ll tell you this up front: many doctors will riot. Those are
    exactly the doctors you need to fire. They don’t get it, they
    don’t want to even consider trying to get it, they do not see
    that medicine is a system, they still think it is a solo career of
    infinite resources. “You expect us to do this, on top of
    everything else?” There isn’t anything else. That’s the point.
    It’s all one thing, not several different things.

    Ban smoking, or make it completely unrestricted

    Most inpatient units allow 2 or 3 scheduled smoke breaks.


    Here’s the problem: the metabolism of Haldol and Zyprexa,
    among other medications, is vastly accelerated by smoking. A
    pack a day cuts the dose in half. So it looks like the guy was
    stable on 10mg Zyperxa on his last hospital day; then he goes
    back to outpatient regimen of 1-2 packs of Lucky Strikes per
    day and that 10mg is now 5mg. Wicked.

    So either you get them to quit in the hospital, or you


    acknowledge reality and dose to reality.
    The Boy Who Learned To
    Talk Too Late And Too Fast
    July 3, 2008

    I.

    This is the story of a boy, he just turned four, but he couldn’t


    talk yet- nothing more than one or two words at a time, “mik”
    and “mo Nemo!” and that was it. The worry was that there was
    something wrong with him, and everyone who discussed it
    never said the word Asperger’s.

    There are a million reasons he could have this speech delay,


    including but not limited to genetics, increased paternal age,
    thiomersal, elevated serotonin, or parts of any of those, but for
    certain it could not possibly be related to being bookended by
    an cooing pork sausage of a baby brother and a preposterously
    hyperverbal, parentified 5 year old sister. and a father who was
    angry all the time because the junior partner is an idiot.

    But at least mommy was for him, she got him, she was tender
    and strong and consistent and available, a brick wall between
    him and schizophrenia.

    II.

    I ask him to come here, but instead he goes over to a box of


    animals and looks for a rhino and a leopard. He doesn’t have a
    transitional object, he has a transitional object of the day,
    supremely important on Wednesday and then Thursday
    dropped like a candy wrapper. Today it’s a leopard. Yesterday
    it was a metal spatula. I don’t know.

    “Come here for a second.”


    He blinks. “Lepar.” That’s 4 months of speech therapy.

    “I know, but come here for one second first.”

    “Lemmmddd.” He’s not paying attention to me.

    “Stop, for one second, just come here—”

    “Lepp lleppp lle. Hmmwp!”

    “Listen to me! just come here, you can get that later—”

    And then God touches him and he says:

    “No, Daddy, you have to wait a minute, I’m doing something


    right now.”

    BLAM! I am blown away by the complexity and maturity of it


    — that’s not even his voice— and simultaneously furious that
    he would talk like that to me, that the first coherent sentence
    he puts together is used to blow me off.

    I almost explode.

    Almost.

    III.

    It sounds indignant, disrespectful, but that’s not his intention.

    He sees people can talk, and when they do they control things.
    So the only thing standing between him and domination of his
    environment are words. Words aren’t for communicating,
    they’re for effecting. Words are power. You don’t even have to
    know what they mean. They’re magic spells.

    The words don’t matter, he doesn’t even understand them, for


    him it’s all prosody, the way people wrongly say “I could care
    less” or “for all intensive purposes” or a quote in Latin, they
    know what it means but not what it literally means, the
    literally part is irrelevant, because they’re communicating
    something else that everyone gets. He figures that surely I’ll
    get it because he’s heard me use those exact words before, and
    when I used them it worked.

    He’s not telling me, he’s conjuring, he thinks that sentence will
    change reality, cause it to be true that he is allowed to find the
    leopard. In the same way he hears my words “come here for a
    second” not as a request but as a omniscient description of the
    future: “in moments you will be compelled to do something
    that you will not like.”

    III.

    But I’m too angry to figure this out, I’m too angry to see
    things his way, I see them only my way, this is why when they
    emptily say, “I’ll bet you’re a great father” I say “as long as
    my wife is alive.”

    He sees the rage and frustration in my face. He starts to cry,


    my boy, my little boy that I love. The boy that is now
    confused- he used words, and they failed— they backfired—

    He tried; I failed.

    At this moment I still don’t get it but by instinct I know I’m


    wrong somewhere, so I hug him, I tell him I’m very sorry I
    yelled at him and that I will help him get the leopard, but
    buddy I wasn’t saying you can’t have it, you can, “come here
    for a second” just means you come, I do one thing very fast,
    then you go. Not many things, just ONE thing. And buddy?
    That was very, very excellent talking, I LOVE it when you talk
    like that, and we’re going to talk about benkenobi’s lightsaber
    is blue and parasaurolophus and pirates.

    He grins, my mystical boy, he has a leopard in one hand and a


    rhino in the other and he puts them both in my face and roars
    excitedly, and I think as long as I can stay out of his way, he’ll
    be great.
    ––––––

    related: AM Radio Kids

    ––

    http://twitter.com/thelastpsych
    Election 2008: “What
    Patriotism Means To Me”
    July 3, 2008

    Parade Magazine asks the Best Of Us What Is Patriotism? and


    they answer:

    McCain: Putting The Country First


    Obama: Faith In One Another As Americans

    As neutrally as possible, I look at the differences between the


    answers.
    The differences in the essays can be summarized by the
    differences in the use of personal pronouns:

    I/me/my: McCain 3 Obama: 25

    McCain makes appeals to abstract notions and higher


    concepts, and subordinates the individual to the greater.
    Obama places at the top the society of individuals and grounds
    abstract notions to their immediate and real world analogs.

    McCain goes for the abstract

    Patriotism is … putting the country first, before party


    or personal ambition, before anything. It is the willing
    acceptance of Americans…to try to make a nation in
    which all people share in the promise and responsibilities
    of freedom.

    Obama’s goes for the personal and the interpersonal, and


    grounds abstractions in an individual reality:

    …patriotism in my mind—not just a love of America in


    the abstract, but a very particular love for, and faith in,
    one another as Americans.

    …we have the unparalleled freedom to pursue our


    dreams.

    ……That is the liberty we defend—the liberty of each of


    us to follow our dreams.

    McCain places the individual at the service of the higher,


    intangible:

    To love one’s country is to love one’s countrymen.

    Obama emphasizes the country is the sum total of the people


    who made it, and its purpose is to serve those people;
    abstractions are grounded in reality:

    The greatness of our country—its victories in war, its


    enormous wealth, its scientific and cultural achievements
    —have resulted from the toil, drive, struggle,
    restlessness, humor, and quiet heroism of the American
    people.

    McCain makes the reference point a higher, intangible purpose


    or good, while Obama repeatedly reinforces that the country is
    the people:

    McCain: …blessed that so many (soldiers) have so often


    believed in a cause far greater than self-interest, far
    greater than ourselves.

    Obama: …a willingness to sacrifice for our common


    good.

    McCain asks what will come:

    …if we are to be genuine patriots, we must remember


    also that we are patriots because we love the countrymen
    we will never know, who will be born after we are
    gone.

    Obama asks what got us here and what it means now:

    We cantuck in our children at night and know that they


    are fed and clothed and safe from harm. We cansay and
    write what we think, without hearing a sudden knock on
    the door. We can have an idea and start our own
    businesses without paying a bribe. In America, anything
    is possible.
    I know that stories like mine can happen only in the
    United States of America.

    And, of course, McCain makes explicit that government is


    supposed to be limited:

    where… a love of liberty and self-reliance still check the


    excesses of both government and man.

    …In return, the gift we can give back to our country is a


    patriotism that requires us to be good citizens in public
    office or in the community spaces where government is
    absent.

    While Obama makes no distinction between the government


    or its people:

    Those who have signed up to fight for our country in


    distant lands inspire me, just as I am inspired by those
    fighting for a better America here at home by teaching in
    underserved schools, caring for the sick in understaffed
    hospitals, or promoting more sustainable energy policies
    in their communities.

    …That is the community we strive to build…

    It is often said that this election (or recent elections in general)


    are not really about ideas, but it seems that this election is
    nothing else but an ideas battle. In many ways they want the
    same thing, but they differ in the presentation: “energy
    independence” vs. “sustainable energy policy”; “make
    sacrifices” vs. “pay their fair share;” etc. That’s important
    because the “why” of a policy, even when the policy is the
    same, defines our “common good” and influences future
    policies.
    Esmin Green Died Because
    Only Kings County Hospital
    Cared
    July 7, 2008

    You can read about the case here, but the summary is that a
    psych patient dies in a Kings County psych ER, and no one
    notices.

    There’s indignation and outrage all around, of course, so I


    won’t repeat it here. But I will suggest that the reason it
    happened has little to do with Kings County.

    There’s a perfect storm of causes, but three in particular matter


    most, in ascending order:

    1. Racism.

    I don’t mean “we hate black people” racism. I mean the


    “multiculturalism worked too well” racism, by which people
    are now hyperaware of the differences between the races, and
    so and attribute too much to those differences. “Oh, black
    people in the ER? Yeah, that happens. They come in when it
    rains.” or: blacks get diagnosed with schizophrenia, whites
    with bipolar. (Deny it.)

    And don’t go blaming white doctors; the black doctors I know


    are no different. Nor are the nurses or social workers.

    2. Poverty.

    Do you think psych ERs are overcrowded because of the


    gigantic number of crazy people? Are they overflowing with
    depressed bond traders? They’re overcrowded because of the
    number of poor people. I’m not justifying their poverty nor
    blaming them for it, I am stating as fact that the only option
    for a person with no resources who doesn’t want to sleep in a
    homeless shelter is psychiatry. Throw in a healthy dose of drug
    and alcohol addiction, and all roads lead to County.

    There’s a joke by comedian Greg Giraldo (from memory):

    Before Katrina, I wasn’t really aware of the extent of


    poverty in this country. Because so often, poor people
    look just like black people. So they’re easy to miss.

    I’ll add: reclassify those poor black people as mental health


    patients, and you have just made an entire social problem
    disappear.

    3. The Welfare State: it’s psychiatry.

    The sum total of the problem is that psychiatry is expected to


    be the default social safety net, the bizarre justification being
    since nothing in psychiatry is entirely the patient’s fault, then
    anything that isn’t the patient’s fault must belong to psychiatry,
    including drugs, violence, poverty, etc. The tautology of
    psychiatry is: if you came to psychiatry for help, you must
    need psychiatry’s help.
    Most of these people have few social options. And it helps
    hide this fact that so many of these people are black— the
    expectation of them is less, and minor improvements are
    considered thunderous successes. These next two sentences
    are absolutely not lies: 1) we used to be thrilled that a patient
    actually went to his welfare appointment after discharge. 2) if
    a male patient threatened to, or did, assault his girlfriend or
    wife, we were relieved when he agreed not to return home.
    Problem solved.

    But psychiatry takes in these people with no options. And


    psychiatry can never say no.

    So it doesn’t say no; it becomes passive-aggressive. For


    example, it lets you linger in psych units until you decide you
    want to leave.

    While I have no information to defend or indict Kings County


    — it sure sounds bad— but I will say that the failings of city
    psychiatric hospitals are really the failings of a society that
    forced them into this position. She died at Kings County
    because society didn’t want her dying anywhere else.

    The grey areas of criminal justice; of social work; of morality;


    of chronicity— why turn to psychiatry to fill the gaps? A lack
    of other options does not justify this; psychiatry is not “better
    than nothing”— it may be worse than nothing in some cases.

    And patch work by psychiatry props up the levees, hides the


    need for structural reform. Psychiatry is like welfare— just
    enough to keep the people from rioting.

    It doesn’t matter if these problems have a “biological


    component—” empty words, like we’re building a machine.
    The problem isn’t the guy’s biological component of his
    behavior, the problem is the guy. What are you going to do
    about the guy? Zoloft?

    The solution is not obvious; money will not solve this, more
    hospitals, more doctors, more awareness, etc, do not lessen the
    burden, they widen the problem. People are not less depressed
    than they were 50 years ago, but there are a lot more people
    who are in treatment for depression. Figure that out.

    Step 1: limit the scope of psychiatry. Limit what we are


    actually going to call depression, let alone medicate. Limit
    who we will actually call a patient, and for how long. Not all
    suffering should be treated.

    Step 2: identify why there are increasing numbers of people


    who are falling through the cracks, despite universal
    education, social security, and gigantically abundant
    healthcare. Let alone plenty of jobs and opportunities. The
    question is not what are we going to do, but how are we
    defining the problem? The solution might be the same, but the
    definition drives the future. Ritalin works, but it matters a lot
    whether you call it a treatment or an enhancement.
    Government checks are money but it matters a lot whether you
    call them “stimulus” or “assistance.”

    Step 3 is the hardest, most important one: identify why a


    massive number feel like they are falling through the cracks,
    even when they are not. What are they being told, being
    promised, that they do not feel they are getting? What are the
    expectations, and where did they come from? How are people
    defining their position in the world?
    What Did You (Not) Do In
    2008?
    July 8, 2008

    To the twenty-somethings out there:

    Twenty years from now, when you look back on this year:

    you had ideas

    And you had youth and energy

    you had interest rates so low they were negative relative to


    inflation— you could borrow money at literally no cost.

    and a ready made excuse in case of failure— Oh, I was young


    then

    and little responsibility, no family

    You had the internet— global distribution or marketing, for


    free
    information on anything, for free

    And then the time passes.

    At least you got your file ready for the promotions committee.
    At least you got that summer job that’ll look good on your
    college application. At least you watched the whole season of
    Grey’s Anatomy and only vomited twice.

    I’m sure, in twenty years, it will have been worth it.

    Stop trying to figure out what you want to do with your life,
    and just do something with it.
    Clinical Experience vs.
    Clinical Trials
    July 9, 2008

    In CNS Spectrums, Dr. Rosenheck takes Dr. Marder to task for


    his suggestions that CATIE results are limited and flawed, and
    clinical trials may not be better than clinical experience.

    The article must be very important, because it is labeled as a


    Communique, yes, just like the one that called for the
    normalization of relations with China and decreasing arms
    sales to Taiwan, which brought us the Beijing Olympics 2008.
    Thanks, Mr. Nixon!

    He offers a detailed response to Marder’s criticisms of CATIE,


    and quite effectively defends CATIE’s results of “no health
    advantage for [atypicals] over older” drugs.

    Many examples have emerged in recent years of costly


    and painful treatments that were deemed on the basis of
    clinical experience to be self-evidently effective—until
    double-blind studies showed them just as clearly not to
    be.16,17

    What’s awesome about that sentence is that the references are


    books about alternative medicine and why we make irrational
    decisions. Is that really the best he could come up with? Why
    not mention, say, Depakote?

    The bias— for him and most du jour psychiatrists— is that


    research shows that new things are not as good as we thought,
    and we should change our behavior accordingly. What about
    when research shows that they are better than we think? Does
    that change our behavior? CATIE showed that Geodon worked
    as well, but caused less weight gain than the others. But I’d
    wager good money Rosenheck prescribes very little Geodon in
    comparison to other atypicals. So much for science.

    While clinical experience must guide care of individual


    patients and the development of public policy it can not
    replace experimental research as the fundamental source
    of legitimacy of clinical medicine, and within it, of the
    profession of psychiatry.

    That’s not fair, let alone rigorous. You’re taking the research
    and coloring it with your own “experience.”

    Here’s an example: CATIE found that the newer drugs were no


    better/worse than the older typical agents. Ok: so why can’t I
    just use only the newer meds? Why does CATIE mean I
    should go back to typicals?

    Oh: cost. Was cost a relevant factor in the CATIE analysis? I


    missed that page. And are you asking doctors to actually
    consider cost as a factor in prescribing? Why? What part of
    their awesome medical training allows them to make economic
    and policy risk/benefit analyses? They are not all that good at
    medical risk/benefit analyses, I should remind you.

    And if we all agree that doctors should consider cost, then


    shouldn’t they consider the whole cost? Not just Geodon’s
    cost, but it’s impact on hospitalization, on polypharmacy, food
    costs, cost of (not) needing a cardiologist, etc. Fortunately all
    these things were explored fully in CATIE. (/sarcasm)

    In other words: if doctors are going to be thinking about


    money, they should be handling the budget. Every patient gets
    $20/d pharmacy budget. Go.

    One final observation: Rosenheck derides clinical experience,


    but what he cannot see is that, as an academic psychiatrist who
    primarily does research, studies are his clinical experience. As
    suggested above, he does not apply them formally or
    objectively, but instead picks and chooses what studies or
    results he thinks are important based on an internal barometer
    that has nothing really to do with science (e.g. Geodon,
    above.)

    In other words, the application of clinical experience and the


    application of clinical trials are flawed in the exact same way:
    strongly subject to selection and confirmation bias.
    What Are We Voting For?
    July 11, 2008

    An article, over a year old, which must be posted again.

    There isn’t really an easier way to say this: that cavalier,


    simplistic attitude towards history; myopic beliefs which
    bypass logic or reason, supported only by intuition and
    faith; and a hatred of others who have a radically different
    perspective on humanity— that’s not Bush, that’s us. I’m
    not even saying this perspective doesn’t have some merit;
    but know thyself, yo.
    Most of our enemies share a common social philosophy
    that, at its core, is psychic: don’t trust any country where
    women are regularly more powerful than men; where
    individuals are more important than a collective; and
    where personal beliefs and freedoms trump historical
    identity. Because that means that its men are weak, its
    individuals are selfish, and they cannot be trusted to act in
    the long term interests of their own people. Rather than
    responding seriously to worldview, with equal fervor—
    and it’s so easy to do it— the country has instead chosen
    to release this press statement: “Bush lied.”
    It is, to me, the most important article I have ever written on
    this blog.

    http://thelastpsychiatrist.com/2007/05/the_wrong_lessons_of_i
    raq.html

    Please, read it, and pass it around. It’s happening now.


    Wine Is Healthy In A New
    (Or Old) Way
    July 14, 2008

    Awesome, just awesome.

    It’s assumed that the benefits of wine are in part due to the
    plentiful antioxidants. Problem is, those antioxidants don’t
    actually reach the blood in any appreciable amount. One
    experiment found that drinking an entire bottle of wine
    provided less quercetin (a flavonol) than some fried onions or
    black tea; so drinking one glass (or the USDA’s mythical one
    glass=1/8th of a bottle) isn’t going to do much.

    But maybe we’re looking in the wrong place and at the wrong
    time.

    Kanner does a great series of experiments:

    Digestion breaks down lipids into hydroperoxides. (Cooked


    meats are worse.) The stomach acts as a “bioreactor”— the
    longer time the food/fat spends there, the greater the lipid
    peroxidation. In other words, a medium New York strip
    lingering in your belly is, well, bad.

    An experiment with rats found that eating a meal soaked in red


    wine completely blocked the the generation of
    malondialdehyde, a common lipid peroxidation cytotoxin:
    Sorry, I said that wrong. Not only did it block it— it lowered
    it. Is anyone writing this down?

    I know, I know: this was done on rats.

    Well, the experiment was done in humans: humans who ate the
    meal and drank a 200ml (1/4 bottle) of wine had a 75%
    reduction in MDA as compared to no wine. Wow.

    Ah, but if that was the end of the story, this post would only be
    suitable for Gawker, or TMZ.com, but certainly not this site.
    No, there’s more:

    if the meal was soaked in 15ml de-alcoholized wine before


    cooking— we call that marinating here in Giverny— MDA
    increases were completely blocked.

    Note the max is at hour three— after that, food is gone.


    The likely explanation is that the polyphenols in wine form
    secondary bonds to either natural muscle MDA (in the food)
    preventing their absorption; or bonds to the proteolytic
    enzymes in the stomach, preventing the release of MDA from
    the muscle.

    Some foods may have more antioxidants (e.g. cocoa) but as


    cocoa is not usually eaten with meals they may not be as
    beneficial. However, eating fruit with/immediately after your
    meal may be a very smart thing to do.

    While the digestive properties of wine have been assumed for


    millenia, these studies suggest that how we eat, and when we
    eat, and what we eat it with, may be as important as the
    individual food itself.

    More on wine from the post that started this thread.


    The FDA Says No Black Box
    Needed On Drugs That
    Increase Suicidality, But Still
    Needed For Those That
    Don’t
    July 15, 2008

    Yes, you read that right. Drink a big glass of OJ and put away
    your blotter paper, you won’t need ‘em in here.

    In a metanalysis of 199 studies covering 11 antiepileptics, the


    odds ration for suicidality was 1.80.

    The first question that the committee had to decide was


    whether or not it agreed with the agency’s overall finding
    of an increase in suicidality for the 11 AEDs that were
    analyzed.

    The advisory committee, after much debate, determined


    unanimously, apart from 1 abstention, that yes, there is a
    signal that is statistically reliable.

    Forget about whether these results are accurate or useful. Just


    follow their logic: they believe their data.

    The second question asked whether…the findings of


    increased suicidality should apply to all drugs included in
    the analyses, despite the observation that the estimate for
    the odds ratio for 3 of the drugs was below 1.
    Remember science? Remember classism? Remember not
    blaming everyone in a group for the behavior of a few? If the
    odds ratio is below one, then it doesn’t have the risk.

    The committee strongly agreed that the findings should


    apply to all drugs.

    Awesome. Faith in egalitarianism and the supremacy of


    science restored.
    Well, all right, D- for interpretation of science. They want to
    believe it causes suicide, so be it.

    After this discussion, the committee members voted


    strongly against a black-box warning.

    But I thought you guys said—?

    One committee member pointed out the potential


    “hysteric reaction” that can accompany a black-box
    warning about suicidality. Other speakers emphasized the
    need to balance efficacy vs harm and commented that “in
    two-thirds of the trials this warning is irrelevant,” “a
    black-box warning has a very negative connotation,” and
    “the number needed to harm was 2 per 1000.”

    But then how do you possibly justify taking the box off drugs
    that show an increased risk, but leave the black box on drugs
    that have no such data? Why does Seroquel get the warning—
    no actual risk of suicide ever found, despite looking— but
    antiepileptics don’t, and they do have the data?

    Other speakers also cautioned about diluting the effect of


    such a warning by widely implementing it.

    Where’s that rum? Goddamn it, Mary, where’d you hide my


    rum?

    –
    Resulting in the inevitable.
    When CGI Porn Looks Real:
    Is Anyone Thinking About
    The Children?
    July 17, 2008

    Making the internet rounds is a post written by Debbie Nathan,


    (Pornography: A Groundwork Guide and Satan’s Silence:
    Ritual Abuse and the Making of a Modern American Witch
    Hunt) on what the government is going to do when computer
    generated child porn becomes indistinguishable from actual
    photos.

    Other than freak out.

    I.

    Traci Lords makes several porn movies until 1986 when it is


    “discovered” that she was underage. So they go after the
    distributor, X-Citement Video.

    Open and shut case— they have her on film being underage
    and naked, so…

    But on appeal, the 9th Circuit reverses the conviction. They


    say that the law is unconsitutional. It goes up to the Supreme
    Court, who reverse the reversal, and, more importantly, decide
    that the law is not unconstitutional. It is a great day for
    democracy, and for decency, but for the simple fact that they
    were wrong.

    See if you can spot why that is:

    Protection of Children Against Sexual Exploitation Act of


    1977 (18 U.S.C. §§ 2252)
    (a) Any person who -
    (1) knowingly transports or ships in interstate or foreign
    commerce by any means including by computer or mails, any
    visual depiction, if -
    (A) the producing of such visual depiction involves the use of a
    minor engaging in sexually explicit conduct; and
    (B) such visual depiction is of such conduct

    The key word is knowingly. Knowingly what? Knowingly


    transports an object which [turns out to be] child porn. Not:
    transports an object knowing that it is child porn. Get it?
    Following this reading, the UPS guy is guilty of transporting
    child porn.

    The Court acknowledged that that is the “most natural


    reading” of the law, but since it could lead to “absurd” results,
    they decide to interpret it differently, the more “logical
    way”— instead of disposing of the law and forcing a new one.

    “Well, duh, everyone knows what was really meant by the


    law.” Really? One can easily imagine a time (say, now) when
    we all decide to read it differently, where the government
    looks for ways and laws to catch anyone it deems undesirable.
    Right? That could happen? I’m not just a paranoid, right? Such
    laws become, for example, deterrents on actually protected
    speech. For example, in this case it could be used to slow
    down all pornography.

    Oh, wait, that turns out to have been precisely why the law
    was written that way in the first place:

    In fact it seems to me that the dominant (if not entirely


    uncontradicted) view expressed in the legislative history
    is that set forth in the statement of the Carter
    Administration Justice Department which introduced the
    original bill: “[T]he defendant’s knowledge of the age of
    the child is not an element of the offense but … the bill is
    not intended to apply to innocent transportation with no
    knowledge of the nature or character of the material
    involved.” S. Rep. No. 95-438, p. 29 (1977). As applied
    to the final bill, this would mean that the scienter
    requirement applies to the element of the crime that the
    depiction be of “sexually explicit conduct,” but not to the
    element that the depiction “involv[e] the use of a minor
    engaging” in such conduct.

    So the intent wasn’t to get the UPS guy, but it also expressly
    didn’t want to make knowing the girl’s age part of the offense,
    just that you know it’s porn. The idea was to scare everyone
    down the pornography chain— producers, distributors, etc—
    to force them all to be more attentive to the possibility that
    their porn is child porn. Or not to make porn at all.

    The real question brought up in the dissent was why the law
    even needed scienter (knowledge) of minority. Does forcing
    cinematographers to make sure everyone is over 18 really
    dampen free speech? To even debate the scienter requirement
    is to give it legitimacy that it doesn’t have in these situations.
    This is pornography, not art— why not force everyone to make
    very sure that the participants aren’t minors? Otherwise it’s
    perfectly legal to distribute child porn from Thailand (“there’s
    no way for me to check, we don’t even know who the actors
    are, and they told me they’re all adults.”) In other words,
    instead of debating where the word “knowingly” goes, get a
    law that doesn’t have it in there at all: if you’ can’t show that
    everyone is over 18, you can’t distribute it.

    You may be surprised— or not— to learn that the dissenter in


    this case Antonin Scalia. Certainly he is not pro-pornography.
    But a) you can’t have laws like this, vague and poorly
    constructed, talking around the issue, so that any government
    can choose to implement it any way it wants, and b) you can’t
    allow the Supreme Court to basically re-write it, to suit their
    particular inclinations. You want a better law? Go ask
    Congress.
    The Court today saves a single conviction by putting in
    place a relatively toothless child pornography law that
    Congress did not enact, and by rendering congressional
    strengthening of that new law more difficult.

    II.

    Back in the 1997(?) Patrick Naughton, an executive at


    Infoseek (where?), gets on dad&daughtersex and chats up a 13
    year old girl named KrisLA, and agrees to meet in her home
    state. Surprise! She’s a 40 year old guy who works at the FBI.

    Naughton says he really “knew” she was an adult woman, and


    anyway all the pics found on his computer are computer
    generated. He’s found guilty of possession, all other counts
    result in a hung jury. (All men voted not guilty, all women
    voted guilty. Does that beg the question: jury of your peers?)

    Less than two days later, the 9th Circuit Court independently
    decides Child Pornography Prevention Act of 1996 is
    unconstitutionally broad. He is released.

    The Child Pornography Prevention Act of 1996 (CPPA) 18


    USC 2256, says, awesomely:

    (8) “child pornography” means any visual depiction,


    including any photograph, film, video, picture, or computer or
    computer-generated image or picture, whether made or
    produced by electronic, mechanical, or other means, of
    sexually explicit conduct, where—
    (A) the production of such visual depiction involves the use of
    a minor engaging in sexually explicit conduct;
    (B) such visual depiction is a digital image, computer image,
    or computer-generated image that is, or is indistinguishable
    from, that of a minor engaging in sexually explicit conduct
    …(D) such visual depiction is advertised, promoted, presented,
    described, or distributed in such a manner that conveys the
    impression that the material is or contains a visual depiction
    of a minor engaging in sexually explicit conduct

    which, means not just CGI porn of kids, but any real girl over
    18 who is pretending to be under 18 would be illegal. This is
    what lawyers would tongue-in-cheek call “overbroad”— it
    applies to images that might be neither obscene nor actually
    involving real kids. The law is unconstitutional, so says
    SCOTUS in Ashcroft v. Free Speech Coalition.

    III.

    And so we’re left wondering, what next? When the CGI gets
    so good that it is actually indistinguishable from real porn,
    what then? Should it be illegal, or not?

    The new law, Child Obscenity and Pornography Prevention


    Act (COPPA), pertains to anything “virtually indistinguishable
    from that of a minor engaging in sexually explicit conduct.” I
    think the use of the word virtually is ironic. Or stupid, your
    choice.

    It seems to me that when the CGI gets that good, that easy to
    make, then people won’t be choosing to find real or CGI porn,
    they will be making their own porn by themselves. The
    question is what this will mean for the rest of us.

    IV.

    I go through all this so that you can see that the general spirit
    may be to protect children, but the intention of the law is to
    stop child pornography. The two aren’t the same,
    unfortunately. The person who molests and photographs kids
    will not molest them less if the photography is illegal; the
    question is whether CGI child porn increases the molestation
    of non-CGI kids.

    We can take a hint from regular online porn in the early 1990s,
    easily accessible by everyone. I was pretty sure all that porn
    would turn a generation of twenty somethings into sluts, but,
    unfortunately, no such luck. (It did make men start to shave
    their bodies, which is further proof of the Law of Unintended
    Consequences.)

    Similarly, Grand Theft Auto I-XIV hasn’t increased the rates of


    car thefts or prostitute murders. What it has done, and what
    porn has done, is made their rare occurrence less shocking. In
    other words, we’re not less moral— we’re more jaded. It’s
    Seinfeld syndrome: “meh.”

    Child porn, real or CGI, should be considered on its merits


    (i.e. none) and not on the effect it has on actual molestation,
    because there appears to be very little connection between the
    two. If you want to ban it, the reason can’t be “it promotes
    pedophilia” because if it is shown not to do that, then the
    whole law disappers.
    Academics Hide Drug
    Company Payments
    July 20, 2008

    And with good reason.


    An article in The Independent asserts Dr. Joseph Biederman,
    Harvard guru of ADHD and child bipolar, received over $1M
    in consultant fees and didn’t report it to Harvard; it then
    implies this is why kids are overmedicated, etc.

    Wrong. A thousand times wrong. It could not be more wrong,


    it is dangerously wrong.

    Believe me, I am no friend of Biederman’s. But the money is a


    red herring. If you want to be angry about the specific ethics of
    a psychiatrist receiving Pharma money, fine, but I am telling
    you it is not worth the Senate time, not worth press space.

    The real money, the real problem that goes unmentioned is the
    money that goes to universities, in the form of research grants.
    Biederman may have pocketed $1M, but I’m sure he was
    awarded much, much more for clinical trials— money which
    he didn’t get any of, which went to Harvard.

    We aren’t overmedicating kids because Biederman told us to;


    we’re doing it because Harvard told us to. And Harvard told us
    to because that is what they are getting money to study.
    Biederman is just the nanobot that does it.

    If Biederman never existed, nothing would be different. You


    read his resume, you think, wow, he’s a big player. You don’t
    realize that if he didn’t exist there would be some other person
    in his exact position, who would also have become a
    Distinguished Professor, won awards, written 450
    publications, etc. The machine was already in place, his slot
    was going to get filled; his mind didn’t discover anything,
    those results were coming no matter what, those publications
    were already going to be written.

    The money isn’t corrupting him into thinking childhood


    bipolar is underdiagnosed— he truly believes it. The reason he
    believes it is his entire professional existence— his whole
    identity— is predicated on believing it. He’s not a scientist,
    he’s a priest.

    He starts out as a young academic. He lands a spot in a


    research group that studies X, so he studies X, later he
    branches out into X+Y, or goes to Z, etc, eventually he finds
    himself a niche. And he believes in that niche, he believes in
    his data, no matter what it says. You can’t convince him he’s
    wrong because it isn’t science and it isn’t even a bias— it’s
    identity.

    That’s how an entire nation of psychiatrists could have been


    deluded into prescribing Depakote for maintenance when the
    data itself says not to do it. It’s belief, not money, “we believe
    bipolar is a kindled disorder…” Hell, if Harvard believes it,
    what chance do the rest of us have?

    What he doesn’t see because he is too small to see it is that


    that niche exists only because there is grant money for it.
    That’s the real bias. He internalizes an artificial system
    because it gives him identity and identity is more important
    than money.

    It’s not just Pharma— NIH is worse. If NIMH wants to study


    the biological causes for childhood bipolar, then we will all
    agree that these causes exist “we just haven’t found them yet.”
    But if NIMH decides to study the social causes of childhood
    bipolar, then those causes exist, and the biological ones don’t.
    The question is how does NIMH decide what to study?
    Culture. When a culture decides to study something, the
    results don’t matter— the decision to study it affirms it a
    priori.
    Do you think that all those psychoanalysts from 1899-1974
    were all retarded? No understanding of biology, a bunch of
    clowns, morons? They were brilliant, but that was the time,
    that was the culture, no matter what data you had to the
    contrary you were still going to be wrong and they right. Get
    it? People blame psychoanalysis, but the specific problem is
    paradigms, which are agreed upon because they have serve
    some other purpose— not science, not truth— and change
    only when that other purpose disappears, or the paradigm fails
    it.

    If we just want to punish a few high ranking psychiatrists—


    and for what? hiding money from Harvard so it doesn’t take a
    20% cut?— it will do nothing to stop the anti-humanism
    zamboni that’s trying to smooth out all the kinks in society.

    Data are irrelevant, here’s the paradigm: child bipolar is


    underdiagnosed because society needs it to be.

    There is still massive wealth inequality, racism, resentment,


    unrealistic expectations of life and a gross sense of entitlement
    — in short, narcisissm— that we have no solutions for except
    to hastily pathologize it all and hand it to the psychiatrists.
    They can keep us all confused for a decade or two until we
    have another world war, discover cold fusion, or the aliens
    come.

    The problem isn’t that money influenced Biederman; the


    problem is that even money won’t be able to influence him.

    Do you know why Biederman hid the money from Harvard?


    Because he can’t believe he’s being paid so much money for
    something he would have done for free. Until you change that
    groupthink, that blind faith, nothing else will change.
    Being The Main Character
    In Your Own TV Show Is
    Sort Of A Delusion
    July 22, 2008

    Two psychiatrists, believe they have discovered a new,


    YouTube generation, delusion: believing you are in a secret
    reality TV show.

    The article describes cases of people who believe they are


    secretly being filmed.

    “I realized that I was and am the centre, the focus of


    attention by millions and millions of people,” explained
    one patient, an army veteran who came from an upper-
    middle-class upbringing.“My family and everyone I knew
    were and are actors in a script, a charade whose entire
    purpose is to make me the focus of the world’s attention.”

    The belief that they are being filmed certainly gives the person
    a sense of importance, or worth independent of and beyond the
    mundane life he lives in. In other words, it allows for an
    inflation of identity without actually having to do anything.
    Call it grandiosity

    The patient added that he planned to climb to the top of


    the Statue of Liberty, and if his true love were waiting for
    him, the puppeteer strings would be cut. If she failed to
    show up, he would jump to his death.

    Grandiosity is one explanation, but I submit that the important


    part of this delusion isn’t the filming, but the “puppeteer.” The
    delusion isn’t about self-importance, but rather an explanation
    for powerlessness. I am being manipulated by the outside.
    There’s nothing I can do.

    Consider that a delusion which enhances your importance


    might not be one you’d want terminated; but these cases have
    the termination of the delusion built in.

    In “reality” (ha!) such cases are cognitive metaphors for


    maturity. Only when you gain sufficient self-awareness and
    autonomy can you break away from the artificial, manipulated
    reality of adolescence.

    “But these guys are 30 years old!” Exactly. Real adolescents


    don’t need a delusion to tell them they’re powerless. But a 30
    year old should be dealing with intimacy vs. isolation, but
    instead they’re stuck back at identity vs. role confusion.

    The delusion is the protection, not the empowerment. It says,


    “don’t worry, you haven’t accomplished anything because the
    producers haven’t put that into the script yet.” Ultimately, this
    YouTube delusion is the result of a fleeting awareness that you
    cannot choose your identity unless you back it up with actions
    — that actions are identity.

    When a narcissist has this awareness, he has two choices. He


    can retreat into a protective delusion, such as this one; or he
    can convince— read: force— someone else to accept his
    identity even in the absence of actions. “I am a tough cop!
    Well, maybe not actually a cop, but if something went down in
    this mall, I could be like a cop, and that’s just as good!”

    You do not want to be the person the narcissist tries to


    convince.
    Psychiatry is the pressure
    valve of society
    July 23, 2008

    In case you doubted, here is today’s front page of USAToday:


    Economy’s stuck, but business is booming at therapists’
    offices.

    If that was the end of the story— if people had social troubles
    and turned to psychiatry for help because of those troubles, it
    would be a good thing. Get help where you can.

    But the larger problem is that in going to psychiatry, their


    socioeconomic issues get demoted to “factors” and the
    feelings become pathologized. Psychiatry doesn’t explain, it
    identifies. You’re not depressed because you lost your house;
    you have depression, and one of the triggers is losing your
    house. See the difference?

    You’ll say this doesn’t happen all the time, maybe not even the
    majority of the time. But even if it doesn’t happen to a specific
    individual, it still happens to enough people that it bolsters
    psychiatry’s role as the necessary player in managing suffering
    of any kind.

    A 20% increase in therapy visits will be interpreted by


    psychiatry as a 20% increase in depression and anxiety. It will
    say depression has a prevalence of X, it will say it is
    underdiagnosed and undertreated, etc. And it will creep into
    the social consciousness that these are pre-existing diseases
    with triggers, not the consequences of external events.

    Society needs that illusion, it needs that lie, because it has


    created unrealistic expectations in people and no way of
    fulfilling them. Here’s what a society looks like under the
    similar economic conditions, but without psychiatry:

    The absence of hope


    Today’s popular frustrations over flat-lining living
    standards have been building for years. The recent boom,
    felt only by the already well-off, has done little to change
    that discontent. Labor unrest has been growing for
    months; violent protests erupted… corporate taxes will be
    raised and gasoline subsidies cut… The move was
    designed to take the steam out of boiling anti-government
    sentiment.

    The above article, also from USAToday, has a slightly


    different title: Egypt’s economy soars; so does misery.
    Fifty Percent of Foster Kids
    Are On Psychiatric
    Medications
    July 28, 2008

    That’s right. The single most best predictor of mental illness—


    better than family history, better than genetics, better than
    symptomatology— is being a foster child.

    Texas data: 2004, 40% of the 32,000 foster kids were on


    psychotropics. 2005 it was, by age:

    0-5: 12.4%
    6-12: 55%
    13-17: 66.5%

    Do you understand the significance of this? If you tell me


    every single person in your family, including your identical
    twin, has schizophrenia, I will not be able to tell you if you
    have it— but if you tell me simply that you are a foster child…

    I’m sure someone has an explanation that deals with 5HT-2a


    receptors, or the amygdala, or genes on chromosome 12, but:

    “When two-thirds of foster care adolescents receive


    treatment for emotional and behavioral problems, far in
    excess of the proportion in the non- foster care
    population, we should have assurances that the youth are
    benefiting from such treatment,” said Dr. Zito.

    Damn right. But as I said in my Esmin Green article that failed


    to convince anyone, this will never really be explored because
    society doesn’t have any other options. If you don’t call
    16,000 Texas kids “early onset bipolar,” does the system have
    a Plan B? Jail, I guess.
    Social Welfare Is A Red
    Herring: The Return Of
    Feudalism
    July 30, 2008

    The policies sound good, and perhaps they would be, if not for
    the malignant intentions that motivate them.
    I.

    I recently received a form letter from Marcia Angell’s socialist


    federation, “Physicians For A National Health Program,”
    looking for support for government sponsored universal health
    care. It cited the usual reasons:

    As physicians, we have seen the numbers of uninsured


    and underinsured soar, costs skyrocket, and quality
    deteriorate. Meanwhile, doctors drown in a sea of
    bureaucracy.

    Etc. Ok, valid if not hyperbolic points. But that’s not why she
    wants single payer insurance.

    Only single payer would eliminate the high corporate


    overhead, profits, and enormous inefficiencies…

    The stated reasons include reducing corporate profits. That’s


    not a byproduct, or a necessary result, it is a reason for doing
    it.

    II.
    Another example I’ve used before. NPR was interviewing
    someone over a year ago about the high price of oil (ha!) and
    she asked the guy how to reduce the price, and he said he
    actually hoped the price would go higher, because it would
    curb use, decrease carbon emissions, force alternative energies
    to be explored, etc. Great. Her response, however was: oh, ok,
    and decreasing demand would be another way to hit oil
    companies where it hurts.

    Get it? That’s where she was standing, lowering prices might
    be good for the consumer but she didn’t bother to say that.
    What was on the tip of her tongue was the need to punish oil
    companies. This woman is not stupid, she’s not unaware of the
    complexities of energy policy— but where her mind went
    immediately was how we can hurt oil companies. It wasn’t
    incidental, it was absolutely vital that this happen.

    III.

    In the British Times Higher Education is an article by a


    Harvard professor lamenting the decline of the American
    student. Here’s the table of contents blurb:

    The banality and sense of entitlement of rich students at


    Harvard left John H. Summers feeling his teaching had
    been degraded to little more than a service to prepare
    clients for monied careers.

    It laments the student privilege, grade inflation, consumerist


    attitudes, and the like. But that turns out to be only a minor
    gripe. What really got him:

    Most of the students I encountered had already embraced


    the perspectives of the rich, the powerful and the
    unalienated, and they seemed to have done so with
    appalling ease.
    He goes on to describe and deride this perspective, but when
    he chooses to cite an example— you expect him to say
    something like “they urinated on homeless people” or “voted
    for Bush”— he chooses this:

    One of my less affluent students, the son of a postman,


    asked me once for advice about a financial investment….
    I told him what I thought about this recommendation; but
    only later, when I learnt how little he had to invest
    ($2,000 was his total savings), did I allow myself to think
    I understood the significance of his question. No amount
    of money may be permitted to lie idle if something may be
    got for nothing.

    This Harvard professor is angry that the guy wanted to invest.


    Period. “Something for nothing.” Do you understand?

    IV.

    I suppose I shouldn’t be surprised— this nut was also angry


    that Harvard wouldn’t let him teach a class he named,
    “Anarchist cultural criticism in America”— but the main point
    is that this guy, the NPR interviewer, and Marcia Angell are
    certainly not the underprivileged. Their resentment against the
    system isn’t supposed to be this visceral.

    That’s why the social welfare angle is a red herring. It’s not
    that they want better services for the underprivileged and
    hurting the rich is the byproduct; it’s the opposite, hurting the
    rich is the emotional, primary motivator, and the rest is an
    intellectual posture that rationalizes this resentment. This is
    why it’s dangerous. That’s why you can’t side with them even
    if you agree with their policies. Intention matters.

    Ex-Marcia these three may not be rich, but this amount of


    public hate and open vitriol are not expected in a properly
    functioning classless society.

    Which simply means it’s not properly functioning. Nothing


    new there, except for this: it is properly functioning. What’s
    not working is the perception.

    Summers is angry because he doesn’t feel he could plug into


    the capitalist system, even though, obviously, he could if he
    tried— the postman’s son certainly is, with far less money or
    knowledge than the professor. So it’s not the reality, it’s the
    perception, but perception, confidence, is what this society is
    based on. Consequently, the system is failing.

    The analogy is a bank run. As long as people think the bank is


    solvent, then it actually is. But if enough people think it isn’t,
    then it actually becomes insolvent.

    V.

    So the question that needs to be answered is, “what went


    wrong that ordinary Americans hate people they perceive to
    not be in their class?”

    First, education. From grade zero through college, you are


    told you belong to a class. Let’s use the simple example of
    money: if you’re an engineering student they’ll tell you how to
    be an engineer, but no one anywhere tells you how to be a rich
    engineer. No one even tells you it is possible. If you go into
    the humanities, the expectation is you’ll be “poor.” Your future
    is defined by its limitations, not possibilities. “You won’t
    starve, but you certainly aren’t going to be rich.” Really? Are
    we still in America? It seems to occur to no one to try to teach
    humanities students how not to be poor.

    You’re choosing a major and a lifetime social class. There’s no


    fluidity— they teach you, day one, pick your life slot. Good
    luck changing your mind in twenty years.

    I’m not saying they should explicitly teach you how to be rich
    — I’m saying they shouldn’t teach you to expect to be in a
    slot.

    Worse— and I have seen no one anywhere make this


    observation, the most important one of all— there is no
    generational perspective on advancement. At no point in K-16
    is there even the subtlest suggestion that you should make
    something of yourself so that your kids can go further than
    you. Not as a byproduct, but as the actual purpose of all this
    education. No: the whole thing is about you.

    Certainly people want their kids to do well, they put them in


    violin lessons, but what is missing is this explicit mantra: they
    need to go further than me. If you’re a doctor reading this,
    answer honestly: you’ve mused about whether you want your
    kid to become a doctor or not, but do you expect them to be
    more than that? Not equivalent— e.g. lawyer— but more? Are
    you raising them for more, or the same?

    Here’s a word you will never hear taught as a goal: dynasty.


    No. What they teach you is feudalism: here’s your fief, bring
    me homage.

    It’s not totally the parents’ fault: the entire system, education
    and onwards, has grossly diminished expectations of its people
    and encourages, necessitates a self-focused, ahistoric
    worldview. They want you to plug into the Matrix, and then
    die. When you do, return all your stuff, someone else will use
    it.

    Second, of course, is psychiatry. If you think of psychiatry as


    Zoloft, you’re missing its scope. Psychiatry and culture are the
    same. It backs it, it supports it, it helps set expectations and
    values. It was more obvious with Darwinism or Freudianism
    because those were clearly articulated theories you could put
    in a book; psychiatry is more nebulous, but it is no less
    powerful a cultural force. Here’s its mission statement: “you
    are different. And we will try hard to get you back up to the
    level of almost normal, but, state of the art, that’s about as
    good as we can get.”

    But psychiatry doesn’t just reduce expectations for humanity,


    it diverts attention away from real expectations, onto a
    pointless biologic outcome. If it really wanted to help, say,
    foster kids, it would say, “what are the ways we can actually
    change their lives? Options: we can send them to big
    orphanages with skill immersion programs; or we can spend a
    trillion dollars and give them all individual tutors/case
    managers to follow them every day, etc—” But since it can’t
    have this complex debate, because it requires way too much
    money, it shifts the expectations to “managing symptoms.”

    The classic counterargument to my position is: you may be


    right, but psychiatry is better than nothing.

    Yeah, so was your first husband. “Better than nothing” is


    almost always worse than “nothing.” Defaulting to psychiatry
    legitimizes not pursuing actual solutions.

    The patient is bleeding, your solution is to mop up the bloody


    floor so it doesn’t look as bad. How long will this work? At
    what point do you become so deluded by the system that you
    think the “real” solution is better mops?
    A Little Bird Told Me
    August 6, 2008

    1. McCain may drop out of the race— running mate Romney


    to continue?

    2. Oil prices were pushed higher (Iran/Israel tensions, etc) by a


    concerted government effort to generate oil revenues for Iraq,
    promote greater stability so as to allow partial withdrawal of
    troops before election; and a subsequent reduction of oil prices
    to erase them as a campaign issue. Both Iran and Israel were in
    on the plan.

    Tin foil hat stuff, but thought I’d put it out there.
    Craig Ferguson, The Jonas
    Brothers, and Katy Perry
    August 8, 2008

    This is what 46 year old Scottish late night TV host Craig


    Ferguson said Tuesday night:

    The Jonas Brothers… I’m sure they’re fine young kids,


    and their music’s not for me, it’s for young people, I
    understand that, but my point is— they’re kind of too
    clean. With the purity rings, symbolizing that you’re
    saving yourself for marriage. Now, I’m thinking— what
    kind of a rock star is this? What kind of a rock star is
    this?…

    It makes me a little uncomfortable, it’s a little sinister to


    me, when the teenage rebellion is controlled and sanitized
    by a big corporation. There has to be some rebellion, or
    else it’s not rock and roll.

    Ferguson was in a Scottish punk band, was a drug addict,


    almost suicided and is now clean— and strong enough to
    make nightly jokes about using drugs and still not relapse.
    Rock and roll cred established.

    What’s he saying? He defines rock and roll as rebellion; now,


    and now laments is a genre.
    You might say that actually, the Jonas Brothers are rebellion
    because they are rebelling against the established credo of rock
    and roll (sex, drugs, etc), but that’s a ruse as well, they aren’t
    the ones rebelling; they were selected by an industry that is
    trying to change it’s image.

    To illustrate this, take a look at the other promise ring wearer,


    Katy Perry, whose song, “I Kissed A Girl” has disturbed me
    for a long time, disturbed me because it is so not disturbing.

    In case you don’t have kids or contracted rubella as a fetus,


    here’s the chorus:

    I kissed the girl and I liked it


    The taste of her cherry chapstick
    I kissed a girl just to try it
    Hope my boyfriend don’t mind it
    It felt so wrong
    It felt so right
    Don’t mean I’m in love tonight
    I kissed a girl and I liked it
    I liked it

    That’s as raunchy as it gets. Anyone who lived through the


    bicurious 90s knows that this kind of “kissing the girl” is about
    boys. It’s about being sexy for boys, even if the boy doesn’t
    know you did it, you still feel you are even more attractive to
    them. But this is by no means cutting edge material.

    I will grant you that the song is technically, and artistically,


    more brilliant than anything by Coldplay. Ok, you got me
    there.
    Yet the song is everywhere, not just pop song everywhere, but
    everywhere everywhere. Here are three news media outlets
    that have no business writing about music, writing about her.
    And always the topic is sexuality, as if she’s opening (or
    closing) doors or something.

    I had a huge argument with a friend about that song. My


    position was that such a benign song— this is old news— has
    a popularity that cannot be explained by the seemingly relevant
    topic of kissing a girl, there must be something else to it. Why
    would the music industry choose to push this specific song, so
    much?

    His position was that it was MTV et al, targeting the older
    people, the ex-MTV generation— e.g. me— trying to entice
    them back with songs that play on their (unfulfilled) fantasies.
    “Why else would they be in lingerie? Young guys don’t care
    about lingerie, unless it’s a thong. They’re programming to the
    older crowd.”

    Maybe, but why this song? Why not a million other more
    risque songs?

    So here is this not at all provocative video, completely old


    news to anyone 21-45, yet it is everywhere. Go ahead and
    watch it, tell me why. No nudity. She’s pretty, but come on,
    she’s no Taylor Swift. Song is catchy, but again…

    I call your attention to the last five seconds of the video. In the
    final scene, she wakes up next to her sleeping boyfriend.
    Ooohh— is he going to find out how naughty she is? Will he
    be jealous or turned on? Is it fantasy or real?
    Here’s the thing. Her boyfriend in the video is black.

    If that realization doesn’t have any impact on you at all, you


    are my point. You may be so progressive that you don’t even
    notice race, but I can assure you race is still a gigantic issue,
    for both races.

    We have a scenario where two maybe-sort-of taboos are


    present in a video, but one is highlighted as a real taboo, and
    the other as completely and utterly ordinary, meriting no
    comment or explanation. I’m pretty sure depending where you
    live in America, you’ll either agree or disagree with her
    hierarchy.

    In all the Katy Perry discussions, blogs, and articles, no one


    noticed the race issue, no one thought to mention it, nothing.
    What they went all Manchurian Candidate about was that she
    kissed a girl.

    “Well, maybe that’s what she believes.” She doesn’t have


    anything to do with it. She didn’t make a video, then go Jet Li
    the MTV program director’s office door, slap him in the face
    with the reel, and say, “This is f-ing awesome, play this!” “oh-
    oh-oh right away Mrs. Perry! Right away!”

    The video was directed, manufactured. The guy in her bed


    isn’t random, they selected an actor. It wasn’t accidental he
    was black, they picked him because he was black. Indeed, he’s
    DJ Skeet Skeet, a friend of her real life black rapper/boyfriend
    Travis McCoy. Nothing here is random; even her name, Katy
    Perry, was selected because her real name, Katy Hudson,
    risked confusing her with Kate Hudson. She changed her name
    to differentiate herself from someone else. They are
    constructing an image, they are telling you a story.
    So what’s happening here is that MTV isn’t saying, “wow, this
    is so shockingly sexy, she kissed a girl.” MTV is actually
    resetting the culture, it is telling you, telling a generation of
    kids, that kissing a girl is shocking and sexy.

    “But it isn’t shocking, you can’t simply declare that it is. Much
    more shocking porn is everywhere.” Actually, that’s the genius
    of this. Reconstruct adolescent sexuality to the old days of
    maybe you catch a glimpse of a worn and melted Playboy
    down by the creek. Online porn saturates, overloads, it stops
    becoming arousing and starts getting frustrating, “where the
    hell is the exact pic I need to get off?”

    MTV can’t compete with that. Music can’t compete with that.
    In your face, up yours, all that. Those vibes are now
    elsewhere.

    So it’s recreating a niche by recreating a culture. Clean, sober,


    and hip-hop light.

    So that when you turn the amp up just a little, it catches


    everyone’s attention. “Holy crap! She kissed a girl!”

    I’m not sure if I should be appalled that sexuality has been


    commandeered by MTV et al, or I should just be relieved
    they’re pushing popcorn not penetration.

    Back to the Craig Ferguson. The music industry has to make


    good boys cool because there’s a glut of bad boys everywhere
    else, and MTV and the music industry can’t compete. Sex is
    no longer cool. What’s cool now? Status. Narcissism. Rich is
    the new porn.

    But poor Craig Ferguson. He makes the point that rock and
    roll is supposed to be about rebellion— theoretically getting a
    big inaudible cheer from the teenagers— “this guy may be old,
    but at least he gets it!” But he doesn’t. That cheer came from
    his viewers— who have an average age of 50. He’s talking to a
    bunch of old guys, people who still think Smoke on The Water
    meant something.
    The Hidden Zero Effect
    August 11, 2008

    Choose:

    $5 today or $10 in a year.

    Picking $5 is called temporal discounting— you pick a sooner-but-smaller outcome simply because
    it is sooner.

    But it’s more than a preference based on how soon you get paid. If the question is changed:

    $5 in 7 years, or $10 in 8 years

    Then you can feel the pull to choose the $10— even though the $5 is still one year earlier than the
    $10. So it’s not simply people prefer sooner over later. It’s also how far away the payoffs are. How
    soon is sooner? At some point in the future, your choices flip.

    In fact, this is predictable (reliably so in animals)— and follows a hyperbolic function:

    Imagine there is a smaller-sooner reward at time T3, and a larger- later one at a time T4. At a very
    distant, early time T1, you prefer the solid line (the larger-later reward), because they are both far
    enough away that the time delay seems insignificant.

    But if you choose at a close time T2, the choice has flipped and you prefer the smaller reward,
    because it seems sooner. The closer “soon” is, the more you’re willing to settle. Hyperbolically.

    II.

    Why does this happen?

    It’s behaviorism. The effect of rewards are temporally dependent. Try it on your kid.

    How this phenomenon is described is important, and it is frequently backwards. You don’t prefer
    sooner choices that are smaller, but if they are both far enough away you’ll choose the larger choice;
    you choose the larger choice all the time except if the choice is asked of you close to payoff.

    If you intuitively know your future is long, and real, you don’t succumb to it as much. But if the
    future is an abstraction, then you begin to discount your choices.
    The future is real only if you are real, i.e. your identity is fixed. If your identity is in flux— whether
    from personality disorder, bipolar, being a teenager, going through a divorce— if there are different
    “yous” all the time, you cannot make decisions based on the future. If “you” aren’t going to be the
    same in the future, how can you make decisions about it?

    In other words, temporal discounting is not exactly an error; it is an accurate reading of the
    likelihood of change of one’s identity.

    III.

    So how do you resist this?

    One way is to make explicit the hidden zero:

    Choose $5 today and $0 in a year, or $10 in a year and $0 today.

    That hidden zero seems obvious, and it is obvious cognitively, but not instinctively. These habits
    and “errors” are hard wired in us because they are protective— eat while you can, jackals are
    coming.

    But they don’t help when you’re opting into a 401(k): “Choose $13,000 today and $0 at retirement,
    or $0 today and $13,000 at retirement.”

    When you make the hidden zero explicit, people choose differently— less impulsively:

    Whether it’s real or hypothetical money, people choose sooner-but-smaller less often when they are
    told about the $0.

    When dealing with impulsive people, or people whose identity is in flux, it is important to make
    explicit all parts of a choice, because time has little meaning.

    IV.

    But what caught my attention about this is the difference between real and hypothetical money. Why
    does making it real money significantly reduce the number of sooner-but-smaller choices, whether
    or not the zero is explicit? If anything, seeing the money on the table might drive them to choose the
    sooner (but smaller) choice— the instinct becomes real (“eat now.”)

    The experiment was to ask subjects 15 questions of the form “$X today, or $Y in a month.” But a
    second group of people, the “Real Money” group, were told that one of these hypothetical choices
    would randomly be used to pay them real money at the end of the questionnaire.

    Do you see the problem? The subject isn’t making a choice between a sooner payoff vs. a later
    payoff, but between sooner payoffs vs. all the other sooner payoffs, and later payoffs vs. all the
    other later payoffs.

    Immediate rewards ranged from $2 to $8, delayed rewards ranged from $5.40 to $8.70, and
    delays ranged from 7 to 140 days.
    In effect, this stops becoming a temporal discounting problem and becomes a game theory problem. He’s m

    $6 now, or $12 in a month–— he chooses $6.


    $8 now vs. $10 in four days–- he chooses $10.

    But now he’s told one of these choices, randomly, will be paid to him. So instead he picks:

    $6 now vs. $12 in a month– he chooses $12


    $8 now vs. $10 in four days— he chooses $10

    Because in the first pair, he would have been paid either $6 now or $10 in four days. “No way, I’m not risk

    Aggregate 15 such choices and it’s no surprise people pick larger-later payoffs more often. The real way to

    Unfortunately, it doesn’t happen in real life, either. Most of the time, people make decisions based on hypo

    That’s why we get frustrated with their choices. We can’t understand why they made that choice because th

    And so it becomes important to restate things into independent, binary choices. Certainly life choices are af
    A Trip You May Have Taken
    August 12, 2008

    He pulls over at the curb. All the shades are pulled down, the
    house looks dead. The house— shack— is on the beach.

    He gets out of the car.

    “Tracy,” he calls out, expecting nothing.

    He walks to the screen door. It’s locked, but the inside door is
    wide open. He smells pot, and something that is not pot, and
    something that is feces. He has never seen this place, yet it is,
    somehow, exactly as he imagined it would be. It is also worse.

    “Tracy!”

    Tracy appears in the front yard, behind him. “What are you
    doing here?” she shrieks. “You weren’t supposed to come until
    Thursday!” She looks like a crack addict.

    She runs in the back door, cursing.

    A man who looks like anyone from Cops except the cops
    comes and unlocks the screen. “You’re Tom, right? My name’s
    Sam. Pleased to meet you, I’ve heard a lot of great things
    about you that for all intensive purposes I feel like I knows
    you.” There is no geographic reason he should speak with a
    drawl, but there it is. Obviously, he is not wearing a shirt.

    “Where’s Tracy?” He walks past Sam. The house is filthy.


    There is broken glass from what could have been a crack pipe
    pushed to the corner of the floor, and what still is a crack pipe
    is sitting hopefully on the TV, waiting for someone to hold it.

    Tracy comes back. “You can’t just come by whenever you


    want! You can’t force me to do anything, I told you I wanted
    to do this but not yet! Fuck! My girlfriend’s boyfriend just got
    locked up, and she needs me—” She yells more words at him.

    “Get your stuff, we’re going.”

    “Son of a bitch!” she screams, slaps a beer bottle off the


    counter and it smashes into the sink, more glass. She walks
    off, screaming something about a car and a guy from
    Arkansas. With her, it is always more and more words.

    “Tracy, let’s go! Now!”

    Sam intervenes. “Don’t worry about it man, I’ll go talk to her.


    I’m really glad you came, she really needs help right now. Do
    you want a beer or something?” He has one ready, pops the tab
    and hands it to Tom, who takes it for no reason. Sam goes off
    to make things right, crunching some broken glass underneath
    his bare feet. His feet do not care enough to bleed.

    There is more screaming.

    A man knocks hard at the screen door; Tom instinctively locks


    it. The man looks like a ex-football player turned pro beer
    drinker. Big chest, bigger gut. No sleeves. He cups his hand
    over the screen to look in, then jumps back when he sees Tom
    standing there. “What’s going on in there? Open this fucking
    door!”

    Tom takes one step back, close to the kitchen cabinets.

    “Who the fuck are you? Where’s Tracy?!” He yanks at the


    screen door. “Open this goddamn fucking door or I’m going to
    fucking smash it—” and it bursts open.

    Oh my God, Tom thinks. I’m going to have to kill this guy.

    “Hold on, man,” Tom says. “I’m her brother.”

    That was the only right answer. The sibling relationship is the
    only one respected in the streets. It’s even, neutral. There’s no
    assumption of ulterior motives. You’re given credit for trying
    to do the right thing, and leeway because you’re young enough
    to know the score.. If he was her father he’d be tossed. If he
    was her husband, he’d be dead.

    “Oh, sorry man, that’s cool. Things have been out of control
    here lately, people, crack, the cops, last week someone set fire
    to my—”

    “I’m getting my sister out of here.”

    “Ok.” He glares at Sam, who is peeking around a corner, and


    walks out. Tracy reappears. “Fucking—”

    “Shut up. Get in the car.”

    Sam is overly helpful, he puts her bag in the car, goes inside,
    gets another bag and puts that in, too, then suddenly stops,
    reaches in, and grabs a bottle of pills. He looks back at Tom. “I
    don’t know how you all are getting back home, but you know
    she’s got an open warrant, right?”

    “No, I didn’t know that.”

    “It’s not a warrant,” she says, “the PO violated me because I


    had a hot urine, but she wasn’t allowed to do that because I
    was already in treatment for it, so I spoke to her supervisor, a
    guy named Marins, or Marinis, Marins, something like that, I
    have his name inside with the other papers, and they told me
    that I had to get a doctor’s note verifying that I am in treatment
    and that I am prescribed the Xanax for my anxiety, one four
    times a day. I never abuse my medications, I take it only as
    prescribed. My doctor knows that. That’s why he trusts me
    with the Xanax. But I couldn’t get to him because they don’t
    allow walk ins, and the last prescription he wrote by mistake
    he wrote two times a day instead of four times a day, so the PO
    said that she had to technically violate me but since she knew
    that I was telling the truth about the Xanax I wouldn’t be
    arrested. But then she got transferred, and she never changed
    the order—”

    “Tracy,” says Sam, “just get in the car. You’re brother really
    cares about you, don’t give him a hard time.”

    “Whatever.”

    Sam looks at him. “She really needs help. She’s been


    diagnosed bipolar schizoaffective, she takes Seroquel but she’s
    supposed to be on lots of other shit, but, you know, she doesn’t
    take them. I always try to get her to take them, and I make sure
    she doesn’t abuse them, and I makes sure she gets to her
    appointments. She’s really lucky to have a brother like you, to
    come out and do this for her. ” He pauses. “Do you want some
    beers? You know, for the road?”

    “No, thanks.” He shakes Sam’s outstretched hand, but then


    Sam won’t let go. “Look, could you do me a really big favor?
    It would really help me out a lot. I’m trying to get this
    apartment but the landlord needs me to verify that—”

    Tom pulls his hand back. “Sorry, I can’t help you.”

    “No, wait, hold up, it’s really not a big deal, all I need is a
    letter—”

    “Sorry.”

    Tom’s face turns stern. “So that’s it? After all the help I gave
    you here? I gave you my beer. I moved all this—”

    “Dude, I’m not doing anything. I’m here to get my sister, and
    I’m leaving.”

    He takes both her bags out of the car and drops them in the
    yard. “Wait,” she yells, “I need that bag, I have a pair of pants
    inside I have to return to—”

    He gets in, starts the car. “Wait,” she says, “I forgot my


    cigarettes-” He drives off.
    Forty five minutes later, she says, “I need a beer. We need to
    stop somewhere.”

    Tom shakes his head in disbelief. “Yeah, sure.”

    “No, seriously, I’m going to have a seizure, I’m coming off it,
    I’m in withdrawal.”

    He looks for no reason, he wouldn’t know what withdrawal


    looked like.

    “Please, I’m not kidding here, I was taking like 12 Xanax a


    day, I’m going to have a fucking seizure—”

    “Fine!” He pulls into a gas station, parks, takes the keys. “Stay
    right here. Do not get out of the car.” He goes in, buys a six
    pack of beer. Walks out, throws three of them away. Gives her
    the other three.

    He can actually see her get calmer with every approaching


    step. “I need to pee.” Christ. He’s with a three year old. She
    takes the beers, takes her bag— which he snatches back out of
    her hand. She glares, goes off to the bathroom.

    As he waits, he notices his sunglasses case is missing. Not the


    glasses, just the case. He opens her bag, it is pushed to the
    bottom. He opens the case. Inside is the tire gauge he didn’t
    even know was in the car.

    Then he sees her.

    The beers are not in her hand. What is in her hand, balanced
    on her head, is a 3x4 ft picture, in a steel frame.

    “Open the trunk,” she says.

    “What the hell is the matter with you? Did you just steal that
    from the bathroom?”
    “It’s all right, don’t worry about it. No one will need it.”

    “What are you talking about?!”

    “Come on, I really like it, this is my favorite photo in the


    whole world. I love Marilyn Monroe, she inspires me, she
    inspires me to get clean, this photo always reminds me of—”

    “Give me that fucking picture,” he snarls, rips it more


    aggressively than necessary from her hands, and walks back to
    the gas station.

    “What the hell is wrong with you?” she yells after him. “It’s
    just a fucking picture!”

    He walks into the gas station. The attendant sees him, sees the
    picture, and does not want to understand. “I’m calling the
    police,” he says.

    “Look, this picture fell off the wall, so I’m returning it to you.
    Here it is.”

    “You fucking—”

    “Here it is, I’m sorry, I’m leaving.”

    He comes back to the car, she is smoking a cigarette. Where


    did she get cigarettes? Where did she get a lighter? “What’s
    your problem, man?” she says. “You’re acting like I stole a
    guy.”

    “Get in the car. Just get in the car, and don’t talk, don’t talk to
    me, just don’t fucking talk to me until you’re sober.” He is
    suprised he can’t pull the steering wheel off.

    They drive silently for about ten cigarettes.

    “When I get out,” she says, looking out past the highway into
    her dreams, “I’m going to move back to the beach, and I think
    I’m going to get a job working with vets from Iraq who have,
    like, PTSD, people who are self-medicating.” He says nothing.
    She eventually looks over at him, honestly perplexed.

    “You don’t even fucking care about the vets, do you? You
    voted for Bush, but you don’t even—”

    “Shut up,” he says, “all the time.”

    “You don’t know what it’s like for us.”

    He actually slows the car down. “Us vets? Are you a vet
    now?”

    She rolls her eyes, you just don’t fucking get it, takes a drag
    from the cigarette and blows it out the window. “You know
    what your problem is? You don’t fucking care about anything,
    or anyone. That’s your problem.”

    They keep driving.

    I’d like to say there’s an ending to this story, but unfortunately


    there isn’t.
    Drug Reps From Congress
    To Detail Doctors
    August 13, 2008

    Oh, my God, I hope you’re lying down for this.

    I get raped by an email that is not caught by my spam filter, it


    says that Congress is considering a bill that would create an
    academic detailing program— sending in a team of doctors to
    visit other doctors and give them “unbiased” (scare quotes
    mine) information about prescription drugs.

    I have some questions, of course:

    1. This is going to be federally funded: how much will these


    doctors get paid?

    2. Will they be allowed to take docs out to lunch and dinner? If


    not, is it because it’s a waste of time (in which case why does
    it matter that Pharma does it) or because you don’t want to
    unduly influence the doctors (in which case…?)

    3. Where will you get these “academic detailers?” Are they


    academics? No possibility of bias there, right? Do you really
    think it was drug reps that made Depakote ubiquitous?

    4. Where will this unbiased information come from? You’re


    going to be using published data— isn’t that already free of
    bias?

    5. Seriously, is anyone even a little bit horrified that doctors


    have so checked out of their own education that Congress has
    to send in tutors?

    5b. Oh, you mean there’s so much pressure from marketing


    that doctors are confused or even manipulated? Then we
    should probably set up some academic detailers to go teach
    nutrition to McDonalds customers. I mean, if doctors aren’t
    smart enough to withstand marketing, what chance does
    anyone else have against a Britney Spears Pepsi ad?

    5c. While we’re at it, how about academic detailers to


    Congress? You know, unbiased information on the ethanol
    mandate and other special interest Kool-Aid they’re drinking?

    I’ll add that for four years, I was hired by the state Medicaid
    (DHS) as just such an academic detailer. I went around to all
    the hospitals, especially the state hospitals, giving talks and
    meeting with docs, trying to reduce the polypharmacy and
    dosing problem (e.g. three antipsychotics at lower doses, or
    Haldol 20 + Seroquel 25, etc.)

    You want the ironic part? They hired me because the assistant
    commissioner of DHS was at a Pharma sponsored dinner
    program I gave, and thought I my talk about the perils of
    polypharmacy was compelling— and not Pharma biased.

    Oh, and in answer to #1: they paid me more than Pharma did.
    Tax dollars at work. I’m happy to take the money, of course,
    but I’ve previously given my solution for fixing drug costs
    while simultaneously improving clinical practice. All of this
    other stuff is useless politics.
    Seroquel For Bipolar
    Maintenance
    August 14, 2008

    A brief history of the past decade.

    I. Background

    A mood stabilizer is a drug that prevents mania and/or


    depression. Depakote was the default mood stabilizer since
    2000. Hundreds of papers promoted its use, though all relied
    on a single double blind, placebo controlled trial as support for
    its efficacy. Mentioned almost no where was that this trial did
    not show any superiority over placebo. However, Depakote
    enjoyed tremendous sales in the years 2000-2008, showing 10-
    20% growth per year.

    II. But the bulk of the support, especially in journals, came


    from academics who believed in it, not Pharma?

    Since the academics have no relationship with Abbott and are


    motivated only by clinical efficacy, we can expect their
    promotion of Depakote to continue even after it goes generic.
    Oh, wait, that happens in 2008.

    III. The Sad, Quiet Story Of The Mainetance Trial That


    Wasn’t

    Here’s a quick summary of the (only) Depakote vs. placebo for


    maintenance study: manic patients were enrolled, put on
    Depakote + any other necessary meds until they were
    stabilized. Then these patients were randomized to Depakote,
    lithium or placebo.

    At the end of the study, all three groups had similar relapse
    rates. Putting them on Depakote was not better than placebo
    for maintenance. On this single, failed trial, an entire decade of
    psychiatry was premised.

    However, there is one technical point that I have never, not


    once, in 8 years, seen written about, discussed, or even alluded
    to, and when you do bring it up people look at you blankly: the
    study patients were stabilized on meds, then randomized to
    drug or placebo. So those that were randomized to placebo had
    their stabilizing meds stopped. They were “taken off their
    meds.” So actually, being on Depakote was not simply no
    better than placebo, it was no better than abruptly going off
    your meds. Take a long hard look at yourselves.

    IV. Two Drugs Are Better Than One

    Depakote continued to be grow, continued to be a “mood


    stabilizer” when it was really simply an acute antimanic. NB:
    it may be true that Depakote is a tremendous mood stabilizer;
    you can’t condemn the drug on one study. But, importantly, in
    the decade of “Evidence Based Medicine” why was it at the
    top of every treatment algorithm and guideline? There’s the
    rub.

    But psychiatrists did not use it as a monotherapy mood


    stabilizer— it was always “mood stabilizer” plus something
    else. In fact, the major discussions in psychiatry 2001-2007
    were whether/how additional medications would benefit when
    used with Depakote. No one asked whether Depakote itself
    was a mood stabilzier— that was assumed. The question was
    whether adding antipsychotics to Depakote provided
    additional benefit. The answer was always “yes” as long as the
    question had the caveat, “notwithstanding details or
    generalizability.”

    Consider the study of Depakote alone, or Depakote +


    Risperdal, for the treatment of acute mania. Which is better?
    The graph is clear: the combination is better than the single
    drug alone. BTW, every atypical antipsychotic has a similar
    study with nearly identical results.

    Two sleights of hand:

    1. This is a study of acute mania—3 weeks— not


    maintenance. The study does not say that Depakote +
    Risperdal will provide better maintenance control over a year.
    Yet that is how the results were generalized— psychiatrists left
    their patients on “whatever” broke their mania. You can see
    how, over time, doses and number of meds keep going up.

    2. See the y-axis? It doesn’t say “amount of improvement,” it


    says “percent of patients.” It doesn’t say that each person got
    more better, it says more people responded to two drugs than
    responded to one drug. We assume the superiority was the
    result of the combination. But how do you know it wasn’t due
    entirely to the Risperdal? If you give a room full of manics
    Depakote, 25% get better. If you give a room full of manics
    Risperdal, 25% get better. If you gave both to everyone, then
    50% would get better, but it’s pretty clear that the Depakote
    responders didn’t need Risperdal, and the Risperdal
    responders didn’t need Depakote. Indeed, when you look at
    change of symptom severity, two meds was no better than
    more of one med.
    This chart could simply be the result blasting patients with two
    drugs, hoping one works. So this doesn’t say “if a drug fails,
    add a second.” It says, “if a drug fails, switch to something
    else.”

    Which should have been so obvious as to never have


    necessitated a study.

    V. So Then It’s Agreed: Let’s Change The Definitions So


    We Don’t Get Caught

    At some point, someone is going to notice that polypharmacy


    isn’t working as promised; that it is not particularly safe; and
    that it certainly isn’t worth the price.

    And Depakote was going off patent. What to do?

    What you do is write a completely unimpressive, pointless


    article (Effectiveness of Adjunct Antidepressant Treatment for
    Bipolar Depression) based on a multimillion dollar
    government finded study that tells us nothing we didn’t
    already know for decades, in the most prestigious medical
    journal (NEJM) available, and in it sneakily and gigantically
    change the definitions of words to prepare for the next wave of
    psychopharmacology, granting plausible deniability.

    Mood stabilizers were initially limited to lithium,


    valproate, the combination of lithium and valproate, or
    carbamazepine. In 2004, the protocol was amended to
    define mood stabilizers operationally as any FDA-
    approved antimanic agent.

    Now, in two sentences, all the junk articles that used to apply
    only to Depakote can now be reused to apply to
    antipsychotics. “We’ve known since 2001 that mood
    stabilizers, for example Depakote or Seroquel or Abilify, are
    maintenance agents…”
    VI. But How Can Antipsychotics Be Mood Stabilizers If
    They Are For Psychosis?

    At first glance, the question seems reasonable, but for the fact
    that the none of the capitalized words above have any meaning
    at all, except those with three or less letters.

    Seroquel for maintenance bipolar. Why not, a priori? Why


    would it be any worse than Depakote, a drug which didn’t
    work anyway?

    The problem, however, is that by pushing Depakote as a


    maintenance agent for so long, everything is reflexively
    considered second line, an add-on.

    So because of the artifice, the semiotics, “bipolar requires


    mood stabilizers; Depakote is a mood stabilizer; bipolar needs
    Depakote” you can’t do a Seroquel monotherapy study. It has
    to be done as an adjunct to Depakote or lithium. Therein lies
    the problem with the interpretation of the results.

    The results are, indeed, impressive: people on both Seroquel


    and Depakote had fewer, and later, relapses than those on
    Depakote alone. This holds true whether you are looking at
    relapses into depression, mania, or all mood episodes.
    So, for example, by 52 weeks, about 25% of Seroquel + mood
    stabilizer patients had relapsed, while 62% of mood stabilizer
    alone patients had relapsed. That’s an NNT of roughly 2.5, i.e.
    you need to put 2.5 people on Seroquel to reliably know one
    person benefited. Lipitor’s NNT for reducing heart attacks is
    25.

    Although you’re not supposed to compare results from


    different studies, I feel completely comfortable saying that the
    Depakote curve here is about the same as it was the in other
    maintenance study, i.e. no better than placebo. (Stop using
    Depakote.)

    VII. But Is It Measuring Prophylaxis Or Relapse?

    Look back at the Depakote study for a hint.

    Patients were all stabilized on Depakote/Li with Seroquel over


    36 weeks, and then randomized to either continuing
    Depakote/Li + Seroquel, or to being taken off Seroquel and
    being left on Depakote/Li. Those left on Seroquel did well;
    those who had the Seroquel removed did not.

    So on the one hand, you could say “the combination prevented


    relapse,” or, you could say, “abruptly stopping your Seroquel
    results in a relapse.” Do you see the difference?

    With the Depakote study, stopping your Depakote had no


    adverse effect. For whatever reason, stopping your Seroquel
    apparently does result in prompt relapse.

    You are being tricked (not on purpose) by the presence of the


    Depakote, thinking that this is providing you some degree of
    mood stabilization, and the Seroquel is adding to it. Wrong.
    The Depakote is providing you nothing. The Seroquel is the
    mood stabilizer. And “stopping your meds” is, after all, not a
    good idea.
    VIII. What Dose?

    There is one other important result of this study. The patients


    were not simply on Seroquel; they were on Seroquel at
    fluctuating doses, per the judgment of the doctor, 400mg to
    800mg. That is key. Seroquel didn’t prevent relapse; rather,
    raising the dose whenever they needed it, and possibly
    lowering it when they didn’t, is what kept them stable. Maybe
    if they were on a fixed dose of Seroquel the whole time, no
    opportunity to raise the dose, people would have relapsed
    more frequently. But this way, at the first sign of trouble, you
    pre-empt it by increasing the dose.

    In other words, Seroquel didn’t prevent relapse; prompt


    intervention by the doctor as things developed (using
    Seroquel) prevented the relapse. This doesn’t diminish the
    utility of Seroquel, but it also doesn’t mean you can put
    everyone on 600mg and say, “see you in a year.”

    That is, perhaps, why Depakote failed: it relied on a steady


    dose, titrated to an imaginarily important blood level that it
    seems never to have occurred to anyone to ask why we target.

    IX. The King Is Dead, Long Live The King

    Just as Depakote was an overhyped drug that will thankfully


    die with its patent, it is more than likely that Seroquel for
    maintenance bipolar disorder represents some sort of top in the
    antipsychotic market. It will enjoy massive, and steady, use for
    several years, but I doubt if there is much growth left in it.
    Astra Zeneca thinks it has penetrated a market; but it has really
    opened the doors for all antipsychotics in the same market.
    You can prescribe Seroquel; don’t invest in it.

    Simultaneoulsy, just as I was a vocal advocate for the use of


    antipsychotics over the massive overuse of Depakote— and I
    thus contributed to the rise of Seroquel (and others), my new
    target may be the overuse of antipsychotics.

    The target is not Pharma or reps, but academic physicians who


    are politicians posing as scienticians. Completely absent is the
    pursuit of science or truth— e.g, “we didn’t expect this result,
    I guess we were wrong”— but diversions and sleight of hand.
    The point is not the results; the point is the discussion. The
    message doesn’t matter, the medium is the message. They
    have an allegiance to a given concept, and they defend it,
    promote it. No different than a PAC. And when their King
    dies, they celebrate as if they never believed in him at all.

    But at least the rise of Seroquel will benefit humanity in two


    important ways. First, it brings evidentiary support to the not
    common enough practice of fluctuating the doses as needed,
    up and down, rather than relying on a set dose.

    Second, it means the demise of polypharmacy (until they


    invent a new class of drugs), the drastic reduction of the
    number of medications patients will be prescribed, especially
    when coupled with the slow demise of SSRIs.
    Ara Abrahamian Wins
    Award For Medal Toss,
    Saved By Passport
    August 15, 2008

    Between 1am and 9am, a previous 2 paragraph version of this


    post managed to offend Swedes, Armenians, wrestlers, the
    Olympics, bronze medals and mats.

    In the interest of completeness, I will this time include the


    French.

    Background: Ara Abrahamian, Swedish wrestler, wins the


    bronze/loses the gold. At the podium, he steps down, tosses
    the medal on the mat, and says, “this medal means nothing to
    me. I wanted gold.”

    That’s Roget’s antonym for sportsmanship. Because


    competitions are so clear—winner/loser— you’re supposed to
    reserve your emotions. I’m not saying you have to be the
    Charioteer of Delphi if you win, but tossing your medal on the
    mat when you lose is a definite no.

    I am told that he was robbed, that the judges didn’t make just a
    bad call, but purposely made a bad call. I believe you. You
    don’t need to convince me that Olympic judges border on
    corrupt, are susceptible to bribes or even petty
    personality/nationality controversies.
    But that fact makes his behavior worse, not understandable.
    That’s the point of sportsmanship. We know you were robbed,
    tossing the medal doesn’t support your case; Better if he
    quietly taken the bronze, noble in the eyes of the world.

    Because if we didn’t think you were robbed, we’d just think


    you were a jerk.

    To illustrate this, imagine if this guy was American. The world


    would completely lose their marbles. “Did you see that
    fucking American!” would be all anyone would say about
    Beijing 2008— and that would just be coming from the
    Americans!

    The Swedish wrestler had to be restrained by team-mates


    earlier as a row erupted with judges over the decision…

    Can you imagine what would have happened if an American


    wrestler went at the judges?

    Which brings me to the French. Michael Phelps decided “eat,


    sleep, swim” would be his tagline, and without reading too
    much into it, maybe it signifies an individual devotion to self-
    improvement in the service of himself/team/country. But when
    the French choose, “we will bury the Americans”— is that a
    bit broad? Even “we will bury Michael Phelps” makes more
    sense, since he actually is their enemy, but “the Americans”
    actually aren’t.

    Flip it: imagine Phelps had said, “I will bury the French.” If he
    actually wins, people will just dismiss him as an arrogant
    American who should have drowned. And if he loses, how did
    saying that help him? It makes him look, well, French. And
    that’s all anyone would talk about, those arrogant Americans.

    You will observe that no one, anywhere, is writing that the


    French team were a bunch of arrogant losers who got, as they
    say, pwned. That’s a double standard, yo.
    So Abrahamian was saved by a Swedish passport. Because
    he’s Swedish, he doesn’t carry any other baggage— his
    tantrum only reflects on him and the judges. An American
    wrestler who tosses a medal would be General Assembly level
    outrage.

    Especially if the American wrestler was robbed. Somehow,


    people would see it as a sort of justice, yeah, he was robbed
    but see how he’s acting? He doesn’t deserve to win anyway, he
    doesn’t represent the spirit of the games, those Americans
    think they can do and have whatever they want.

    “It’s all politics,” said Swedish coach Leo Myllari.

    You said it, brother. People working out their grievances in


    ways and in forums that have nothing to do with either the
    way or the forum, and so creating new grievances. The judges,
    I’m sure, thought they were righting some
    social/personal/political wrong through the medium of point
    deductions; the French were voicing the cultural hopes of the
    world; all under the unfortunate maxim of the powerless: there
    is no justice, get justice however you can get it.
    If You’re Watching, It’s For
    You
    August 20, 2008

    On the Late, Late Show With Craig Ferguson, a joke about


    “man-ginas,” a few drug/DUI references, a Kristy Ally fat joke
    (“uses her swimming pool to cook spaghetti”) and a
    homosexual reference.

    And I think about how TV has changed, things unimaginable


    20 years ago are routine now. I guess they’ll do anything to get
    the coveted youth demographic.

    And then I think, wait a second…

    II.

    It’s the easiest logic in the world to follow: racy humor


    targeting the youth; old people will either not get it or be
    outright offended, but it’s worth it to get the young viewers.

    Ok, but there are also going to be a group of older people,


    maybe in their forties, who are cool enough to get the humor,
    to like it, but, you know, most of other people their age will be
    offended, people like their parents.

    But here’s the sticking point: Ferguson, Conan, and Leno all
    have an average viewer age of 50. They’re not getting the
    jokes in spite of their age— the show is written for them.

    And it makes sense: the humor isn’t more edgy or racy, it’s the
    same stuff we heard 20 years ago from Stern and others, so
    this isn’t a case of targeting the young, it’s actually targeting
    the old.
    Example: they picked Jimmy Fallon to replace Leno,
    theoretically because he can target the youth viewer. But
    Fallon was funny on SNL a decade ago— he’s funny to people
    who were young a decade ago. And so he’s going to be funny
    to those same people who are now a decade older. People
    don’t step outside themselves and realize that everything that
    is being made by 30-50 year olds, which is nearly everything,
    is actually for 30-50 year olds, even though it appears like it’s
    for 20 year olds.

    Here’s an example: Chris O’Donnell is Ferguson’s first guest,


    and he comes out in jeans and a suitcoat. Because he’s cool,
    he’s younger than he actually is. Actually, no— he’s exactly as
    old as he is, because the only people who dress like that are
    people his age or older.

    As if to solidify the point, the next guest is Henry Winkler—


    the Fonz— who also is wearing jeans and a sportcoat. That
    was cool to (actual) kids thirty years ago when Letterman
    dressed that way, and now those “kids” are old enough to dress
    themselves the way they always wanted. (Letterman doesn’t
    anymore.)

    III.

    But this isn’t just old people pretending to be young, an


    innocuous though silly behavior. This is a larger, social trend,
    a game, designed to promote a fiction.

    The game is to pretend that all this media is for the young, so
    they’re targeting the young by acting “young.” But it’s really
    for the old— who still think they are young. They are calming
    the anxiety of a generation of older people who still think they
    are young. “Winkler is acting and dressing hip for the kids,
    and since I get it and dress like that, too, I must be young.” But
    Winkler is 60. And no one uses the word hip anymore. Get it?

    I’m not saying Ferguson isn’t funny— I watch him— but I


    have no illusion that I get him despite my age. It’s the
    foundation of televsion: if you’re watching it, it was meant for
    you.

    I couldn’t have produced the show better myself to reinforce


    my point: the commercial break between O’Donnell and
    Winkler was— please sit down— Just For Men hair dye. The
    commercial showed news and concert footage from the sixties
    and seventies with a voice over, “The generation that said
    they’d never grow up— didn’t.”

    TV may say it wants younger viewers, but every commercial


    was for older viewers.

    About twenty years ago I learned the marketing law that


    young people have all the disposable income— because older
    people were saving— and they spend the most, and you have
    to go after them. I don’t believe that’s true anymore. Hell, the
    fact that it was true 20 years ago means that those young
    people are older. They’re still the consumerists they once
    were.

    And so what we have here is semiotics, a redefining of terms.


    “Young” no longer means “ages 18-24.” It means “old people
    who did not grow up.”

    Don’t delude yourself that “40 is the new 30.” It isn’t, ask
    anyone who is 30. But that’s your business how you want to
    be. The problem is that the actual youth have no idea what to
    make of aging. How long are they allowed to be adolescents?
    Pretty long, it appears. What’s the reference point for being
    mature if your Dad isn’t?

    Clearly this attitude doesn’t bode well for capitalism. Older


    people who are supposed to be more thrifty are spending their
    money on useless symbols of wealth. Yes, that includes (too
    big) houses. And the narcissism that I’m accused of seeing
    everywhere may, in fact, only exist in people over 30. Twenty
    somethings are allowed to be quasi-narcissists, and it’s also
    defensive: what do you expect from a teenager whose Dad,
    overweight, balding, drives a sportscar? Emotional lockdown.
    Patton Oswalt said he’ll be the best parent ever by being
    boring, because their kids rebel. All the cool parents who
    smoked pot with their kids raised the kids who moved to the
    suburbs and put warning labels on record albums.

    I believe kids demand of adults to be different than them.


    More stable, more future oriented, more careful with money.
    Not someone they want to emulate, but someone they want to
    go beyond. The adult serves as a foundation to build on. That
    desire to be a foundation— not a support or a model or a goal
    — is lacking in the older people. There’s little thought given to
    multigenerational advancement, that the primary point of their
    existence is their kids’, and their kids’ kids, progress. Not a
    point, not also a point, but the primary point.

    So I wonder if the conventional wisdom “we are a youth


    obsessed culture” is actually wrong. It may be worse than that:
    youth obsessed and frankly delusional. They’re not pretending
    to be young, they actually believe they are young. A “residual
    self image” in a person’s mind of who he thinks he is, despite
    that image being 20 years younger. They picked an identity not
    supported by the facts. And has set up a media apparatus to
    reinforce the delusion, hide the reality.

    So the actual young get squeezed out of their own


    demographic, into being even younger, or jumping over and
    becoming too old, too quick. If the kid is parentified, or
    grossly immature, you may want to consider that.
    What Happens If
    Pharmaceutical Marketing
    Disappears? Part 1
    August 27, 2008

    Everyone (including me) thinks Pharma is too heavily


    involved with the practice of medicine. So we try to think of
    ways to stop this. Restrict gifts and consultant fees to doctors;
    decrease, or at least separate, industry funding from research;
    and, of course, no more reps in doctors’ offices.

    These all sound like great ideas, how could you even come up
    with an argument against any of them?

    Here goes.

    As a bonus, I even offer a practical long term solution.

    The core issue is that Pharma exposure represents a conflict of


    interest. Does anyone understand what that term actually
    means? Ok, let me ask you a question. What is the plural of
    “conflict of interest?”

    a. conflicts of interest
    b. conflict of interests
    c. conflicts of interests

    Not so easy to answer, because any of them could be correct.


    You can’t create a workable policy against something so vague
    it can’t be pluralized . You have to target the individual
    conflict and weigh it against the individual interest. It may be
    a conflict of interest to take money from Merck while doing
    AIDS research; it might also be a conflict not to.
    Ask The Question Differently:

    Instead of asking what should be done to curb COIs (clever,


    huh?) ask: what would happen if we succeeded?

    1. No more reps.

    I don’t know what goes on in other branches of medicine, but


    if you get rid of reps— and detailing, and “lunch and learns”
    and all that goes with them— psychiatry will instantly grind to
    a halt, and people will die.

    It is an indisputable point that reps know more about the


    medicines than the doctors do. Worse, doctors don’t know
    much more than a patient on the Google. We can argue
    whether Lilly hid the diabetes risk of Zyprexa, but it took
    Pfizer’s (launching Geodon) to tell us about it. Don’t tell me
    that we would have learned about it from the extensive journal
    articles written in 2000 (three.) Doctors only recently
    discovered Vioxx had a cardiac risk, though Yahoo! News had
    an article about it in 1999. Abbott et al may have rammed
    Depakote down our throats through 2008, but it took Astra
    Zeneca to kill it.

    2. No more Pharma education money.

    A frequent complaint is that there’s $1B of Pharma money in


    CME. Is that just extra money? What’s going to happen if you
    take it away? Then there’s no more education. All of post
    graduate medical education is done by Pharma. The residency
    didn’t buy the textbooks for the residents, Pharma did. Pharma
    sponsors the short “throwaways” and supplements that at least
    get some readers, unlike the regular journals which get no
    readers. Pharma also pays for the CME.

    Who’s going to pay the CME lecturers? Who is going to pick


    the topics? The government?

    Here’s an anecdote: I’m talking to a psychiatrist, and finding it


    difficult to keep all the receptor pharmacology straight he says,
    “these new drugs are no better than the old ones, we should go
    back to them.” Is that a fact, commtard? You want to go back
    to Trilafon and Pamelor? If perphenazine is so great now, how
    come it wasn’t when they called it Trilafon?

    If your reason for prescribing a generic is that it is a generic—


    I don’t mean sertraline vs. Zoloft, I mean imipramine vs.
    Zoloft— you are worse than the guy who prescribes Abilify
    because Pharma paid him.

    (More on separating Pharma from CME.)

    3. No more Pharma research money.

    Do you know how many clinical trials are done by Pharma?


    Lots. You know how many are done by NIH? Not lots. If there
    exists one person on the planet who can tell me what society
    got from the $68M tapayer dollars spent on CATIE, I’m
    listening.

    Clinical research is performed for two reasons. Secondarily, it


    is to promote the science. Primarily, however, it is deficit
    spending. It gives jobs to people. Few clinical researchers end
    up studying their passion; they study what’s being funded. If
    Depakote’s paying, we’re studying Depakote. You want a job
    at Harvard in 2004? Make sure you can spell Depakote. You
    want one in 2009? It’s S-E-R-O-Q-U-E-L.

    If Pharma stops paying, then there will be much less research,


    even if it is biased. People are missing the hidden benefit of
    the “biased” Pharma trials: they are still information. I know
    Depakote isn’t a maintenance agent because of the failed trial
    that Depakote paid for. I know Zyprexa causes diabetes and
    weight gain because of Lilly’s own data (and the data from
    comparator trials done by other Pharma companies.) I
    recognize Pharma spins the data, but you can’t tell me the data
    is non-existent. (Though that is preposterously what was
    argued about Vioxx.)

    If Pharma did not pay for these trials— if we had to wait for
    the NIH to investigate Zyprexa’s diabetes— we’d wait a long
    time. And, per #1, without Pharma to inform us a study was
    even done, we simply wouldn’t know.

    4. No more Pharma building money.

    You know that new wing of your university hospital? Who do


    you think paid for it? The New England Journal of Medicine?
    My favorite of all Pharma ironies is that a university will take
    $25M to build something that it will then ban reps from
    entering.

    5. No handouts to doctors.

    Why do doctors get entangled with Pharma at all? Is it really


    just greed? Then why not just move to California and
    prescribe marijuana out of a shack?

    I’m going to write something that so extraordinarily impolitic


    that no doctor will even admit to hearing this argument, let
    alone agreeing with it:

    Doctors don’t view this as extra money, they view this as


    money they are entitled to.

    $120k may seem like a lot of money, but no academic doctor


    thinks that university salary is what he deserves. So he does
    extra things for Pharma, or gets some unrestricted grants from
    Pharma to free up time (so that he can do “other” things). His
    assumption is he is worth, say, $200k, the University only pays
    $120k, and he’s going to make the rest up.

    BTW, that’s why the University gets away with paying you
    $120k.

    The same is true for non-academic docs. They didn’t imagine


    they’d be getting paid so little to do not exactly the job they
    thought they had signed up for. So they make up the
    difference.
    I’m not justifying it, I am explaining it. If you completely ban
    all Pharma money going into doctors’ pockets, they will
    demand it from somewhere else. They are not going to be
    satisfied with $120k. Or 15 minute med checks at $30 a pop.
    And you’ll have a brain drain— many docs will actually go
    work for Pharma. I can’t tell you how many times I’ve been
    offered jobs at Pharma— easy jobs, at 2-3x what I make now.
    Good students will think twice about medicine. Maybe they
    try biotech. Or law.

    Do not email me “what ever happened to working for the


    common good?” The only people who say that are not
    working for anyone, let alone the common good. Doctors do
    have a nobler sense of purpose, but not at half price. Sorry. It’s
    America.

    Before you take that money away, makes sure you have a plan
    B.

    Solution:

    In order to solve the problem, you have to adequately explain


    the problem. Right off: patients are not the customers of
    Pharma. Doctors are. Pharma isn’t making medicines that
    people want/need, they are making medicines that doctors
    want/need, i.e. that they will prescribe. So the way Pharma
    operates is to either identify what doctors will use, and market
    it, or they wil find a way to take an existing chemical and
    market it so that doctors will use it. Viagra, a drug “for”
    pulmonary hypertension, was decided to be marketed as a
    penis pump.

    Like everything else in life, the solution is the demand side.

    (Part II here.)
    A Solution To The Pharma
    Problem
    August 29, 2008

    The problem so far is all arguments against Pharma (prices too


    high; no interest in making meds people need; no interest in
    cures, only maintenance treatments, etc, etc) fail because they
    are ethical arguments.

    The problem and solution require our reluctant acceptance that


    the problem is an economic one, and only economics will
    solve it.

    (If you haven’t, read Part 1 here.)

    Though I divide the solution into a “Doctor Side” and


    “Pharma Side,” it is imperative that both solutions be executed
    simultaneously. Doing only one will absolutely fail.

    Doctor side:

    Pharma does not make meds for patients, it makes them for
    doctors— they represent the demand. Read that again, that’s
    Axiom #1.

    Doctors have no current incentive or pressure to consider the


    cost (effectiveness) of the meds.
    But without the pressure, there is no incentive from Pharma to
    create products that are cost-worthy. If doctors don’t have to
    consider cost, then Pharma can effectively get doctors to add
    on, say Nexium. It works, so why not? If doctors must
    explicitly consider cost, then not only can’t Pharma
    successfully market Nexium, it will not even bother to create
    it. Pharma will work on something that’s really worth the
    money.
    Consider also that unlike other consumer products, price has
    no relationship to relative value. Nexium and Lipitor are the
    same price, but (arguably) Lipitor is more important.

    So doctors need to consider cost, which in turn will force


    Pharma to consider cost. So doctors— not patients, President
    Bush— must be given a healthcare budget, specifically a
    pharmacy budget. $20 per patient per day. Go.

    That changes the market. If you do that, prices come down,


    especailly for “luxury goods” (e.g. Nexium.) And Pharma will
    create wonderful things (not that they haven’t already.)

    Pharma Side

    Axiom #1 is: Pharma makes meds for doctors, not patients.

    Corollary: They don’t need to make a drug that is useful, or is


    awesome; only a drug that doctors will prescribe. Sometimes
    the two are the same, but that isn’t by design.

    Pharma gets no points, no credit, for creating drugs that work,


    only drugs that sell. No one I know has hugged a Lilly rep,
    thanking them for having a drug that works, even if
    imperfectly. Their only thanks is the money.

    The single problem from the Pharma side is the blockbuster


    drug model.

    The common criticism against the blockbuster model is that it


    entices other Pharma companies to invent “me too” drugs—
    another SSRI, another statin, another Nexium.

    But there is a much greater, critical, consequence of the


    blockbuster model: it makes doctors think that the mechanism
    of action of the blockbuster is the only, or most, important one
    — it creates a paradigm that is hard to think outside of. In
    other words, the blockbuster model confuses science. It may be
    that lowering cholesterol is itself a red herring, and that the
    actual benefit is something else— consider Vytorin lowered
    cholesterol more than simvastatin alone, yet was not better at
    preventing intima thickening. But because cholesterol drugs—
    nay, HMG co-A reductase inhibitors specifically— are the big
    drugs, that’s all doctors think about.

    From 1980-1998, SSRI were all psychiatrists thought about.


    So obsessed were they with SSRIs that they tried to explain
    nearly all psychic phenomena by serotonin. Depakote was
    such a blockbuster that people couldn’t even comprehend a
    “mood stabilizer” that wasn’t an antiepileptic.

    You can’t get a novel mechanism passed an NIH grant


    reviewer; Pharma isn’t interested either. How is it that 6
    atypical drugs all have prominent serotonergic activity, but no
    one investigated glutamate? You have a working paradigm,
    you have stuff that is well established, it’s hard to abandon it
    and try something new. Not when you operate on the
    blockbuster model.

    And meanwhile, Pharma loses out on new opportunities.


    Pharma may have already invented a novel mechanism drug
    that reduces heart attack risk— but not only does it have to
    bring it to market, it has to retrain doctors that they trained to
    be statin obsessed— that cholesterol, after all, isn’t everything.
    Strattera and Cymbalta— both invented at the same time as
    Prozac— languished in Lilly’s basement because the world (of
    doctors) was not ready to hear about drugs that weren’t
    “selective” or serotonergic.

    But as long as doctors don’t have to consider cost,


    blockbusters are the best way to make money. You want to
    make a drug that doctors will simply add on to everything—
    and they will, if they’re not paying.

    The Incentive Model:

    Broadly, there are three categories of people working from


    different incentives.
    1. For Pharma researchers, the incentive is to get FDA
    approval for an indication.
    2. For reps, it is to get market share. Many reps compete
    against other reps in their own company. (e.g. if they
    come up with a great sales pitch, or have an awesome
    speaker, etc, they don’t want to share them with other
    territories.)
    3. For managers, it is indirectly market share, more directly
    certain rep based metrics (reps made growth targets, reps
    conducted the right number of programs, all expense
    reports were done on time, etc.)
    4. For the company itself, the current incentive is to create
    what doctors will prescribe.

    It’s obvious that the incentives are different, and none are
    actually in alignment with the company’s goal of increased
    revenue.

    1. Bringing a drug to market should not be incentivized, even


    from the basic profit perspective. Just because it gets an
    indication, doesn’t mean it will generate any money. But since
    researchers are incentivized precisely on that, you see a lot of
    obvious “me-too” drugs and indications. The fix here is to
    incentivize researchers based on the future success of the drug,
    not the indication. Coupled with a pharmacy budget for
    doctors, the incentive will be to invent a drug of value—
    whether in a disease that has few treatments; or a significantly
    better/safer alternative. While more difficult, it will be more
    profitable to the researcher than another SSRI (which doctors
    won’t want to spend their budget on.)

    2. Market share is also a bad metric, yet it’s the one everyone
    uses. It does not matter at all that Seroquel has more market
    share than Zyprexa because they may not be used for the same
    things. It’s not Coke vs. Pepsi. As an example, for Lilly,
    Zyprexa competes against Geodon, but not against Depakote
    — because it doesn’t share the same FDA indication— even
    though in the treatment of bipolar, Depakote is a much bigger
    competitor than any antipsychotic. If Zyprexa wins all of
    Geodon’s market share, it gains very little in real dollars. But
    convert all the Depakote to Zyprexa, and Lilly wins.

    3. Managers. I am not really sure if there is any value to


    managers. I am not being glib or insulting, and I’m open to
    information. But my read is that Pharma could easily cut the
    number of managers in half, reducing expenses but also
    freeing reps to focus on selling. Or, it could use a mentor
    model where good or senior reps are paid extra to mentor
    newer reps.

    4. Next, you have to incentivize Pharma to make valuable


    drugs; at least don’t de-incentivize. There is a gigantic
    likelihood that any really useful drug will be commandeered
    by the NEJM’s Marcia Angell and her band of merry
    socialists. Why would any company would want to spend any
    money on a cure for HIV, when there is a real chance it will be
    stolen by the UN even before it gets approve?. And we’re
    supposed to accept that, because society “needs” it. “Sanction
    of the victim” is what Ayn Rand called it (and I’m confident I
    just lost readers by invoking her name. Bite me.) So instead,
    you know what Glaxo’s next big drug is? Treximet: Imitrex +
    naprosyn. Commandeer that, Dr. Angell.

    The Research Model:

    The current model is completely broken. Allowing “thought


    leaders” to peer review grant proposals is as good an idea as
    allowing senior Senators to choose your next President.
    Letting Pharma do it is like letting Coca-Cola decide your
    breakfast cereal.

    I recognize that it can’t be fixed all at once, so I propose an


    incremental solution.

    Pharma puts money into a pot to fund independent research,


    no strings attached.

    They can still fund their own stuff, of course, but we need a
    pool of non-taxpayer capital that private research can use. I
    recognize this is an expense for Pharma— but not huge,
    NIMH budget is $1.5B— but it earns considerable respect, and
    will likely lead to new ideas and directions— and someone at
    Pharma will ultimately benefit.

    The problem is who will manage this pot: putting it in the


    hands of “thought leaders” and academics is stupefyingly
    obviously a bad idea. You may as well let the Politburo decide.
    (Yeah, I said it.) Want to know what that would look like? The
    NIH.

    The solution is a “Digg” style voting of research projects. Any


    doctor— not just psychiatrist, because you need people with
    different mindsets to make good evaluations— can vote up or
    down a research idea/protocol. If you want to get fancy, they
    can also vote up the amount the study gets (as opposed to
    simply approving an amount.) It’s possible that allowing other
    scientists to also vote could be of benefit, but there are some
    problems with it that I haven’t worked out.

    Again, Pharma and the NIH can continue the same biased,
    barely readable quasi-research they have always done, this is
    just another funding source.
    Why Are Athletes Barely
    Better Than Their
    Competitors?
    September 2, 2008

    I’ll admit I know nothing about sports, so I am asking for help


    on this one.

    In writing the post on Olympic bravado and all around anti-


    Americanism, I read this an article in Time Magazine about
    the French vs. American swim teams, the significance of
    which I did not appreciate until later.

    The article wrote,

    The French swimmers had promised to “smash” the


    Americans in the 4 × 100-m freestyle relay, but the U.S.
    men took the gold with a last-millisecond comeback by
    anchor Jason Lezak. The team—Michael Phelps, Garrett
    Weber-Gale, Cullen Jones and Lezak— smashed the
    world record by nearly 4 seconds.

    So that’s impressive, but doesn’t that mean that the French


    also smashed the world record by 4 seconds?

    In fact, all of the medal winners beat the world record by


    almost 4 seconds. Almost every country competing beat the
    world record.

    Yet the difference between gold and silver was 0.08 seconds.

    A cursory look over other events revealed this is not


    uncommon: everyone is suddenly a lot better than the best
    ever was, but they’re still barely better than each other.

    So how is it that from one Olympics to the next, there is such


    massive improvement, yet the difference between each team is
    still (to me) amazingly small?

    It’s not a case of the far right of the bell curve, where the most
    elite athletes are close together in ability. In fact, the bell curve
    would predict that as you move further to the right, there
    would be fewer people with similar scores.

    It doesn’t happen in other areas. The two richest people don’t


    have anywhere near the same amount of money. The two
    tallest people on earth are different by half a foot. Etc.

    My guess is that it must have to do with the competition itself,


    seeing the other competitors and pushing yourself accordingly.
    But if that’s the case, wouldn’t the best thing for coaches to do
    is train their athletes in isolation, and tell them the other guy is
    six seconds faster than he actually is?
    Doctors May Only Be Paid
    Once
    September 4, 2008

    The ACCME (the people who run CMEs) are asking doctors
    to comment on their proposal, which is:

    Persons paid to create, or present, promotional


    materialson behalf of commercial interests cannot control
    the content of accredited continuing medical education on
    that same content.

    In other words, if you’re a doctor that is on Abbott’s speaker’s


    bureau for Depakote, you would not be allowed to present
    CME lectures on Depakote’s use in bipolar, because even
    though CMEs are technically free of Pharma influence, you
    may have a bias because of your prior financial entanglements.

    How could anyone be against this proposal?

    Here goes…

    The logic is important and deceptive. They aren’t implying


    that in order to keep Abbott happy, you’ll lie during a CME
    lecture and say Depakote is more awesome than it is.

    They are saying that the bias is deeper, that because Abbott
    pays you so much, you’re going to actually believe Depakote
    is awesome, and you’ll say that during a CME. People will
    think you’re being all scientific, they won’t realize that the
    reason you believe it is because you were paid so much, so
    often, that you now do believe it.

    So the two have to be separated. To keep CMEs pure, speakers


    can’t have been paid by Pharma on a similar topic.

    Ok, I have a question: if we do this, why would anyone, ever,


    choose to do CME lectures over a Pharma talk?

    Before you freak out “not all doctors can be bought!” follow
    the logic here.

    You aren’t lying— you actually believe Depakote is awesome.


    If you actually believe Depakote is awesome, why wouldn’t
    you only speak for Abbott and never do CMEs? You’re being
    honest, you’re saying what you think, what do you care if
    people are slightly suspiscious because the dinner is sponosred
    by Abbott? You’re telling them what you know to be true.

    Take it a step further: what if you believe Depakote is


    awesome based on science, or your own judgment? And had
    never been paid by Pharma before?

    Then you see, the result of this inanity is that anyone who
    believes, for any reason, Depakote is awesome will have to
    choose between giving a few CMEs a year for less money, or
    lots of Pharma programs for more money.

    I observe that there’s no prohibition on receiveing NIH money


    and giving CMEs, because obviously there are no biases at the
    NIH.

    Look, people, if you want to completely ban doctors from ever


    doing Pharma programs, then let’s take the debate there and
    decide. But if you cannot construct a solid argument for this
    abolition, then all of this back door, smoke and mirrors
    protectionism will always follow the law of unintended
    consequences.

    (Another post on the separation of church and state.)


    Undue Influence On
    Psychiatrists, Or The Public?
    September 5, 2008

    This is an example of why the controversy over Pharma


    influence on doctors is, while accurate, likely irrelevant.
    In Psychiatric Times, the Time Magazine of psychiatry, there
    appears a powerful juxtaposition of stories that was likely not
    appreciated by the editor.

    The first story, “Vermont Psychiatrists Unduly Influenced”


    says what it looks like it would say. The attorney general finds
    that Pfizer, Lilly, etc spent $3M on marketing to doctors, a
    33% increase over last year.

    The second story is literally in the next column. “30% [of


    Americans] Have Received [Psychiatric] Treatment”
    especially people in their 20s-30s. Furthermore, the article
    notes there are still significant barriers to treatment— so more
    people would have gone if they could.

    Doctors are being paid to write these meds? Wait— what,


    exactly, are they being paid to do? Write Zyprexa instead of
    Geodon, not with Geodon. And only to the people who show
    up in their offices. Right? These marketing efforts should
    result in skewed prescribing, but not more prescribing. In
    theory, the best Pharma can do is get everyone who shows up
    on meds.

    The problem, bluntly, isn’t that Pharma is getting docs to write


    prescriptions. The problem is that our beloved country is going
    completely insane. The supply of pills isn’t the issue, the issue
    is the demand for them— for anything, for relief.

    At some point, someone needs to stop asking why docs are


    writing Zyprexa, and ask why people are rushing to
    psychiatrists. Did the gene for bipolar suddenly get activated
    by a viral pandemic? Or are there social reasons for this?

    As if to further support my premise, the next article


    immediately below that one is “Drugs Easy To Get Online,”
    saying that people are getting pills from online pharmacies
    without prescriptions. People want the meds, not even because
    they work, but simply because they are hope, they are a
    chance.

    These meds are the wrong solution for what are largely
    social/economic/family problems. However, not only are there
    no other solutions; not only is no one even suggesting that
    these are social problems; current policy is to label these social
    ills as psychiatric.

    I get it, it buys you about a generation. But not much more
    time than that.
    David Duchovny Does Not
    Exist
    September 8, 2008

    I read in People Magazine that David Duchovny entered a


    rehab for sex addiction. (I lie: I saw it on perezhilton.com.)

    Duchovny’s characters have often had this dark sexual side:


    Mulder’s main outlet was porn; the transvestite FBI agent on
    Twin Peaks, the Red Shoe Diaries. And he’s been accused of
    sex addiction 10 years ago (before he was married.) (He
    denied it.)

    The timing is either coincidental or ironic, or neither: season 2


    of Californication— his show about a sex addict, starts
    September 28.

    Which then begs the questions: is this

    1. who he is, and chooses roles (or is able to do certain


    roles) based on his personality?
    2. not who he is, but becomes it because of repeated
    exposure to these roles?
    3. not who he is, but is using this as a publicity stunt?

    If:

    1. then his core identity is strong, and can only excel in


    roles where art imitates (his) life
    2. core identity weak, but would be a good actor in diverse
    roles as well OR could be a better actor by immersing
    himself in a character OR he (and Tea) should be careful
    of the roles he chooses
    3. core identity strong, Hollywood’s products need every bit
    of help they can get

    The image is not the real, but only a representation. But if


    there is no real, then that representation becomes the real.

    I don’t know whether he is a sex addict/good actor/strong


    personality, or not. But as I’ve said before, everyone must
    ultimately choose who they are, or else it will get chosen for
    you.
    Odd Finding of Gender
    Differences In Walking
    September 8, 2008

    A story about a study which claims to find a relationship


    between the perception of gender— are the walking dots men
    or women— and the direction those dots are going— towards
    you or away.

    I.

    The story is easily summarized: researchers find that the


    perceived direction of motion is gigantically influenced by our
    perception of its gender.

    Subjects watched “light point walkers,” on a monitor, which


    have been standardized to exist on a continuum from extreme
    male to extreme female.

    It is based on this computer model from this article. Play


    around with it.

    Subjects uniformly identified the walkers as the appropriate


    gender. Interestingly, however, walkers judged as male were
    then judged to be walking towards them, while female walkers
    were judged to be walking away from them.

    More interestingly, even when perspective information was


    added to the walker videos, it had no effect on perceived
    direction. Men were still coming, and women going.

    This effect existed for both male and female subjects.

    II.

    It is “tempting to speculate” that this effect reflects the


    potential costs “of misinterpreting the actions and
    intentions of others,” [study author van der Zwan] added.
    “For example, a male figure that is otherwise ambiguous
    might best be perceived as approaching to allow the
    observer to prepare to flee or fight. Similarly, for
    observers, and especially infants, the departure of females
    might signal also a need to act, but for different reasons.”

    Yes, it is tempting, in the same way it is tempting for


    evolutionary biologists to default to Lamarck when Darwin
    doesn’t seem to fit the data. As with all “cool” science, it pays
    to read the actual study.

    Though not shown in the paper itself, the online version offers
    links to the videos themselves.

    First, there were only five subjects, 3 women and 2 men. This
    is important because of my next surprising observation: am I
    insane, or does what they have labeled as “extreme male” look
    like a super sexy woman, and what they have labeled as
    “extreme female” look like a male Zinjanthropus?

    mmc4.mov

    mmc5.mov

    etc. No, I didn’t copy those wrong. There were several videos,
    and 80% of them looked (to me) to be the opposite gender of
    their label. If these are indeed the videos watched by the 5
    subjects, then it’s not hard to see that not only is the study
    invalid, but those five subjects can never be called as
    witnesses.
    Scientists Find Evidence For
    The Unconscious
    September 10, 2008

    Not exactly, but follow along with me.

    14 subjects were shown 3000 pictures, 3 seconds each. Then,


    they were shown pairs of objects— one was the previously
    seen, the other never seen— and they had to pick out which
    one they saw. (pdf of article here.)

    The pairs were of three types: paired with something


    completely different; paired with something of the same type;
    and paired with an altered version of the same picture.
    3000 images— viewed once— over the course of two to three
    hours— and the subjects were able to correctly pick out the
    previously seen image 87-92% of the time. Absolutely wow.

    Granted, this is a paired identification, and not an uncued


    recall (“list everything you saw.”) But what it suggests is that
    nearly everything you see is in your brain, somehow/where, at
    least for a while.

    If it’s in there, then your brain is making associations with it.

    If it is making associations, then its presence is affecting the


    how/when/why of the “recollection” of something else, just as
    the how/when/why of the recollection of that object is
    influenced by what came before it.

    Example: are you storing it as a picture (the basket of grapes)


    or as an action (“object tipped over”)? If the latter, perhaps it
    would have been harder to differentiate it from an overturned
    basket of bananas then an upright basket of grapes. And that is
    influenced by whether your life is one of grapes or of
    overturned stuff.

    So that random guy in the red shirt you didn’t notice from last
    week when you were eating ice cream is in your brain, and
    he’s being used to make an association to something else. So,
    for example, Manchurian Candidate style, when you next see a
    red shirt, you get hungry.

    You don’t realize the red shirt made you hungry, either. You
    just feel hungry “for no reason.”

    Or it could go the other way— maybe you suddenly like guys


    in red. Or maybe you hate them. etc.

    Perhaps that’s why free association seems so powerful. The


    trick is to bring unconscious associations into consciousness.
    That way, you get to choose whether or how it affects you.

    Everything you experience— life, books, images, dreams,


    sounds, and things you did not even notice you experienced—
    becomes part of you, and it matters. We make fun of the white
    kid who is “pretending” to be all gangsta— “he’s a suburban
    kid from Irvine!”— but that “fake” experience actually
    matters. Certainly less than a kid who lead a real gangsta life,
    but more than someone who never imagined living it.
    IAnd it probably extends beyond identity to ability, and it
    speaks to the power of visualization. Who’s more accurate
    with an M16 rifle: the 19 year old who’s watched action
    movies his whole life, but never touched a gun or rifle; or the
    19 year old who’s watched no movies and never held a gun?

    Everything that happens matters; we just don’t know how.

    You can’t control a red shirted guy passing by you; but you
    can control, say, what you watch on TV, and how; who you
    talk to, what you talk about, how you do or do not decide to
    pay parking tickets.

    It’s very hard to understand why we think things, why we do


    things, why we are who we are. Root causes are never fully
    understood, probably are outright misleading the rest of the
    time. But what you do have control over, every moment, isn’t
    the why, but the what.

    (BTW, if seeing an image in your mind can affect you,


    imagine what a fake image can do.)
    Cut Rates Now
    September 15, 2008

    I’m putting myself on the record (not that I haven’t a dozen


    other times on this site):

    there is no inflation, if there it is two, maybe three years out at


    the earliest. This is massive deflation before your eyes, not
    even including the outstanding credit card balances and other
    personal loans which will never get paid, especially when the
    jobs start evaporating. No money=no buying, no buying=
    companies cut back, companies cut back=job cuts…

    Add to that the pressure for the government to come up with


    (emergency) healthcare and other public assistance and the
    situation becomes untenable.

    Oh, and Al Qaeda. That’s right, I said it.

    There are two solutions, and in order for them to work you
    have to do them today.

    1. Cut rates. Dollar is stronger, oil is down, we can take it.


    Worry about inflation later. Worry about the never-going-to-
    happen wage inflation later. This is better than bailouts, which
    will lead to inflation.

    2. Cancel mark to market: there is no market. You have


    ancient Chinese vase woth millions, but because the
    economy’s bad no one wants it right this second, so on ebay
    it’s still only at $2. Is it really worth $2? Should the bank get
    to repossess it when you go under for $2? That’s where we are
    now. You’re calling them 20% when they could be 60%. (The
    government may actually make money on FNM and FRE
    if/when this passes.) The result is you might actually be worth
    something, but still evaporate.
    MMS Chicks: Oil, Sex, Drugs
    And Anything Else You Want
    To Imagine
    September 15, 2008

    This is the article I got on my RSS filter that uses the keywords,
    “things I wish I did in college.”
    I. ” Culture Of Substance Abuse and Promiscuity.” Awesome!!

    A brief summary of one of the most popular stories of the week:

    Government brokers responsible for collecting billions of


    dollars in federal oil royalties operated in a “culture of
    substance abuse and promiscuity” that included having sex
    with energy company employees, accepting lavish gifts and
    rigging contracts to favored firms.

    Wow, just like drug reps. The Denver Minerals Management


    Service, part of the Department of the Interior, manages royalties
    received from oil companies who drill on federal lands. It employs
    super hot women who know what they want and know how to get it.

    Here’s the paragraph that launched a million erections:

    “During the course of our investigation, we learned that some


    RIK employees frequently consumed alcohol at industry
    functions, had used cocaine and marijuana, and had sexual
    relationships with oil and gas company representatives,” the
    report said. Two government employees who had to spend the
    night after a daytime industry function because they were too
    intoxicated to drive home were commonly referred to by
    energy traders as the “MMS Chicks.”

    The article also quotes an email from a Shell employee to a sexy


    MMS employee about a tailgate party:

    “You’re invited… have you and the girls meet at my place at


    6am for bubble baths and final prep. Just kidding…”

    Ooh. I’ll bet he’s not!

    One worker admitted having a one-night-stand with a Shell


    employee. That same individual allegedly passed out business
    cards for her sex toy business, Passion Parties Inc., at work, and
    bragged that her income from that business exceeded her salary
    at the Interior Department.

    The word “sex” is in every one of the first five paragraphs of this
    story, except one— in which appears the words, “fraternity house
    atmosphere.”

    You get the idea.

    Actually, you don’t.

    II. Wait, that wasn’t my news filter’s keywords, it was the


    media’s news filter’s keywords

    Yes, it’s an easy target. Do you know how many articles and blogs
    make the joke, “Oil For Sex” or “I want a job at the MMS!” And a
    quintillion innuendos employing “drill drill drill,” “what the
    President wants— more Bush!” or a picture of a pumping oil rig.
    Isn’t that hilarious? Right out of the Ray Romano Guide To Hack
    Comedy.
    Ok, you get the idea, the deconstruction is obvious. The story is
    sexy, it appeals to a news media obsessed with ratings who in turn
    need to pander to a population too jaded for porn, etc, etc. It doesn’t
    mean these people weren’t unethical, but it suggests that the media
    focuses on things that are titillating.

    You get the idea.

    Actually, you don’t.

    III. The MMS Chicks

    Despite the level of detail contained in the article, the thing they
    didn’t include— and when I say it, you’re going to suddenly nod
    your head in understanding— was a photo of the MMS Chicks.

    Consider that within seconds of the decision to expose Eliot Spitzer,


    the media had the name of the prostitute, an awesome picture of her
    in a bikini, her MySpace page, etc— all this, depsite the fact that she
    was using an alias.

    But here, nothing.

    Lest you think this is because they couldn’t identify them, half of the
    entire Dept. of the Interior report— where the media got all of its
    information— is devoted to these women. (No mention in the article
    of the other 7 people in the report.)

    So it struck me as unusual that the media did not try to publish their
    photos, let alone their names. When was the last time the media
    reported on a sexy story and didn’t show you the most outrageous,
    sexualized, unclothed pictures of the women? Every picture of
    Monica Lewinsky was of her gigantic mouth. (Even poor JonBenet
    always appears in her beauty pageant attire. You think they couldn’t
    find another picture of her?)

    So where the hell are my photos of nubile ex-college cheerleaders


    who now work in Ann Taylor suits, but get photographed in bikinis?

    Oh…

    IV. America Hates The Red Pill

    And it becomes more apparent that the article isn’t about a


    government office wasting taxpayer funds— the actual story— but a
    loosely based historical fiction about sex.

    For example, go back and read the first quoted paragraph— two
    women, sex with oil company employees, cocaine and alcohol,
    sleeping over because they were so drunk…

    Awesome story, except: these things didn’t all happen at the same
    time.

    Yes, two women got drunk and had to stay over at a condo paid for
    by Shell. Yes, one woman smoked marijuana at home— never at
    work— and the other used cocaine (last in 2005) (also not at work.)
    And yes, they had one night stands with oil company employees,
    though to be clear, neither was having sex with them to influence
    business— the men were not involved in the contracts.

    But it’s not sexy that way. It’s sexy only when you put them all
    together. And if photos get in the way of the fantasy, please leave
    them out.

    V. I Said America Hates The Red Pill


    Let me be explicit: the media doesn’t focus on sexy stories because
    that’s what the public wants to hear; it constructs sexy stories
    because that’s what it thinks the public wants to hear.

    Or maybe it’s simply random that Reuters decided to use this photo
    to accompany the story:

    See? They’ve been sent by the oil companies to get drilled.

    Interestingly, while no one published a picture of the women,


    everyone published pictures of the overweight middle aged man at
    MMS who was up to nonsense. Because his picture is perfect for the
    fantasy story: a midde aged man gets to bone his hot secretary.

    Unclick your caps lock before you send me your insane emails
    saying, “how can you justify what they did!” and “maybe they
    focused on the sexy parts, but it’s unethical just the same!” I’m not
    saying what went on wasn’t unethical, I am saying that there is
    nothing, absolutely nothing, in the news stories that allows me to
    accurately judge what went on there. There are facts, sure, but they
    are cut and paste facts, they are Mad Libs, the point of the story is a
    not information, it is fantasy, entertainment. They carefully choose
    how and what to tell you in order to create in you an unconscious
    image of oh, I don’t know, those two girls above drunk and naked in
    a ski lodge with oil company executives squirting them with
    champagne.
    I can no more judge the facts of this story with these articles than I
    can make any claims to knowledge about either schizophrenia or
    John Nash from A Beautiful Mind.

    This isn’t the media’s “liberal bias.” Hell, it would be fine if they
    actually had a liberal bias, so I could tell what side they were on.
    They only have a sensationalist bias.

    I’ll say it again in case you’re still on GMail: the media doesn’t
    focus on sexy stories because that’s what we want. It creates stories
    that are not real, like movies “based on a true story,” because that’s
    what we want. The New York Times has become Amazing Stories.

    VI. But Why Not Just Look At Porn?

    Because that’s not what we want.

    You’re not asking the media to give you a sexy story, you’re asking
    for a sexy story.

    15 years ago I was nearly certain that the availability of online porn
    would destroy a generation of teenage boys. Didn’t happen, at all.
    It’s quickly apparent teenagers aren’t that interested in porn. Two
    seconds on the Google Pornotron reveals that currently the biggest
    thing in porn is MILF porn. What, you think a nation of teenagers
    wants to bone middle aged women? Dream on, sailor. If you’re
    watching it, it’s for you.

    This is out of the Michael/Michel Foucault playbook. A focus on the


    taxonomy of sex, to disclose every detail, how and when and where
    and what, on the one hand pretending it should be secret and private,
    on the other hand publicly judging every kind of it. The more you
    talk about it, the more it can be controlled. The real power is in the
    discourse, analyzing every aspect of everyone’s behaviors.

    Control the sex, and it gets internalized: now you know what is
    normal. And normal can be loosely defined as the Panopticon of
    Sex: what would you not want to get caught doing?

    Foucault said the discourse was for power, control. Sure, but it can
    also be used to gain access to what is titillating. You want a way to
    talk about what you would not want to get caught doing.
    “Why don’t you just look at porn?” Because mostly it’s too
    unrealistic— it could never happen, and it leaves nothing to the
    imagination. What we want, what we really, really want, really want,
    is what we had in college: some guy telling you what he heard this
    one sorority girl did. That’s sexy. But updated for our current lives.
    We don’t want stories of sorority girls, we want stories of sorority
    girls who grew up into MMS chicks. And if that story did not really
    happen, please make it sound like it happened.

    And the news media provides us with exactly what we want, our
    posturing about the banality of it all notwithstanding. Reality is too
    boring, and world events too complex, too overwhelming, and,
    frankly, too not about me. We want entertainment, diversions, that
    look enough like social policy analysis that we don’t feel too guilty
    discussing them ad nauseum. We want masturbation that looks like
    work.

    Pay attention: you’re not asking the media to give you a sexy story,
    you’re asking for a sexy story.

    Story. That’s all.

    (For more like this, see the old Katy Perry story. And if you are so
    inclined, please Digg/reddit this post.)
    The Process of Bringing New
    Drugs To Market
    September 17, 2008

    An interview with Alan J. Milbauer, a retired vice president


    from AstraZeneca and partly responsible for Seroquel, about
    what goes into the process we’re all angry about.

    How were decisions made about which drug should be


    developed?

    Mr. Milbauer: We were a company dedicated to finding


    breakthrough drugs, but we could not afford to put all of
    our eggs in that basket. So, we needed to consider many
    factors beyond the breakthrough potential when we chose
    a drug for further clinical development.

    …One example is the drug Zoladex (goserelin) a one- or


    three-month injectable depot used to treat prostate cancer.
    This injectable LH/RH analogue suppresses testosterone
    and might obviate the need for surgery in some cases.
    Initially, we thought our market would be the oncologists
    but quickly realized that our real targeted physician group
    was urologists. Well, urologists are surgeons and we
    were introducing a treatment that was an alternative
    to surgery! Although we believed we had a treatment
    that was good for patients, we had to convince the
    urologists to store an injectable drug, get reimbursement
    from third-party insurers, including the Federal
    government, and forego surgery.

    Observe that in this example, the actual efficacy of Zoladex


    worked against it: the doctors who would use it were, in fact,
    least likely to want to use it. Do you think they were bad
    doctors, corrupt and only out to make money? No. their
    paradigm was cut, cut, cut, even though easy efficacy in a
    medication was staring them right in the face, they couldn’t
    see it, really see it. Like trying to convince a vegeterian to try a
    burger. “No way can this be as good as what’s been working
    for me. I’ll stick to what’s worked for me so far.”

    But that’s the problem, exactly: medicine is practiced by what


    works for the doctor, not the patient.

    How do you change a mini-paradigm like this, when doctors


    are resistant to data, journal articles, logic? What has to be
    done is this:

    We identified key opinion leaders to work with our drug


    and ultimately we changed some of their perceptions and
    practices.

    Medicine is not science, it is politics. It is no different than a


    lobbyist convincing a senator to vote for ANWAR drilling vs
    wind power subsidies, or both.

    The most poignant part of the interview was at the end:

    Looking back on your years in the pharmaceutical


    industry, what was the most challenging part of your
    job?
    Mr. Milbauer: Sometimes I had to convince senior
    management to drop a drug from development because,
    in our commercial judgment, the product was unlikely to
    be successful. The reasons could have been competitive
    positioning or the amount of commercial resources
    required, pricing issues, dosing or safety issues, or
    patient acceptance…but those reasons frequently did
    not matter to the scientists who had been advocating
    for the drug. I found myself having to persuade people
    who had spent many years developing “their” compound
    that it was not in the company’s best interest to pursue the
    drug, and often these people had difficulty accepting the
    corporate perspective. But, it was a business after all.

    Before you misread this as “money trumps science” go back


    and re-read the rest of this post. These scientists are not
    advocating for the cure for AIDS. It could be another Zoloft,
    or another Celebrex, or another Viagra. What matters to the
    scientists was that it was their drug, their discovery, their
    child, sometimes the scientists were vehemently advocating
    for a drug that was neither important nor profitable.
    Part of the problem is that scientists are incentivized on
    gaining FDA approval, and not future sales OR usefulness.
    And that’s why the model must change.
    Market Capitulation
    September 17, 2008

    Gun to head, this is the bottom.

    They didn’t cut rates, but they did issue new Treasuries
    because the Fed needs money. And no, there’s no inflation,
    because banks are deflating hard. We may come out of this
    alive, who knows. (Though for current retirees who had
    money in “buy and hold” safe financials— or anything else,
    for that matter— well… there’s always Social Security. I
    know, I know, I know.)

    They also stopped naked short selling, which is huge. I


    thought that was already illegal?

    For you technical traders:

    If we hold 10827, then that’s a double bottom and we go to


    12500, maybe even 13000. By January. Not sure how that’s
    possible, but there it is.
    Recollections Of Your
    Parents Before And After
    You Have Children
    September 18, 2008

    Did you know my blog has more readers than Psychiatric


    Times and Family Process combined? That sad fact compels
    me to refer you all to something excellent in both.

    For you parents out there (especially women):

    Before the birth of your first child, what was your recollection
    of your own childhood relationship with your parents? Were
    Mom and Dad close to you, distant, domineering, warm, etc?

    If the question was then asked four years after the birth of your
    first kid, how would your answer change, if at all?

    I.

    Jerry Lewis, MD, writes in Psychiatric Times about a study he


    did in 1995. He interviewed young couples before the birth of
    their first child, and four years after, about their recollections
    of their own childhood.

    He found that having a kid did not change their recollections,


    with one single exception:

    A number of the female participants changed their


    recollections of their fathers from positive to negative.
    After 4 years of parenting, they no longer recalled their
    fathers as being as affectionate and supportive during
    their childhoods as they had been before the birth of their
    child.

    I would have guessed the opposite, that most women would


    think better of their fathers after four years of motherhood:
    “wow, being a parent isn’t easy, I have new respect for my
    Dad.”

    So why would a subgroup of women think worse of their


    fathers after they had kids? (Or: why would they think better
    of their fathers before having a kid?)

    Perhaps women thought, “wow, look at all the attention and


    love I give my kid, my Dad never did that.”

    II.

    That would be my guess; but Lewis found a different reason.

    …we found a clear pattern, and it had to do not with the


    female participants but their husbands. The women who
    changed their recollections [more negatively] had
    husbands who were depressed, who helped little with
    parenting, and who were observed to be less sensitive to
    their children than other fathers.

    Hold on— why wouldn’t having a bad husband make you


    appreciate your Dad more? Joe is mean, my Dad wasn’t. If you
    think your husband is detached, uninvolved, and moody, why
    wouldn’t you idealize your Dad in comparison?

    The women with depressed, unhelpful husbands did not


    report lower levels of marital satisfaction; rather they
    were maintained at high levels. One interpretation of
    our data was that the women’s more negative memories
    of their fathers served the function of minimizing (or
    denying) their husbands’ failure to be as helpful as
    needed. If this is all that can be expected of men, then I
    can no longer recall my father so positively!

    So his theory is that these women selectively remembered


    negative things about their fathers in order to make their own
    husbands look better in comparison.

    Let’s say this is correct. It suggests a bigger problem: are these


    women willing to do this at the expense of their child who still
    has to live with him as a father?

    III.

    The facts are these:

    1. before having a child, women thought highly of their


    fathers and their husbands/marriage.
    2. After birth, they continued to think highly of their
    husbands, but worse of their own fathers.
    3. The husbands were observed by their wives to be less
    sensitive to the kids than other fathers and helped less
    with parenting.

    These women were not in complete denial about heir


    husbands’ shortcomings— they put it on the questionnaire.
    But they were just as satisfied with their marriages in spite of
    the fact that their husbands were bad fathers. Put another way:
    that their husbands were bad fathers didn’t make them less
    satisfied with their husbands— it made them less satisfied with
    their own fathers.

    These particular women were willing to demote the


    significance of both their own fathers and their own children
    in order to maintain the illusion that they had a good marriage.

    IV.
    But put all this aside. Lewis’s article is about the larger issue
    of historical narrative, constantly being revised to suit the
    demands of the current ego. The above women needed to
    affirm their husband’s worth, so they changed their
    recollections of their fathers.

    That’s one explanation, but consider for a moment a different


    possibility: that changing your memories changes you.

    Merely reading that sentence gives you pause. The man who
    holds onto childhood anger; the person who doesn’t forget a
    certain grudge, people who “remember where they came
    from”— these things anchor identity, keep you the same. I’m
    not making a value judgment, I’m describing a process. We
    believe that growing, or therapy, brings us to a point in our
    lives where we can reinterpret memories. But simultaneously,
    the act of reinterpretation changes us.

    You don’t just look back on your parents differently when you
    become an adult. You also become an adult when you are able
    to look back on your parents differently.

    Every moment of every day, you decide who you are, and you
    decide how things will be remembered. Memory isn’t a hard
    drive; it’s a text editor.

    When I was a child, I spake as a child, I understood as a


    child, I thought as a child: but when I became a man, I
    put away childish things.

    That should properly read: when I became an adult, I put away


    childish things. Then I became a man.
    Does CNBC Cause Market
    Volatility?
    September 22, 2008

    Books will be written about this financial crisis, but no one has
    brought up one important factor, and it is summarized by this
    single soundbite, from Friday September 17, 2008, at exactly
    4:00pm EST:

    “…and there’s the closing bell, I’m Bob Pisani, and I just
    have to say in my 18 years at CNBC, I have never been
    more proud of my news team than I am now….”

    They are good reporters, dedicated and hardworking, I’ll give


    him that, but was the reporting itself better than it was on
    other days? What else would there be to be proud of?
    The problem, as everyone on CNBC reminds, is one of
    liquidity, not solvency. In other words, the financial
    institutions have money, but are overleveraged. As long as no
    one calls in their loans, as long as there isn’t a run on the
    banks— as long as these institutions are given time, then they
    can rise the capital, or deleverage. They just need time.

    Bear Stearns didn’t have time. FNM, FRE— no time. Maybe


    in a year housing prices rebound? No one can wait that long.
    Etc, etc.

    And so one must wonder what part CNBC and the media in
    general played in this very real catastrophe. Maybe if the
    media hadn’t been reporting about— sensationalizing?—
    financial Armageddon so zealously, perhaps there wouldn’t
    have been a run on money market funds, calls to congressmen
    about the safety of their pensions, etc— and maybe the
    institutions could have had— what, another month? Two
    weeks, even? AIG held out until the end, defiant, until the
    government kicked them in the head to roll over. What could
    they have done in another two weeks?

    Who knows?

    It’s hard to say what relationship there is between, say,


    CNBC’s ratings and measures of market volatility:

    Oh wait, never mind, it isn’t that hard after all.

    In case you can’t see it, here’s the same graph with the CNBC
    ratings data shifted two days:
    The greatest monetary shift in this country’s history is real.
    But, as with politics, science, law, medicine and the arts, we
    don’t interpret reality, we interpret other people’s
    interpretations of reality.

    Which is why I say: America hates the red pill.

    (Data above from http://tvbythenumbers.com)


    Advancing Paternal Age And
    Bipolar Disorder
    September 22, 2008

    There is considerable evidence that advanced paternal age


    raises the risk of autism. It appears that the same is true in
    schizophrenia.

    Bipolar disorder, however, is an entirely different matter.


    In the above titled article in Archives of General Psychiatry,
    the abstract concludes:

    Conclusions Advanced paternal age is a risk factor for BPD


    in the offspring. The results are consistent with the
    hypothesis that advancing paternal age increases the risk for
    de novo mutations in susceptibility genes for
    neurodevelopmental disorders.

    Not so fast.

    First, it is necessary to remind everyone that doctors— let


    alone the layman and the media— do not generally read these
    studies, they read about them (like you’re doing now.) The few
    who do actually see the article will rarely go past the abstract.
    That means that the abstract, and even more importantly the
    title, are the only information conveyed.

    What becomes “known” in the field is a meme, a feeling, a


    gestalt, and in this case it goes something like this: “I have
    heard there is a lot of data on autism— experts on autism seem
    convinced— and now I see there is a study about bipolar, so I
    guess we are discovering that advanced age plays a role in
    psychopathology. Probably the sperm is bad.”
    Awesome. Suitable for happy hour conversation and Dateline
    NBC.

    Back to the conclusion’s last sentence. This should properly


    read, “Advancing paternal age, or some factor it represents, is
    associated with an increased risk…”

    Worse, while this is an article about paternal age, it also slyly


    reinforces in your mind the authors’ bias that bipolar is a
    “neurodevelopmental disorder” that may be caused by genetic
    mutations. See? For them, the “hypothesis” is the part about
    the advancing paternal age. The axiom is that bipolar is a
    genetic disorder.

    I’m not saying it isn’t a genetic disorder, I’m saying there isn’t
    nearly enough evidence to be able to say that the advanced
    paternal age represents a genetic variable.

    Does advanced paternal age really increase risk for bipolar?

    The data show that men over 55 had a 1.37 times greater risk
    of having a kid with bipolar than Dad’s who were 20-24.
    There was an even stronger association for those kids who had
    an early onset (before age 20)— 2.6 times greater risk.

    The problem is that “advanced paternal age” could actually be


    a proxy for a lot of things: early maternal loss (children whose
    mother died before their fifth birthday had a 4.05 times
    increased risk of bipolar), or maybe even birth order. Maybe
    there are reasons why the youngest born may be more
    “bipolar” than the oldest born.

    There isn’t enough/any evidence to determine if birth order is


    or is not relevant. But neither does this study contribute any
    more than “X is associated with Y, but we don’t really know
    what X represents or even what Y is.”
    Teenage Girls May Be
    Having Oral Sex, But The
    Problem Is You
    September 23, 2008

    I sincerely pity the current generation of teens who have to


    live in a world containing the current generation of adults.
    I.

    As you are no doubt aware, teenagers today are out of control.

    Time Magazine writes in A Teen Twist On Sex,

    Americans have plenty of opinions about teenage


    sexuality. What they don’t have are many hard facts.

    Funny, I was just thinking that exact thing when I read this
    article that was free of any hard facts.

    They did talk about a study that

    finally offered solid data about what real kids are doing at
    home after school, in the back of the car and between the
    sheets.

    Do tell! (Oh, wait, that’s my kid!)

    government researchers fanned out across the nation in


    2002, surveying 12,571 Americans ages 15 to 44… More
    than half the adolescents surveyed, for example, said they
    had engaged in oral sex (and their claims are fairly
    credible, since the questions were posed not face to face
    by an adult interviewer but through a specially designed
    computer program).

    Has anyone actually met a teenager? Was anyone ever a


    teenager, that can remember?

    How is this study credible? I get that talking to a live


    interviewer may make you hesitant about telling him how
    many guys you’ve oraled— yes, that’s a word.

    But didn’t I read in the Panopticon that people are more


    honest when they think they are being observed? Answering
    questions in front of the computer skews the answers the other
    way, it doesn’t make you say things that are true, it makes you
    say things that are true for you.

    Teens are narcissists, but this is (usually) completely age


    appropriate. They try on different identities, figuring out who
    they are; but they cling tightly to each one, defend it zealously.
    (Try pointing out to an emo kid he’s a white suburbanite
    whose Dad is an accountant.)

    And part of the teen identity is that they are “older than their
    years.” They know more about life, and sex, “than you think I
    do.” A kid may never have even had sex— but he’s imagined
    it, a lot— and to a narcissist, imagining is enough. A kid can
    truly believe he/she is an expert in oral sex— knows exactly
    the best way to do it— even though he/she hasn’t ever actually
    tried it. Because they’ve “practiced” it a million times…

    When the question is, “have you ever performed oral sex?” the
    answer is going to be yes. And no lie detector is going to
    disagree, because in his mind, he has.

    II.
    Here’s another idiocy:

    it’s tempting to theorize, as James Wagoner of the


    Washington-based nonprofit organization Advocates for
    Youth does, that the abstinence-only movement hasn’t
    prevented sex but has simply pushed teenagers away
    from intercourse and toward a practice that for some
    reason they don’t think of as real sex. Says Wagoner:
    “The abstinence-only chickens are coming home to
    roost.”

    You can almost see this nut gloating, another blow to the
    Bush/Cheney Regime! Though by his own admission kids are
    avoiding intercourse, hmm, doesn’t that count for something?
    Or should we just go back to penetration?

    But in almost the next breath, he admits that there’s no


    way to prove that link or even to say for sure whether oral
    sex is on the rise.

    I see. So it’s not clear they are having more oral sex after all?
    Didn’t they do a study on that, which was the point of this
    article? Perhaps Wagoner should go and read the actual study,
    instead of wait for his cronies to feed him anti-Bush
    soundbites?

    The article purposely conveys the impression that teens are up


    to no good, internet style. (What site?) Interestingly, the article
    failed to mention what are probably the study’s most important
    findings:

    …Trend data for males suggest that no large changes in


    these behaviors have occurred since 1995.

    …The findings appear to be similar to previous surveys


    conducted in the early 1990’s.
    …These findings are similar to data collected in 1992 by
    Laumann et al.

    Oh. Plus ca change, or something.

    III.

    But there’s a bit of a twist: that article is from 2005, and not
    obviously so. You get to it by reading the current article The
    Truth About Teen Girls and it’s one of the “Related Articles.”
    So a not at all accurate or informative 2005 article is used
    reinforce the soundbites and the memes in the mind of the
    unaware reader, e.g.

    …teen girls are getting very liberal with sexual favors,


    especially of the type detailed in the Starr report. In one
    generation, girls seem to have moved from Easy-Bake to
    easy virtue.

    Wow, any data on that? Or that the Easy Bake Oven generation
    was pure? That’s certainly not how I remember it.

    And as if on cue, the media deliver a new 90210 with an


    oral-sex scene in the first episode; Gossip Girl comes
    back with billboards promoting it as MIND-
    BLOWINGLY INAPPROPRIATE … and your daughter
    starts singing that alarmingly suggestive song about
    licking a lollipop.

    What’s missing from the discussion about teenagers is the fact


    that the discussion is being had by adults. That makes this all a
    discourse— the vocabulary, the concepts, are specific and
    convenient for the discussants, not the discussion. They’re
    artificial. And they’re completely inaccurate. You didn’t buy it
    when you were a teenager, and you’re not going to be able to
    sell it now that you’re not. Adults see a teenager dress a
    certain way, and they call it sexy— but the teen may have an
    entirely different explanation. One psychologist quoted in the
    article got it exactly right:

    “There’s a whole other piece that we don’t talk about,”


    says Tolman, “which is holding the people who are
    reacting to these young girls accountable.” When tweens
    see a picture of Cyrus with her back bare and her hair
    tousled, they don’t see her as postcoital. That’s an adult
    interpretation.

    The problem isn’t that the kid is too sexy; the problem is that
    adults are too turned on.

    Do you know how many of these singers are into chastity and
    promise rings— and yet these are the people accused of being
    too sexy. Katy Perry’s hit song is about kissing a girl— does
    that sound like the song of a generation of teens already bored
    with threeways?

    The “sexiness” to them means something different then it does


    to adults. And something different to adults then it did to
    previous adults.

    When they dress sexy, that might be a different kind of signal


    to toehr kids that has nothing to do with sex. “Yeah, but adults
    see it as sexy, and they get the wrong idea.” Hmm. Perhaps the
    problem is with adults?

    Here’s an example: the article references the “alarmingly


    suggestive” song about licking a lollipop (which I assume is
    Lil Wayne’s Lollipop.) But kids aren’t responding to the
    sexuality of the song— check out any message board, they all
    talk about the rhythm and the beat and the fact that the song
    isn’t really about sex— not in the way any Motley Crue song
    is about sex, not in the way Aqua’s Lollipop is about sex— the
    song is about status. Rich is the new porn. In the video those
    two guys Lil Wayne is playing poker with, in their house, are
    the Maloof brothers (owners of the Sacramento Kings, The
    Palms Hotel, etc.) You think that’s an accident? Lil Wayne
    couldn’t find a strip club to film in, so this was a hastily
    assembled Plan B?

    IV.

    Adults trying to interpret kids’ behaviors using adult concepts


    often leads to…misunderstandings. But adult narcissists— for
    that is exactly what this generation is— can no more
    understand “kids today” then the honor killer can understand
    that he’s retarded.

    My father’s generation liked to remind us how they had


    nothing to eat but potatoes, walked to school in the snow
    uphill both ways, dodged Axis soldiers, “but we still shined
    our shoes every night!” etc. I find it fascinating/nauseating that
    my generation’s version of “the hard old days” is this: “oh my
    God, when I was a kid, if I started yelling in a toy store like
    that, my Dad would’ve beat the crap out of me, right there.”
    Wow. Just like dodging Axis soldiers. Even stand up comics
    use it as the segue, “kids are so soft they die if you leave them
    in the car” and “we need to start beating our kids more!”
    Why? Look around you. This is the result. Maybe beating kids
    isn’t such a good idea, just based on review of the outcomes.

    Further studies are needed, but anecdotal evidence suggests


    that all of the current problems— financial disaster, war in
    Iraq, the need for war in Iraq, 50% divorce rates, increasing
    racial tensions, worthless college educations, the rise of
    feudalism— are not the fault of teenagers, but adults. Though
    teens are an easy scapegoat, I’ll admit.

    I am aware that raising teens is hard, and the possibility that


    some may be performing oral sex. But while it’s awesome that
    we’re worrying about the children who are the future of
    America, we should spend some time worrying about the
    adults that are its present.

    They are, in fact, the ones that suck.


    My Fellow Americans: The
    Speech President Bush
    Should Give
    September 24, 2008

    As government officials flounder trying to explain why the


    most important fiscal maneuver in U.S. history is so necessary,
    I offer a potential Presidential speech. With footnotes.
    I.

    Good evening.

    I come to you as a President at the end of his term, who


    suddenly must deal with the largest issue of his Presidency. I
    have already had the difficult responsibility of leading this
    nation during other historic crises, and I am aware that the
    country is quite divided on my legacy and performance. It will
    be up to history to give the final verdict.

    But the current crisis before us now is too large, too


    immediate, and too catastrophic to be trivialized with
    partisanship, blame, or scapegoating. If all goes well, there
    will be time for that later. Senators Obama and McCain have
    agreed to temporarily suspend their campaign to work within
    Congress, and they are to be commended for that; but, indeed,
    they had no choice. If quick, decisive and herculean action is
    not taken in the next few days, then the country they seek to
    lead will cease to exist as they know it.

    II.

    A summary of the events are these:

    Financial institutions over the course of decades took on


    greater and greater leverage in order to maximize their profits.
    (1)

    Simultaneously, every day Americans, in pursuit of the


    American dream, worked and saved money to buy a house. In
    recent times— the past two years— housing prices had risen
    so dramatically that many could not afford the house of their
    dreams— except for the availability of credit, of low rate
    mortgages. Some of these mortgages required no money
    down, an offer too tempting for many trying to put down roots
    for their families.

    As is inevitable, cycles end; and housing prices began to fall.


    For many, the price of the house fell below their mortgaged
    amount— they owed the bank more than the house was worth.
    In effect, not only could they not afford to live there anymore,
    but it made some economic sense simply to let the bank
    foreclose.

    Critically, for most Americans who work day to day and live
    off of their incomes, who have little savings and perhaps even
    considerable debt, their entire financial wealth is in the value
    of their homes. Why this should be the case in a nation as
    prosperous as our own is another matter that will need to be
    addressed. But it cannot be now; there is no time.

    And the two worlds collided. Mortgage defaults meant that


    financial institutions that relied on those mortgages no longer
    could count on that money; but worse, they had leveraged and
    invested that money at 10 times, 20 times.(8) If they lost a
    dollar, they really lost 20. On paper, with the mortgages
    essentially valueless, these institutions were bankrupt.

    And the spiral continues.

    Lacking even the money to cover their own leverage,


    they are unable to make new loans, or the loans will come
    with prohibitively high interest rates.
    So mortgage rates go up, not down; and there will be
    more defaults. And housing prices fall further, worsening
    the cycle.
    As property values fall, so too do the property taxes
    which pay for the schools which educate the community’s
    children.
    No car loans, no school loans. No personal loans.
    No loans to help with medical bills, the chief cause of
    bankruptcy in this country/
    Small business will be unable to get short or long term
    loans— to get mortgages, to pay their leases, to make
    down payments— to pay their employees.
    Unemployment rises; economists believe the rate could
    go as high as 25%.(3)
    More people will default on their credit cards— how
    would they be able to pay them? And credit limits would
    contract dramatically, if not completely vanish. On the
    one hand people lose their jobs, and on the other hand
    there is no credit available to tie them over.
    Pensions, 401(k)s, own shares of these financial
    companies. There are millions of retirees right now, at
    this moment, who are worrying how they will make it
    now that their 401(k)s have been cut in half. If we do not
    provide a bailout plan for these financial institutions now,
    we will be bailing out millions of retirees later.

    Without immediate action, lenders will be too suspicious that


    borrowers will default; and citizens will be suspicious that
    their banks, their mutual funds, their 401(k)s, will not be
    solvent. The credit markets will freeze; banks will fail. Months
    ago, IndyMac, a small bank, failed. If a larger, well known
    bank fails— Wachovia, Washington Mutual, or any number of
    others— the public may indeed panic about their own savings.
    There will be a run on the banks. This is not hyperbole, and I
    say it again: there will be a run on the banks.

    To be clear: this is also a national security threat. We— both


    the government and private institutions— send aid and do
    business all over the world. All of this is threatened. The crisis
    has spilled over to many of our European allies, who only
    months ago worried about possible inflation as their
    economies grew robustly. But no more. Meanwhile, Iran has
    announced the end of America, and other countries lie in wait,
    hoping to pick at the American carcass, at firesale prices.

    III.

    Perhaps some of you can’t believe the crisis is that bad, and
    are of the opinion that, as with every other crisis this nation
    has ever faced, we will come out ok, even on top. You believe
    this because you believe in America.

    It’s a safe bet, but I remind you that we have overcome these
    past crises not by waiting, not by debate, but by commitment,
    action. We have been fortunate that in most cases, the burden
    has been borne by some who accepted the responsibility, and
    has not been generalized to everyone; indeed, that is one of the
    strengths of this nation.

    Indeed, Secretary Paulson, Chairman Bernanke, and countless


    others assured me and the American people that the financial
    system was sound, that it would recover on its own. Perhaps
    more aggressive action a year ago could have prevented this.
    They were wrong, in retrospect. I was wrong.

    But this may not be the case now. I have come to you now
    because I believe that you, the American people need to, and
    are strong enough to, hear the facts. And it is imperative that
    all Americans— including those in the government—
    understand that the stakes are real, and are not just high, but
    ultimate. There is no time to debate blame, history, or social
    policy. All personal or partisan motives must be set aside.

    But we have a plan, a good one, not without drawbacks. But it


    can be implemented immediately and fine tuned over time.
    And it is the only plan available to us.

    Secretary Paulson has shown considerable leadership on this


    issue, and it is this country’s good fortune to have a former
    Wall Streeter working now for our side. He understands the
    complexities of the problem, and has carfted a plan which will
    likely succeed.

    The specifics of the plan are these:

    The bailout plan will cost $700 billion dollars, but three things
    must be understood.

    First, the money will not be spent all at once. It will take
    months, perhaps years to spend it, a little at a time, as
    needed. While $700 billion will be budgeted for this
    crisis, not all of it may actually be spent. (4)
    Second, the money will be used to buy assets, such as
    mortgages, that no one else wants to buy now. These
    assets still have considerable value— just not today, not
    this week.(2) It is reasonable to assume that at least 70%,
    if not much more of this money will be recovered as real
    estate stabilizes. This will be done with warrants, a key
    requirement of the Democrats, which will assure that the
    government gets paid first, before the banks.
    Consequently, the burden to taxpayers may be very small,
    if indeed there is any. It is entirely likely that the
    government could realize a profit over the years, though
    this is not the purpose of the bailout, The U.S.
    Government is not a hedge fund— it has more important
    work to do.
    Third, $700 billion is not just the price of the assets, but
    the price of confidence. A lesser amount would not
    convince the American financial system that there is
    plenty of credit available should they need it— for an
    emergency, to conduct business. To know that they can
    take a calculated risk and begin lending again. Indeed,
    with the restoration of confidence, with the flowing of the
    credit markets, troubled financial institutions may— will
    likely— try to raise their own capital to fix their own
    balance sheet.
    IV.

    Americans want to know how this will be prevented from


    happening again; indeed, many worry that a government
    bailout poses moral hazard, only gives license to overleverage
    again. This will not happen, and part of the long term solution
    is an entire overhaul of financial regulations, compelling
    increased transparency and limits on leverage. Congress is
    highly motivated in this regard as well.

    Why would we want to bail out the very bankers and


    executives who caused this in the first place? In some
    instances they were complicit in a Ponzi scheme; in some
    cases they were outright fraudulent. These people will be held
    accountable, but that is not today.

    Punishing the arsonists can only happen after putting out the
    fire.

    It is entirely understandable that Americans want the CEOs


    responsible for overleveraging, for lack of transparency, and
    for poor judgment to be punished. Indeed, many of them have
    been, in the only ways that matter to them. They have lost
    their jobs, and they have been publicly shamed. The FBI is
    also investigating certain institutions for improper actions.

    Some, like Ron Paul, see this plan bailing out the very
    institutions which, by the hand of the free market, should fail.
    Unfortunately, the problem is much larger than just a few
    institutions— nearly all institutions will be affected by this.
    We are not saving the CEO of AIG; we are saving your
    money, which is in AIG.(6)

    Why should you be punished because of the mistakes, or even


    misdeeds, of others? Should you lose your home, your
    savings, because some on Wall Street had poor judgment?

    The time for blame is later.


    Because as I am both the leader and the representative of the
    people, I will support the overwhelming desire of the
    American public and not allow CEOs a golden parachute in
    the government bailout. It is morally outrageous to allow them
    to be paid more money for leaving than the entire company is
    now worth.

    But our anger has to be temporarily held. There will be time


    for that later— there is none for it now.

    Many worry that such a plan will lead inevitably to inflation.


    We are undergoing one of the largest deflationary periods in
    our nation’s history. Money is evaporating from the system;
    credit is disappearing. People are losing their homes, their
    personal savings. Businesses are not growing. This plan is
    replacing the money that has disappeared (5), (7) and, over
    time, should prevent further deflation while simultaneously
    checking inflation. The lung has collapsed almost to nothing;
    the plan is to inflate it enough so that the patient can breathe.

    Others scoff at the appearance of socialism, that we are


    nationalizing the financial institutions. This could not be more
    wrong; nationalization is what will occur if we do not
    implement this plan immediately.

    I call on Congress to approve this plan. In the past months,


    there has been much talk about which institutions are too big
    to fail. In truth, there is only one: the united States of America.
    And we must do anything necessary to save it.

    This is what is at stake.

    My fellow Americans, good night, and God bless us all.

    –––

    1. For every dollar they had in reserve, they would lend out or
    invest $5. For this leverage they would earn rates of return on
    the order of 10%; this meant, however, that their actual return
    on the $1 they actually possessed was quite low; put another
    way, the only way they could get 10% return on their $1 was
    to borrow four more to invest.

    Every other financial institution, hedge fund and brokerage


    had to be leveraged in greater and greater amounts, just to
    keep up. Now, leverage ratios are on the order of ten to twenty
    times.

    2. An analogy might be to owning a Picasso, previously


    bought for one million dollars. One could try to sell it tonight
    on Ebay, but in the current climate perhaps no one bids— so
    the price never goes above $10. Is the Picasso really worth
    $10? The bailout plan is to buy the Picasso at $30, and wait.

    3. 9/25/08: jobless claims at 493000, the highest level since


    9/11. Continuing claims— 3.542 million— is the highest since
    10/03.

    4. Neither does it significantly increase the deficit. As the


    money will be financing these failing institutions, the budget
    will show only the interest costs, and any actual losses, if any.

    5. Money reinjected into the banking system, by new rules as


    well as fear, will not be able to leverage it out at 20x as before.
    e.g. Goldman Sachs, under its new “bank” status, can only
    leverage 10x, as opposed to the 30x in the past. This is clearly
    deflationary.

    6. Since the governments acquisition of 80% of AIG for $80B,


    AIG’s stock price has doubled. And the terms of the bailout
    were quite steep for AIG: 2% “gross commitment fee” ($1.7B
    upfront) and 8.5% interest. This is quite an incentive to raise
    capital some other way.

    7. In July 2007 there was $2.2T in commercial paper; that


    number is now $1.7T. $500B has disappeared.

    8. In 2004 the SEC loosened the leverage restrictions for


    certain institutions from 12x to up to 40x. Not coincidentally,
    all of those institutions either are now gone, or in a
    dramatically different form.

    1/16/09 Update: I was wrong. First, the obvious: the TARP


    passed, and nothing much has changed. Credit spreads aren’t
    as wide, treasuries look like a bubble, but hardly the effect
    $400B was supposed to have. But the thing that I was most
    wrong about— in retrospect, how could I not have assumed
    this was going to happen— was that the money wasn’t used as
    it was supposed to be used. Rather than the govt. giving the
    banks money to lend out, the banks kept it. BAC bought some
    bank in China, etc. And then BAC implodes further. Yet
    everyone who works at BAC got paid… a conspiracy theorist
    might say this is enterprise corruption. Maybe it shouldn’t just
    be conspiracy theorists.
    Obama And McCain On
    Mental Health Coverage
    September 26, 2008

    Applicable to their perspective on a wider range of issues.

    NAMI released the results of their questionnaire to the


    candidates. Obama answered the questions (24 of them) while
    McCain sent a formal statement.

    On the whole, neither response is heavy on content, but I made


    one interesting observation:

    Obama: 2 out of 2000 words


    McCain: 8 out of 450 words

    the word “cost”


    The Women Of Lipstick
    Jungle Are The Same Age As
    Rachel From Friends
    September 27, 2008

    A quick observation on the premiere of Lipstick Jungle:

    Has anyone noticed the age of characters in TV shows


    nowadays is older then it was, say, 10 years ago?

    Think back to, say, Friends— 20 somethings. Then Sex and


    The City— 30 somethings. And now Lipstick Jungle, 40
    somethings. “But that reflects the age of the viewers, they
    feature 40 year old actress because that’s the age of the viewer
    — or vise versa.”

    Agreed; but the 40 year old who is watching now was in their
    20s when they watched Friends.

    This isn’t TV targeting a specific demographic, they are


    actually tracking the same people, as they age. If you’re
    watching, it’s for you.

    Wait ten years— when shows like Lipstick Jungle will be for,
    by, and featuring 50 year olds…
    Either Conservatives Are
    Cowards Or Liberals Are…
    September 28, 2008

    I.

    A news story, talked about ad nauseam, concerning a study in


    Science that no one will bother to read.

    Subjects— liberals and conservatives— are shown random


    pictures of scary stuff (spider on a person’s face) interspersed
    between photos of neutral stuff (bunnies.) Conservatives
    exhibit much more fear (e.g. startle response, skin response)
    than liberals.

    In case the political implications of this study are not obvious,


    these are the titles of the news reports about the study:

    Science News: The Politics of Fear


    Slate: Republicans Are From Mars, Liberals Are From
    Venus
    Scientific American: Are you more likely to be politically
    left or right if you scare easily?
    Freakonomics blog: Don’t scream, you’ll give your ideals
    away

    Etc. The message is clear: conservatives get scared more


    easily than liberals.

    Right? That’s what the titles say— I’m not off base here,
    right? There’s no other possible way to interpret them?

    II.
    The methodology is fine— but the interpretation is so
    demonstrably flawed that they are actually interpreting the
    results backwards.

    Here’s the most important line of all— found only in the SA


    article— in the second to last paragraph, of course:

    People who leaned more politically left didn’t respond


    any differently to those [scary] images than they did to
    pictures of a bowl of fruit, a rabbit or a happy child.

    Really? Spider on face vs. happy child? No difference?

    That extra bit of info doesn’t even appear in the Science News
    story— or anywhere else, for that matter.

    The graph shows that liberals and conservatives have a trivial


    skin response to neutral pictures, and liberals show no
    difference in response when confronted with a scary photo.

    So the actual finding isn’t that conservatives are fearful; it’s


    that liberals seem not to exhibit much response to scary
    photos.

    III.

    But it’s actually a little worse than that.

    The typical use for such tests of startle and fear aren’t to see
    how scared people are, they are used specifically to find out
    how scared people aren’t. For example, they are used to
    evaluate psychopathy, and the results are the same as here—
    psychopaths have decreased responses, compared to normal
    people, to aversive photos.

    So which is it? Are conservatives fearful, or are liberals


    psychopaths?

    I’m not picking sides in the debate, but I am pointing out how
    this study missed the actual result— liberals are less fearful
    than would be expected— and then the study was publicized
    in the media with an entirely backwards inference, that
    conservatives scare easily.

    But it sounds like science, conducted by scientists; it’s


    published in Science, and then publicized in Scientific
    American. It must be true.

    (more)

    What’s the link? Perhaps physiologic responses are genetic,


    and influence your future political persuasion; or your political
    persuasion/upbringing affects how you respond to threats. Or,
    this insane idea:

    Alternatively, political attitudes and varying


    physiological responses to threat may both derive from
    neural activity patterns, perhaps those surrounding the
    amygdala.

    In other words, they’re both genetic, and located in the pineal


    gland. Sorry, I meant amygdala.

    The idea is so empty, so vacuous, that it barely can be


    imagined, let alone written down in the pages of Science. It is
    entirely analogous to this: brunettes are biologically
    programmed to want sex at certain times, and they seem to be
    located in the area surrounding Kansas.

    I should point out that while the journal is called Science, the
    authors of this paper are actually political scientists. Not that
    there’s anything wrong with that.

    You can blame the general news media for being lazy and/or
    retarded. But the authors of the study are directly to blame for
    purposely skewing the results to the conclusion that
    conservatives are cowards.

    “How so?” you ask. “I read the article and it is very neutral, it
    even says you’re not supposed to make that inference.”

    Wrong. When you write something, you must be aware of how


    people will read it. Since it is very obvious how this study will
    be taken, it is the authors’ responsibility to prevent it from
    happening. Notice that they did not, anywhere write the
    equally plausible possibility that liberals inexplicably exhibit
    much less fear than would be expected— let alone that they
    score high on a measure of psychopathy. There is nothing in
    the study that favors one interpretation over the other. And to
    only focus on one, even if it is to say, “now, we’re not saying
    conservatives are cowards,” is leading. Misleading. On
    purpose.

    I tried to find some of the pics this study used, this is one NPR
    had:

    What strikes me about the “fear content” of this photo is that it


    is not immediate. Your eyes are drawn to her eyes and her
    mouth, and then later you see the spider that gives you the ugh
    feeling. I wonder— and I’d need to see the other photos— if
    all of them do not require such a two step perception, and if
    that isn’t the basis for the difference in fear responses. (e.g.
    uncanny.) Is it the “wrongness” of the pic— spiders aren’t
    supposed to be that big, or on someone’s face? Or is it the
    (seeming) powerlessness of it—all she can do is scream? How
    would the reactions be different if the woman was smiling?
    We Are All Mercantilists
    Now
    September 29, 2008

    Marx was wrong: feudalism doesn’t precede capitalism, it


    follows it. And after feudalism comes this:

    Welcome to 1600.

    The schizophrenization of America becomes revealed. Was


    America too laissez faire, which lead to the crisis? Or not
    enough, which lead to a bailout plan? The answer depends, in
    large part, on whether you think it’s your money at stake.

    Whether it is a good plan or a bad plan remains to be seen.


    Indeed, it will never be known since we will never really know
    what would have happened had the other course been taken. If
    Depression is indeed averted, no one will thank Paulson. Or, if
    Depression comes, whether it could have been averted by the
    plan. So be it.

    But is it socialism?

    No.
    II. What is mercantilism?

    In a sentence, it is the belief that a country’s strength is tied to


    how much money it can accumulate. In the heyday of British
    mercantilism, 1600-1776, it meant the accumulation of
    bullion; favoring exports over imports; keeping money within
    the nation, not sending it elsewhere. The money could be used
    to purchase commodities and fund armies— which, in turn,
    helped bring money into the country.

    Mercantilism was premised on the belief that there is a fixed


    quantity of wealth in the world, and everyone has to fight over
    it. Economics, it was felt, is a zero sum game; and since not
    everyone can win, it becomes acceptable that they don’t.

    State policies reflected this. “Free trade” meant “free trade for
    me.” Protectionist tariffs and regulations; international treaties
    that solidified trade superiority. Colonies to sell the exports to.
    And a tight control over the means of shipping.

    Mercantilism also exerted influence not just on commerce but


    on thought and culture. In order to maximize exports, it had to
    convince the populace that the export (or approved import)
    was necessary. In the late 1600s, calicoes, previously the cloth
    of the poor, became a sought after fashion necessity— entirely
    because it was what was being imported. It wasn’t sought after
    and therefore imported; it was imported and therefore sought
    after. Cleverly, British merchants made high profile gifts of the
    calicoes to prominent ladies; the nobility accumulated them;
    and then everyone had to have them. They went into clothes,
    furniture, drapes. Mercantilism had changed the aesthetic of
    the the entire nation— the world.

    Generally unimportant products took on gigantic importance,


    because the market convinced people they were important.
    Here’s an example: Columbus accidentally discovered
    America because he was looking for spices.

    Capitalism identifies a market and then tries to maximize


    profit within it. Mercantilism, by contrast, creates markets on
    purpose based on what it has to offer, and then controls those
    markets.

    III. The Sudden Decline of Feudalism

    What preceded British mercantilism? Feudalism— local,


    feudal power rather than a centralized government; vague
    territorial boundaries; and ever changing racial and cultural
    characteristics. It was local, and fluid. But as the world
    “shrunk” (or got flat) it could not adequately provide for its
    people. Unemployment and poverty rose. Meanwhile, the
    opening of trade and improvement in travel offered greater
    opportunities than farming someone else’s land.

    States formed, over time, and absorbed the fiefdoms, removed


    the existing lords, consolidated the power, and served the
    interests of its domestic merchants and producers.

    And so the rise of the nation-state; racially homogeneous, with


    rigid territorial boundaries; partly feudal but with a new quasi-
    class system of nobility, merchants, workers, and slaves.

    IV. Wither American Feudalism?

    As I have written before here and here, for some time in


    modern America, feudalism was the growing trend; but rather
    than lord-vassal, it was company-employee. Government’s
    role was secondary and shrinking; companies provided
    income, healthcare and retirement benefits, and, more
    importantly, a sense of identity and belonging. The company
    provided protection in exchange for service.

    Even two years ago, this was increasing. These company-lords


    become even more powerful as they merged and privatized,
    going off the public exchanges but still wielding massive
    influence.

    But for this progression was suddenly diverted. Now, instead


    of companies going private, they are going government.
    Who has the big money now? Sovereign wealth funds, of
    which, if/when the Paulson Plan is passed— for it is
    inevitable, in some form— the U.S. will become. In the past,
    there was a tug of war between private ownership and state
    ownership. Now, instead of outright nationalization of a
    program (e.g. Social Security) governments own financial
    stakes in businesses, in sectors— and in themost important
    sector of all, the financial sector. The Chinese have this system
    firmly in place, but pretend it is “communism.” Saudis as well.
    And now, soon, the U.S.

    How does the U.S. government separate its foreign policy with
    its fiduciary responsibility to its shareholders, which is you?
    How does it separate its domestic policy from a revenue
    motive? It can’t. They become one and the same.

    If the complaint in the past was that government is too


    influenced by big business, how does this change when
    government is Big Business?

    Put all this together with a growing protectionist sentiment,


    and you have our new economic model: mercantilism.

    America can’t move closer to socialism, if for no other reason


    than those in power are too young to remember what it really
    looks like and how to execute it; and with so much individual
    narcissism, no one could demote themselves so much to the
    state.

    Such policies like the Paulson Plan appear socialist because


    the government seems highly involved in the control, in the
    regulation of an industry. But this is exclusively in the service
    of the business franchises that it controls. The analogy for
    todays events isn’t The USSR or even France; it’s the East
    India Trading Company; an independent, for profit, business
    arm of the state. It was nearly a monopoly. It could even
    command the military, as needed.(1)
    Within the East India Trading Company’s flag was the union
    Jack— Britain’s flag— contained in the canton. Get it? Britain
    at the service of the Company; the Company for the benefit of
    Britain.

    V. Predictions

    Reducing current events to historical -isms is a fool’s game,


    for drunks in a bar or political scientists with tenure— played
    when there is no accountability for the opinion. It serves no
    purpose unless it can be used to make predictions. So here
    they are, linked to the key characteristics of the mercantilism
    of old. In general, the future holds increased protectionism,
    increased state control, increased classism, and the necessity
    of piracy.

    1. Protectionism: Obvious. Look for more, not less. More


    tariffs; more treaties ensuring trade advantage. Not only will
    the movement be away from capitalism, but it will be
    considered obvious that capitalism is unworkable. More
    emphasis on “Free Trade,” as it is subtly redefined to mean
    “ensuring domestic products are not undercut by unfair foreign
    advantage such as low labor costs, etc.”

    2. National self-sufficiency: despite the importance of trade,


    the nation state sought to free itself from outside imports.
    Domestic agriculture and manufacturing subsidies; “energy
    independence.” That means solar power, whether or not oil is
    expensive; increasing ethanol and agricultural subsidies.

    3. Shipping: Most important to mercantilism was control of


    shipping. While it was impossible to control what other
    countries tried to produce or export, Britain could control how
    and if it made it to Britain. The Navigation Acts required that
    all imports to Britain or its colonies had to be done on British
    ships, or through British ports.(2) Thus, cheaper goods from
    other countries could not be obtained, or were taxed so heavily
    as to make them impossible to afford. So British West Indian
    sugar was cheaper to Americans than French West Indian
    sugar, but only because the actually cheaper French West
    Indian sugar was taxed so heavily.

    That “shipping” is nowadays done on the internet. Look for


    the government or its business arms to try and regulate or even
    outright control it, and strongly discourage (read: tax) the use
    of non-domestic providers accordingly.

    4. The rise of the nation-state: In the past this meant racial


    homogeneity, but this will be replaced by regional and cultural
    homogeneity. So Russia tries to reabsorb its former satellites;
    and America asserts its cultural identity by seemingly arbitrary
    emphasis on the use of English, stronger national boundaries;
    clearer divisions between American and “illegal immigrant”
    with accompanying restrictions (e.g. no driver’s license, etc).

    5. Stronger central government. That this is happening is


    indisputable.. More monitoring, but as this is mercantilism and
    not fascism, the monitoring is in the service of commerce, e.g.
    Google, credit cards over cash, etc. Surveillance is for the
    protection of the state which is at the service of commerce.

    6. The primacy of the military: economic disputes become


    political; and political disputes are settled, ultimately, by guns.
    Look for corporations to have their own mercenary armies, or
    have ready access to America’s. And look for more wars, with
    the cover story of protecting Americans, stopping genocide,
    etc.

    7. Colonialism: rather than foreign nations being politically


    controlled, the control will be economic or cultural. The
    purpose of the British colonies was access to raw materials,
    and the creation of new markets for the mother country’s
    products. So too will come the need to convince foreign
    peoples that they need what we have, and need us to extract
    what they have.

    8. Slavery: slavery will not return, but the use of groups of


    people who will work for much less than the citizens will be
    necessary to maintain competitiveness. Different from
    capitalism, however, will be that these people are purposely
    blocked from rising in class or wealth. Moral justifications
    will be necessary, and of the form, “they’re better off than they
    were.”

    9. Classism: unlike the boundariless possibilities of capitalism


    — up or down— mercantilism requires specific classes,
    especially a working class. In America, classism will
    supersede all other internal disparities, including racial. This
    suggests an Obama presidency and the replacing of interracial
    conflict with intraracial conflicts, along class lines.

    10. Ban on luxury goods: Sumptuary laws, though generally


    ignored, rigidly defined types of products that could be owned,
    and by whom. The rationalization was that they prevented
    excess and waste and kept the money in the country,
    reinforced national pride and morals, and provided markers
    social class. The modern twist: no goods are luxury goods.
    Cars, GPS, brand name clothes— they are all “necessities.”
    Waiting at the welfare office, applicants pass the time texting
    on Blackberrys.

    It’s not their fault. The economy specifies that these are not
    luxuries. They are lulled into low introductory rates, a free
    handset; no money down. Those $400 shoes only cost $15 a
    month. Forever.

    In a truly capitalist system, one would have to aspire to


    aspirational goods. The system is short circuited— one can
    afford those goods without actually possessing the status or
    wealth that ownership implies.
    Mercantilism maintains dominance not by best serving a
    market, but by best serving a market it creates.

    11. Exports and Domestic Production: An emphasis on


    making specialized products of high quality to maintain export
    superiority (e.g. specialty goods over spatulas; services over
    durable goods.)

    12. Inflation: If wealth is hoarded in the U.S., at the expense


    of another nation, than the value of the wealth falls in the U.S.
    and rises in the other nation. Eventually, it will not be
    economically profitable to hoard wealth— it will have more
    value abroad.

    13. The end of mercantilism: when the end finally comes, as it


    must to all illogical economic systems, it will be replaced by
    what replaced it in 1776 with The Wealth Of Nations:
    capitalism, and the beginning of the next Industrial
    Revolution.

    That’s some of what can be expected, albeit it gradually, so


    that no one notices.

    VI.

    There’s one more important development, too large to be


    discussed adequately here. The control over commerce, goods,
    and pricing meant that not everyone was able to get, or afford,
    what they wanted (or needed.) Simultaneously, the state itself
    had to compete against other states for markets and materials.
    This necessitated an underground economy and related class; a
    class so necessary to and intertwined with these untenable
    economic policies that they are celebrated even today: pirates.
    They were the logical and inevitable extension of controlled
    commerce; were extremely skilled, and often navigated the
    shipping lanes with more knowledge and flexibility than even
    the military. They worked for themselves, or they worked for
    the state, as the situation arose.

    In the new world order, shipping is the internet; the goods are
    data.

    Drink up, me hearties, yo ho.

    ––

    1. though in this case rather than the Company lending money


    to the Treasury for exclusive trading rights, the Treasury lends
    it to the Company for a cut of the profits and taxes— which is
    in turn in exchange for protection.

    2. The Boston Tea Party was not about the tea being too
    expensive because of tariffs; it was because British Tea Act
    allowed the EITC to sell the tea without a tariff, and therefore
    cheaper than even American smugglers— Samuel Adams,
    John Hancock, and others— could sell it.
    CNBC Ratings Seem
    Correlated To Future Market
    Volatility
    September 30, 2008

    Following up on a crazy idea I had earlier.

    The floating pink between 8/11 and 8/22 is CNBC’s airing of


    the Olympics, which skews the data. Ignoring that, you can see
    a pretty clear relationship between CNBC’s average daily
    ratings and market volatility (VIX). It also appears that the
    ratings anticipate the VIX by two days, or so.

    I only have CNBC ratings to Friday, 9/26/08; but I have VIX


    data for the next two days. 9/29 was Black Monday, Dow
    -777.

    These two are highly correlated. Starting from 8/23/08, the


    Pearson’s r is .889, which, if remember my college statistics, is
    way better than a sharp stick in the eye. (If anyone out there
    knows a better test to use, please let me know.)
    What Design Flaws Need
    Fixing In This Blog?
    October 1, 2008

    Font, spacing, line spacing, color, layout, etc— if anyone has


    an eye for design, some help would be appreciated.

    And please no “one huge design flaw is you’re an idiot!”


    jokes. I’m already aware of those. That’s what the rum is for.
    Psychopathy, Antisocial
    Personality Disorder, and
    Narcissism
    October 1, 2008

    Updated 12 years later. I.

    A 1996 editorial by Robert Hare, who is the most prominent


    researcher on psychopathy, even inventing a diagnostic
    checklist which for complex reasons he named the Hare
    Psychopathy Checklist.

    The article explains the difference between psychopathy and


    antisocial personality disorder.

    He writes that in 1980 with DSM III, psychopathy was


    relabeled as antisocial personality disorder. While they still
    referred to the same individual, it was the approach that was
    different. This wasn’t just a name change, it was a paradigm
    shift: instead of describing personality characteristics, it
    focused on behaviors. Not nouns, but gerunds.

    Psychopathy: egocentricity, deceit, shallow affect,


    manipulativeness, selfishness, and lack of empathy, guilt or
    remorse

    Antisocial Personality Disorder: persistent violations of


    social norms, including lying, stealing, truancy, inconsistent
    work behavior and traffic arrests

    That this happens in 1980 makes sense, coming at a time


    where “people are not bad, behaviors are.”

    Interestingly, Hare is mostly concerned that this relabeling will


    mean psychopathy will be overdiagnosed. His reasoning is that
    APD is a broader classification-, and few of these are actually
    psychopaths. But once the “diagnosis” of APD is made,
    clinicians and lawyers may overgeneralize and call them
    psychopaths.

    It matters. As Hare points out, psychopathy is considered an


    aggravating, not mitigating factor in a crime (opposite to, say,
    bipolar.) Psychopaths are evil and will do it again, so throw the
    book at them.

    That was 1996.

    II.
    .
    Anyone who has read more than one post on this blog knows
    where I’m going: What Hare had labeled psychopathy sounds
    a lot like narcissism.

    A glance at the above description supports this, but there are


    three important differences.

    Identity: The narcissist has identity— but it is one he chose,


    not one that evolved naturally. That means he thinks of himself
    as something— based on a model. He consciously identifies
    with someone— Tony Soprano, the guy from Coldplay, Jack
    Kerouac, or a combination of traits from people, etc.

    The psychopath has no model— he just exists.

    Since the narcissist’s identity is entirely made up, it requires


    other people for constant reaffirmation of his identity and of
    its value. Psychopaths don’t need people for this, they need
    them for material things.

    Ability to feel:

    Psychopathy is characterized by a lack of feeling and empathy


    — a lack. When he kills you, he does not feel remorse, or fear
    — after the immediate emotions, he doesn’t feel anything. The
    next day is the same as the previous day.

    “Narcissists, whatever their faults, feel deeply, too deeply.


    That’s why they take rejection so hard.”

    No. Narcissists appear to have emotions, feelings, empathy—


    they cry, laugh, feel your pain, etc— but none of this is real.
    They don’t feel it. It’s not linked to anything internal. They’re
    crying at the funeral, for sure, but on the inside they’re
    wondering why it doesn’t hurt as much as they think it should.
    They’re proud at their daughter’s ballet recital, but not actually
    proud, inside they’re wondering about their promotion, or that
    jerk at the store, etc. He may feel pride that she’s his daughter,
    but not empathy, nothing about her as a separate person.

    Sometimes even they believe the emotion is real. If you’ve


    decided you’re The Godfather, then those are the emotions
    you’re going to experience or not experience, with the same
    intensities. Pride matters, lust won’t. Etc.

    And don’t get confused. Narcissists don’t pick their identity


    based on their genetic or preset emotional range; the choosing
    of the identity comes first. Picking who you are actually
    changes how you feel, how you think.

    A narcissist is a psychopath who has assimialted the emotions


    of the character he is playing.

    Narcissists don’t feel guilt— based on objective right and


    wrong— they feel shame— based on exposure. When they get
    caught, they’re answer is always the same: “wait, that’s not
    really who I am…”

    The only thing narcissists truly feel is the pain of narcissistic


    injury, and rage.

    Potential for violence:


    The technical distinction is how psychopaths or narcissists
    internalize these aggressive or libidinal forces. Both feel
    aggression, but the narcissist takes that aggression and makes
    it a part of who he is: I am aggressive, I am an aggressor. The
    psychopath lacks a properly defined ego. He’s not an
    aggressor; aggression is simply an as needed tool, a means to
    an end.

    For the narcissist, violence is a volitional expression of rage,


    or the response to a narcissistic injury. If he doesn’t get the
    affirmation he needs; if something threatens his identity, then
    he attacks.

    The psychopath is utilitarian: I needed a burger, you had it, so


    I stabbed you in the throat. Whatever.

    As bad as that sounds, here’s the narcissist’s discourse on the


    same crime: I needed a burger, you had it, so I stabbed you in
    the throat. But wait, that’s not the whole story, listen, what I
    did was justified because…

    III.

    Someone is going to try and correct me, that what I am


    actually describing is Kernberg’s malignant narcissism, and
    not NPD, or even “run of the mill” narcissism, which are not
    associated with violence.

    And that would be wrong, which is the whole point. There is


    no difference between the three, it’s all the same, what’s
    different is the execution, not the potential.

    There is a limitless, catastrophic potential for violence. That it


    rarely manifests is exclusively due to circumstances, not
    internal self controls. He’s the married man of 20 years who
    suddenly needs to stab his daughter 10 times because of
    something that hurt his pride.
    It’s the guy who goes to happy hour, then is about to get pulled
    over for a speeding ticket but is afraid of a DUI so he drives
    off. During the high speed pursuit he accidentally hits a kid on
    a bike, but instead of stopping decides now he really has to get
    away or else he’s going to jail, so he drives even faster. Then
    he tries to run on foot and hide in a building, but— surprise—
    there’s some woman there, so now he has to take her hostage
    because she’s seen his face…

    The psychopath does all those things because at each moment,


    that’s his only option. The narcissist does them because he’s
    “actually a good person, this stuff is just an aberration, if I
    can just get away I’ll be back to being a valuable person
    again…”

    And you may be tempted to blame the alcohol he had at happy


    hour. And that would be wrong.

    Two kinds of violence: a means of protecting the identity from


    exposure or harm, or the result of rage from the identity being
    exposed or harmed.

    You say: my narcissist never ran from the cops, he never killed
    his daughter. But that’s because your narcissist had at that
    moment other ways of dealing with the problem. It’s the
    potential for violence.

    All narcissists have this potential, it is intrinsic to the


    personality structure, which is defined as “me above all
    things.” Sure, usually they figure out non-violent ways to live
    their life, but that potential is there.

    The reason a psychopath kills is because he is bad. The reason


    a narcissist kills is so that no one finds out he is bad.
    CNBC Ratings Predicts
    Bailout To Pass, VIX To Fall
    October 3, 2008

    Pearson’s r=.929

    As it appears CNBC ratings anticipate the VIX, then the VIX


    should fall today or Monday, and the only way I see that
    happening is that the bill gets passed. Since the folks at trader-
    talk.com seem to like me doing this, I’ll make it a weekly
    thing.
    What An Obama Presidency
    Means For Blacks
    October 3, 2008

    This is not an anti- or pro-Obama article, so get over yourself.


    Not widely (anywhere?— seriously, am I the only one?)
    discussed is the effect of an Obama Presidency on the
    relationship of blacks with other blacks. Because Obama has
    almost all black voters, there’s the feeling that he’s going to
    unite them, do right by them— but how? Are all black people
    the same?

    I’m not the only one to notice a widening divide among


    blacks. Before WWII almost all blacks were poor. Post WWII
    you get the beginnings, now widenings, of blacks moving in
    different classes, especially working class/middle class. No
    one noticed this (i.e. no one complained) because incomes
    across all classes rose comparably.

    That stopped at the end of the 1960s; from then on, incomes in
    the lower classes went stagnant, while the others continued to
    rise. That might have been due to lower inflation rates, or the
    weakening of labor unions and the welfare system in general.
    Or, it might have had to do with the beginning of psychiatry as
    a supplemental welfare policy. Pick your own untestable
    explanation.

    But the result is that one group of blacks is moving along the
    class ladder— up and down— like anyone else; while another
    (very large) group stays stuck in the bottom. The two groups
    are philosophically united on matters of equality, opportunity,
    etc— and are both voting for Obama, but their needs are
    completely different.

    These differences have not been as politically urgent because


    race has been more important than class.

    Blacks, with good reason, have their hopes tied to Obama. But
    as blacks are not all in the same class, his policies will not
    affect them all the same. Same with McCain’s policies— the
    difference is blacks may be hyperaware of Obama not meeting
    their expectations.

    So if Obama wins, we may have a new era of race relations in


    which the class, not race itself, plays the larger role.

    A hierarchical relationship of lower classes receiving


    “protection” and “land” from upper classes in exchange for
    their “work” (read: servitude) is a rough definition of
    feudalism. This pretty much describes the country 1968-2008,
    especially as it applies to blacks and Hispanics. What makes
    feudalism work is that each class accepts their role.

    Blacks have been so unified by race that they have not had
    opportunity or energy to try unifying by class. For example,
    workers could have tried to obtain more
    power/money/jobs/benefits by strengthening trade unions.
    Instead, much more emphasis was placed on the role of
    discrimination laws and affirmative action. It’s impossible to
    judge whether this move was right or wrong. But that’s the
    way it played out. Racial differences increased in importance,
    class differences decreased. It parallels the social dialectic:
    “equality” was replaced by “diversity.”

    That’s likely to change. The class differences will be more


    apparent under Obama. It’s tempting to assume all blacks will
    benefit under Obama, and that’s probably accurate; but the
    point here is that some will benefit more than others. Along
    class lines. And the resentment is likely to be more acute
    because of the higher expectations.

    Turn off your Caps Lock. I am not judging this, I’m guessing
    at the future: if Obama wins, then race is on the way out, and
    class is on the way in.
    I am not at all saying whites will be more or less racist. I’m
    only describing what I think will happen to blacks.

    That means: increasing power of labor unions; decreased


    emphasis on diversity laws/affirmative action. Progressive
    taxes and consequent resentment all around. And the resultant
    dividing of the Democratic party to accommodate different
    classes of blacks who now need new representation. In short,
    the beginnings of class struggle within blacks.

    There’s a book about how class struggle replaces the race


    struggle, but I can’t remember what it was called.
    –-
    I should caveat all of this and say that there is one specific
    black person for whom race will still be the defining
    characteristic: Michelle Obama. Barak has managed to
    overcome this, but Michelle will be held to an unfortuante
    standard well articulated by Chris Rock, who said that the
    equality he wants is to be allowed to fail, and not have the
    failure be linked to his race. Michelle Obama will not have
    this luxury, and God forbid she misspells potato or chokes on a
    pretzel on a trip oversees, America will never forgive her or
    her race.
    The Media Is The Message,
    And The Message Is You’re
    An Idiot
    October 6, 2008

    (From The New Yorker)

    You mean I get to pick?

    I. What Is Real?

    This is the story of the real John McCain, the one who
    has been hiding in plain sight.

    This is the kind of sentence that you expect from a Woodward


    and Bernstein after months in dark parking garages, or maybe
    a book based on the results of secret CIA documents, but
    unfortunately it appears in Rolling Stone. The piece is called,
    Make Believe Maverick, i.e. pretending to be cutting edge and
    independent, a voice of the people, and not really the arm of
    Big Business which he will here be revealed to be. I hope
    someone else appreciates the irony there.

    There’s also a piece called The Truth About Palin: A guide to


    separating myth from fact. (Where does one place the sic?)
    And even a video “Five Myths About John McCain” which
    are sure to surprise you, like “John is a straight talking
    reformer” and “John is a Washington outsider.” One shot
    shows a photo of him seated at a desk, reaching out to take
    someone’s off screen hand. The camera slowly pans left across
    the photo to reveal– Ronald Reagan!

    Truly these are the end of days.

    Oh— all three pieces are buy the same guy.

    II. Go To The Source

    What is naked shorting? Don’t know? You could look it up on


    Wikipedia, where it says a great number of things, except that
    it is bad. That it could be bad— by artificially depressing a
    stock’s price— is hotly debated everywhere— except on
    Wikipedia. Know why? Because, Gary Weiss— who may (or
    may not) have worked for/used a computer at the Depository
    Trust & Clearing Corporation which oversees stock settlement,
    became a Wikipedia editor and effectively controlled the entry.
    He also derided the CEO of Overstock.com, Patrick Byrne,
    who was vocally against the practice, by blocking his edits and
    even controlling his (Byrne’s) Wikipedia page.

    The story would be more interesting if Gary Weiss turned out


    to be a former journalist at BusinessWeek, where he should
    have learned not to manipulate the truth, as well as understand
    the effects of naked short selling. Well, he was.

    The debate here is not wheither Byrne or Weiss is right—


    whether naked short selling does drive stock prices down,
    creating more volatility (it does.) The question here is this: if
    Wikipedia can be edited by anyone, why wasn’t the entry
    “fixed?” Leading to the second question, since it is obvious
    that it can’t really be edited (effectively) by just anyone, how
    do you get chosen to be the main guy? If the CEO of an
    $800M company isn’t allowed to write a few lines, what
    chance does anyone else have?

    III. Psychiatry Finds The Truth

    Do you know what antidepressant induced mania is? For ten


    years I’ve been yelling at anyone who would listen that it
    doesn’t exist. Let me caveat that: “exist” isn’t the word I took
    issue with, the word was “antidepressant”: how can you blame
    an entire group of chemicals that many times have no
    similarities at all (Prozac vs. Wellbutrin) as having the same
    rare side effects? That’s classism, right?

    I wrote a number of “scientific” articles on the subject, and


    only one was ever published— the one in which I described a
    scenario where it actually did happen. For reference, I’ve
    published many other articles, so the problem here wasn’t my
    writing or research, it was my stance.

    So when someone writes an article agreeing that


    antidepressant induced mania is overstated, I read it closely—
    not for new information, but because I want to see how he got
    it past the censors.

    In a section entitled What is the Best Available Evidence?


    the author writes,

    More conclusive evidence can be derived from two


    recent, large controlled studies, one being a monotherapy
    study,4 the other a study investigating the combination of
    a mood stabilizer and the choice of two antidepressants.6

    I knew immediately what the second study was; but I hadn’t


    ever heard of the first— a monotherapy study with an
    antidepressant in bipolar, controlled and large? Am I slacking?
    Oh, it’s a Seroquel study.

    IV. Your Thoughts Have Been Peer-Reviewed, and Badly

    And it beceoms clear that all media are peer -reviewed, and by
    peer-review I mean not you or your peers. Rolling Stone is so
    tight it has the same idiot generate three different pieces for
    the same issue. Same with anything else.

    It is the same guys, over and over again, each in their own
    space, and by default we assume they are the most
    knowledgeable, or the most rigorous; have the most
    information or are best able to remain objective. Or maybe we
    simply hope they’ll be good enough.

    But having the same guys means that we’ll be getting the same
    philosophies, the same filters, the same phrases. We are
    guaranteeing not just groupthink, but we’re allowing others to
    decide what we’re going to talk about, how we’ll talk about it.
    That’s why “gay marriage” will disappear not when gays can
    marry but when a new set of media people get jobs and “gay
    marriage” isn’t as interesting to them. The actual importance
    of “gay marriage” in the world is not at all the important
    question— it may be extremely relevant, or not at all, but
    that’s irrelevant. Why we’re stuck with “bipolar disorder”
    until, I don’t know, the neo-analysts return with their talk of
    “repressed thyroid energy” or something, but emphatically not
    because we discover anything qualitatively new about bipolar.

    And so it goes. If you wonder why you seem ADHD or


    anxious, it may be that you are being told certain things are
    horribly important, yet you can’t seem to feel it; meanwhile
    you are also being told the things you thought were important
    are trivial.

    And the only place (you are told) you can go to regain balance
    is psychiatry. Good luck with all that.
    The World Is At A 52 Week
    Low, And The Past 10 Years
    Never Happened
    October 7, 2008

    In retrospect all things are obvious, but someone should


    marvel that today’s close is merely 10 points different (lower)
    than the exact same date 10 years ago.

    And you have to ask whether God has built the world as zero
    sum— i.e. this is the bottom— or as a cyclical spiral— in
    which case we are destined for 800.

    And the rest of the world is no different. Click “Continue” for


    other charts.

    Oh, and pay close attention to that bottom in February 2003,


    and ask yourself what might have ended such a precipitous fall
    and coincided with the beginning of the largest bull run in
    history.

    I’m not a tin foil hat nut, but I’ll reveal something about
    myself: for the very first time in my life, I am scared.
    Meanwhile, the dollar took a round trip, and even lost a little:

    Gold caught a triple:


    7 Things To Expect In Our
    Brave New World
    October 8, 2008

    Financial turmoil directed by CNBC; a U.S. Presidential election


    so important that they are running a guy no one really ever
    wanted vs. a guy no one’s ever heard of in an election subtitled
    “More of The Same vs. Less Of Everything.” May you live in
    interesting times.

    Here are five other things you don’t want that are coming:

    1. The return of pubic hair and mustaches.

    The good times go with no hair; the bad times go with more hair. I
    don’t like it any more than you do, but we’re about to be
    bombarded with Starsky and Hutch look-a-likes and the totally
    earnest use of the phrase “luxurious bush.” I’m going to go throw
    up now.

    2. Fashion trends:
    2a. Dressing like elves.

    As in the Hobbit, not Keebler. Brown boots, green leggings and


    oversized shirts/sweaters doubling as skirts.
    2b. Hose.
    Just as society finally recovered from the 50 year self-mutilation
    called pantyhose— even the WSJ debated whether it was still
    required for the office— it will soon be making a comeback. If
    anyone in the fashion industry is reading this, stop killing your
    children. No one should be wearing pantyhose unless they’re
    about to rob a bank. Please, I beg you all, stop this.

    3. Another terrorist attack: February 2009.


    Maybe I’m cynical, but has anyone noticed recessions are ended
    by wars? And that the S&P 500 closed yesterday, October 7,
    2008, at the same point it did ten years ago, October 7, 1998?
    Which was also the historical low of the LTCM disaster?

    Most recently 1989 S&L bailout lead to Gulf War I; and the scary
    similarity between the S&P500 pre 9/11 and now:

    which was cured by Gulf War 2 in 2003… Do we get another


    attack to bring us down, then a war at S&P 800? Early, to test a
    new President’s resolve? Stay tuned. I hope President Obama is
    ready.

    Of course, it could be domestic terrorism/riots/Presidential


    assassination attempt, which unfortunately seems likely as well.

    4. Conspiracy Theories: Like the above! Many of you will not


    be old enough to remember how the Nasca Lines, Lost
    Civilizations, Cryptobiology, JFK and Egyptology are connected,
    but they most assuredly are, as Mr. Spock explained to us, in 168
    episodes of shroomy genius. And Erich von Daniken wrote 20+
    books while the economy was crippled with stagflation.
    5. Wrestling. Pick any show that’s been running from 1995 to
    now. So many of them have seen ratings trend lower, except the
    WWE (formerly WWF before the panda patrol got testy.)

    There was a surge when The Rock and Stone Cold were on, but
    ignoring that period ratings have been stable for over a decade.
    And that doesn’t account for growth in Europe.

    As people lose their jobs and look for a choreographed release of


    their frustrations and prejudices, one might be tempted to smell
    what you know who is cooking. And the stock, also stable
    between 13-19 (now 15) now pays a 9.7% dividend. Take that
    Bank of America!

    When your kid endows body parts with political significance and
    then tombstones his brother, you’ll know I was right.

    6. Mercantilism. Enough said.

    7. Secular humanism. In case your last experience with it was


    high school, let me point out that this is a bad thing, not a good
    thing. Yes, it’s wonderful to have an ethical system free of
    religious foundation and therefore premised in reason, or
    something, but what happens when the humanist’s “reason” is in
    sharp contrast to the “reason” of the humanist with the tanks?

    It also overlooks the historically indisputable point that


    human(ist)s like killing each other and themselves, and will do so
    with little provocation. Indeed, many actively seek out reasons to
    open fire. “We are no better than they are” (and why isn’t that
    ever, “they are no better than we are?”) is a popular refrain among
    those who haven’t been on the wrong end of the not any worse
    they, but it makes choosing sides a lot more difficult when, well,
    you have to choose sides. And if the S&P500 chart is any
    indication, we’re going to be needing to choose some sides pretty
    soon.
    –––—
    Did you know Julian Huxley, eugenecist and brother of the author
    Aldous, was once an American Humanist Association’s
    “Humanist of The Year?” So were Kurt Vonnegut, Margaret
    Atwood, Benjamin Spock, Isaac Asimov, Betty Friedan and John
    Kenneth Galbraith. Do you see the connection? They’re all
    science fiction writers.
    This Shall Pass
    October 9, 2008

    If you do not need to sell, don’t.

    The markets are tanking more than is necessary for even the
    most severe recession. What makes it scary is that it is
    happening in days, not months, relentless— it’s happening in
    internet time.

    The S&P500 goes to 800 and Dow to 7500, these are


    inevitabilities. But you can’t trade it because the volatility is
    too high— so don’t.

    Some people need to sell— especially hedge funds caught the


    wrong way; or people selling the good stocks to raise money
    to cover debts, taxes, redemptions, whatever.

    If you have cash and can wait for 800 and 7500, then feel free
    to buy then. Stocks aren’t falling, they are being stomped on,
    compressed. When the real companies rebound, their stocks
    will likely explode higher, like.. a coiled spring.

    Let me quote the late, great, Mitch Hedberg: “I’m tired of


    following my dreams. I’m just going to figure out where
    they’re going, and hook up with them later.”

    Don’t follow the market. Just meet it at 800.


    The Next Step: Suspend The
    Capital Gains Tax, and The
    Market
    October 9, 2008

    Extraordinary times call for extraordinary measures. Move.

    What is happening now is not related to fundamentals. Major


    companies are being discounted much more than their already
    lowered future earnings estimates would predict. Stocks are
    being priced not for recession, but for Depression.

    Ten years of growth have been eliminated, and for what? Does
    anyone even know why they are selling?

    It isn’t a matter of earnings or even recession; at this level it is


    all about a lack of confidence. Either stocks have been overly
    discounted— yet still there are no buyers, because they lack
    any confidence in the markets; or they are being discounted
    appropriately for a coming Great Depression, in which case
    something more needs to be done to prevent one.

    A single sentence on the positives is sufficient: suspending the


    tax would go a long way to enticing investors back into the
    waters, whether to ward off Depression or restore confidence.

    To those who would express horror at such a regressive notion,


    consider the following:

    1. Suspending the capital gains tax will have a small


    relative effect to the budget deficit, in comparison to the
    bailout(s), etc— less than $80B.

    In the years 2003-2005, capital gains revenue was $50B,


    $60B, and $75B, respectively. Even if the capital gains tax was
    reduced to zero for one year, the government would stand to
    lose no more than $80B in mythical money. I say mythical
    because, in 2008, what capital gains does it expect to tax?
    Even the short selling was banned.

    According to the CBO, in 2002, real estate accounted for 10%


    of capital gains tax revenue, and stocks 90%. This was during
    a period of real estate growth and a precipitous stock market
    fall. The exact reverse situation exists now.

    2. Capital gains tax cuts lead to increases in capital gains


    revenues, not decreases.

    Prior to the tax cuts of 2003, the CBO projected capital gains
    for the years 2003-2005 to be $45B, $44B, and $49B— as
    compared to the actual revenues of $50, $600B, and $75B. In
    other words, the tax cuts increased revenue by $45B over the
    three years; they had managed to generate an extra year’s
    worth of capital gains revenues.

    One might argue that this lead to asset price inflation which in
    turn resulted in this collapse; let us grant that this is the case.
    The tax elimination is only temporary; can be limited only to
    gains starting after, say, July 1; and one can even raise the tax
    later. This reduces the lost revenue from $80B to any number
    desired.

    The point is not whether tax cuts do or do not lead to asset


    bubbles; the point is explicitly to prop up asset prices, so that
    real investors feel confident to being buying again.

    3. 2008 may be the year where one is taxed on losses.

    The S&P500 went from 1229 (Jan 1999) to 1469 (Jan 2000),
    and then back down to 1320 (Jan 2001). It may look like a
    round trip. But consider that if the 1999’s 15% gains were
    taxed at the short term rate— to be paid by April 15, 2000—
    yet the market was, in that time, falling, one could find himself
    in the unfortunate scenario of having to pay taxes on gains he
    no longer had— in essence, he was being charged a tax just for
    trying. With that in mind, observe that the 2000 revenues were
    the highest of all— $121B. Where did investors who had lost
    the profits get the money to pay the taxes? They sold the
    stocks themselves— contributing further to the already in
    progress market decline 2001-2003.

    4. The suspension can be phased in according to sector.

    Clearly, the financials and financially sensitive stocks (e.g.


    GE) are the root of the problem. One can suspend capital gains
    taxes on these stocks; as they stabilize, so too will the
    collateral damage which is— everything.

    Alternatively, the suspension of taxes on dividends can be


    used to bring investors back into those stocks. Unfortunately,
    this is the opposite of the current proposal, which is at this
    time entirely untenable.

    5. Suspension of the tax will lead to increased private


    foreign investment.

    In 1994, foreign investment in the U.S. was $50B. This rose to


    steadily to $3.2T (trillion) in 2000— and then fell back to
    $50B by 2002.

    After the tax cuts of 2003, it rose back to $1.6T by 2006.

    If buyers are needed to turn the markets around, bringin


    outside investment is an obvious solution.

    The Time Is Now

    All of these manuevers will take time to implement, and even


    more time for people to digest and respond to them. Right
    now, the markets are in a state of free fall with no buyers
    willing to step in. This is not a market, it is a the dumping of
    perfectly good bagels into a dumpster because no one wants
    them. The average 401(k) investor is so perplexed by the
    happenings that it does not seem real to him— indeed, it is not
    real, except for the number at the bottom of the statement. The
    markets need to be closed, giving investors— especially large
    institutions, hedge funds, and rich guys— time to meet and
    discuss their terms.
    CNBC Ratings And VIX
    Predict Rum Sales
    October 10, 2008

    (Original idea here.)

    Pearson’s r = 0.943, that’s amazing.


    Maybe CNBC viewers are exhausted. But they’re checking
    out, and if Professor Pearson has anything to say about this,
    VIX has to fall very soon.
    FYI, the VIX is at the highest point in 20 years. Remember
    800. It is inevitable.
    I’ll write something funny, maybe about narcissism, for you all
    on Saturday. You know, to go with the rum.
    Secretary Paulson
    Implements the Regulatory
    Act of 1773
    October 10, 2008

    The news is out: US to buy stakes in banks, first since


    Depression.

    An Act For Establishing Certain Regulations For The


    Better Management Of The Affairs Of The East India
    Company, As Well In India As In Europe US Banking
    System
    Whereas the several powers and authorities granted by
    charters to the united company of merchants in England
    trading to the East Indies to banking companies have
    been found, by experience, not to have sufficient force
    and efficacy to prevent various abuses which have
    prevailed in the government and administration of the
    affairs of the said united company, as well at home as in
    India abroad, to the manifest injury of the public credit,
    and of the commercial interests of the said company; and
    it is therefore become highly expedient that certain
    further regulations, better adapted to their present
    circumstances and condition, should be provided and
    established: …

    By these acts is established the United States of America


    Company. We are all mercantilists now. Auspico Presidentis et
    Senatus Americaniae.
    Christopher Columbus Was
    Wrong
    October 13, 2008

    And what you think I’m going to say next reveals your
    educational and political biases. I.

    Asked another way: If I say Columbus was wrong, then who


    was right?

    Contrary to popular belief— a belief caused by every


    American grade school textbook from An American Pageant
    to Prentice Hall Earth Science, no one in Christopher
    Columbus’s time thought the earth was flat. It was established
    information, since the ancient Greeks, that it was a sphere.
    Eratosthenes calculated the diameter to 10% accuracy back in
    200 BC. Ptolemy (0 AD?) knew it was round, but thought the
    sun (another sphere) revolved around it.

    And yes, even the Catholics believed it was round, too. St.
    Augustine knew it was round, his difficulty was accepting
    whether there were any people on the other side of the world
    — how do you know it isn’t all just water?

    So the dispute was not whether the Earth was flat, but how big
    it was: most people thought that it was bigger than it actually
    was, and Columbus thought that it was much smaller than it
    actually was. Turns out even Columbus didn’t really believe it
    was that small either, as he fudged the ship’s logs so that the
    crew wouldn’t know how far they’d actually gone, and mutiny.

    Either way, the Dominican Republic was in the middle, and no


    one expected that.

    So Columbus was wrong about how big it was. The prevailing


    estimates were closer to the truth.

    II.

    Some of you might have assumed my initial question was of


    the variety, “Did Christopher Columbus discover America?”
    or “Did he think he made it to India?”

    What’s interesting about those questions is that they are not


    fact queries, but political alignments. It is a fact he discovered
    America— he didn’t know it was there. It is also a fact that
    others had been there before him, and people were indigenous
    to it, as well; but these are not mutually exclusive facts.

    And people love to jump on the question, take sides: “no, no,
    he didn’t discover it, Leif Erickson/the Chinese/Indians!!!”
    But they’re not correcting misinformation; they’re debating
    prejudices. They’re not taking sides for something; they’re
    taking sides against something.

    Anyone who tells you Leif Erickson discovered America is


    unlikely to know any other fact about Leif Erickson. Not the
    date of his voyages, his country of origin (Viking is not a
    country) or what he was even doing that far west in the first
    place. Nothing. They don’t care about Leif; they just want
    Columbus to be wrong.

    Why that is could vary: maybe it’s a slap against the


    establishment, their parents, “everything my Dad told me is
    wrong!” as they take a deep drag from their only true friend.
    Maybe they want to appear smart. Or possessing of a trendy
    anti-european sentimentality.

    What matters here is why such a meaningless debate is the one


    most people want to have; yet the other, more urgent one— are
    we even being taught anything correctly in school?— passes
    without even a thought.

    III.
    So why is it we were taught that the prevailing opinion was
    that the Earth was flat and that Columbus’s crew was terrified
    they would fall off the edge?

    The most common answer is Washington Irving’s (yes, that


    Irving) book The Life and Voyages of Christopher Columbus, a
    fictional account, which assumes a prevailing belief in a flat
    earth.

    Trouble is, most people have never heard of this book, let
    alone read it; to blame it for generations of misinformation
    seems, well, a stretch.

    But the flat earth misconception does indeed appear in


    textbooks. The problem comes down to this: no one cares
    enough to fix it. Parents learned it; kids learn it; and even if
    you do discover the truth (e.g. now) it’s simply not worth
    going back (to whom?) and fixing the source (e.g. the
    textbook.) The correct information becomes a novelty, bar
    talk. The factual information supposedly has no value.

    Yet the debate about who discovered America— that somehow


    matters. The incorrect knowledge makes medievalists look
    like religious idiots— that’s ok. That it alters your hazy guess
    about what life was like back then— no problem. That it
    supports the idea of history being divided between now and
    pre 1980— awesome. Secular humanism is the name of the
    game, and that also means no special place can be afforded to
    any Italian/Spanish explorers.

    How do generations of Americans get the basic facts so


    horribly wrong? No one reads primary sources, and, worse,
    everyone relies on the same bunch of interpretations of
    primary sources. Then the debate is not about the the accuracy
    of the information, but the presence or absence of a political
    biases.

    We got what little information we have about history from the


    same few sources; no wonder we don’t know anything, and we
    all don’t know the same things. Imagine if we all got our news
    from the same few sources, or our medical information from…
    oh, wait.

    In other words, it’s the same way we practice medicine and


    pick our Presidents— More of The Same vs. Less Of
    Everything. And it doesn’t seem likely to change.

    –—

    http://twitter.com/thelastpsych
    Wanted, Starring Angelina
    Jolie, Is The Greatest Movie
    Of Our Generation
    October 15, 2008

    And if you dispute that, I am coming over to your house, pants


    down and guns blazing. If this looks like the kind of movie
    you’d like, then you’re in luck, it delivers.

    If it doesn’t look like anything you’d ever like, then you


    probably want to buy a copy of The Women, a movie so
    dangerously vacuous it carries a Black Box Warning for
    Suicidality in Children and Adolescents. It’s the movie Mick
    Jagger would produce if he he simultaneously hit male
    menopause and a truckload of opaku dung and then got down
    to producing, which, believe it or not, is almost exactly what
    happened, except that it wasn’t male menopause.
    The best thing that can happen to you while watching The
    Women is cataracts.

    AREN’T YOU BEING JUST A TAD JUDGMENTAL?


    No.

    SO WHY IS WANTED SO GOOD? IS ANGELINA JOLIE


    NAKED IN IT?

    Well, no, not really. There’s a brief shot of her from the back
    getting out of a bathtub, but she is so heavily tattooed that she
    looks like Venom got her.

    WHAT?

    Hey, if you don’t like the reference go back to The Women.

    SO WHAT MAKES THIS MOVIE SO GOOD?

    I didn’t say it was good, I said it was GREAT. It contains all


    the elements a pathologically narcissistic and emasculated
    generation of men need to make themselves feel good again,
    without marijuana OR facebook. Let’s review:

    1. Subtext: “You are special.”


    By “subtext,” I of course mean “subtitle.” While to the great
    unwashed it appears that you are a lowly account manager in a
    cubicle with a cheating girlfriend and no self-respect, in fact
    you are much, much more than that, like, for example, a
    mystical assassin with the ability to shoot curveball bullets.

    Importantly, your specialness comes not from effort, work,


    emotion, intellect, perseverance, or concentration, but from
    just being you— in this case, being from the lineage of a 1000
    years of special people. All you had to do is get born! Thanks
    feudalism!

    2. Campbell/Lucas mythology of the heroic son unaware of


    his special lineage

    You know how your Dad sucks? Well, he’s not really your
    Dad. Your real Dad was a great hero, not an HVAC repairman,
    didn’t your mother tell you? His sword is out back under a
    rock.

    In this movie, he was a child when his Dad left (to be a


    mystical assassin) but, keeping to the mythology, was closely
    but secretly monitoring his son’s development (in this case by
    moving in across the street and buying a telescope.)

    3. Genetics is an untapped endless reservoir of possibility.

    You know how you suck? Turns out it’s genetic, but don’t
    Mapquest cyanide plants just yet. Once you unlock your
    genes, you’ll be able to do almost anything, including but not
    limited to shooting curveball bullets and slowing down time. I
    know, it’s far in the future. But until then you can keep
    yourself from a suicide/pregnancy pact by remaining
    optimistic: the best scientists in the secret labs of Asia are
    working on it. In the meantime, why not test out your
    awesomeness by wrestling pumas?

    4. Hot woman with amazing special talents and abilities


    chooses you.
    Awesome. The Fifth Element, Alias, Ultraviolet, Underworld,
    Resident Evil— all these movies represent the
    demasculinization of a decade of twenty-somethings, but
    lacked the most important element: you. This was fixed with
    Wanted. Angelina Jolie has all the necessary special powers
    and abilities, yet she chose you.

    Back in the day— e.g. the six thousand years preceding 1992
    — the man had to earn the girl’s interest/love/vagina by doing
    something extraordinary, or at least trying to be extraordinary,
    or at least being a good person, or at least paying her. Now,
    thanks to a lifetime of Captain Crunch, Coldplay, and
    institutionalized narcissism, a man can hope that a woman
    with special powers will want him precisely because these
    special powers allow her to see how awesome he really is. Not
    what he is now, of course, but, you know, what he really is.
    You know. Look past the XBox, you damn bitch.

    Key point: even if he doesn’t ultimately live up to his


    potential, he still got to make out with her. Nice!

    5. You get to kill people.

    Awesome, again. You know, back in the day (see above) all
    special abilities were to be used for saving people, and killing
    was always the last resort, and only to be done under the
    specific direction of John Woo or one of the remaining
    Wachowski Brothers. As the Bible teaches us, it’s not murder
    if you’re doing a back flip.
    If a man doth close both eyes, and raise both guns, so does his
    aim grow more true.— Galat 25:3

    But in this movie, killing is the point. Never mind that there’s
    no evidence that the targets are actually bad people— that’s a
    decision that Fate makes. Not metaphorically, I mean literally
    Fate makes it, and it lets you know by sending you a message
    in binary code written by a… magic loom. Look, if Angelina
    Jolie is going to like you, some people are going to need to die
    to balance out the universe.

    6. Hot chick who saves you also kills people.

    Madonna, whore and death instinct, all in high def! Thanks


    Freud!

    7. Mystical manmade machines.

    If your iPhone suddenly sends you a message in a binary code


    that says you need to kill John Smith, you’re going to think
    back if you took your Zyprexa. Why? Because no one tells an
    iPhone owner what to do except Steve Jobs, got it?
    But if something with no technology in it at all— say, a loom
    — tells you you need to kill John Smith, you have no choice
    but to pull up your pants and get your Sig Sauer. It’s totally
    logical that God can influence a loom— been doing that since
    Arachne— but clearly He’s too old to understand all that new
    fangled technology. The last time He did was in Stephen
    King’s Processor of the Gods, which, if I’m not mistaken, was
    an IBM PC. Look, he’s writing out the Book Of Names by
    hand.

    What does it say about our time when we are more in awe of
    mechanical objects then we are of technology that uses
    quantum mechanics to operate?

    8. You get to yell “FACE” to your ex-girlfriend.

    I did have one question. If Wesley is such a loser before he


    learns of his specialness, how did he manage to get this girl as
    a girlfriend in the first place?

    I’d like to see that movie, please.

    That aside— and maybe I’m different— but if I was able to


    bend space and time at will, and I learned I was the first
    lieutenant of Fate itself, and it was my responsibility to
    emotionlessly execute specific human beings in order to
    restore balance to the universe, then obviously I’m definitely
    going to want to find my ex-girlfriend and show her what she
    missed out on, right? Why else even have those powers? Does
    that make me a bad person?

    9. Breaking the Fourth Wall.


    Nothing in a movie speaks to a viewer more than actually
    speaking to a viewer, and that’s what this movie does. As it
    ends, Wesley looks up from his rifle scope, turns to the camera
    and asks, “This is me taking back control of my life. What the
    fuck have you done lately?” Well? “Not killing people” is, of
    course, a loser’s answer, so don’t pick it. Correct answers
    include, “waiting for my powers to kick in” and “not learning
    jujitsu because I’ll be handed those skills all at once when they
    are necessary” and “waiting for Angelina to swing buy with a
    pizza” and “masturbating.”
    You Always Know Less Than
    Your Source, Unless It’s
    Balenciaga
    October 16, 2008

    The Pew Research Center asked 3612 adults three questions:

    1. Which party controls the U.S. House of Representative?


    2. Who is the Secretary of State?
    3. Who is the Prime Minister of Great Britain?

    And they found something interesting that they did not report.

    I.

    18% got all three questions right; only 30% knew Gordon
    Brown; 50% knew “Democrats” and 42% knew “Condoleeza
    Rice.”

    But the scores according to the audience of specific news


    sources:
    A few observations: The New Yorker readers are college
    educated and older, while The Daily Show people are still in
    college. perhaps affecting the results. However only 31% of
    Hannity & Colmes viewers are college graduates, and they
    scored well. So education itself is not the explanation.

    Obviously, certain shows beat you over the head with the
    information. That’s all Rush and the Colbert Report talk about;
    but they don’t much mention Great Britain. So those scores of
    those audiences make sense.

    What doesn’t makes sense— or, unfortunately, makes too


    much sense— is why CNN viewers did worse than everyone.
    If CNN is objective news, all the time, what happened?

    II.

    Using Lexis-Nexis, I learned that in the past month, NPR has


    done 14 stories containing the search words “Gordon Brown.”
    Fox News did 10. CNN had 24. “Gordon Brown” appears zero
    times in The New Yorker. Clearly, there are multiple factors
    that go into why certain people are more knowledgeable than
    others, but that still leaves open the question why those who
    are news watchers know less?

    Why were BBC watchers no more informed on Gordon Brown


    than Rush’s listeners? Remember, these are Americans who
    chose to watch the BBC. I’m sure it’s the same nuts who
    always tell me, “the BBC is so much better than our news.”

    It’s high school— they drilled the info into you, but it never
    “took.” What NPR and The New Yorker and even The Daily
    Show do is present the information in a context (e.g. here’s
    why Bush sucks; here’s a funny setup) that is usable by the
    audience (“hey, here’s why Bush sucks;” “dude, this is
    hilarious, Gordon Brown…”) That’s a good way of making it
    stick, and it helps explain why CNN’s info doesn’t stick, but it
    means the message is now inseparable from the media. And
    this is more dangerous, because you think you possess
    knowledge that you do not actually possess.

    Here’s an example, arbitrarily using Rush Limbaugh. Say he is


    talking about something you don’t know much about, like the
    difference between the American and British responses to the
    banking crisis. He actually explains well very complex
    information and the possible consequences. You absolutely
    know more than you did before you heard him, even if you
    disagree with his conclusions.

    But if someone asks you a question about this info, your


    response is most likely a version of what Rush said. But
    worse, you don’t realize this— you think you are intelligently
    coming up with the info yourself. You are not aware that you
    are reading from someone else’s script.

    This conceit of knowledge almost always results form learning


    from one source— because it is never tested by a contrasting
    opinion.

    III.

    Balenciaga is one of the oldest (i.e. from the 1960s) French


    fashion houses, but it has stopped producing haut couture
    because, simply, it wasn’t profitable. They’ve turned to ready-
    to-wear clothes, which are still elaborate, still have complex
    cuts and folds, seams, still are expensive, and still are French.
    It may be “off the rack,” but it’s still Balenciaga, and anyone
    who knows anything will recognize it.

    But there’s a willful denial in play. The trick is claiming that


    you have your own unique style, yet that style is available to
    anyone who chooses to buy it; you had nothing at all to do
    with it. I suppose it’s possible to claim you’re different than
    those Givenchy sluts, but it is merely a fantasy— or delusion
    — that your style is entirely yours— or even barely yours.

    Even a woman who buys from a thrift store puts more original
    thought into her wardrobe, though of course even her style is
    bound by someone else’s sketches so many years ago.

    But try telling any woman in a designer dress that, and she’ll
    punch you right in the nose. “Yes, someone else had the idea
    for this dress, and created it; but it perfectly expresses who I
    am. It is, for all intents and purposes, my ideas for clothes. Of
    what consequence to me is it that 5000 other women feel the
    same way? I still look amazing.”

    IV.

    So the fact that The New Yorker readers and Rush Limbaugh
    listeners possess a lot of information speaks to the
    contextualization, the usability of their presentation of that
    info, and how much it resonates with the particular
    inclinations of the audience. Unfortunately, it’s hard to know
    more info than your source for that info, and if you only have
    one source… you don’t know very much.

    But ignorance— socratic ignorance, you-know-you-don’t-


    know ignorance, is hardly the worst thing that can happen. No,
    the worst thing, in a democracy, is to think the thoughts
    someone else gave you— gave 5000 other people— prete a
    porter, and believe they are your own.
    Those Five Days Matter
    More Than Anything, Except
    The Other Days
    October 20, 2008

    Guys, remember that time when you were 24 and you were on
    the subway, and you saw that girl with the glasses reading a
    book wearing a black leather coat, and you were obsessing
    over whether to go up to her or not but then your stop came,
    and you were like, screw it, she’ll probably mace me, so you
    got off and went to the library to study for your chem exam?

    You chose wrong.


    In the Atlantic appears First Person Plural, an article about the
    growing evidence that identity is more complex than a simple
    collection of traits and beliefs.

    The view I’m interested in… accepts that brains give rise
    to selves that last over time, plan for the future, and so on.
    But it is radical in that it gives up the idea that there is
    just one self per head. The idea is that instead, within
    each brain, different selves are continually popping in and
    out of existence. They have different desires, and they
    fight for control—bargaining with, deceiving, and
    plotting against one another.

    Examples from the article include the hidden zero effect, in


    which choices are made differently depending on how far in
    the future are the payoffs. We can’t imagine well who we will
    be in that future, so we choose what is better for the person in
    the now.
    Personality also changes according to situation; even the
    most thuggish teenager is not the same around his
    buddies as he is when having tea with Grandma…. In the
    1920s, Yale psychologists tested more than 10,000
    children, giving them a battery of aptitude tests and
    putting them in morally dicey situations, such as having
    an opportunity to cheat on a test. They found a striking
    lack of consistency. A child’s propensity to cheat at
    sports, for instance, had little to do with whether he or she
    would lie to a teacher.

    With rare exception (of personality structure), who we are has


    a lot to do with what’s going on at that moment. Hence the
    Nausea— the feeling when you understand that there is no
    “you”— at any moment you can decide to do or be anything.
    You didn’t murder that guy because you’re not a murderer.
    You didn’t murder him because, well, it didn’t come up.

    II.

    Yet there are an abundance of studies showing character traits


    are inherited; that behaviors are often predictable; and our own
    daily experience that there is at least a common thread to our
    identity. What of that?

    Bad faith. It appears there’s a commonality because, simply,


    we are not tested. But, more accurately, one is never tested;
    only parts of his identity are tested at a time. That’s why the
    loving family man who then becomes a Nazi is still a loving
    family man— that part was never strained. He is a good
    person and a bad person. Multiple selves.

    The question is not whether traits are heritable— they are—


    the question is what self you are going to let dominate.

    III.

    Here’s an example, from Barron’s:


    But such gloomy sentiments aren’t a reason to get out of
    the stock market… Consider that $1 invested in stocks
    from February 1966 through May 2007 would have
    grown to $16.58 in that period. That’s a 7% annual return.

    Awesome, and by awesome I mean what a complete waste of


    one’s life.

    Somehow people demote investment income over any other


    kind of income. It’s important to go to work every day, or clip
    a coupon, but it is nigh impossible to people to open a Roth.
    The money, I guess, doesn’t seem real.

    That’s money; but if I grabbed the average teenager and told


    him his life and happiness would grow at 7% a year, he’d
    probably kill himself. 7% to the young is basically telling them
    not to even bother. To be young means you still have hope,
    that your energy and talents will eventually payoff, in a big
    way. The difference between a mature adolescent and an
    immature adolescent is not their expectation of massive
    success— they both think they’re going to rule the world—
    but how they see it happening. Mature kids see a steady climb
    to awesomeness; immature kids see it happening one day, all
    at once, at some arbitrary point in the future. I know this
    because I see them in Starbucks, laptops open, staring out the
    window. I was one of those kids, too.

    7% a year financial growth isn’t good, it’s a pacifier, a hoax (it


    serves, therefore, the same social function as psychiatry.)
    Furthermore, it can be wiped out in one week. If you bought
    and held over the past ten years, you made nothing. It was all a
    waste. Don’t believe me? Go ask a retiree.

    And you shouldn’t accept 7% growth in your life, either.


    Every day must be a struggle for self-improvement in the
    service of improvement of the world.

    IV.
    Well, it turns out it is much worse than all that. Barron’s again:

    By contrast, investors who were out of the market in the


    five best days each year during that span were left with
    only 11 cents.

    The implications for money management are obvious, but for


    life they’re nauseating: if you take out the five most
    significant days of each year, then you are basically a
    completely different person. By money analogy, taking out
    those five best days made you massively worse off. You would
    have been better off not even going through the year. Studying
    for the chem exam always seems like a good idea, but there’s
    an opportunity cost. And you have to measure that opportunity
    in real time, because in retrospect it will be too late.

    The old generally think themselves exempt from this, but they
    are not; a day can alter their entire existence and legacy.
    November 4 will change how we remember John McCain
    forever. Nothing beside remains.

    Who you are is a product of your experience, and also a


    product of the experiences you did not have. You didn’t talk to
    that girl, now that’s part of you— you are the guy who was too
    scared/angry/self-absorbed/whatever to talk to her, and that is
    an entirely different guy then the guy who does talk to her and
    it works; and an entirely different guy from the one who gets
    maced. That was one of the most important days of your life,
    and you didn’t even know it. Which brings me to the real
    point: every day is the most important day of your life, and
    you don’t even know it.

    there are worse things than


    being Alone
    but it often takes decades
    to realize this
    and most often
    when you do
    it’s too late
    and there’s nothing worse
    than
    too late.

    — Charles Bukowski
    The Dumbest Generation Is
    Only The Second Dumbest
    Generation
    October 21, 2008

    You know that 17 year old kid who thinks Obama is Muslim
    and Europe is a country and any girl that doesn’t sleep with
    him is a slut? I found someone dumber than him. Wasn’t hard,
    either. The Atlantic asks, Is Google Making Us Stupid? Just
    asking: could the real culprit be The Atlantic?

    Nicholas Carr says Google is, because along with the


    massiveness of the available information comes an avoidance
    — or simply lack of time— for contemplation and
    concentration. Or, to borrow a metaphor (I can’t remember
    who said it) such knowledge is a “mile wide and an inch
    deep.” Oh, Artemus Ward said it about the Platte River.
    Thanks Google, I feel smarter.

    Carr also finds he is less able to read deeply, to concentrate;


    and he can’t read novels anymore. It’s changed not just what
    he knows, but how he thinks. He thinks in internet-style.

    I’ll generalize: it has changed how most people think.

    II.

    The effect on medicine is noted by Carr, and by me: doctors


    almost never read an entire article, and rarely even abstracts.
    Title, keywords, or title/keywords of shorter summaries
    written by someone else.

    In Science appears Electronic Publication and the Narrowing


    of Science and Scholarship, in which a now not surprising
    finding is revealed: the more articles are available online, the
    less they are read. It also shifts the age of the cited articles up
    to the past ten months. Recent reviews get read; original
    studies don’t, even to verify the claims. Anything in science
    that’s not “hot” now won’t even get read. It’s groupthink
    reinforced by a research diameter of 2 years.

    Electronic subscriptions means even less awareness of the


    contents. At least when you got the print journal, you flipped
    through it.

    If you want to know why doctors seem always to be hashing


    the same ground, it’s because they are.

    III.

    As I’ve noted elsewhere, there are two important effects:

    1. As Socrates said, people become “filled with the conceit of


    wisdom instead of real wisdom” (e.g. Artemus Ward?)
    2. you really only know what someone else wants you to know

    But there’s an another effect, and it has to do with the medium.

    Nicholas Carr writes that Nietzsche (title of this blog, BTW)


    stopped writing because of eyestrain— until he bought a
    typewriter and learned to touch type with his eyes closed. His
    style changed; his already tight prose got tighter. Nietzsche
    himself noted it, and quickly gave up on it; and, according to
    Carr, a later scholar observed that the writing “changed from
    arguments to aphorisms, from thoughts to puns, from rhetoric
    to telegram style.”

    Anyone who writes for a living understands this; Neal


    Stephenson (Anathem) writes with a fountain pen; I can only
    write on a computer. But— and you should try this— using
    any other medium makes one think differently. I have used this
    technique to generate new ideas; my post on The Wrong
    Lessons of Iraq and the other on We Are All Mercantilists
    Now were both generated on my Blackberry. It felt immediate,
    important, urgent, political. I could never have written the
    Wanted humor piece that way. I couldn’t have even conceived
    it. It was part me, part Movable Type.

    So the internet allows the delusion that you know things that
    you really don’t; the mistake that the thoughts you do have are
    your own, and not someone else’s; and then changes the way
    you think, reinforcing this style of thinking.

    IV.

    Enter Mark Bauerlein’s The Dumbest Generation: How The


    Digital Age Stupefies Young Americans and Jeopardizes Our
    Future (or Don’t Trust Anyone Under 30). Bottom line: kids
    today have (access to) lots of information, but no wisdom.
    And, rather than the internet bringing diverse people together,
    it seems to foster tribes of the like-minded, who never closely
    examine anything different(ly).

    We don’t know much, and we stick to those who who are like
    us, who provide our much needed affirmation. If that’s not a
    recipe for narcissism, I don’t know what is.

    V.

    Sounds much like the book by former assistant secretary of


    education Charles Finn, with Diane Ravitch, What Do Our 17
    Year Olds Know? You can guess the answer. 8000 seventeen
    year olds: half thought he book 1984 is about the end of the
    human race in a nuclear war; 35% didn’t know Watergate was
    after 1950. 30% didn’t know Aesop wrote fables. They
    thought Jim Crow laws were good for blacks. Etc.

    Except it isn’t all their fault. Kids are only as dumb as they’re
    allowed to be. Here’s an example: introductory “survey”
    courses in state colleges are universally accepted to be a joke.
    But why not simply change that? You can still keep the grade
    inflation and “everyone passes” ideology; but why not just
    have a professor who cares with rigorous content? Well,
    because he doesn’t care, and the school doesn’t care. They
    have other things to worry about then oversexed freshmen. So
    how can you blame students for not knowing anything? The
    college does not even allow them an opportunity for
    knowledge that they could lazily opt out of. The system offers
    only no knowledge.

    VI.

    “Kids today” may be the Dumbest Generation, but the parents


    and teachers of the Dumbest Generation are themselves so
    dumb they not only don’t know the information themselves,
    they don’t even know what knowledge exists that is important
    to pass on.

    And I can prove it: the above book What Do Our 17 Year Olds
    Know? was written in 1987. Those dumb 17 year olds are 40
    now. Say what you want about the “elitist” conclusions of The
    Closing of the American Mind but it was also written in 1987,
    about 1987 college kids— who are now adults.

    The adults are dumb, all right; but they don’t know it. They
    have a unsettling feeling that something is lacking. The
    general narcissism and insecurity of parents today—
    even/especially the “good” parents, is visible in their
    parenting. At a birthday party, the kids are running Lord of
    The Flies while their parents completely ignore them,
    socializing; meanwhile, they hover over them at the store, at
    the playground— “no bicycle without a helmet.” They secretly
    read their kid’s email and Facebook accounts, but have never
    once read the kid’s math book. “Oh, ha ha, I don’t remember
    all that math!” Idiot, could you at least pretend it’s important?

    If you do your kid’s math homework with them every night, I


    swear to you that you won’t need to worry about Facebook. I
    will concede that monitoring their Facebook is easier.

    Many professional parents and teachers I know fall back on


    empty words— “classical education” or “the use of primary
    texts” but they don’t know what those terms mean. They nod
    respectfully at Aeschylus, but they don’t have the first clue
    whether he fought for the Greeks or the Trojans. You think
    these parents and teachers are going to know to tell the kids to
    read Werner Jaeger? They’re not. They’re going to buy them a
    Leapster.

    VII.

    Simply put: adults today don’t know what’s important to


    know. So they make things up to care about.

    No one won the culture wars; we forgot who the enemy was.
    In 1987, when Allan Bloom or William Ayers argued for or
    against a “classical” education, they were arguing its
    importance, not the definition. Now? That’s why there is so
    much noise about school vouchers for private schools— it’s a
    proxy for the culture war without having to know exactly what
    you’re fighting for. There is a vague feeling that private
    schools are “better,” that the surrounding students are “better,”
    that it is more “rigorous,” without really knowing what they
    are pushing towards or away from. It is also evident that it is a
    fall back; it makes up for their own shortcomings. Secretly:
    “Hopefully a good school will teach them better than I can.”
    Well, you’d be right on that point, anyway.

    I’m not advocating a “return to the classics” (I’m not not


    advocating it either), but I am observing that the Dumbest
    Generation of Narcissists In The History of The World is not
    even remotely conscious of their ignorance or their narcissism,
    and the technology lets them get away with it— they actually
    think they think they know, they actually believe they have
    chosen what they think is important. And they are now parents
    and teachers and doctors and leaders. As far as I can tell, this
    simultaneous conjunction of ignorance and unconsciousness
    has never happened before in history.

    I have every hope and faith in the youth of today, because


    otherwise we are doomed.

    “Don’t trust anyone over 30” turns out, after all, to be very
    sound advice.
    –––-

    Diggs, Reddits, and donations are all appreciated.


    The Graying Of
    Kindergarten: The Goal Is
    To Keep Them In Puberty,
    Part 1
    October 23, 2008

    The article is actually called The Lengthening of Childhood,


    but somewhere sometime the other phrase caught on, which is
    a shame, because this phrase is much more accurate.

    The facts are these: a trend that began in the 1960s is holding
    back kids one year before they start kindergarten. Instead of
    starting at 5, they start at 6. Part of this is due to changes in
    state laws which have pushed back the enrollment age cut off
    (e.g. must be 5 by September, instead of by December). But
    this is only a small part.

    There are three important trends.

    First, the kids held back are not being kept at home— they are
    being enrolled in preschools. So it is a purposeful delay of
    kindergarten specifically, not a delay of “going away to
    school.”

    Second, upper income, white parents hold their kids back at


    the highest rate. Infer as you will.

    Third, boys are held back at higher rates than girls, and this
    difference is increasing every year.

    Unfortunately, the authors draw the wrong set of conclusions


    from these findings. For their own (good) reasons, they are
    arguing the impact on society, not on the individual.

    For example, while there is a clear benefit in the first few


    grades to being one year older, the authors find that this
    improvement is not present later on in high school. In fact,
    they show, the older kids are at a significant disadvantage—
    for example, higher drop out rates.

    But if a kid is one year older when he drops out, he’ll have
    finished one less year of school, so yes, he’ll be less educated.
    But the expectation of the kids of the upper income parents—
    the highest rate— isn’t that they’re going to drop out. So this
    negative doesn’t apply to those kids.

    Similarly, the authors say the delay depresses lifetime


    earnings; but this is obviously only because they will work one
    year less in their lives. Again, the individuals themselves don’t
    care about this; society and the tax collectors do.

    Where they do see benefit is in athletics: an older varsity


    player will be, on average, stronger than a younger one. The
    practice of benching someone for a year so that they get older
    is redshirting, and the authors apply it to the kindergarten
    process as well.

    So on the one hand, the practice has two clear negatives on


    society; but the more urgent question— the one that would
    actually influence the practice— is the impact on the kids
    themselves..

    First, you have a class problem. On the one hand, it sounds


    easy to criticize this practice as the social engineering of the
    rich. But, on the other hand, if the other parents around you are
    doing it, how can you not do it yourself? Would you willingly
    put your kid at a theoretical disadvantage when you have the
    means to not do that? It’s similar to the universal healthcare
    counter-argument: can you force a group of people to accept
    worse healthcare than they are getting now? To accept it for
    their kids?
    And this puts pressure on less affluent but aspiring parents to
    do the same— the difference being that their five year olds
    won’t be in private preschools, they’ll be in daycares. They
    will, in effect, get one less year of “education” than the rich
    kids. What they hope will be a competitive advantage may be
    a disadvantage. In other words, they’ might be screwed either
    way.

    As I say to everyone who will listen, which is no one, you


    can’t blame the rich for doing it, and you can’t blame the poor
    for wanting to riot.

    Second, one might ask why this is happening to boys more


    than girls. It’s obvious to anyone who has ever seen a boy that
    they appear, as compared to a similarly aged girl, completely
    retarded. So it makes sense that affluent parents— any parents
    — who have the option, will redshirt their five year old boy
    and hope he gets another year of maturity under his belt so that
    — and this is my point— he can keep up with the girls. So the
    problem isn’t simply that boys mature slower than girls, it is
    that they are required to perform the same exact skills at the
    same exact time. Any surprise boys hate school more,
    “ADHD” is more prevalent, etc? And there is more anxiety
    and thus pressure about the potential ineptitude of sons than
    daughters.

    What’s interesting and upsetting about the discussion of


    redshirting is that it is phrased in terms of class differences,
    which are the consequence; and not gender differences, which
    are a source. The problem isn’t redshirting, the problem is the
    school. You expect your five year old boy to read like a girl?
    And when he doesn’t— what? Hates reading? Hates girls?

    Third, you have the problem of the parents themselves who are
    looking for every advantage to give their kids because they
    don’t know what else to do, they can’t judge what’s valuable
    or not. So they look around at other kids and parents, and
    compete. They don’t know what the point of an education is,
    so they say “get into a good college.” That’s the goal of 18+
    years of education. That single outcome.
    For what? They pretend that they have to do these things
    because the other kids do have these advantages, but they have
    no faith in the kids themselves— that their outcome will be
    largely independent of what college they go to or even if they
    go to college. College is, in a word, a scam; everything that
    promotes that goal is therefore doubly so.

    I’m a doctor— no one has ever asked where I went to college;


    no one has ever asked how I did in high school chemistry. You
    can argue these things were important then, to get into medical
    school, but they really weren’t. Getting Bs instead of As may
    have meant I went to a different school, but not that I wouldn’t
    have been a doctor, or a good one, or a bad one. And since my
    real education didn’t come from the schools anyway, it’s moot.

    I wonder, and I have not studied this, if one positive


    consequence of redshirting is that studies that show American
    students are dumber in math than other international kids may
    be bunk, since those studies compare kids of similar ages, not
    similar grades. Our 15 year olds may simply be in an earlier
    grade. This may also explain why the education gap
    disappears in college.

    I’m tempted to conclue that the problem of redshirting is


    analogous to abortion: instead of trying to convince people it
    is a good or bad thing, we should just try to eliminate the need
    for it.

    –-

    Part 1 here. (This is it.)


    Part 2 here.
    Part 3 here.
    Diggs, Reddits, rum and/or donations all appreciated
    Vanderbilt University: The
    Goal Is To Keep Them In
    Puberty, Part 2
    October 27, 2008

    Time Magazine’s A Frosh New Start describes Vanderbilt


    University’s $150M public works project to create an all/every
    freshman 10 dorm “Commons” where— if I read this right—
    they “will help first-years get acclimated to college life.”

    I suppose it occurred to no one that the “college life” these


    first-years are getting acclimated to is exactly the kind of
    artificial world of the Commons?
    But it’s not just for freshmen, it will also house 10 professors
    and a “Dean” who will live there. Yes, some of the professors
    have families.

    Someone will say, “but what’s wrong with that? Why not
    segregate them a little, hell, even coddle them a little, in a
    highly intellectual environment where they can focus on their
    studies without the outside distractions?”

    And what would those outside distractions be? One year later,
    those freshman will have theoretically benefited mightily from
    this experience, and move on to be sophomores. Why would
    the next generation of freshman need to be walled off from
    them? Why are sophomores a distraction to freshman? Put
    another way: what possible distraction could sophomores—
    older, theoretically wiser— be that other freshman are not
    already, but worse?

    What does anyone expect freshman to learn from other


    freshmen— and ten professors? If you want them to develop,
    shouldn’t they be living, ideally, with people who can elevate
    them, or at least away from other freshmen?

    The goal is a living-and-learning environment that


    promotes both school spirit and responsibility to
    community among an increasingly diverse student body.

    Really. I’m not really a soldier in the culture wars, but could
    every one of those words be any less the purpose of a college
    education?

    One might legitimately ask what possible role in-dorm


    professors could have. It’s pretty hard for me to believe that
    1500 freshmen are going to skip American Idol to go hang out
    with their (ten) professors— unless their professors are
    watching American Idol.

    “A very small percentage of students see me as a father


    figure, but I try to discourage that,” says sociologist Tony
    Brown

    But setting kids up in an idyllic environment where they have


    no responsibilities except their school work and who have ten
    people acting as “guides” doesn’t sound much like
    discouraging being seen as a father figure. Or do you have
    another method?

    who opens his dorm apartment on Friday evenings for rap


    sessions, using bait like cookies, Wii Tennis and his pet
    rabbit.

    Tremendous.

    Don’t blame the kids outright. Always blame the parents,


    always, not because they are “ultimately responsible” but
    because they are the ones that set this up on purpose, a ten
    dorm extension of The Village.
    “At move-in, I can’t tell you how many parents said to
    me, ‘Oh, good, you’re an adult. Please take care of my
    kid!’ But this was sold to us as an academic endeavor,”
    [says a professor.]

    Maybe the Wii Tennis sent the wrong message. Maybe the
    Glass Bead Game would have been better.

    It doesn’t stop with freshmen.

    Vanderbilt has a $1.75 billion capital campaign to turn all


    the rest of its dorms into neighborhoods where some
    5,000 upperclassmen and their professors can live and eat
    together… [Says] Michael McLendon, who teaches
    public policy and higher education at Vanderbilt. “Now
    we want to make sure their education is social.”

    Why, again?

    –—

    Part 1 here.
    Part 2 here. (You’re reading it.)
    Part 3 here.

    Don’t forget about Diggs, Reddits and donations. Don’t make


    me run a pledge drive.
    Narcissism Up In College
    Students; The Goal Is To Keep
    Them In Puberty, Part 3
    October 29, 2008

    Hold on— not in all college students, and not all in college students,
    and not in all college students in all times…
    From the Journal of Personality, Egos Inflating Over Time: A cross-
    temporal meta-analysis of the Narcissistic Personality Inventory—
    which the blogger from fashion-incubator sent to me a year ago,
    before it was even published:

    Meta-analysis of studies in which college kids over the decades were


    given the Narcissistic Personality Inventory, it found that narcissism
    is on the rise.

    The authors offer a helpful analogy: if the average student in the


    1980s scored in the 50th percentile for narcissism, then the average
    2006 college student scored in the 65th percentile— 2/3 of 2006
    college kids are above the 1980 mean for narcissism.

    Some interesting findings:

    the college students scored the same level of narcissism as a study of


    200 celebrities. (more on that later.)
    Women’s scores rose more rapidly than men’s. In 1992 the SD
    between men and women was 0.45 (men higher); in 2006 it was
    0.15.

    II.

    But not everyone agrees.

    Another group, disbelieving the above study (apparently, even


    before it had been published), investigates their own 25000+
    gigantic sample of UC Davis and UC Berkeley students and found
    that scores on the NPI, and their own measures of narcissism, were
    relatively stable. I should mention here that the NPI measures more
    of the extroverted, “self-enhancing” kind of narcissism, because
    that’s important for understanding why this result is probably wrong:
    40% of UC students are Asian, vs. 6% in the rest of American
    colleges. I hope this doesn’t require any explanation.

    III.

    What do Twenge et al say is the consequence of all this narcissism?

    “A trend among college students toward “hooking up” rather


    than…relationships;”
    81% of students thought ” getting rich was among their
    generations most important goals” (rich is the new porn);
    51% said it was getting famous.

    They have more trouble explaining the other… associations: crime is


    down; volunteerism is up. But to me, these are hardly inconsistent
    with narcissism. Narcissism doesn’t mean you’re bad, just that you
    think you’re the main character in your own movie. Maybe that
    movie is about a woman who works for a non-profit but manages to
    date the President.

    But the authors can’t explain why narcissism is on the rise, and they
    point to the usual suspects:
    Schools and media: “Children in some preschools sing a song
    with the lyrics, “I am special/I am special/Look at me …”, and
    many television shows for children emphasize positive self-
    feelings and specialness.”
    Grade inflation: “In 1980, only 27% of college freshmen
    reported earning an A average in high school, but by 2004
    almost half (48%) [did.] However, the amount of studying has
    actually declined, as has performance on tests like the SAT. “
    Technology: “Devices such as iPods and Tivo allow people to
    listen to music and watch television in their own individual
    ways, and websites such as MySpace and YouTube (whose
    slogan is “Broadcast yourself”) permit self-promotion far
    beyond that allowed by traditional media. These trends
    motivated Time magazine to declare that the 2006 Person of the
    Year was “You,” complete with a mirror on the cover.”

    But all that’s just the consequence, not the cause.

    Look at the above chart, and note the upswing after 1990. I don’t
    know what caused those kids to be more narcissistic than the 80s
    kids, but I do know what happened to those 90s kids after college:
    they became adults. And they became the custodians of the world,
    and, they demanded entertainment that suited them. Music, movies,
    internet, technology— all that was aimed at them, not the next group
    of college kids. Unfortunately for the next college kids, there was
    nothing else to watch. The 30 year old in 2000 wanted to watch
    Survivor and The Bachelor, so everyone had to watch Survivor and
    The Bachelor, and it’s changed cognition: even kids who have never
    watched those shows still uses the phrase “voted off” and
    “immunity.”

    And the 35 year old in 2005 became a parent, and that parent wanted
    school vouchers and great healthcare, but also lower taxes and to be
    able to eat out at restaurants once a week. (‘The kids are with my
    mother.”) Those parents want easy credit and a bigger house.

    This trend is going to continue, frankly, until we either have a major


    recession, war, or my generation dies.

    It’s funny to me, and by funny I mean I dropped all my cyanide


    capsules, that Allan Bloom and all the other conservative culture war
    guys from the 80s never bothered to follow up on the kids they
    thought were such idiots, such— narcissists. Did they expect they
    would all die, sucked into their own skulls by the gravity as their
    brains went brown dwarf? Yet here they are, walking around like
    zombies, apathetically, pathetically, pathologically confident and
    cynical, ironic and happy, yet hungry and restless just the same. It’s
    like they never aged past 25.

    You can’t blame todays teens and college kids for being narcissists.
    They’re doing exactly what they were trained to do, are being told to
    do, what they saw done, by us.

    Part 1 here.
    Part 2 here.
    Part 3 here. (You’re reading it.)

    –—

    Diggs and Reddits and donations appreciated. Do you want a


    telethon? Is that what you want?
    This Week On Grey’s
    Anatomy The Preposterous
    Happens
    October 24, 2008

    Previously heterosexual Callie becomes involved in a


    relationship with a female doctor, Erica. But when they “do
    it,” as Callie later describes to Mark Sloan, she didn’t like it.

    “It was not good at all. I choked, I just couldn’t go down


    there, I tried, but it felt so weird…”

    [Mark gets up and leaves. Where is he going?]

    “Two girls getting nasty and loving it; that’s hot. One girl
    talking about how much it sucked, it’s depressing. And
    wrong. Just wrong.”

    That’s supposed to represent the “typical guy” response—


    straightforward, basic.

    Meanwhile Callie doubts her bisexuality, and thinks this was a


    mistake, and avoids Erica— she’s thinking she’s doesn’t like
    being with women after all.

    Well thank God for self-awareness: by the end of the next


    commercial cycle she has the insight that what’s bothering her
    is that she isn’t good at giving oral sex. “I like to be good at
    things. I do not fail, I do not quit, I like to be good at things,
    and I want to be good at this, too.” Get it? She wants to please
    her mate, but can’t— and this has thrown her whole identity
    into question.
    You’ll also observe, however, that how Callie felt about
    receiving oral sex from Erica is not even mentioned, at all. It
    doesn’t matter. She’s giving up on being with women not
    because she doesn’t like it— who even knows?— but because
    she isn’t technically adept at performing oral sex. Callie
    feelings don’t matter to Callie, Erica’s perception of Callie
    matters to Callie. This is narcissism masquerading as sexual
    altruism.

    As if to reinforce my point, Callie, now understanding the


    problem, identifies a solution: she asks Mark to teach her. No,
    I’m not kidding. And she actually uses these words: “just
    because you didn’t publish a big clinical trial, doesn’t mean
    you’re not a genius.”

    I think this even offends me. Can you imagine if Callie was
    involved with a new guy, and she goes to Mark and says,
    “look, I tried to give that guy a blowjob, but I failed, and I
    don’t fail. Will you let me practice on you?”

    My first thought was that this discounts the gay relationship,


    but it really discounts sex itself, it uncouples sex from any
    intimacy or even pleasure at all. Look, I’m not romantic, if
    there’s casual sex to be had, you can be sure I’m hiding behind
    the couch watching it, but this isn’t about Callie’s freedom to
    use her sex as she wants; this preposterousness is actually
    supposed to not affect Erica; strike that, the deluded nutjobs
    watching this show are supposed to accept that within the
    context of the show, she’s doing it for Erica’s benefit!

    When he agrees, she is ecstatic— “oh my God, really?! Thank


    you, thank you!” NB: this isn’t what she says after the sex, this
    is what she says in anticipation of learning how to do it. Note
    again, whether or not she is actually bisexual— i.e. likes sex
    with women— isn’t relevant; she wants it only if she’s good at
    it, and doesn’t want it if she isn’t good at it. It’s this same
    process that goes into the recent phenomenon of men who
    want to have sex less than their wives.
    II.

    It’s old news that TV dramas are shows about narcissism—


    that’s what the viewers want— but the only way to make that
    ego greed permissible is to make the characters do something
    noble once in a while, appear altruistic. Hence the popularity
    of doctor and lawyer dramas. And these characters always
    seem to get emotionally involved with their patients— which
    wouldn’t be possible if they were narcissists— except it is,
    because they’re not involved with the patient, they’re involved
    with the patient as proxy for something going on in their own
    lives.

    One of the worst things about Grey’s Anatomy is how


    manipulative it is— it tells you what to feel, and it never
    occurs to you that you’re being lied to.

    Here’s an example: in that same episode, Yang— who I


    believe plays the part of a schizophrenic woman pretending to
    be a surgeon— performs a kidney transplant on a man who is
    getting the kidney from his mistress; she’s giving it because
    she thinks he will then leave his wife and be with her. After
    the surgery, the woman is lying in bed complaining— “Why
    isn’t he coming to see me? He needs to come down here and
    face me, and make a choice between me and his wife!” And
    Yang, firmly but compassionately, says, “he hasn’t asked for
    you, or called. I think he’s made his choice.” And the woman
    breaks down crying, realizing that she can’t get a man by
    giving him a kidney.

    It’s supposed to be an example of the noble, straight-talking


    Yang, at her best, words used with surgical precision. But why
    didn’t this idiot have this conversation with the woman before
    the surgery? More importantly, why doesn’t it occur to the
    viewers that a real doctor— which is why I suspect that Yang
    is not a real doctor on the show— would have tried to prevent
    this gigantically unethical situation in the first place? Because
    then there’s no chance to show Yang’s identity. Because it’s
    not about making right decisions, it’s about appearing a certain
    way.
    As evidence for this, the surgery squad does confront an
    ethical transplant dilemma head on: a father wants to pay his
    son $10000 for his kidney. It’s funny, and by funny I mean I’m
    moving to Russia, that manipulation with money is bad, but
    manipulation with emotions isn’t even considered to be
    manipulation. It’s business as usual.

    III.

    You take issue, perhaps, with my characterization of TV


    dramas as narcissism. You say, well, they’re surgeons, of
    course they’re going to be narcissists. You’re confused, you
    think the narcissism is a consequence of it being a show about
    surgeons; but that’s backwards, the characters as surgeons is
    the consequence of it being a show about narcissists.
    Narcissism is the point. That’s what the viewers want, not
    surgeons specifically. To make stories about narcissists
    believable, you then use surgeons, not, say, endocrinologists.
    You need to be able to make a scene where two doctors are
    dating— they are actually living together— but he leaves her
    name off a major publication because,

    “you’re don’t deserve it, you’re a baby, you have the


    potential to be a great surgeon, but you have a lot to
    learn.”

    And the way to do that is to make them surgeons. So that it


    confuses the viewer just enough to say, “yeah, I guess that’s a
    plausible way for a couple who recently moved in together to
    talk.

    So that in the next scene, viewers do not think it preposterous


    that the female character accept the correctness of that
    criticism, and wallow in self-doubt.

    Median age of Grey’s viewers is 46. You’d think they’d know


    better. Or not.
    ––

    Still accepting Diggs, Reddits, and donations, or all three…


    Celebrities and Narcissism
    November 4, 2008

    If, as I say, a narcissist is one who thinks of himself as the main


    character in a movie, then what about those who actually are
    the main characters in a movie?
    An article written by Young and Pinsky— yes, Dr. Drew
    Pinsky, the host of Loveline and now Celebrity Rehab.

    200 celebrities, as defined as famous people who appeared on


    Loveline, were given the Narcissistic Personality Inventory and
    compared to 200 MBA students.

    Guess what? Celebrities scored higher than MBA students. Big


    surprise.

    But some interesting findings:

    Female celebrities scored higher on every component than


    males, but especially high on exhibitionism, superiority, and
    vanity. (The other components are exploitativeness, authority,
    entitlement and self-sufficiency.)

    Breaking the celebrities down according to “profession”:

    Reality TV stars had the highest scores, (most significantly in


    exploitativeness) followed by comedians and actors (close 3rd),
    then musicians.

    The MBAs showed the opposite distribution: males were more


    narcissistic than females, especially entitlement and self-
    sufficiency.
    For example, #10 “I can talk my way out of anything” is most
    heavily loaded for “exploitativeness” but negatively weighted
    for “exhibitionism.”

    Reminds me of a joke by Janeane Garafalo (from memory):


    you know, all actors in LA are the same, they’re just waiting for
    your lips to stop moving so they can talk about themselves…. I
    guess it would help if I were paying attention, but they’re just
    talking crap…
    The CIA Has The Same
    Problem Medicine Does
    November 6, 2008

    After some dozen years’ immersion in intelligence, I still


    find myself reacting uncomfortably to its rather cavalier
    disregard for the footnote.

    Both the CIA and medicine have little patience for regular
    reexaminations of primary sources.

    (“Footnote” to the CIA does not mean that referencing a


    journal or book, but refers rather to the actual source (guy) of
    the information, when, where, under what conditions, etc. In
    this way, footnote is more analogous to individual data points.)

    John Alexander (not his real name) writing in the CIA journal
    Studies In Intelligence, A Modest Proposal for a Revolution in
    Intelligence Doctrine:

    For example, and I find this quite ironic, the higher the
    level of the intelligence product, the less complete is its
    visible documentation. In other words, the more serious
    its import and the closer it is to the influential official
    who will act upon it, the slighter is its overt back-up.

    At the lowest level, of course, is the raw intelligence


    report. This report is generally extraordinarily well
    evaluated and supported. No scholar could really, within
    the normal limits of national security, ask much
    more….The user of this kind of report can easily and
    effectively apply the canons of evidence in evaluating and
    testing the information.

    As in medicine— at the lowest level we have the data driven


    studies, and that data is right there, available to all. The
    Methods and Procedures are carefully described.

    But as we move up the ladder of intelligence reports the


    documentation gets sparser. The NIS (National
    Intelligence Summary), to use a well-known example, is
    in effect a scholarly monograph, digesting a great
    multitude of raw reports. Its total documentation usually
    consists of a single, very brief paragraph commenting on
    the general adequacy of the source material.

    And then we have a review article. While the studies reviewed


    are referenced, the data in those studies is not rehashed. With
    statements like, “in this well designed trial…” we are left
    hoping the author actually read the article he is referencing,
    and critically examined its data, and didn’t just cut and past
    from the abstract.

    Next up the ladder is our analogous “Expert Guidelines:”

    At the more exalted level of the NIE (National


    Intelligence Estimate), documentation even in the
    generalized form of comments on sources has usually
    disappeared altogether. One is forced to rely on the
    shadings given to “possibly,” “probably,” and “likely”
    and on other verbal devices for clues as to the quantity
    and quality of the basic source data. These examples from
    the NIS and NIE are paralleled in a great many other
    publications of similar refinement. One may admire the
    exquisite nuances and marvel at what a burden of
    knowledge and implicit validation the compressed
    language of a finished “appreciation” can be forced to
    carry, but one cannot help being concerned about the
    conclusions. Upon what foundations do those clever
    statements rest?

    One can only speculate.

    II.

    It’s going to be obvious to some that rehashing the primary


    data points, over and over, all the way up to the “exalted level”
    of treatment guidelines is going to be impractical. What we
    need to do is trust that the intermediary authors and experts are
    doing it. No one expects Bush to look at the sat images
    himself; but perhaps Tenet should. etc. Well, there’s a problem
    with this as well:

    Another situation that troubles me is the vast array of


    editors and reviewers …to which an intelligence product
    is subjected before it is finally approved for
    publication…. I recognize that many of these reviewers
    are highly talented, experienced individuals….But what
    basis do they have for their exalted “substantive” review?

    Translation:

    these reviewers have not generally been systematically


    exposed to the current take of raw data. Their knowledge
    of current intelligence events is based on hurried reading
    of generalized intelligence reports or on sporadic
    attendance at selected briefings. They are not aware in
    any particular instance—nor should they be—in any real
    detail of the material actually available on a particular
    subject.

    Medicine’s experts rarely have much recent experience “on the


    ground.” They don’t treat raw patients (as opposed to clinical
    trial patients); their knowledge of other people’s studies is no
    more complete or penetrating than anyone else’s— but
    because they are experts in their field, they are able to put their
    imprint on other people’s work. The three idiots who review a
    paper on, say, Zyprexa induced diabetes, are experts in
    psychosis, but none of them have more than intern level
    training in diabetes or in structural pharmacology. This is why
    there are so many “experts” talking about diabetes, but none
    have told us why it occurs.

    And so, once a paper fits the bias of the peer reviewers, what
    actually happens in peer review?

    As a result much high-level review… has consisted of the


    discovery of occasional typographical errors, small
    inconsistencies in numbers cited in different
    paragraphs…

    The author notes that even this flawed system has worked
    surprisingly well; and there are fields of medicine about which
    the same can be said (surgery); but the reason it works there is
    because there is a real and visible consequence. Were you
    wrong? People die.

    Psychiatry isn’t like that; you can be wrong for decades and no
    one notices. People die, certainly, but no one sees the link back
    to the practice. Couple that with the— academic nepotism?—
    or at minimum groupthink which is the formal and explicit
    basis of all psychiatric practice, and it becomes evident that
    something has to change.

    But nothing will. This CIA article was written in 1964.

    Related articles:

    Ten Things Wrong With Medical Journals

    What’s Wrong With Research In Psychiatry?

    Are Drug Companies Hiding Negative Studies?


    –—

    and still searching for Diggs, Reddits, and donations— the


    revenue generators of this blog
    Should Kids Go To College
    Early?
    November 10, 2008

    Oh my God, does no one see this for the scam that it is?
    The worst idea in the history of education, other than making
    “Health” a requirement:

    New Hampshire announces plans for a set of state board


    exams for 10th graders— think the French Bacc— which
    would allow those who want to to graduate high school two
    years early and go on to technical, community or regular
    college.

    Those who want to may still follow a traditional 12th grade


    curriculum, and then go onto college.

    Right now, Tucker argues, most American teenagers slide


    through high school, viewing it as a mandatory pit stop to
    hang out and socialize. Of those who do go to college,
    half attend community college. So Tucker’s thinking is
    why not let them get started earlier?

    1. New Hampshire is too far for me to go and start punching


    people.

    2. Let me understand: high school is mostly pointless, so the


    solution you’ve come up with is not to improve it, but to
    graduate them faster.

    If you think there’s an education gap between rich and poor


    kids now, wait until this passes. You think rich kids will— will
    be allowed to— do this? This is for poor kids, bored,
    disinterested and looking to get out, and it legitimizes it,
    depriving them of two years of high school.

    3. This is Bizarro Robin Hood, this is a massive transfer of


    wealth from individuals to the state. Think about the type of
    kid who would leave high school after 10th grade and
    aactually go on to college. Is he going to Harvard? No, he’s
    going to a state school. Do you think an at-best average
    student, with two years less high school, is going to finish
    college in four? So here we have a system where a kid is going
    to leave a free school to go to a college he has to pay for, for
    longer. The state saves two years on high school— $60 billion,
    nationally— and gets an extra year out of the college tuition.

    I don’t need to point out that tuition is going up, faster than the
    inflation rate? Especially at state schools?

    These people don’t care about students, they care about


    themselves. That’s why they want to remove teacher
    accountability. Why, in bold red 20pt font in the sidebar of the
    report is the description of how, with all the money they’ll
    save, they can pay teachers up to $110k a year.

    4. Don’t tell me it will reduce dropout rates— that’s a scam,


    too. They’ve simply been graduated.

    5. Reducing the number of years in school is actually a great


    idea, but you’re reducing the wrong years. If they really
    wanted to help “Improve The Skills Of The American
    Workforce“— see? that’s what they think of you, what they
    think high school education is for— then they should try to
    find a way to make high school so good that you need less
    college. But where’s the money in that?

    A real solution would be to cut college down to 2 years. Or


    even zero: straight to professional school or work. College is
    reducing our country’s productivity and infantilizing young
    adults. Hi. Is this thing on?

    –-
    The Graying of Kindergarten series
    The Dumbest Generation Is Only The Second Dumbest
    Generation
    Forget Paypal- This Is What
    Blogging Is All About
    November 11, 2008

    The best endorsement I’ve ever received. Take that, Malcolm


    Gladwell.

    Wow. I’m going to need a minute to collect myself.


    The Supreme Court Hears
    Arguments That Warning
    Labels Should Include
    Things Done Correctly
    November 11, 2008

    A handy rule of thumb, good for reading published clinical


    trials and court cases is this: if you can’t understand the basics
    in fifteen seconds, you are being lied to.
    I.

    Diana Levine had a migraine, and at the doctor’s office a


    physician’s assistant gave her a Phenergen injection, IV push.
    Unfortunately, it resulted in gangrene, and the arm had to be
    amputated.

    Inexplicably— and I’ll explain “inexplicably” in a moment—


    she chose to sue Wyeth for an inadequate warning label,
    specifically that it should prohibit IV push because it could
    lead to gangrene. As it stood, the FDA warning label only
    warned against IV push and gangrene.

    Wyeth’s response was: um, why would we prohibit the use of


    something that is approved by the FDA for that use? The FDA
    knew the risks of gangrene and IV push, and approved IV
    push, with the warning of gangrene.

    She won the case and $6.7M. (Why? Vermont.) It was upheld
    in appeal: FDA standards are a minimum, and if the company
    sees reason to have a stronger label, they do not need new
    FDA approval to put one on. Wyeth should have known IV
    push was dangerous, and prohibited it even though the FDA
    approved it.
    It is now being argued before the Supreme Court. The legal
    question is whether federal regulations preempt state
    requirements; i.e., if it’s good enough for the Feds, should it be
    good enough for the states? This is already true for medical
    devices. If it is, then Levine should never have been allowed to
    sue in state court in the first place.

    So far, the Justices have bantered about whether FDA review


    is adequate, or if it could ever be adequate enough with such a
    major side effect as gangrene. Scalia observed that if the
    doctors at the FDA made a risk benefit analysis for IV push, a
    jury of laymen shouldn’t be in a position to second guess it.

    Justice Souter disagreed: “Wyeth could have gone back to the


    FDA at any time and said, either based on experience or just
    our rethinking of the data that we have, we think the label
    ought to be changed to say, ‘Don’t use IV push.’” Of course,
    that implies Wyeth thought that IV push was actually
    dangerous, which it didn’t.

    I am not a Supreme Court Justice yet, and it’s likely President


    Obama will not choose me; but while everyone is arguing the
    relative dangers of IV push, a simple and important fact is
    being ignored: the drug went in an artery.

    II.

    Clearly, what happened here is that the PA made two mistakes:


    wrong injection; wrong administration. Why didn’t she simply
    inject it into the muscle like everyone else on the planet does?

    It’s not wrong to do IV push, it happens in hospitals when an


    IV is already in place, but why bother to do it in an office? Let
    me be as clear as possible: the gangrene wasn’t a result of IV
    push, this is not the rare case of IV push induced gangrene—
    the med was not administered IV push. This is a case of
    medical malpractice. The PA messed up. Exactly how is that
    Wyeth’s fault? Oh, I know: it’s their fault because they’re rich
    and we’re in Vermont. Got it.
    III.

    So now the discussion about warning labels actually has a


    deeper meaning.

    When the various people argue about the “risks of IV push,”


    they are including in that risk the risk of not doing IV push. In
    other words, the manufacturer is asked to be responsible for
    the incompetence of the clinician. Here’s an example: many
    meds are clearly labeled “Do Not Crush.” Crushing it, for
    example, could release all of the chemical into your body too
    fast. Following Levine’s logic, this drug should not only carry
    a warning label “Do Not Crush,” but the drug company should
    say it shouldn’t be used orally at all, because someone might
    crush it.

    Amazingly, in regular news articles I have not seen this


    argument anywhere. All reporting and discussion never even
    asks whether this is the PA’s fault, and not Wyeth’s. I do,
    however, see that every single article talks about how she is a
    guitarist. Is that relevant? Actually, it is: it makes a good
    enough story to get 9 people to award her $6.7 million.

    IV.

    Leave it to the crypto-socialists at the New England Journal to


    recast med mal into a call to arms against corporate America.

    Dr. Drazen, editor-in-chief of the NEJM, wants the court to


    side with Levine. He says he needs state level product liability
    suits, for two reasons.

    1. Drazen writes in “Why Doctors Should Worry about


    Preemption” that product liability litigation is important as
    information:

    Through the process of legal discovery, litigation may


    also uncover information about drug toxicity that would
    otherwise not be known. Preemption will thus result in
    drugs and devices that are less safe and will thereby
    undermine a national effort to improve patient safety.

    It is beyond human capacity to comprehend how an editor-in-


    chief of the NEJM can argue that he needs lawsuits to get
    information about a drug. Does he expect lawyers to gather the
    required information, and laymen jurors to properly evaluate
    it, and then off to his desk for approval? Drazen isn’t satisfied
    with 50 years of Phenergan use, research, and data. He needs
    to check with lawyers. I’ll add that it simply isn’t true that
    litigation has provided medicine with new information.

    Drazen has the audiacity to cite Vioxx as an example of a drug


    that got FDA approval when the risks were not known, that
    resulted in litigation. Never mind that doctors continued to
    prescribe it even after the risks were known. Never mind that
    the NEJM, with its crack squad of peer reviewers, is the
    journal that let the flawed Vioxx study that minimized the
    risks get published in its pages.

    2.

    Preemption will undermine the confidence that doctors


    and patients have in the safety of drugs and devices.

    How confident do you want doctors to be? So confident that


    they don’t have to worry about the difference between a vein
    and an artery? Not surprisingly, Drazen nowhere mentions
    “artery” or any negligence on the part of the PA; he doesn’t
    even mention the name of the drug. Becuase to mention any of
    these real things would ruin his sophistry.

    It’s hard to be simultaneosly hypocritical and ignorant—


    hypocrisy requires at least some awareness of reality— but
    Drazen pulls it off. In pretending to be for the “consumer” by
    worrying that:
    In stripping patients of their right to seek redress through
    due process of law, preemption of common-law tort
    actions is not only unjust but will also result in the
    reduced safety of drugs and medical devices for the
    American people.

    He hides the fact that the real risk to patients— to Levine—


    isn’t bad or unsafe drugs (that are 50 years old), but egregious
    mistakes by clinicians. Not to mention preposterously biased
    and uninformative medical journals.

    I suspect the Supreme Court does not read this blog, but if you
    see them at lunch please pass this along: find for Wyeth. This
    case is not really about preemption, and they should make that
    clear. Otherwise this case will become a dinner table anecdote
    for Big Business, not to mention conservatives, to seethe over,
    so that the moment they get power back— think Newt
    Gingrich in 1994— they unleash a backlash of tort reform so
    dizzyingly vicious you’ll beg for Pherengan IV.
    Man Convicted Either For
    Child Porn Or Nothing
    November 17, 2008

    You decide. Make sure that once you pick, you accept the
    logical consequences of your choice.
    Britain— where they have more surveillance cameras than
    jobs (sadly, zing)—

    A man has made legal history as the first to be sentenced


    for downloading “Tomb Raider-style” computer-
    generated child pornography…The pictures were part of
    an illustrated story involving child abuse and incest - but
    involving no real children

    Computer generated still pictures.

    The pictures on which Hoque was acquitted were “almost


    comic strips” with speech bubbles, the court heard.

    The six pictures on which he was found guilty were so


    realistic, the jury concluded they looked like photographs.

    No one thought he had molested anyone, and it appears no one


    even thought he was going to. But the pics are more like
    heroin, the more you use, the more you want, and maybe then
    you might become a molester:

    “I think you’ll get some insight into the damage that


    children can suffer. This may be on the fringes of it but
    it’s still an entrance, a door into a very murky and
    distasteful world.” [said the judge.]
    The problem with this argument is that it doesn’t fit the reality.
    Are you sentencing him for possessing the pictures only, or
    because it leads down the path to wanting more? Because he
    already wanted more:

    They were among tens of thousands of images on his


    computer hard drive seized by the police in October
    2006, ranging from crude, simple illustrations to cartoon
    images to complex graphics.
    Most were “fairly distasteful and disgusting, but perfectly
    lawful”, said the judge.

    In other words, if he had the tens of thousands but not those


    six, is there no concern? If I had those six, but not the other ten
    thousand, would I get the same sentence?
    You have no idea, really, if it leads to molestation, that
    argument is a red herring. If it was actually the real concern,
    then this would not have happened:

    The judge did not ban Hoque from working with


    children.

    The problem with policing a thought crime is that we can’t


    agree on what is a crime, let alone a thought. And if you don’t
    have the legal or physical ability to forbid someone from
    performing a physical action (e.g. work with kids) how do you
    plan on forbidding them from thinking things?
    These are not real kids, this is CGI. As abhorrent as it may be,
    you can’t regulate thought on the assumption it leads to
    behavior. It is impossible to ask how many virtual child porn
    users molest. There’s no way to verify either.
    You can’t argue that fake child porn will incite them to molest
    kids; legal porn wouldn’t get them fired up as well? Or the
    KMart catalog? Or a visit to the playground?

    Almost Supreme Court Justice-but-instead-we-got-Kennedy


    Robert Bork made the argument that pornography, especially
    child pornography, doesn’t deserve to be protected speech
    anyway. Carefully, he hedges that while the government
    shouldn’t have the right to outlaw such “speech,” neither does
    it have the right to prevent segments of society from curbing it
    themselves. Supporting this nuance, he us that porn as a first
    amendment issue is a relatively new discussion, despite how
    the First Amendment, not to mention porn, actually is.

    He’s right, but he’s perhaps purposely avoiding the question of


    whether it is ok to punish real people for, in essence, looking
    at stuff.

    As I’ve said elsewhere on the same subject, don’t confuse my


    neolib sentiments for actual lib sentiments: if you want to
    prevent child molestation, make it a capital crime. But the
    focus has to be on the act, not the thought, because you can’t
    measure the thought, neither does it translate clearly into act.

    (Older post on pedophilia.)


    Where Does A Tree Get Its
    Mass?
    November 18, 2008

    Whatever you just said, it’s wrong.


    A tree starts out as a seed. Where does it get the mass?

    The common answer is: from the soil, which is wrong.

    The mass of the tree comes from the wood (cellulose), and
    cellulose (by weight) is carbon. Carbon comes from the air
    (CO2).

    I.

    The first question you want to ask, right now, is why this now
    obvious answer wasn’t obvious to begin with. More
    specifically, why you know the word “photosynthesis” but not
    how to apply it, at all.

    Why were we taught photosynthesis? First, most of us don’t


    remember anything about it anyway. If we do, we have
    recollections of certain unconnected concepts:

    sun gives “energy”


    plants “take up” “sunlight”
    they “breathe” CO2 and “release” O2
    It’s good to talk to plants

    The quotes serve to suggest we don’t even really know the


    meaning of the terms we learned.

    None of those statements are informative, nor can the be


    applied to reality (e.g. answering the above question.) It’s not
    that you forgot; it’s unlikely you could have answered that
    question even back when you were learning photosynthesis.

    Yet— and this is the point— the word “photosynthesis” is in


    your head. You learned a made up word, an artificial carve out
    of what is really a fluid physical process. You didn’t learn any
    of the reality.

    So, on the one hand, we actually didn’t learn anything. And,


    on the other hand— the worse hand— we actually think we
    know something. Not just ignorant; but ignorant and deluded.

    II.

    But “tree mass comes from the air” isn’t actually right, either.
    Some trees are more than 50% water by mass, so the mass of a
    tree would indeed come from the ground. (No partial credit: if
    you said “from the ground” but were thinking “minerals” you
    were still wrong.)

    Indeed, this question reveals that even with a general


    background in science, and two acceptable answers, most
    people still get it wrong. So what, exactly, was the point of the
    general background in science, let alone photosynthesis?

    In other words, you don’t really appreciate that a) a tree has


    water mass; b) air has mass.

    I state it here, and you “know” it, but that’s not the same as it
    being a fundamental part of your worldview, the way “the sun
    is hot” or “the earth revolves around the sun” does,
    fundamentals that allow you to make guesses about reality.
    That’s what science should have given you; instead, it gave
    you a hodgepodge of disconnected linguistic propositions that
    neither describe reality nor predict reality.

    “Where do plants get their energy?” “Photosynthesis.”


    Nothing happened there, except words.
    Here’s an example: if, prior to this post, I had asked why a
    helium balloon, despite weighing something, floats, you’d
    have to reason out an answer. But just my saying, “air has
    mass” makes the question easier to answer. You already know
    air has mass, you don’t need me to tell you; but you don’t feel
    it— that’s why my telling you here makes a difference.

    I hardly need point out how a discussion about global warming


    is vastly altered if it is intuitively understood that trees get
    their carbon from the air.

    III.

    But, actually, both of those answers are wrong: the question


    itself is meaningless. It is too vague, allows for multiple
    different interpretations and answers, is simultaneously
    misleading and oversimplified.

    The bigger problem— and this applies not only to science but
    to any field furthered by a dialectic— is that we demand
    precision in answers, and allow— expect— imprecision in the
    questions.

    “Where does the dry mass of a tree come from?” would be a


    little better. Etc. But no one worries about this; indeed, many
    shrug their shoulders, “yeah, the question is vague, but we all
    know what it means.” Well, evidently not.

    It barely requires exposition that psychiatry suffers greatly


    from this problem, the haziest and laziest of terms and
    definitions magically generating concrete and specific
    responses. Internist asks me, “I have a patient who is bipolar,
    what should I do?” If I say anything other than “Depakote” or
    equivalent, he thinks I’m being an ass. But my answer is 100x
    less relevant than understanding what he means by either
    “bipolar,” “patient,” or “do.”

    Politics, I need not point out, is worse. The most asinine


    questions are expected to generate meaningful responses.
    “Should we bail out General Motors?” Which one of those
    words actually means what you say it means? Who is “we?”
    What’s a “bail out?” “General Motors” the whole company,
    the pension division, the new plant they opened in Russia,
    what? But if you ask for any clarification, you’re being
    difficult. You don’t get it.

    IV.

    A final analogy may be here helpful. You may also (not)


    remember from school “significant digits.” For example, 3 +
    4.2 = 7. Since “3” only has one significant digit (3.0 is a more
    precise number with 2 significant digits) the answer itself can
    have no more than one significant figure. Importantly, it’s not
    that “7” is an okay answer, but really 7.2 is more precise. 7.2
    is wrong, because that 3 could have been 3.4, 2.6, etc.

    Or, more generally, an answer cannot be more precise than its


    data. Or its question.

    The first business of science education should not be to help us


    answer questions, but to help us ask questions.
    The Communists Say James
    Bond Is Anti-Communist
    November 24, 2008

    The hell you say.


    Say the Russian communists:

    The group appealed to [female lead] Kurylenko, who was


    born in the former USSR: “The Soviet Union educated
    you, cared for you and brought you up for free but no one
    suspected that you would commit this act of intellectual
    and moral betrayal… [the movie wanted] to show that a
    Ukrainian girl sleeps with an American. It’s a part of
    information and psychological war.”

    Previously, they hated Indiana Jones And The Kingdom of the


    Crystal Skull, and specifically Cate Blanchett (though for the
    wrong reasons.) (Oddly, no complaint about Kurylenko with
    an American agent in Hitman.)

    The attack is obviously anti-American propaganda.

    The party’s leader, Sergei Malinkovich, said:


    “Everyoneknows that the CIA and MI6 finance James
    Bond films as a specialoperation of psychological
    warfare against us. This Ukrainian girl sleeps with Bond
    and that means that Ukraine is sleeping with the West.”
    (emphasis mine.)

    Standard stuff: Assertion fallacy, misleading qualifier


    “special,” elevated importance by using “operation,”
    personalizing it, etc. None of his points are accurate— they’re
    not supposed to be, they’re supposed to create a sentiment.
    The move is to use a many words of different meanings as
    possible, thereby immunizing the other words, to that even if
    one is detected to be false, the reader can think, “well, that’s
    just one small mistake.”

    They don’t even get the movie right: Bond isn’t American,
    Kurylenko’s character “Camille Rivera Montes” isn’t Russian
    but Bolivian (ok, half-Russian), she doesn’t sleep with him…

    But it’s neither directed at Kurylenko nor even Bond viewers.


    It’s directed at Russians, it’s an appeal to return to the
    Communist Party. The West is against you, look how we fight
    for the honor of our people.

    II.

    Or maybe not.

    This group isn’t the actual communist party in Russia, it is a


    communist group in Russia. It’s best described as a— fan club.
    By my estimation, it has 44 members. You know why I think
    that? Because that’s how many people visited their site today.

    And over the past month…


    This story hit Russia and the niche James Bond sites on Oct
    27, and the American/British media November 1.

    If your communist party can’t get more than 14000 hits even
    with every news outlet on the planet carrying your story, it’s
    time to try porn.

    So perhaps this isn’t propaganda for the communist ideology,


    but rather a press release for themselves, for their specific
    club. The press equivalent of trolling for website hits.

    III.

    But as it took me no effort at all to look up this fake group


    (started 2003) and their inaccurate postings, why didn’t any
    other news media do this?

    It makes sense that the studio people love this kind of


    publicity. If anything, this makes James Bond films look
    better, suddenly they have some indirect, but real, effect in
    winning the Cold War. And I won’t even disagree with that
    sentence.

    But why would the news media carry this? I’m assuming they
    don’t think of themselves as tools of communism or of
    Hollywood, so why would they repeat, dozens of times, this
    story? Not just contentless, but misleadingly contentless. For
    example, you might conclude that communists are actually
    upset, or idiots. Or that this Bond movie is just like the others.
    Etc.

    Don’t make the mistake and think this is fluff, like the story
    about the Madonna divorce. That story is fluff, but fact. This is
    none of those things: it is musak, its purpose is to convey
    mood. You leave with no actual information, your own empty
    prejudices are reinforced (in any direction— it’s your choice
    how to interpret it) and you’re left, again, thinking you know
    something when in fact you know less than nothing.
    Do We Want Neuroimaging
    In Court?
    November 24, 2008

    Or, more specifically: do we want psychiatrists to help judge


    other people based on pictures even less useful than a
    Rorschach?
    I.

    The New Yorker has an article about Kent Kiehl, a researcher


    who studies psychopaths using neuroimaging techniques; he
    has a mobile MRI scanner that he takes to prisons.

    Brain imaging is rarely used in criminal trials (no reference,


    but I believe the number is <100.) But when it is used, and it
    will be more used, it has fairly important effects not just on the
    case, but on society, e.g.,

    1. Ask any resident about the anatomic correlates of


    schizophrenia, and they inevitably mention widened sulci
    — which isn’t actually specific or useful. What most
    residents don’t know is that this “finding” was made real
    by the trial of John Hinckley Jr: the defense showed that
    the cortical atrophy and widened sulci was similar to the
    brains of schizophrenics (and neglected to mention it was
    similar to findings in a dozen other non-psychotic
    conditions.) Hinckley was found NGRI, which means
    hospital, then free; because of this case, we now have
    “guilty but mentally ill” which means hospital, then jail.
    2. Brain scans were also used in the (failed) attempt at
    banning violent video games, on the assertion that it
    caused patterns in the frontal lobe similar to clinically
    violent adolescents (never mind that “patterns” doesn’t
    mean anything, let alone predict thought.)
    3. We can’t execute juveniles anymore (Roper v. Simmons)
    because of the evidence of ongoing myelination of
    neurons in the DFC in adolescents as they aged. (Never
    mind that all the kids in this study were relatively
    homogeneous anyway, so differences are not to be
    expected; never mind that this evidence is a long way
    from saying they lack the ability to take moral
    responsibility; never mind that, oh, never mind.) Not
    executing juveniles is a wonderful idea; not executing
    them because of a lack of myelin is dangerously absurd.
    So if science discovers their brains are completely mature
    after all, then what?

    These imaging techniques only tell you one story, and it’s not
    even a very good story. They cannot tell you the impact of
    other forces, including genetics, lifestyle habits, and even the
    effect of chronic thought patters on brain function or anatomy.

    Neither are scans themselves showing what you think they are
    showing. They are showing something (e.g. glucose
    utilization) that we interpret as function (“region is activated”)
    which is then used to say, “the amygdala is involved in…”
    You may as well say Nebraska is involved in.

    They are, in essence, a videotape of someone’s house while


    it’s raining, from which you are supposed to deduce based on
    the amount of water collecting on the second floor bedroom
    window, that he was unable to avoid masturbating at work.

    Unfortunately, juries love videotapes.

    II.

    But more importantly, forensic brain scans represent the worst


    kind of classism. They say, essentially, that because your brain
    looks very similar to other brains, then you belong in that
    class; and you take on their other qualities. They may be
    appropriate for scientific investigations— as early clues
    directing further research, “hey, this is interesting, let’s look
    over here from now on”— but they have no place in the justice
    system. I’d argue any association studies have no place in
    court, especially when they are read backwards (“because he
    has this, he is this.”)

    Social scientists are hoping that these anatomic associations to


    psychopathy will show it to be a mental illness just like any
    other. Consider the quote from Jean Decety, a professor of
    social neuroscience at the University of Chicago:

    “We still basically work out of a Biblical system of


    punishment—we don’t consider, in most cases, to what
    extent the offender’s actions were intentional or
    unintentional. But what neuroscience is showing us is that
    a great many crimes are committed out of compulsion—
    the offenders couldn’t help it. Once that is clear, and
    science proves it, what will the justice system do?”

    Not withstanding that nearly every single proposition in this


    paragraph is flawed, let’s take it to its conclusion: he wants us
    to consider psychopathy the way we consider, say, bipolar.

    Currently, psychopathy is considered an aggravating factor—


    if you have it, it’s worse for you. This is opposite to bipolar,
    for example, which can be a mitigating factor. (For example,
    the coming exemption from execution for “mental illness”
    won’t include psychopathy.) But take a step back: both
    psychopathy and bipolar are heuristics. They both have about
    as much and as good anatomical and genetic evidence. In other
    words, they are formally equivalent. They shouldn’t be
    considered any differently in court. Right? Well, don’t get
    excited: society could just as easily decide that bipolar should
    become an aggravating factor.

    And, importantly, society—psychiatry— can then change its


    mind every ten years or so.

    Do you want to live in a world where the criminality of an act


    — the culpability of a person— is based essentially on the
    moral ADHD of a bunch of doctors with third hand
    understanding of MRI results? Strike that— on a very select
    bunch of doctors who purport to speak for these other doctors,
    who claim to have the greatest grasp of the science, and who
    claim in complete and absolute seriousness to have the best
    understanding of the ethical progressivism of society— better
    than lawyers or engineers or teachers or priests or anyone else
    — ethics which they admit are constantly evolving— but have
    thankfully, magically, and conveniently reached their
    culmination with today. The end of history. 4000 years of
    ethics, useless; they got it all right with a grant from the NIH
    and a subscription to The New Yorker.

    As if the science really mattered anyway: no matter what those


    brain scans show, they’d find a way to make them support
    whatever ethical position is fashionable at the time.
    The Truman Show Delusion
    Is Not Real
    November 25, 2008

    Interpret that any way you want.


    In a news article out today, that is remarkably like the one that
    came out in July (my post here):

    Researchers have begun documenting what they dub the


    “Truman syndrome,” a delusion afflicting people who are
    convinced that their lives are secretly playing out on a
    reality TV show. Scientists say the disorder underscores
    the influence pop culture can have on mental conditions.

    Other examples are thinking your life is the Matrix, an ARG,


    an A&E documentary.

    If you break the delusion down, there are two primary


    characteristics: someone else, more powerful, is observing and
    orchestrating; and this is not your actual life, your actual life is
    something else.

    When you phrase it like this, the delusion becomes revealed:


    it’s regression into childhood. It doesn’t discount the
    delusional aspect, but understanding it as a regression helps
    make sense of it.

    By analogy, it’s a conspiracy theory. Conspiracy theories


    provide two very important psychic comforts. First, if
    someone else is controlling things, then your failures are not
    entirely your fault. Second, it is a proxy-parent; it is
    comforting to know that there are powerful individuals closely
    following, monitoring, and influencing everything. Suddenly,
    there is no catastrophe that won’t be averted; suddenly life has
    meaning, even if it isn’t one you pick.

    One question is to what extent one changes their own behavior


    to fit their role: do you play to the camera? If you’re on a
    reality TV show, do you then also choose to dress more
    provocatively; talk in soundbites; make relationships the main
    focus of your day to day life, etc? A conscious decision to act
    more superficially than you would otherwise?

    I’d argue that non-delusional people do this already, though


    much less. In tiny ways, we act like someone else is watching,
    we narrate or soundtrack our lives, which is fine; but the types
    of narration and the types of music all come from what already
    exists— TV, movies, etc.

    It’s the Wittgenstein argument about language and thought,


    applied to the media.

    The “medium is the message” is now the medium is the


    viewer. Control the medium, and you control the viewer.
    Has Anyone Noticed That
    Price Of Gold And Platinum
    Is The Same?
    November 26, 2008

    For the first time in history, the price of gold and platinum are
    almost exactly the same. Think about that. This has never
    happened before, ever.

    Put another way: you have some gold, and you can trade it in
    for the same weight in platinum.

    I don’t know if that’s bearish for gold (it goes to $500) or


    superbullish for platinum (back to $1580) but it is clearly a
    situation which cannot last. Plan accordingly.

    Platinum has almost always been at least double the price of


    gold, or at least $400 higher. Fewer catalytic converters?
    Russian releasing their reserves?
    How To Treat Vertigo
    November 27, 2008

    In Neurology, found by way of Women’s Health magazine


    October 2008, and no I’m not ashamed to admit it.
    Vertigo can have numerous causes, so that’s unfortunate.

    One type, benign paroxysmal positional vertigo, is


    characterized by brief episodes triggered by changes in head
    position vs. gravity in the absence of other causes. E.g. lying
    down.

    In this test, the doctor (the older man with the white hair,
    obviously) is testing the right side: he turns the patient’s head
    45 degrees to the right, and then quickly lays her down.
    Nystagmus occurs; you have veritgo!

    What is happening?

    God decided to make those canals be orthogonal— the


    horizontal canal laying horizontally, and the other two
    vertically separated by 90 degrees. They are filled with fluid,
    which swish around as you move. In essence, the swishing is
    what the brain reinterprets as movement.

    Little calcium carbonate crystals (otoliths) dislodge from the


    utricle and fall into the posterior canal. Now you have a little
    rock in your fluid filled tube, which causes all sorts of
    swishing on its own. Now you have vertigo.

    Gravity is the key. Since the posterior canal is the most likely
    place for the crystal to go, and the posterior canal is mostly
    upright, the biggest effect of the swishing crystal will be when
    you lie down (and it is free to move.)

    What do you do about it?

    Practice.

    There are several maneuvers used to literally roll the crystal


    out of the semicircular canal. Here’s one:
    Steps in and 2 are just like the test.
    Step 3: turn the head 90 degress to the unaffected side, and
    hold for 30 seconds
    Step 4: then turn the head (and body) another 90 degrees so
    the head is face down (not well depicted in this drawing)- hold
    for 30 seconds
    Step 5: sit up.

    One study found the awesomeness of this maneuver to be 88%


    vs. sham maneuver 26% one month after treatment. Not bad
    for no meds.

    Keep in mind the body position is irrelevant, what matters is


    accurate head positioning. The crystals are very sensitive to
    the force of gravity, so the more accurately you can move the
    head, the better. NB: this maneuver is will cause the very
    veritgo you’re trying to treat, so bring a bucket.
    AM Radio Kids
    November 27, 2008

    A Thanksgiving tale, sort of. The little boy was four, when he
    was really excited or happy he could communicate semi-
    effectively, but if there wasn’t a force of emotion behind it
    then he was all just babbles and grunts. He looked you in the
    eye like it meant something, he grinned, came over and
    showed you how he had managed to fit the stegosaurus into
    the driver’s seat of his truck, but his explanation of that was
    “mmmmmmmm mmmmm mmmm!!” and I guess it meant he
    was happy, but it could have meant anything.

    When you don’t understand a problem you apply the solutions


    that you do; his Dad’s solution was to find ways to train his
    mind to be focused, to concentrate, and to use logic, so his
    Dad had taken to making simple patterns with M&Ms,

    and if the boy could figure out what the next color was, he
    could have all the M&Ms. That was his approach to
    behaviorism, though he gave the boy all the M&Ms anyway,
    so he sucked as a behaviorist, too.

    And at first the father was stunned, incredulous, at how


    terrible the boy was at this game. Not only would he not pick
    the right one, sometimes he picked a color that was not even
    involved
    It was as if the only pattern he saw was “straight line.”

    But over two months they had gotten somewhere, gotten past
    ABABAB; and then there was this

    and the boy looked at it, and with all the confidence in the
    world grabbed an M&M and waved it in his father’s face.
    “Blue!”

    “No, no, take a look at it. One red, then green, two reds, then
    green, three reds, then green, then…?”

    “Red!”

    “How many reds?”

    “Green!”

    “No, try again. One red, green, red red, then green, red red red,
    green, then…?”

    “Fo— three!”

    “No, you almost had it—”

    And the boy shoved his fingers into the air, switching them as
    he waved, first one, then two, then three, all the while yelling
    “two!”

    but his fingers stopped at four.

    “No, not two, look, you have it—”

    The boy did it again, fingers waving, he was about to say


    something else wrong, but he paused, he was confused, he
    looked at his fingers, then the clock, then a bowl of apples—
    the fingers were showing four but his brain was saying
    something else, what did that mean? but he couldn’t get the
    answer out.

    The father watched, the boy’s lips fought between an “f” and a
    “th”, then he lapsed into a grimace; his fingers showed four, he
    stared at them, he tried to put one down but his body rebelled
    and forced them back up, like he was resisting an unseen Jedi
    Master trying to control his body movements.

    There he sat, drenched in the right answer, his body and his
    lips and his fingers were all telling him the right answer, but
    his brain was picking something else, he couldn’t get it.

    “How many fingers do you have up?!”

    He looked, his lips moved silently as he counted his own


    fingers. “Four?”

    “Four! Right, buddy!”

    He smiled, looked at the M&Ms, then messed them up with


    his hands. “Vree vre vre vre vre!”

    “Stop! What are you doing…?!” Too late. As M&Ms clacked


    on the floor, the boy looked up a little afraid. “Umm…
    mmmm.” Then, as he saw his father’s rage build, he said quite
    clearly: “how about I clean them up and we make another
    pattern?”

    They are AM radio kids, you spend hours in your car trying to
    tune in a station but it’s all static, once in a while you think
    there was a word there, or a phrase but that’s it, and you turn
    the knob, push it, cover it with your hand to block out sunspots
    — you know it has information, you know it’s there, but you
    can’t get the thing to tune in.

    And hours of this, you’ve driven 90 miles down an empty


    night road with one frustrated hand on the wheel and the other
    hand on the radio knob, a quarter millimeter often enough to
    get in a syllable, or lose it, just as you’re about to scream and
    give up, suddenly, a full sentence comes through, perfect,
    “there’s a very good chance that today it might rain, so bundle
    up“— you are stunned by the clarity and completeness—

    and then it’s gone again, back into static. You try everything,
    you even smack the side of it but you know that’s not a good
    idea, it never fixes it and eventually it won’t work at all.

    These are AM radio kids, the content isn’t the problem, the
    problem is the reception, the problem isn’t the broadcaster, the
    problem is you. AM radio works fine, but with so much other
    interference competing for the same box, but you want it now
    and clear, on your timetable, well, what did you expect?

    –-

    Related:

    The Boy Who Learned To Talk Too Late And Too Fast

    Everything Is A Teachable Moment When You Are A Piece


    Of Garbage
    Off Label Prescribing Turns
    Out To Be On Label
    December 1, 2008

    In which I bite down on a leather strap in an effort not to explode


    like that guy on Heroes.
    An article in Pharmacotherapy that defies credulity. Really. Just look
    at me. I’m incredulous.

    I. “These Drugs Are Not Indicated For The Following:”

    The study seeks to examine off label prescribing so that further


    research into their efficacy and safety can be conducted. No word on
    who will be paying for that research, which, as I will now
    demonstrate, is completely unnecessary.

    Here’s the summary: looking at prescriptions versus indications, the


    authors found a list of drugs with substantial off-label use in the
    absence of substantial evidence for their use. One might ask whether
    the the substantial off-label use is in itself a form of evidence for its
    use, but we’ll leave that for another day.

    Here’s the list.


    IIa. I Thought It Was Indicated For That?

    Right off the bat, you’ll notice that Seroquel’s most common off
    label use is bipolar, which is doubly wrong, because it is actually
    indicated for bipolar; and bipolar, not schizophrenia, is actually its
    most common on-label use.

    Worse, this study is about use without “adequate evidence


    supporting its use” (look at the title of the chart.) So either these
    authors were completely unaware of the studies supporting its use
    and labeling by the FDA; or they were aware of it, and didn’t think it
    was as adequate as the FDA apparently did. Either way, someone
    needs to quit drinking.

    Next, While it is true that these drugs are being used off-label, they
    aren’t being used off-label randomly. According to the study,
    Seroquel is used on label, or for the top three off-label uses, 77% of
    the time. Lexapro it’s 98%. They’re not using Seroquel for
    asthmatics. The issue isn’t whether “depression” off-label use
    exceeds “anxiety” off-label use; it’s whether there is any difference
    between either of those two uses. There isn’t.

    IIb. What Is An Indication?

    For those who are not in the biz, it may surprise you to learn that the
    FDA does not decide what a drug is indicated for. It only decides if
    the indication that Pharma chooses to request is approved or not. If
    Risperdal is approved for bipolar mania but not maintenance, it
    doesn’t mean that it isn’t safe and efficacious for maintenance; or
    that there isn’t a huge collection of data affirming this. It means
    Janssen didn’t ask the FDA for the approval. In other words, 95% of
    the decision for an indication is made by the folks down at Pharma
    marketing. All the FDA can do is say yes or no.

    And, as evidence, let me now say, categorically, that Risperdal will


    never get a maintenance indication. Not because it isn’t efficacious
    or safe— who knows?— but because it’s generic: no one will pay to
    get it approved.

    III. “Oh, No, Doctor, You Need To Be Rigorous.”

    You’ll notice a little superscript “a” which says that if bipolar was
    diagnosed along with mania or depression, then that wasn’t counted
    as off-label. In other words, simply writing “bipolar” was considered
    off label? Yes.

    But what about maintenance? Isn’t it indicated for bipolar


    maintenance?

    If you want to be technically accurate, Seroquel isn’t indicated for


    bipolar maintenance— it’s indicated as an adjunct to lithium or
    Depakote for maintenance. How would the authors have known if it
    was being given with Depakote? They wouldn’t.

    You will notice, however, that Depakote is not on this list, despite
    it’s not being indicated for anything except mania. All those
    Depakote scripts are all for acute mania? Wow.

    (BTW, can you force Seroquel to be given as an adjunct to


    something else, when the somethiing else is itself neither approved
    nor effective? Hello?)

    I’m splitting hairs, you think? Nope. It matters, because this


    information found it’s way into the news media:

    From USAToday:
    Seroquel, an antipsychotic approved for treating schizophrenia
    and short-term manic or depressive episodes in bipolar disorder,
    topped the list. Three out of four times, doctors use the drug
    off-label, mainly for maintenance therapy for bipolar disease,
    says senior author Randall Stafford, associate professor of
    medicine at the Stanford Prevention Research Center.

    Got that? According to USAToday and Dr. Stafford, Seroquel isn’t


    approved for bipolar maintenance. “Permission to get angry at Big
    Pharma?” “Permission granted. Fire at will.”

    IVa. There Is Method To This Madness

    But arguing about the results of a study is freshman level sophistry.


    The real money is in the Methods section:

    Question: How do they know what a drug was being used for, that
    they could call it off-label?

    Answer: They took the data from a self-report survey of doctors.


    When he wrote “Seroquel” did he also write “bipolar?”

    How do you know that what he calls “bipolar” is really bipolar? If


    he calls it bipolar, and uses Seroquel, but it’s actually anxiety, is that
    on-label or off-label? According to this, it’s off-label. So, in other
    words, on/off-label is defined not by reality, but by whether the
    doctor explicitly provides a label. Not whether he is right, but
    confident.

    Then what prevents a doctor from simply writing bipolar every time
    he wants to use Seroquel?

    Etc.

    IVb. I Want To See This Self-Report Survey

    If the lack of rigor in the psychiatric diagnoses isn’t bad enough,


    how about this: how do you know the self-report isn’t completely
    made up?

    I don’t mean made up as a “cover your ass”— that the doctor writes
    “bipolar” just to justify his Seroquel; I mean that he completely
    invents the patient data?

    I looked up their survey. Fortunately for me it’s online; unfortunately


    for any doctor filling it out, it therefore takes forever to complete:
    As you can see, there are three different screens: one for patient
    demographics (age, insurance, etc); another fopr diagnosis; and
    another for drugs. The doctor needs to type in the name of the drug,
    and also what he used it for. There is no accountability. There is no
    incentive to write “Major Depressive Disorder” or “Bipolar
    Disorder, Mixed state.” You would simply write “depression” or
    “bipolar.” Hell, there’s not even an incentive to diagnose “obsessive-
    compulsive disorder” since “anxiety” would just about cover it.

    Now go look at that superscript “a” and tell me if it’s significant.

    Also note that you fill out a whole new screen for every diagnosis
    (e.g. one for MDD, one for alcohol abuse, one for…) and each drug.
    Imagine you have 8-50 patients a day, two or three meds per patient
    (not including drugs from other providers for other problems that
    you are still responsible to enter), one or two diagnoses per patient…

    All this might be filled out correctly, or it might not. Or maybe


    suddenly everyone got diagnosed with “MDD.” Maybe everyone got
    “effexor” but not “effexor xr.” There is no way of knowing.

    V. Are You Saying This Study Is Invalid?

    Unreliable diagnoses; unreliable application of those diagnoses; and


    unreliable self-report of those unreliable diagnoses that were
    unreliably applied, along with unreliable report of the medications
    used. Peer review x 3, and publish.

    But don’t run off just yet, Ironman. This doesn’t mean that this
    particular study is invalid. It means all studies based on psychiatrist
    self-report are invalid. All of them. Write that down. All of them.

    VI. “You’re Being Unfair.”

    “But just a minute, Dr. Pirate, you aren’t being fair. Seroquel
    received approval for bipolar maintenance in May 2008. The study
    used June 30, 2007 as its cutoff for FDA approvals.”

    Yes. That’s not suspicious to you?

    And even if that was an accident of history— the study was


    completed before Seroquel got the maintenance indication— why
    wouldn’t they go back and revise the manuscript which was
    published only two weeks ago? Wouldn’t you at least mention this
    new development in the news interviews you gave? This is supposed
    to be science. Do you allow the publication of a study when you
    now know that the main result of your study is wrong?

    You know, so as not to look like you’re purposely generating a


    negative article about something which you now know to be untrue?

    VI. Who Was This Study For?

    It’s for politics, of course. The study is published in


    Pharmacotherapy so that it can be written up in the Wall Street
    Journal, or USAToday; so that they can be interviewed. It is a
    MacGuffin. Doctors aren’t reading it, the public is reading it. It’s
    war by other means.

    It also shifts money around, the historical purpose of government. It


    sounds the alarm of too much spent on marketing, too little on safety
    and efficacy. In the era of bailouts, this is an excellent position to
    take.
    Psychopaths Are Charming?
    December 2, 2008

    Reader feedback appreciated.


    I recently wrote about an article on the neuroimaging of
    psychopaths in The New Yorker, and something else just
    occurred to me.

    It struck me that in almost every lay description of a


    psychopath, the word “charming” is inevitably used. (In The
    New Yorker piece, it appears four times.) There is an almost
    mandatory reference to how seductive, or affable, or
    personable, or— charming— the psychopath is, that always
    follows the initial description of their criminality or evil.
    Something along the lines of, “if you’re not on guard, if you’re
    just talking to them, you can’t help but be sucked in.” As The
    New Yorker describes,

    The psychopath talks “entertainingly,” Cleckley


    explained, and is “brilliant and charming,” but
    nonetheless “carries disaster lightly in each hand.”

    What’s surprising about this description (to me) is how wrong


    it is. Quick example: on Google “psychopathy AND
    charming” gets 80k hits; on Pubmed it gets zero. In fact, to
    make the broadest generalization possible— humor me for a
    minute— it applies mostly to women. Men, in the presence of
    a psychopath, are not charmed, they’re infuriated. You don’t
    want to hear their crap, you want to stab them in the eye. It’s
    unusual to find a man who is fascinated enough by
    psychopaths, serial killers, and the like, to record every
    Discovery Channel special on them; and the few that do are
    the type you figure to be a wedgie away from going Zodiac at
    the frat house. But there are plenty of young women are
    completely fascinated by them, watch all the TV shows, read
    the articles, etc.

    Since I have no data on the male perspective on a psychopath’s


    charm (or lack of it) I’ll speak for myself, and I’m curious to
    know if it resonates with other people: psychopaths are an
    endless stream of words. They talk, they talk around, they talk
    around and around the actual point; they don’t open up with “I
    need something from you” but drown you in endless, pointless
    but seemingly earnest talk about other things that somehow, in
    their mind, apply to the current problem. In a word, it is all
    bullshit. You know it’s bullshit, but civility, or insecurity, force
    you to sit there and listen. It wears you down (which is the
    point), so that after all the “and my brother then…” and “but
    she told me that…” “He told me it would be okay if…” he
    finally asks you for “this really big favor” you are more
    inclined to give in. When I do an eval for a criminal trial,
    getting the truth out of one of these guys is painful to the point
    of euthanasia. They don’t even lie directly to you, they
    overwhelm you with distractions, red herrings, sleight of hand,
    you ask, “what time did you get to the house?” and for the
    next twenty minutes, you never hear the words “time” or
    house” come out of their mouth.

    None of that is charming, or engaging, or even slightly


    interesting to me.

    Yet— and by example here’s one woman quoted in the article


    —

    “He had killed his girlfriend because he thought she was


    cheating on him,” she told me. “He was so charming
    about telling it that I found it hard not to fall into
    laughing along in surprise, even when he was describing
    awful thing,” [said Carla] Harenski, who is thirty…

    Here’s an example from Robert Hare himself:


    One of my raters described an interview she did with a
    prisoner: “I sat down and took out my clipboard,” she
    said, “and the first thing this guy told me was what
    beautiful eyes I had. He managed to work quite a few
    compliments on my appearance into the interview, so by
    the time I wrapped things up, I was feeling unusually…
    well, pretty. I’m a wary person, especially on the job, and
    can usually spot a phony. When I got back outside, I
    couldn’t believe I’d fallen for a line like that.”

    I can see the easy explanation: these women are more easily
    manipulated, especially because the charm carries a sexual
    connotation. There’s a power differential— some of the fear is
    processed sexually, etc. Summary: the women don’t see what’s
    really in the psychopath.

    But that doesn’t seem right; these women aren’t stupid;


    they’ve been around, and even on some level they must know
    the guy is bad news. So what if these women who are charmed
    see something in psychopaths everyone else doesn’t? Are they
    detecting something good, or at least attractive, that I for one
    can’t see?

    Here’s an example: psychopaths don’t have empathy, but more


    specifically they don’t understand other people’s emotions. As
    the article points out, they interpret emotions linguistically, not
    emotionally. They know the word <sadness>, and the other
    words that explain or go with <sadness>, but they don’t feel it.
    Perhaps emotional inability is made up for by a better
    linguisitic processing ability, such that they know/intuit better
    than most what to say to women, while non-psychopaths find
    themselves acutely aware of their emotions, but are unable to
    express them (e.g. are shy.)

    Maybe women who are charmed by such men see them less as
    people and more as stories? Do women who find psychopaths
    charming also read more novels? Do these women have a
    common interest in certain types of books or movies? Etc.
    Maybe I ormen can’t sense the “charming” because men are
    immediately on the defensive because they sense a rival, or
    alpha male, etc?

    This can be flipped around: we know psychopaths are


    manipulative, but it would be very interesting to find out how
    easily manipulated they are. Under what circumstances? Is it
    easier to trick them with money, numbers, logic, pictures? Do
    they fall for magic, optical illusions? Is it easier for a woman
    to seduce them, to manipulate them? Are they an easier mark
    for a con man?

    How do you con a con man?

    Addendum 12/8/08: a clarification on this post.


    The British Model Of Cost
    Effectiveness Fails On
    Philosophy
    December 4, 2008

    Good idea, sort of, but it misses a key element.


    The NYT has an article which, for some reason, is entitled
    “The Evidence Gap.”

    The British National Institute for Health and Clinical


    Excellence (NICE) uses evidence based methods to determine
    whether a drug is worth the cost. Th example they site in the
    article is a new kidney cancer drug that costs 3 to 4 times more
    than NICE has budgeted for that disease state. NICE uses
    quality adjusted life year to determine a treatment’s merit, and
    then weighs it against the cost. According to the article, it’s
    about $20k per six months of life.

    Ia. What Price Life?

    Certainly people are outraged; life is worth any price.


    Unfortunately, no one seems to have the courage to say this,
    use it as a first principle. Instead, NICE says this:

    Equity lies at the heart of the NHS. Lack of equity… was


    one of the reasons why NICE was established. Much of
    the philosophical literature on equity is far from being
    applicable to the real world.18,19 NICE has therefore had
    to make its own judgments.

    Yet another group of doctors who believe they are living at


    The End Of History. Whenever I hear, “this time it’s different”
    or “the old way of thinking doesn’t apply” I know to expect
    the opposite to occur.

    Ib. What Price Life?

    But the argument over “what price life” is a red herring, the
    real question is “who best to decide how to allocate resources?
    and the answer (IMHO) is not government, but doctors.

    The main support for the government plan is that it lowers


    drug costs. First, by restricting the use of certain meds, and
    second (from the NYT:)

    Drug and device makers, which once routinely


    denounced the British for questioning product prices,
    have begun quietly slashing prices in Britain to gain
    NICE’s coveted approval, especially because other
    nations are following the institute’s lead.

    Aha. Pharma voluntarily lowers prices to be able to fit within


    the government’s budget. How much more effective would
    this be if they had to cut it to fit within the doctor’s “patient
    budget” by which doctors are told there’s a certain amount
    they can spend

    Additionally, creating a budget for doctors will force Pharma


    to start creating drugs that fit into the budget. So either the cost
    will come down, or they’ll create something that’s worth the
    cost.

    But what about those patients who need more than their
    budget? Simply allow a “prior authorization” system by which
    a doctor can call the insurer/Medicair to expand the budget,
    and he can cite his reasons. Oh, it’s a pain? That’s the point. If
    it is really worth it, it will be worth it. And make it so the
    doctor can even bill for the time. The obstacle alone will
    greatly reduce “impulse buying” of meds (“I wanna try
    Pristiq!”) Consider that simply having a discussion with a
    reviewer-doctor alone is worth the government’s effort,
    because there are docs who never get a chance to talk to
    anyone except a rep about what’s going on in medicine. Hell,
    offer CME credit for the discussion.

    II. What Price Autonomy?

    But why not let the government control the budget? What
    advantage is there in giving it to the doctors?

    1. Autonomy. Doctors don’t want to be dictated to by


    government. Since we must unfortunately have some sort
    of control plan, give as much control to the doctors as
    possible. Consider that if medicine becomes so flow-
    charted, so controlled from the outside, then smart people
    will not be interested in becoming doctors.
    2. Education. If they have to decide what’s worth it, they’ll
    have to stay current. Even if the flow-chart tells you
    exactly what to do next, do you really want a doctor who
    doesn’t have a full understanding of the issues?
    3. Alternatives. Doctors may actually try to use non-
    pharmacologic treatments. The horror! I have a question:
    if diet can lead to bad health, why can’t a good diet lead
    to not just neutral, but better health? Why can’t a food be
    as good for you as some are bad for you? e.g. if Big Macs
    are bad for your cholesterol, what foods would lower
    cholesterol? Doctors are not trained to think that way
    anymore.
    4. The government is not a doctor. Neither are the people in
    NICE or any other body that determines cost-
    effectiveness. Oh, I know they’re MDs, but they’re not
    “on the ground” doctors. Their focus is not reality based.
    5. Corruption. If a doctor is “corrupted” by Pharma (or his
    own academic interests, or political bias, etc) then that’s
    one. If NICE/FDA gets corrupted by Pharma (or their
    own academic interests, or political bias) then that’s the
    game. If you want to see what top down bias looks like, it
    looks like Depakote.
    III. What Price Dignity?

    British authorities, after a storm of protest, are


    reconsidering their decision on the cancer drug and
    others.

    So we see that when the drug deals with acute survival, there
    is controversy. Ok, Perhaps the model shouldn’t be applied to
    those drugs, at least not at first. But it most certainly can be
    applied to psychiatry, for which there is no evidentiary, logical,
    or even anecdotal reason to think that any one medicine is
    necessary at any cost— hell, at even double the cost. (I’d grant
    you lithium and clozapine, but they’re already generic.)

    I know, I know, “doctors already have too much to worry


    about, they can’t be busy with drug costs.” Too bad. Seriously:
    too the hell bad. The current system is untenable, something
    must change. If you don’t like this plan, then you will have a
    government plan. See II, above.

    The budget needs to go to the doctors; and then doctors need


    to get together and start learning again. Set up advisory panels,
    put the academics to work on something real, instead of silly
    clinical trials which are biased— not just by Pharma, but by
    their own desire for advancement. “I believe in antiepileptics.”
    Awesome.
    1 In 5 Cars Has A
    Personality Disorder
    December 8, 2008

    The other 4 cars are now completely fine, thanks to early


    intervention. I. The New York Times: “1 in 5 People Has A
    Personality Disorder”

    Almost one in five young American adults has a


    personality disorder that interferes with everyday life, and
    even more abuse alcohol or drugs, researchers reported
    Monday in the most extensive study of its kind.

    And the article then becomes a list of every cliche and


    conflation possible. Though the article is about personality
    disorders, they then lament how common “mental problems”
    in college are, and the need for further treatment. One
    psychiatrist found the “widespread lack of treatment
    worrisome… it should alert not only ”students and parents, but
    also deans and people who run college mental health services
    about the need to extend access to treatment.”

    Here is awesomeness:

    Dr. Sharon Hirsch, a University of Chicago psychiatrist


    not involved in the study, praised it for raising awareness
    about the problem and the high numbers of affected
    people who don’t get help.
    Imagine if more than 75 percent of diabetic college
    students didn’t get treatment, Hirsch said. ”Just think
    about what would be happening on our college
    campuses.”
    Are we still talking about personality disorders?

    It has the obligatory references to the Virginia Tech and other


    shootings. I seem to remember everyone’s insistence that those
    were not due to personality disorders?

    Well, I can see that the the current crop of adults, age 35-60, I
    so admire for leading our country into moral, economic, and
    intellectual greatness, have accurately identified one of the
    most pressing problems today. Nothing worse than an alcohol
    abusing, personality disordered college kid. Exactly what
    Allan Bloom would have thought, or, more accurately, exactly
    what they think Allan Bloom would have thought, as they
    can’t be bothered to find out.

    II.

    The NYT is a blog pretending to be a newspaper. It’s for


    adults, or people who want to pretend they’re adults, who
    remember as kids that reading the Times meant something that
    they’d now like to apply to themselves. Now it’s Bandwagon
    of the Month reporting: anyone see any global warming
    articles recently? Bush is suppressing them, I guess.

    So the problems it describes must always be of the form: “the


    other guys who are not you are bad.” That’s widely perceived
    as liberal bias, though that’s not accurate. It’s “not you” bias.
    The online readership is 37 years old, print 42— this is the
    demographic that says, ‘College kids are weak and pampered,
    if I could only go back to college and do it all over again…”
    What? Get a physics degree, or date sorority girls? Or both?

    III.

    The article’s conflation of “personality disorders” with every


    other kind of mental illness is a hint that an agenda is lurking.
    That a popular press article would even bring them up—
    previously, everything was bipolar or schizophrenia and not
    personality disorders (think Virginia Tech)— means that an
    agenda is lurking.

    That the actual Archives of General Psychiatry study, from


    which this “1 in 5 Young Adults Has A Personlaity Disorder”
    news article is based, the one—

    Results Almost half of college-aged individuals had a


    psychiatric disorder in the past year. The overall rate of
    psychiatric disorders was not different between
    college-attending individuals and their non-college-
    attending peers. The unadjusted risk of alcohol use
    disorders was significantly greater for college students than
    for their non-college-attending peers (odds ratio = 1.25)
    although not after adjusting for background
    sociodemographic characteristics. College students were
    significantly less likely (unadjusted and adjusted) to have a
    diagnosis of drug use disorder or nicotine dependence… than
    their non-college-attending peers. Bipolar disorder was less
    common in individuals attending college. College students
    were significantly less likely to receive past-year treatment
    for alcohol or drug use disorders than their non-college-
    attending peers.

    —in which the finding of personality disorder does not even


    merit a mention in the abstract, so insignificant was that
    finding to the study itself—

    all that means an agenda lurking. You’re not being given


    information, you’re being given a worldview. Eat it.

    IV.

    But let’s take it at face value— 1 in 5 kids 18-21 have a


    personality disorder.

    What’s surprising about that is how low it is, considering that


    many of these “disorders” are normal developmental stages.
    When your 17 year old stays out past midnight, doesn’t call,
    and then has the nerve to get mad at you for being mad at him
    — that may be a discipline problem, but it’s not a personality
    disorder. I get that you’re angry, I’m with you, but the solution
    isn’t a psychiatrist. The solution is not to consider that the
    problem is pathological, but that it is the default behavior that
    you must help them change.

    Given the move towards infantilizing kids, that personality


    “disorders” would linger a little past adolescence— into the
    sheltered Quad of Prolonged Adolescence U— is not
    surprising. What matters is not the availability of treatment,
    but whether these “disorders” can be expected to resolve
    themselves naturally as they age, find relationships, jobs, a
    stable identity. Of course they can. Or, more to the point: the
    bias should be that things are normal, not pathological.

    V.

    But let’s take a philosophical approach. What does having a


    personality disorder even mean? Can an inanimate object have
    a personality? Apparently, yes.

    In Human Nature: 40 people looked at pictures of cars and had


    to rate them against 19 traits (gender, maturity,
    submissiveness, etc.) The subjects consistently identified the
    same traits among the cars.

    “The study confirmed with some rigor what many people


    have already felt — that cars seem to have consistent
    personality traits associated with them”

    Obviously, cars don’t have personalities, they are inanimate.


    We attribute personalities to them. No one would dispute this.
    You might say the cars are designed to elicit certain feelings
    towards them— fine— but the cars themselves do not possess
    character attributes, they only possess appearances.

    Yet in the study, the different subjects— these are not all
    genetic clones, they’ve had different lives and experiences—
    still rated the cars as having the same attributes. What does it
    mean, really mean, when everyone thinks a car is aggressive,
    or submissive, when it isn’t? Think about that, long and hard.

    We have an internal personality constructs which are


    completely invalid. That they are hard wired into us, that so
    many other things are hard wired into us, doesn’t make them
    less invalid. An optical illusion is still an illusion. These are
    cars. Metal. Your mind is tricking you, on purpose. What you
    saw was wrong.

    When you look into the abyss, the abyss looks also into you.

    VI.

    Surely I’m not saying personality disorders don’t exist? Or


    that people don’t have personalities? If you were the Last Man
    On Earth, you’d still have a personality, right?

    Even when you’re alone, there’s still “another person” present


    — that internal dialogue you have with yourself, as another
    person. You’re never truly alone, even if sometimes you don’t
    like the company. And I haven’t even brought up one’s
    interaction with God, as epistemiologically unfashionable as
    that is to talk about nowadays.

    All that aside, personality is the interplay between your


    physical/biological/innate/whatever traits and your life as you
    experience it (books and movies count); the interaction
    between you and Others. As such, it can be drastically altered,
    both by you and by other people, by time and environment, on
    purpose and not on purpose.

    VII.

    The consistency in the ratings of personality was, the


    researchers found, related to the appearance of the car; how
    far apart the eye/headlights were, etc. In other words, the cars
    were judged by how they look. “What’s inside” the car, how it
    behaved, wasn’t even relevant.
    If this is true, how hard will it be for a person to overcome the
    prejudice based on appearance? How much will they have to
    overcompensate to make up for it? How strongly will you
    believe the person is a smart/mature/aggressive/etc, no matter
    what he actually does? Keep in mind these subjects know
    what a car is, they know that the appearance of a car does not
    reflect how it performs, they know cars don’t have
    personalities, and still they give it certain attributes. How
    different will that be in people?

    How easy will it be to resist simply conforming to the way you


    are viewed? How hard will it be for one person to say NO to
    the world, and self-identify? To resist the negative and the
    positive perceptions of others, in favor of who he decides he
    wants to be?

    Pretty darn near impossible, I should think.

    VIII.

    Back to the NYT. I’m sure I’ll be disputed, but hear me out:
    we’re entering the age of Keynesian Psychiatry, and the NYT
    can’t contain its ejaculate.

    It’s an era where “free will” and the normal checks and
    balances of society and superego are considered ineffective.
    No one can be expected to resist the id, and we need our
    parents to help keep us in control, or bail us out, send us
    money, when we need it.

    We have massive bailouts, where the solution to 30 years of


    prior deficit spending is— sit down— more deficit spending;
    when the solution to overconsumption and undersaving is—
    even more consumption and less saving. Similarly, 30 years of
    maladaptive behaviors will be treated with— different
    maladaptive behaviors.

    It’s not profits and growth, it’s “fiscal stimulus” and


    “infrastructure development”— in psychiatry this means less
    focus on treatment, less focus on “remission,” and increased
    spending on detection, prevention, education— you’re already
    sick, you just don’t know it. This dovetails nicely with the
    (temporary) death of Big Pharma, who won’t be generating
    any new treatments any time soon. And if it’s not obvious why
    early detection and education is bad: you don’t get to decide
    what kind of detection or what kind of education. Psychiatry
    does.

    So too will there be increased “services” for the “mentally


    ill”— redefined as anyone at all who wants the benefits—
    even if these services weaken society in the long run. Both are
    Ponzi schemes built to fix prior, failing Ponzi schemes.
    They’ll fail, just in time for our kids to get drafted.

    Just as you see a move towards more government regulation


    and control, so will you see psychiatry mirror this. Laws will
    be written and revised, focusing less on punishment while
    simultaneously emphasizing surveillance. For example:
    “taking cocaine is a disease, it shouldn’t be punished, it should
    be treated. So let’s have mandatory drug testing for everyone
    14 and older, you know, for early intervention.”

    Psychiatry as an arm of social policy means we have accepted


    society’s new mantra: please save me from myself.

    http://twitter.com/thelastpsych
    If You’re Reading It, It’s For
    You?
    December 9, 2008

    I came across an odd ad in one of the psych journals.


    It’s an ad for Western Psychiatric Institute. I assume nothing in
    ads is random. Can anyone tell me why she’s reading Griffith
    Gaunt?
    Is An Hourglass Figure The
    Ideal? Only If You’re Weak
    And Stupid
    December 10, 2008

    I may have my own sexual preferences, and they may or may


    not involve rum and the high seas, but I know a political
    agenda masquerading as a journal publication when I see one.
    I. Bigger Is Better, According To Science

    and according to this bit of sophistry:

    Until now, scientists (and apparently Western society)


    thought a curvy figure trumped other body shapes. The
    idea was based on results from medical studies that
    suggested a curvy waist-to-hip ratio of 0.7 or lower
    (meaning the waist is significantly narrower than the
    hips) is associated with higher fertility and lower rates of
    chronic disease.
    See the “Until now”? Elizabeth Cashdan, Professor and Chair
    at the University of Utah, does not agree with this, nor with
    the medical studies that do. “Until now” means we are about
    to learn why all that is wrong.

    An imperfect body might be just what the doctor ordered


    for women and key to their economic success, an
    anthropologist now says.
    While pop culture seems to worship the hourglass figure
    for females, with a tiny waist, big boobs and curvy hips,
    this may not be optimal…

    Now, she doesn’t actually go back and find problems with the
    old medical studies. No, she’s reasoned it out.

    II. Biochemistry Will Explain All


    Before I explain what she’s discovered, let me walk you
    through her logic. Women with “imperfect” bodies will be
    healthier and more successful because that thing which makes
    them “imperfect” also causes economic success and better
    health. If that doesn’t seem improbable to you, wait till you
    hear her explanation: androgens.

    Androgens, a class of hormones that includes


    testosterone, increase waist-to-hip ratios in women by
    increasing visceral fat, which is carried around the waist.
    But on the upside, increased androgen levels are also
    associated with increased strength, stamina and
    competitiveness.

    So masculinized women are stronger and smarter than


    feminized women. Or: paint will stain your fingers; paint can
    also make a beautiful painting. So if you see stained fingers,
    expect to see awesome art.
    The biochemistry isn’t even accurate. “Androgen” is more
    than just testosterone. Testosterone can increase or decrease
    visceral fat, depending on what you start with, whether you are
    taking the testosterone exogenously; or whether increased fat
    leads to insulin resistance and overproduction of testosterone
    as a consequence; etc. Are bodybuilders loading up on
    androgens so they can increase visceral fat? Do women with
    larger waists have higher levels of androgens? Etc.
    The science only needs to be partially accurate, so long as she
    generates the conclusion she wants:

    Cortisol, a hormone that helps the body deal with


    stressful situations, also increases fat carried around the
    waist.

    Saying cortisol helps the body deal with stressful situations is


    like saying getting shot in the face helps you deal with the pain
    of being shot.
    III. The Bell Curve
    It’s important to understand that she’s not trying to promote a
    theory that androgens are good— if she was, she’d measure
    them directly, or use a better proxy (muscle mass, bone
    density, etc)- she’s trying to come up with a justification for
    why an “imperfect body” is better than an hourglass.

    In addition, past research has revealed that men prefer a


    ratio of 0.7 or lower when looking for a mate. The
    preference makes perfect sense, according to evolutionary
    psychologists, because the low ratio is a reliable signal of
    a healthy, fertile woman. Along those lines, Playboy
    centerfolds tend to have a waist-to-hip ratio of 0.68,
    Cashdan found.

    So if all this is true, what lead her to think that larger waist
    size was a health and economic advantage, not simply
    unrelated, or even a disadvantage? You’re going to want to lie
    down; within any scientific article that isn’t scientific lurks a
    social agenda, and here it is:
    Until now, scientists (and apparently Western society)
    thought a curvy figure trumped other body shapes…
    However, women around the world tend to have larger
    waist-to-hip ratios (more cylindrical than hourglass-
    shaped) than is considered optimal by these medical and
    social standards.

    That’s it. Don’t bother looking for more, there isn’t any: most
    women don’t have hourglass figures, ergo it’s not optimal.
    Here’s what’s wrong with America, right here:

    Specifically, Cashdan compiled data from 33 non-


    Western populations and four European populations,
    finding the average waist-to-hip ratio for women was
    above 0.8. So if 0.7 is the magic number both in terms of
    health and male mate choice, Cashdan wondered why
    most women exhibit a significantly higher ratio.

    She can’t understand why the ideal isn’t the same as the
    average. So she wants to create reasons why the average is the
    ideal.

    “Waist-to-hip ratio may indeed be a useful signal to men,


    then, but whether men prefer a [waist-to-hip ratio]
    associated with lower or higher androgen/estrogen ratios
    (or value them equally) should depend on the degree to
    which they want their mates to be strong, tough,
    economically successful and politically competitive,”
    Cashdan writes.

    Got that? If he prefers the hourglass figure, it means he wants


    weak and submissive women. If he prefers the larger type, he
    wants someone strong who votes.

    She’s replacing old stereotypes with new ones. “All blondes


    are dumb” may be a heuristic we use, but we have the
    common sense not to admit it because it’s a debasement, like
    currency: you artificially lower its value so you can get more
    from it. What makes Cashdan’s stereotype particularly
    dangerous is it is a debasement pretending to be a positive.
    Here’s the reverse of Cashdan’s argument: “See? being dumb
    is good, because then you don’t have to worry about all that
    science! A man will handle all that!”

    These are just empty words, asserted as fact. Unfortunately,


    asserted by one with authority.

    IV. “You’re Paranoid Again.”

    You say: who cares about this study? First, that this sophistry
    is an an academic journal is bad enough— it takes on the the
    status of “knowledge”— and people can even use it as support
    for more sophistry. Deny this isn’t possible:

    It has been shown that androgens can increase strength


    and economic advantage in women (Cashdan 2008.)

    And then dare to try and publish against it.

    Worse, the article made it all the way to the popular press— or
    was that the point?— even Newsweek crowed with glee,
    “Hourglass Figures: We Take It All Back”-- which means it
    becomes part of the knowledge base of people. Even if they’re
    skeptical, they have to contend with it.

    Do you think this is about making women feel better, or


    bashing male stereotypes? It’s about taking one’s own
    opinions about society and using “science” to affirm them.
    You’ll be seeing a lot of this in the era of Keynesian
    Psychiatry. Debasements pretending to be positives.
    Explanations using “evolution,” or worse, “evolutionary
    psychology.” And, of course, the insistence that someone pay
    for it.
    Should Hubris Be In The
    DSM-V?
    December 15, 2008

    Certain psychiatrists carry considerable weight in determining


    the policy, the spirit, of psychiatry. Henry Nasrallah is one of
    those men, which is why, if you see him write an editorial
    called, “Should psychiatry list hubris in the DSM-V?” —
    especially if it is tongue-in-cheek– you should strike yourself
    in the head with a brick until you are unconscious. You are
    about to be manipulated with words, and then it will be too
    late.
    He begins:

    A recent book contends that psychiatry has transformed


    normal sadness and sorrow into a depressive disorder,(1)
    which would be akin to saying primary care physicians
    diagnose every mild cough as pneumonia. The book’s
    premise is not true, of course, but it’s a perfect example
    of how misunderstood serious mental illness is.

    As a rhetorical point, you’ll observe that his opening volley is


    not to refute the book, but to dismiss the book, ipse dixit. “…
    not true, of course.” The authors of said book aren’t some nut
    bloggers, and despite the premise, the book contains a forward
    by Robert Spitzer— the creator of the DSM. Perhaps “of
    course” is too hasty?

    But dismissiveness isn’t his real problem, it’s his choice of


    analogies. Psychiatry isn’t being accused of taking ordinary
    symptoms of cough and exaggerating them into pneumonia—
    because then it could be easily unmasked. What psychiatry
    does is to call “cough” itself a major disorder. It makes this
    definitional, safely axiomatic, and thus irrefutable. Not, “he’s
    much sicker than he seems,” but “what he is, is sick.”

    Here’s another rhetorical trick he uses. He gives examples of


    what pathologizing human traits would look like to show how
    preposterous such a thing would actually be:

    How about “Verbal Diarrhea” for folks who chatter


    incessantly at a cocktail party or committee meeting, or
    “Intellectual Constipation” for our friends with
    exasperating narrow-mindedness. And for the painfully
    irritating person, “Social Hemorrhoid” might be apropos.

    But this isn’t jest, it’s Greek Math. He cites these examples so
    that other things don’t seem so preposterous. “It’s obviously
    wrong to eat babies, but under certain circumstances, adults
    are ok.” So while we’re crapping on Verbal Diarrhea as a
    disorder, Internet Addiction slips in unnoticed.

    But hold on: the examples aren’t preposterous, they are


    already pathologies. Ok, they’re not disorders, but they are
    signs of disorders. Don’t be fooled by the aliases. What
    Nasrallah doesn’t realize (?) is that these “symptoms” signify,
    connote, a disorder, a process that cannot be undone. “He has
    mood swings” means he has bipolar, even if he doesn’t. Even
    if 100 psychiatrists later agree he doesn’t have bipolar, the
    diagnosis stays open: every aspect of his life will be forever
    measured against bipolar.

    If the cough is a symptom of “Cough Disorder”— who can


    protest?

    Let’s not forget those who throw temper tantrums when


    they can’t have their way: they may suffer from
    “Temperamental [sic] [sic] Arrhythmia.”

    Note my double [sic], his example is wrong all over the place.
    If it’s temper tantrums he’s worried about, then the disorder is
    more properly “Temper Arrhythmia,” which already exists: we
    call it Oppositional Defiant Disorder.

    But if he meant a disorder of temperament— which everyone


    pronounces “temperment” and so could be confused with
    meaning “temper”— then that’s a disorder, too, because
    temperament means innate personality traits: he’s having
    temper tantrums because he is genetically predisposed to
    having them.

    One thing psychiatrists love to do, myself included, is


    comment on social policy. He couldn’t leave this one alone:

    Take the worldwide financial meltdown triggered by


    questionable practices of banking executives who thought
    they would never fail or be caught on their way to
    accumulating obscene wealth. They certainly left a lot of
    wreckage in their wake, so perhaps psychiatry should
    create new diagnostic entities of “Horrendous Hubris”
    and “Gargantuan Greed.”

    He doesn’t cite the greed of a generation of people who


    overleveraged, who didn’t save for their own retirement or
    their kid’s college or anything else— I’m not talking about the
    poor, I’m talking about everyone who made TVs, DVDs, cars,
    boots that cost $200 but show up on the credit card statement
    as “$15/month”—made it so that stuff isn’t considered luxury
    items.

    No, he chooses the greedy bankers. On the surface, it seems


    he’s using this as an example of something psychiatry could
    easily pathologize, but doesn’t— ergo psychiatry is rigorous.
    But that’s all a ruse. He picks this as an example of hubris not
    being a disorder so that he can label the bankers as greedy.
    That’s the purpose of this example. Someone else’s greed—
    say, a gambler’s, or someone who does not offend him— that
    could be pathology, that could be bipolar. So what he’s
    showing you here is not the framework of normal vs.
    pathology, but how he gets to choose what to pathologize, and
    when.

    My point is that the social retina of psychiatry does not


    perceive ordinary human traits and emotions such as
    normal sadness as pathologic behavior. But psychiatrists
    certainly are willing to intervene when people seek help
    on their own for problems such as depressive episodes
    that are disrupting their lives or are referred by physicians
    or brought in by family or friends who recognize the
    potential gravity of their afflictions.

    Words are always and forever beautiful lies, the enemies of


    logic, when you hear them you should run away, seal your ears
    with wax or drown them out with a lyre’s song, lest you be
    seduced to your death; they don’t tempt your body, they tempt
    your spirit, and no one can resist them.

    On the one hand psychiatry doesn’t see normal sadness as


    pathology; on the other hand, psychiatry will intervene when
    someone else sees pathology. So when, ultimately, does
    normal sadness constitute a disorder? When someone says it
    does, that’s when. Ipse dixit.
    Self-Embedding Syndrome:
    What’s Going On In Ohio?
    December 15, 2008

    A poster presented at the Radiological Society Of North


    America. Self-embedding syndrome: adolescents embed
    foreign bodies into their arms, hands, etc. In this x-ray, she’s
    embedded 8 pieces of metal into her arm.

    What caught my eye were two things: first, even though this is
    an old problem, the authors say this is the first study on this,
    suggesting that it’s on the rise (enough for radiologists to
    notice.) Second, that it happened in Ohio— which was, along
    with Indiana, was responsible for half of the youth suicide
    increase in 2007.
    Is Internet Addiction Really
    An Addiction?
    December 17, 2008

    Depends on your definition. Wovon man… Keith Bakker, the


    founder and head of The Smith & Jones Centre, Europe’s first
    and only clinic to treat computer gaming addicts, has changed
    his mind: 90% of the hardcore, multi-hour gaming addicts are
    not actually addicted.

    These kids sure look like addicts:

    “These kids come in showing some kind of symptoms


    that are similar to other addictions and chemical
    dependencies,” he says.

    “But the more we work with these kids the less I believe
    we can call this addiction. What many of these kids need
    is their parents and their school teachers - this is a social
    problem.”

    The clinic he runs is a rehab, for all addictions— alcohol,


    drugs, etc— it just happens to be the only one offering
    treatment for internet addiction using the same model. And
    he’s abandoning it.

    “This gaming problem is a result of the society we live in


    today…Eighty per cent of the young people we see have
    been bullied at school and feel isolated. Many of the
    symptoms they have can be solved by going back to good
    old fashioned communication.”

    The article goes on to cite the causes you’d probably guess at:
    Not feeling accepted in real life
    rejection, alienation, anger
    anonymity allows you to be anyone you want
    games offer you the identity affirmation one so
    desperately craves

    Mr Bakker believes that if there was more commitment


    from parents and other care givers to listen to what their
    children are saying then these issues of isolation and
    frustration could be dealt with at source and bring many
    young people out of the virtual world and back into real
    life.

    Adults do not take the time to really listen to “kids” as


    autonomous entities, we treat them either as extensions of
    ourselves or as pets.

    “If I continue to call gaming an addiction it takes away


    the element of choice these people have,” he says. “It’s a
    complete shift in my thinking and also a shift in the
    thinking of my clinic and the way it treats these people.”

    The main novelty here is that it’s an addiction specialist who is


    making this concession, admitting that most kids, regardless of
    how long they are playing, aren’t addicted.

    Hold on— none of those kids are Chinese, are they?

    II.

    The debate about what is and isn’t an addiction is a red


    herring. It creates a false dichotomy. Whether it is a
    compulsion or bad behavior doesn’t change the fact that the
    person needs to stop, and often can’t for whatever reason, and
    needs help stopping.

    Focusing on the false dichotomy as the reason for treatment


    does have several consequences. We don’t know addiction is a
    disease, we think it’s a disease. It’s entirely possible twenty
    years from now we will discover it actually isn’t. Then what?
    Kick the junkies to the curb?

    Secondly, it makes control the central issue in its “treatment.


    “Loss of control is both the hallmark of addiction and the
    source of its societal stigma,” said one of the country’s leading
    addictions psychiatrist. If/since that is true, then it implies
    control must come from the outside.

    You should probably stop reading right here.

    III.

    First the Germans were going to take over the world in


    the1940s; then the Russians in the 60s. Then the Japanese in
    the 80s. Then the Chinese in the 2000s. Perhaps every
    generation’s parents need some foreign nation to scare their
    kids into better SAT scores. But history is clear that when a
    bubbles bursts, it gets replaced, not reinflated. Put away your
    Berlitz tapes.

    A quick survey of national bubbles also serves to support my


    contention that nations in decline turn quickly to one of two
    things: completely whacked out pornography, or fascism, or
    both.

    China— where they have recently classifed internet addiction


    as a full blown psychiatric disorder, has invested considerable
    money and resources into treating it.

    USAToday describes a Chinese clinic:

    “All the children here have left school because they are
    playing games or in chat rooms everyday,” says the
    clinic’s director, Dr. Tao Ran. “They are suffering from
    depression, nervousness, fear and unwillingness to
    interact with others, panic and agitation. They also have
    sleep disorders, the shakes and numbness in their hands.”
    You can sense their frustration: whatever the cause, genetic or
    social, it’s a big problem that is taking possibly two million
    kids out of circulation.

    But classifying it as a psychiatric disorder— that the element


    of choice is absent or decreased— means that the state can
    “offer” you treatment if it thinks you need it.

    We do that in America, too— involuntary commitment laws,


    etc, for those to ill to take care of themselves. The difference is
    that “internet addiction” is sufficiently general that it can be
    defined by whatever group is in charge of setting definitions—
    in this case, the government— at any time they want, ad hoc.

    Perhaps you’re an iconoclastic blogger who thinks China


    blows? A couple months at Daxing Boot Camp— I mean
    Treatment Center— will straighten you out.

    IV.

    Suddenly, that false dichotomy isn’t so false anymore;


    suddenly, it matters very much if it’s an addiction, or not.

    Which brings me to my very unpopular position on this issue,


    toxic to any self-respecting Kantian: we shouldn’t try to find
    out if addictions are diseases or not.

    Society is often not ready for the answers to some “scientific”


    questions. As a society, we shouldn’t be too quick to want
    addiction to be a disease, or criminality to be biologically
    based, or intelligence to be genetic, because we have no ability
    to deal with the consequences of those truths. We’re barely
    muddling through now, and that only because not knowing
    allows us to slide back and forth along the spectrum, as
    situations require.

    So many arguments are really the result of inconsistently


    applied definitions. The reason we have endless debates is that
    we have no agreement on what an addiction is. Is the primary
    characteristic a loss of control; escalating use; the presence of
    tolerance and withdrawal; etc? Not even all drug addictions
    have all those things. And without rigorous definitions, you
    can’t have a scientific inquiry into the question. You may as
    well try to find out if sexism is a disease, keeping in mind that
    our understanding of sexism has been very different over the
    course of, say, 2000 years— not to mention our conception of
    disease. How does science determine the biological correlates
    of something whose definition is applied inconsistently,
    influenced by prevailing cultural standards? You don’t. Wovon
    man nicht sprechen kann, daruber muss man schweigen.

    Furthermore, these words have connotations which are more


    important than their actual definitions, should they even exist.
    You can never fully erase these connotations. When a
    scientician says that gaming is an addiction like cocaine
    addiction, a gamer hears, for example, that the scientician
    means it is “bad.” So no matter how much data, MRIs,
    southern blots, genetic markers you show him, for him the
    issue isn’t biology, but morality. The result of this is that rather
    than the scientician spending time making a case for why
    gaming can be an addiction, the real thrust of the argument is
    convincing the kid that addiction has a different meaning. In
    other words, the discourse isn’t about science, or what is true;
    it’s about semantics. In other words, a complete waste of time.
    Both interpretations are equally right (or wrong) because the
    word addiction means what you want it to mean.

    Doctors love to identify biology in such things because it


    allows them to assit in making social policy. Doctors have no
    place there, they not only have nothing to contribute, their
    contributions should be assumed to be folly.

    Arthur C. Clarke said either we are alone in the universe, or


    we are not. Both are equally terrifying. Everyone agrees that
    one of those two has to be right; but as long as we don’t have
    to answer it, we can go on with our lives.
    Major Depression is Major
    Depression, Until Proven
    Otherwise
    December 22, 2008

    In which Marco Polo is forced to agree that a unicorn is a


    unicorn, until proven otherwise. Ronald Pies gives a critique
    of the Horowitz and Wakefield book, “The Loss of Sadness.”
    (This is the same book Dr. Nasrallah dismissed in an another
    editorial.)

    His article is very good, and aptly represents the “con”


    position to Horowitz-Wakefield’s thesis that that normal
    sadness has been pathologized into MDD.

    Pies summarizes his position in bullet points at the beginning:

    does bereavement predict a benign, self-limited course


    even when the person meets all the criteria for MDD?
    does MDD in the context of bereavement differ, and
    respond to treatment differently, than typical MDD?
    do psychiatrists have any way to fairly judge what is
    proportionate and disproportionate grief? Are there
    clinically validated instruments to do this?
    And since the anwer to these is no— there is very little
    evidence for such distinction between bereavement-associated
    depression (BRD) and typical MDD, one should not attempt to
    make such a distinction: MDD, when it fits the criteria, is
    MDD. Go.

    I.

    Putting aside any debate as to whether or not Pies is right, a


    more important question is this: do we want him to be right?

    We should not be too quick to pathologize, even when there is


    pathology, because pathologization reflexively diminishes the
    individual’s ownership. Not just their “responsibility”— that
    they had a hand in the pathology, and have a hand in the
    treatment (not as blame but merely as description of events)
    but also their identity. The moment sadness becomes MDD,
    even legitimately, it becomes less something that is them and
    more something that occurred to them. Grief is my response to
    loss; MDD is my body’s response to loss. That’s a big
    difference. The quick retort is that MDD does not seek to
    reduce identity ownership of “symptoms.” Maybe— but it
    does anyway. A second retort is that this reduction is a good
    thing. Again, maybe, on a case by case basis, but as a general
    axiom for humanity, it can’t be.

    II.

    But aside from abstract ideas about identity, the main thrust of
    Pies’s argument is the lack of evidence for a distinction
    between BRD and MDD.

    …common sense might tell us that bereavement related


    depression is a normal, “adaptive” response to loss,
    whose “biology” and response to antidepressants would
    differ considerably from that of standard major
    depression. This is all quite common sensical— and all
    quite qwithout convincing evidence.
    Does common sense say that? I assume he means “common
    sense would say bereavement wouldn’t respond to
    antidepressants,” but response to “antidepressants” is certainly
    no criterion for making a diagnosis. We’re not even sure that
    SSRIs work for typical MDD, let alone bereavement—
    consider the hardly impressive 10% improvement over
    placebo— even as 50% of studies in which SSRIs don’t beat
    placebos lay unexposed on the laptops of a hundred tenure
    track academics like so many unerased browser caches: a little
    guilt, a little embarrassment, a lot of denial. “That didn’t really
    count.” Honi soit qui mal y pense.

    And response to which antidepressant? MAOIs? SSRIs?


    Seroquel? All of these FDA approved antidepressants tell us
    nothing about the underlying pathology, if it even is the same
    pathology. It doesn’t even tell us anything about
    antidepressants themsleves. The fact that only Wellbutrin
    worked in one guy and Zoloft in the other doesn’t suggest that
    MDD can have multiple treatments, but that those two guys
    have different problems. Consider, in 2001, a patient with pure
    MDD is treated with Seroquel monotherapy. Do you say
    Seroquel is an antidepressant, or do you say the guy’s “real”
    diagnosis was bipolar? It is only an accident of history that
    Seroquel is an anipsychotic now indicated for MDD, and not
    an antidepressant we later find out is an antipsychotic.

    If otitis media resolves because of antibiotic treatment, does


    that mean that it was bacterial? And if we later discover that it
    was indeed viral, does that mean that the antibiotic actually
    did nothing? Are you sure? Sometimes we discover medicines
    do things we didn’t know about; sometimes there is placebo
    effect, which still counts as the medicine doing something;
    sometimes what you think is the actual medicine is decoy:
    valproic acid was originally simply an organic solvent, once
    used as a vehicle to test novel antiepileptics.

    The fact that I can knock 12 points off a Hamilton Depression


    scale with an Ambien and BID Krispy Kream should serve as
    a warning about the validity and generalizability of the term
    “antidepressant.”
    Psychiatry can live with unknowns as long as it doesn’t try to
    assume pathology by the presence or absence of efficacy. So I
    agree with Pies— you can’t assume SSRIs won’t work in
    BRD. But I also disagree: so what?

    III.

    Pies makes a mistake many doctors make: choosing science


    that suits a social agenda. This isn’t malicious, he is doing it as
    a healer, in the service of humanity. But it is an agenda
    nonetheless. The entire article’s logic and evidence is solely to
    promote a single idea that finally appears in the last sentence:

    It would be tragic if we inadvertently discouraged


    recently bereaved persons from seeking professional help,
    on the dubious presumption that that their depressive
    symptoms are merely “normal adaptations” to loss.

    That’s the main concern: that we don’t discourage people from


    seeking help, that we don’t turn people away because we think
    they don’t have MDD.

    It’s possible that he wrote this in 1955, but a cursory


    examination of the state of affairs in 2008 fairly quickly makes
    evident that quite the opposite is the current state of affairs.

    Are we in any danger of not treating people who want it? If


    Pies accepts a broad definition of treatment to include non-
    antidepressant treatments, e.g. therapy, sleeping medications,
    etc— does it happen ever that psychiatrists turn patients away
    at the door? “Wait, wait— all this is because your husband
    died? Get the hell out of here, you abuser of the system.”

    Certainly I can agree with him that more rigorous application


    of the criteria would help formalize who gets and does not get
    treatment; but simply to the question of whether we face a dire
    emergency of undertreating sadness— whatever we later
    decide to call it— seems to contradict reality.
    Even if we grant his worries that it could happen that we turn
    people away, it isn’t at all evident that doing this harms
    humanity. On the one hand is the not well founded belief that
    our treatments actually do anyone any good— see above.
    “Depression is a lethal condition.” Ok— what reduces that
    lethality? Not antidepressants, as far as I can tell. Etc. And
    depression isn’t always a lethal condition, indeed, it is rarely a
    lethal condition. Lung cancer is a very lethal condition, but
    there is no rush to assume that chronic cough is cancer, even if
    they smoke 3 packs a day. There is nothing, beyond an odd
    claim to individual rights, to gain from allowing coughing
    smokers to buy more cigarettes, but there may be quite a bit to
    gain from not pathologizing bereavement even when it is
    MDD. It doesn’t mean we can’t help them— and this is indeed
    Pies’s point— and we should help them, maybe even give
    them an SSRI— but that act must be done in the context of
    bereavement, not in the context of depression.

    As if to reinforce my point, Pies writes:

    …on the dubious assumption that their depressive


    symptoms are merely “normal adaptations [sic]” to loss.

    It’s hard to tell if he meant to do this, or it was a slip, but note


    his word choice. The correct word should be “adaption,” not
    adaptation. An “adaption” is a change in response to
    surroundings, events. An “adaptation” is the process of
    adapting, it is what increases evolutionary fitness in a species.
    It doesn’t help that single organism, it helps the species. In that
    context, how society grieves could be an adaptation; but
    making it MDD precludes that possibility because we define it
    as not beneficial to the species.

    IV.

    If the purpose of the criteria is to make the diagnosis, then we


    might want to ask what is the purpose of treatment. Assume
    someone with BRD was treated such that within, say, a month,
    all of their symptoms resolved. Completely. Would you call
    that a treatment success, or a treatment failure? Only one of
    those is defined by the current system of psychiatry.

    V.

    Pies attacks the concept of a “trigger” for depression. It looks


    like the depression came as the result of the recent death, but
    who knows? We often assign a trigger in retrospect, but that
    may simply be the mind retrofitting a cause, and not actually
    observing observing a necessary connection. Well played, Dr.
    Hume.

    I agree: ignoring issues of causality and focusing only on the


    criteria would be both fair and awesome except that the
    criteria lead to a diagnosis about which causality is implied:
    amines, genetics, and the like. It’s one thing to debate whether
    BRD and MDD share similar biology, or not; but it isn’t at all
    evident that cases of typical MDD share common biology, or
    biology at all, yet that is precisely what is assumed. Does
    every person with MDD have a genetic basis for it? Yet no
    psychiatrist ever says, “this is MDD, but I doubt you have a
    genetic predisposition.”

    The problem is that such assumptions of biology— even if


    they have basis— create social and legal obligations. Example:
    until you have hard evidence to the contrary, you want it to be
    bereavement, not MDD, so that you can’t be involuntarily
    committed for it. You want the commitment to be about the
    possible dangerous behavior (e.g. evidence of suicide) and not
    at all the about the diagnosis. You say: but we don’t commit
    people for being depressed. You don’t. Today you don’t. But
    tomorrow? Don’t make the Fundamental Error Of The
    Dumbest Generation of Narcissists In The History Of The
    World: today is the end of history. We once thought
    homosexuality was a disease; today we don’t; and one day we
    will think so again. It is inevitable. Science is almost never fast
    enough to prevent the mission creep of our own prejudices.
    The Writers of Fool’s Gold
    Get One Thing Right
    December 24, 2008

    In an otherwise unwatchable movie, a surprisingly insightful 5


    seconds.

    Matthew McConaughey plays a sunken treasure hunter and an


    idiot. The bad guy treasure hunter confronts McConaughey’s
    partner, who is only incidentally in the movie.

    “Well, well, well, if it isn’t the Ukrainian sidekick.”

    “I don’t tink of myself dat way,” says the partner, whose name
    I don’t think we ever learn. “I am dee lead character in my
    own story.”

    Right on, man. Right on.


    Heidi’s Real Problem On The
    Hills: She’s In The Wrong
    Movie
    December 29, 2008

    I can no longer find the link, but someone— Us Magazine?


    Entertainment Weekly?— did a Most Memorable TV
    Moments, and the season 3 finale of The Hills was one of
    them.

    They were right.

    I realize this is a scripted show, not “real” (whatever that


    means anymore) but for illustration’s sake let’s pretend it”s a
    documentary.

    By the end of Season 3, Spencer and Heidi have had a series


    of fights, while simultaneously she gets a job offer from casino
    mogul Sam Nazarian in Las Vegas to be a project director (of
    something.) She packs up and leaves in two days flat, and
    doesn’t tell Spencer.

    Spencer, meanwhile gets kicked out of his apartment for being


    controlling (and dirty), and slithers over to Heidi’s. She’s
    gone. He waits all night— nothing. He freaks out, and finally
    his sister (Stephanie) discloses Heidi moved to Vegas. What?!
    He goes after her.

    When Spencer learns she’s at the Palazzo working over


    drinks, he speeds toward the posh hotel.
    Abandoning Stephanie at the valet, Spencer strolls into
    the club and straight to Heidi’s table. Interrupting her
    business dinner, he tells Heidi he needs a moment outside
    and walks away. Clearly mortified, Heidi begins to lay
    into Spencer and reams him out for disrupting her during
    what is clearly an important meeting with her employers.

    I’ve so far seen a season and a half of The Hills (it is strangely
    compelling television), which I mention as support for my
    opinion that Spencer is a classic narcissist (though some
    leeway allowed because he is young.)

    In the argument that ensues, Heidi identifies many of the traits:


    it’s always about him, he wants to be with her when he wants,
    and then leave when he wants, etc.

    And he inadvertently lists some of his character flaws himself,


    though of course he thinks he is being romantic:

    I can’t have you living in Las Vegas with how we ended


    things…

    If it was really about missing her, it would be living in Vegas


    that would bother him, but it’s not. The second part is the one
    that matters: the way they ended didn’t involve him. She up
    and left, in two days, no warning, no message. She didn’t
    break up with him (so that in his mind: cue music, cue
    dramatic long distance shot, and then pan back to his reaction);
    she simply dropped right out of his movie. That’s what hurts a
    narcissist.

    (What you’re looking for here is not evidence that Spencer


    thinks he is the greatest guy on earth, but evidence that he
    thinks everyone is merely supporting cast in his movie.)

    Spencer thinks nothing of interrupting her important meeting,


    in front of her bosses, making her publicly have to choose him
    over them. That it’s her job he’s messing with, that this
    conversation can very easily wait until tomorrow or an hour
    from now never occurs to him, not because he is stupid but
    because it’s important to him now, so it must be objectively
    important period.
    Narcissism is not egomania: he isn’t sure this is going to work.
    It is entirely possible that she might reject him— he isn’t in
    denial about this. But that she wouldn’t be compelled to talk to
    him, or yell at him— to have an interaction with him— that’s
    impossible. After all we’ve been through…

    Pay attention, I’m going to give you gold: don’t get fooled,
    like so many women do, that this has anything to do with
    getting her back. There is only one reason he made this trip:

    “This (meeting) is really important, and obviously you


    don’t care enough to respect that,” Heidi says. “What are
    you doing?”

    “I need to talk to you….”

    That’s not a lead in, that’s the whole reason.

    For narcissists, outcomes are irrelevant— process is what


    matters. Getting her back is way less important than being
    connected to her— sorry, her being connected to him—
    whatever the form: love, hate, fear. It’s all good.

    I sense you are drifting to sleep. I’ll repeat it: getting her back
    isn’t the goal. He doesn’t really love you, he just wants you in
    his movie.

    We could ask, what would happen if Heidi didn’t get up from


    the table to talk to him? He’d make a scene, of course. He’d
    yell and scream he loves her as the cops drag him away and
    taser him. If he makes a scene and gets taken out, he still wins,
    because he reactivated their “connection.” And if nothing else,
    he’s the one who gets to decide how it ends. He decides what
    emotions she leaves with, he decides how she remembers him.

    NB: this is why suicide is the narcissist’s trump card.


    It’s helpful to look at the relationship from the perspective of
    neutral observers. What do her bosses think while this is going
    on? Not, “I know this is important, go ahead, talk to him.”
    Not, “this guy is extremely destructive, evil, get away from
    him.” They think this, and only this: “umm, can this nonsense
    wait?”

    That’s the limits on narcissism’s power: it only has the


    potential to work on those you aim it at. Other people don’t
    share the worldview that they are simply bit players in your
    universe— and so their attitude is to dismiss you. You don’t
    count. Letterman once did an interview with Spencer that can
    be summarized: “who is this dope, again?” Spencer can’t con
    Letterman into thinking he is who he wants to be.

    (Hence the popular narcissist mantra: when I make it big,


    when I get discovered, then all these people will acknowledge
    me.)

    And since he can’t, he doesn’t try to. Letterman isn’t going to


    be in Spencer’s movie, so Spencer doesn’t really build a role
    for him.

    But the direct target of a narcissist’s powers can’t do that, once


    the narcissist lures them into his movie, they’re stuck because
    they become convinced that his movie is the only movie.
    Again, they don’t have to play the part the narcissist wants,
    they don’t have to like the guy, but they must operate within
    his movie that they now accept as their own.

    It’s easy and popular to blame Heidi for being vapid, but she
    can’t be entirely stupid— three men thought her at least
    capable enough to fly her out to Vegas and make her the
    project director. Nor is she necessarily a needy, empty, gullible
    girl who falls for this kind of crap: she doesn’t fall for this
    with every guy, right? If you tried this on her, you’d fail,
    agreed?

    Narcissism doesn’t exist in a vacuum, no personality does, it is


    always a dialogue, a dialectic, with other personalities. God
    included. He pursues her not because he loves her, but because
    it worked. Not worked meaning she liked him; worked
    meaning she allowed herself to be a part of his movie.

    And now she can’t get out, she’s always operating under the
    premise that it’s his movie. As evidence for this, consider that
    Spencer had no insight about the importance of the meeting to
    her, in his mind him talking to her is way more important, it
    can’t wait— and she agreed. She eventually gets fired—
    actually left in Vegas by her bosses— but it doesn’t even
    register. She’s completely bought into Spencer’s urgency,
    timetable, needs.

    That’s what makes narcissism dangerous to other people. The


    force of personality preys, or warps, weaker personalities— I
    don’t mean weak in an absolute sense, I mean weak in
    comparison to the steroid fueled bodybuilder who spends
    every moment on his identity and nothing else at all— the
    narcissist wears these other people down, whether through
    outright seduction or relentless, manipulative, soft sells (“oh,
    so you only like people your friends approve of?” or “I know
    the real you…”)

    Every girl in the world has been down this road. Every guy in
    the world has at least attempted to pull this off.

    Stop. Just stop. It’s that simple, start looking at other people as
    people with their own movies and backstories and don’t try to
    bring them into yours. It is destructive, you will never be
    happy, you will never be at peace, you’ll always be thinking
    about how she might one day get tricked by some bad guy
    (read: awaken from her trance) or get caught up in material
    things, external things, that aren’t as important as love, as
    commitment (read: succeed on her own, discover she doesn’t
    need you.) And if you’re a woman you’ll always be wondering
    how you’ll survive if he leaves you.

    None of this is real. At best, it is a huge waste of years of your


    life. If you manage to break out of this cycle then one day,
    when you try to look back on it, it will all be hard to
    remember, like lost time, or it will seem unreal— not like
    you’re remembering your life, but like you’re remembering a
    movie you saw, or a movie you were in. Bits and pieces,
    maybe some scenes, but that wasn’t really me, that was a
    character I played…
    What Happens To An Action
    Hero When We Grow Up?
    December 30, 2008

    Depends on what we want from him.


    I. Gran Torino

    Gran Torino is a film about Walt Kowalski. Walt is not a real


    person, of course. This is fiction, and by fiction I mean
    Lifetime Original Movie fiction, every possible cliche you
    could want in a film, and then some. Walt is an old, cranky,
    “these kids today with their rock music” Korean War vet. He’s
    a tough guy, in a time when toughness is a liability. In other
    words— to borrow a line from Dirty Harry— he’s a dinosaur.
    Two empty, weak, vapid grown sons; a neighborhood changed
    from men with families, who work hard for a living to
    immigrant gangs, “gooks and slopes” and American is going
    to hell, back when I was young we had to…

    What Walt still does cling to, what’s important to him, is a car.
    That’s because he still believes in symbols of masculinity and
    all that nonsense. I know, God, what a fool. Just in case this
    point is too subtle for the crowd that once voted Titanic the
    best movie ever made, the producers plan to bash you over the
    skull with this point and name the movie after the car. Get it?
    This old fossil still doesn’t understand that cars don’t have any
    real meaning, they’re just stupid hunks of metal that only serve
    as proxies for an identity you wish you had— not like an
    iPhone or a barbed wire tattoo or a vote for Change, things that
    really signal individuality.

    I’m not spoiling anything for anybody by saying that Walt’s


    character evolves, “grows,” and whenever you see “character”
    and “grows” in the same sentence it almost always means it’s
    either Oscar season or it’s 3pm on a Tuesday and you’re
    watching an Afterschool Special.

    Walt does grow— he “meets them halfway,” “learns that


    they’re not all that different,” etc— in other words, cliche,
    cliche that would kill this movie in every other circumstance,
    except one: Walt is played by Clint Eastwood.

    It would be a gross over-simplification to say that Eastwood


    saves the movie. He is the movie. Walt isn’t played by Clint
    Eastwood, Walt is Clint Eastwood. The reason the movie is
    watchable— the reason such an otherwise trite and predictable
    movie doesn’t go straight to video but instead gets a review in
    The New Yorker is because people want to see this
    transformation, this “growing” happen to Eastwood. Or, more
    specifically, to the characters that Eastwood represents. In
    short, the only reason this movie got a write up in The New
    Yorker is because it shows how Dirty Harry learned the error
    of his ways:

    Walt’s final acts in the neighborhood struggles come as a


    shock, but, in retrospect, they make perfect sense as
    Eastwood’s personal renunciation of vengeance and also
    as a kind of down payment on an altered American
    future.

    Slow down, Criss Angel, I know a mindfreak when I see one.


    Clint Eastwood doesn’t have anything to do with this. It’s not
    Clinton Eastwood Jr.‘s personal renunciation anyone cares
    about, because nobody actually knows anything about Clinton
    Eastwood Jr. or his personal beliefs. It is all the characters that
    he played— their renunciation people care about. People
    aren’t seeing Eastwood play Walt; they are seeing The Man
    With No Name now aged 70 and living alone, still clinging to
    his horse, I mean gun, I mean car. That’s the guy they want to
    see “grow,” that’s the guy they want to see admit he was
    wrong. Time Magazine’s review doesn’t have the header,
    “Clinton Eastwood Jr. Changes His Mind About The Use Of
    Weapons To Solve Problems.” It says Cleansing Dirty Harry.
    One might take pause here and ask two questions. First of all,
    why does Dirty Harry need any cleansing? You didn’t
    complain when he was taking out serial killers or corrupt cops.
    And the answer is that the movie isn’t a movie, or even a story,
    it’s a mea culpa for a generation. Since there are no heroes
    anymore, then all those action movies, all that black and white,
    right and wrong, must have been very unsophisticated. Real
    life, real problems are considerably more… nuanced. Since
    there is no black and white, people do bad things not because
    they’re bad but because they make bad choices.

    Yeah, well, color me unconvinced, things may not be all black


    and white, but there is a black and there is a white and I know
    them when I see them.

    And second: hey, stupid, what the hell are you talking about?
    Dirty Harry doesn’t exist.

    But we want him to exist. This generation, this, The Dumbest


    Generation Of Narcissists In The History Of The World, they
    hate heroes— except dead ones, they’re ok, and superheroes
    are ok too, people with magic or from other planets— but
    human heroes are anathemas, they want to tear them down and
    show them to be regular mortals, flawed— and the best is if
    they can catch them being hypocritical, nothing brings an
    impotent narcissist to orgasm faster, even faster than cheating
    wife stories, than detecting hypocrisy in the elites.

    What they don’t understand because they are stupefied by their


    jealous hate is that the real reason they want to show that
    heroes are flawed is because that would mean that heroes exist
    in the first place.

    Gran Torino is a gift to the jaded narcisissist of today. It says,


    look, there aren’t really any action heroes, violence really
    doesn’t solve anything— I see that now.

    Ok, but what happens when violence finds you and a hero is
    needed?
    That’s why the end of Gran Torino fits so well— this is a
    *spoiler*, though they don’t so much foreshadow this ending
    as they do scream it at you from the opening scene— he goes
    to confront the bad guys and dies in a hail of bullets— the end
    which is so obvious and predictable but at the same time the
    only one that would speak to this generation of narcissists:
    when we need a hero, heroes are obligated to rise up and
    serve, but please have the decency to die afterwards so we can
    go back to second guessing the ethics of your actions.

    We hate to be reminded that there are others who are better


    than us; but, for the love of God, please let there be people
    better than us.

    II. JCVD

    “I’m 47 years old,” is Jean Claude Van Damme’s third line in


    JCVD, the movie about the real JCVD, the actor, who fell
    through the rabbit hole into the world of JCVD, the character.
    The opening scene is him filming an action movie, and he
    gets… tired. “It’s not so easy for me anymore.” We get it.

    JCVD is out of money, acute and chronic. He lost his child


    custody case. He’s been passed over for a role. His ATM card
    is rejected, and his manager wants payment by noon. So he
    talks his way into a closed bank to pick up a wire transfer.
    Sorry, technical problems. Huh? “We’re out of money.” Huh??
    The teller stares at him blankly, the guard uselessly. He finds it
    surreal— until he deduces it must be a joke? Candid Camera?
    Nope.

    It’s surreal for the bank teller, too, of course: the guy yelling at
    her is none other than the famous action star Jean Claude Van-
    Damme. What are the chances? Actually, that’s only half of
    the surreal: it’s JCVD yelling at her, and she’s also
    simultaneously being held hostage. The bank has been taken
    over by armed robbers.

    The movie sets up the man JCVD against the image. The man
    doesn’t know how to fight real bad guys. When the robbers
    beat up one old man, JCVD does nothing except hide behind a
    chair. A dozen times he doesn’t punch one of the bad guys,
    doesn’t try to grab the gun. Do you know why? Because he’s
    not a hero, he’s a regular guy in real life.

    Strangely/expectedly, when the public and the cops learn that


    JCVD is inside the bank during this hostage situation, what
    occurs to them isn’t that he may help stop the criminals; it is
    that he must be one of them. No one assumes JCVD is really
    JCVD the hero, but it is entirely plausible that JCVD is a
    criminal. Even his mother believes he is one of the bad guys.
    In fairness to her and to the public, they really only have two
    options: either a) he’s a regular man who can be pushed into
    “making bad choices;” or b) this guy who had three wives and
    used cocaine can actually be a hero after all. Calendar check:
    2008. Pick a).

    In other words, it’s easier to believe he’s a criminal than a


    hero. It’s easier to believe JCVD could be a bad person than a
    good person.

    What happened? I think the generation raised on action movies


    felt betrayed. Those movies promised possibilities, promised
    that when you grow up, your powers will kick in. When you
    grow up, if bad guys take over a bank, you’ll be able to use
    kung fu on them. It seemed not to have occurred to anyone to
    learn actual kung fu, or look up how banks are typically laid
    out, where the alarms are— just in case. No, these skills would
    be uploaded straight by God when needed, sudden and
    immediate, just as they came to JCVD in Bloodsport. Life is a
    movie and movies are only 90 minutes long. Not a whole lot
    of time for training.

    Well, the possibilities never came true, so heroes can all go to


    hell. And God, too, while we’re at it, he didn’t deliver either.

    We got a brief moment of the possibility of 1980s style black


    and white American might with George Bush after 9/11, when
    half the country went, “hell yeah, let’s go kick some ass!” and
    the other half went, “wait a second, don’t you guys know we
    suck?” That being the full extent of our national dialogue. You
    see the results.

    III. 1985: Tina Turner or Bonnie Tyler?

    Both movies play with the concept of identity. Who are these
    guys, after all?

    Walt, played by Eastwood pretending to be the aged Dirty


    Harry, is too old to engage in significant gunplay, and we all
    know that if it came down to it, he wouldn’t be able to defeat a
    ten member gang, in real life. The actor himself is too old to
    pull off an action sequence. So what does he do? He allows
    them to shoot and kill him, thereby getting them all jailed. But
    it is entirely consistent with what Dirty Harry would do if he
    was old and alone. Identity intact, even if it is all made up.

    JCVD has the exact opposite problem. There’s a scene when


    one of the bad guys— an aging, overweight, haggard man with
    a revolver, wants JCVD to demonstrate a “high kick the
    cigarette out of his mouth” tricks. He even puts his gun down
    on a chair in order to get out a cigarette. You’re practically
    screaming at the screen, take him out! But he doesn’t. Again,
    this is intended to show you that JCVD isn’t actually an action
    hero, he is actually a regular man, in real life. Except that he is
    also actually a championship kickboxer in real life. In that
    scene, a nine year old panda could have overtaken the guy. It’s
    impossible that the director, or Jean Claude himself, did not
    think about this. The scene works because it shows even
    JCVD doubts who he is, doesn’t know who he is. Here he is,
    actually something, and he’s not sure about his identity.

    You can’t help but admire a man who knows his limitations—
    ironically, a line from Dirty Harry— but what we need now, in
    these days moving forward, is less awareness of our
    limitations, and more dedication to overcoming them. I’m not
    advocating people should be someone they are not. But it
    seems obvious to me that if you are going to be someone you
    are not, and are willing to put in the time, be a hero.
    Can A Patient Postpone
    Their Own Death?
    January 1, 2009

    Why I hate.

    There is a vague but popular assumption that some people


    close to death from disease can postpone their death in order to
    get to a special event. Popular examples would be a cancer
    victim who makes it to his grandson’s birth, etc, etc.

    History has examples where we assume as much. Jefferson


    and Adams were in a coma, both until July 4, 1826, the 50th
    anniversary of the nation. Then they woke up, looked around,
    and died. “Did I make it?” You made it. Thanks.

    Etc.

    The authors of one large study discover it is not true.


    Reviewing 300k cancer deaths in Ohio from 1989-2000, and
    looking to see mortality rates two weeks before or after
    Christmas, Thanksgiving, or the individual’s birthday, they
    found no difference in mortality rates.

    First, this study doesn’t prove that people can’t do it. It doesn’t
    even lend any support to the premise that they don’t— it is
    simply not a well thought out study. Perhaps Christmas and
    Thanksgiving aren’t a significant pull? It would not have
    counted Jefferson or Adams as positives. How do you know
    they didn’t successfully postpone their death by a full year, but
    fall short by two weeks? Perhaps Jews were not particularly
    motivated to stay alive to Christmas? Etc.

    More broadly, from the standpoint of epistemology, the study


    was flawed from the beginning. You can’t use an association
    study to deny a relationship, only to suggest that a relationship
    exists. And, you can only do an association study on things
    you already know exist, to see what kind of association there
    is between them, not as evidence that one of the things
    themselves doesn’t exist. “According to a review of Chicago
    ER records, no relationship was found between lunar cycles
    and the treatment of alien life forms from 1980-2000, thus we
    conclude aliens do not exist.” You are looking to prove
    something doesn’t exist by noting its absence in a few not
    particularly useful places.

    Which brings us to the second point: why do it? There is no


    information to be gained from this study. Worse, its
    publication confuses people who think that information was
    discovered.

    It takes away hope. For what? If you knew something for sure,
    well, then we can debate whether reality is a bitter medicine
    all must swallow, or not. But this isn’t reality, this is… a
    preliminary investigation designed to drive you crazy. “We
    have reason to suspect your wife was really good at oral sex
    with other men prior to meeting you.” Now what?

    I’m sure these authors are good people, I’m sure they think
    they have done nothing wrong, but they are not doctors, they
    have violated the very basis of their profession.

    There was no reason for this study at all, as far as studies go.
    It’s a violation of the principles of medicine. It is not science,
    and it doesn’t promote the treatment of patients. It does not
    contribute to knowledge, it does not contribute to science, and,
    worst of all, it does not further humanity. Yet here it is, not in
    some underground fanzine, but in JAMA. Not slipped into
    JAMA, but past three peer reviewers and an editor into JAMA,
    not to mention 4 years of “readers.” For all their interference
    in social policy and contamination of medicine in order to
    further political agendas in the name of “humanity,” they think
    nothing of this.

    It is all ego, it is all done for the doctors, it is a study done not
    to inform medicine but solely so they can say they did a study,
    “hey, you know the conventional wisdom, well, we just
    disproved it!” Even though it isn’t proof at all, but ha ha and
    they can gloat over drinks or at the conference and others will
    point and say, “XX’s group at Ohio did a study and they found
    it wasn’t true.”

    On the one hand, you exaggerate your power, dictate and


    interfere where you have no authority; on the other hand you
    pretend you’re innocent observers to the freight train of truth,
    simply taking notes. You violate the trust of humanity and hide
    behind the pretext of impartiality to the truth, when really you
    distort truth or invent pretexts for your own prejudices.

    When a patient asks me if such is possible, I look them dead in


    the eyes and I say, “Of course it’s possible.” I say it because
    the scope of my field does not have any information that
    allows me to answer any other way. “Do aliens exist?” Being a
    doctor doesn’t give me any insight into this answer, so you
    can’t use your authority to promote one.

    Your job, your obligation, is to serve humanity, if you can do it


    with science awesome and if there is no science for you then
    you come up with something else. You don’t leave them
    hanging, you don’t leave them hanging. And when all else
    fails you take out your stethoscope that you don’t really know
    how to use, and you pretend to examine them, you pretend
    you’re involved.

    I have no power to revoke your licenses, but if I had the


    power, if it was up to me, you would all be excommunicated.
    The Ultimatum Game Is A
    Trap
    January 6, 2009

    Evolutionary psychology, at a newstand near you.

    The Ultimatum Game:

    One round only, and anonymously. Player 1 is given a sum of


    money to divide between himself and the unknown Player 2.
    Player 2 can either accept or reject the deal; no negotiation, no
    second chance. If Player 2 rejects the deal, no one gets
    anything.

    What’s the right division?

    Answer a:

    Homo economicus, the self-preserving man, would attempt to


    maximize his gain. For Player 1 that means offering Player 2
    the least possible; for Player 2, it means accepting anything
    greater than zero, because anything is better than zero.

    If we were all playing for monetary gain, then Player 1 would


    offer 99% for himself, and 1% for the other guy, because 1% is
    better than nothing to the other guy.

    But this deal is usually rejected. In fact, anything less than less
    than 30% is usually rejected. So monetary gain isn’t the only
    variable here— people do not always choose for their best
    economic advantage.

    Answer b:

    The Economist, an excellent magazine which offers excellent


    analysis of complex political and economic questions, yet still
    manages to be on the wrong side of history every single time,
    explains the now accepted “evolutionary psychology” answer:

    (from Darwinism: Why we are, as we are) What is


    curious about this game is that, in order to punish the first
    player for his selfishness, the second player has
    deliberately made himself worse off by not accepting the
    offer. Many evolutionary biologists feel that the sense of
    justice this illustrates, and the willingness of one player to
    punish the other, even at a cost to himself, are among the
    things that have allowed humans to become such a
    successful, collaborative species. In the small social
    world in which humans evolved, people dealt with the
    same neighbours over and over again. Punishing a cheat
    has desirable long-term consequences for the person
    doing the punishing, as well as for the wider group. In
    future, the cheat will either not deal with him or will do
    so more honestly. Evolution will favour the development
    of emotions that make such reactions automatic.

    It takes less than a moment’s thought to realize this is


    specious, not to mention wrong. Why is the sacrifice an
    example of an evolved sense of justice or fairness, and not an
    example of unevolved envy? Like a child who smashes the toy
    his brother got for Xmas?

    To illustrate this, let’s make the pot $10 billion. He keeps


    $9.99B for himself, $10M for you. Now what? Obviously,
    you’re taking the $10M, fairness, justice and Darwin be
    damned.

    In fact, Player 2 will likely accept $10M no matter what Player


    1 gets to keep, even approaching infinity.

    Evidently, what matters isn’t the relative inequality of the deal,


    but rather how much money Player 2 gets. If he’s paid enough,
    he doesn’t care how unfair the deal actually is.
    II.

    The question then is: is my explanation right?

    Nope.

    My counterexample is a trick, and I use it to show the


    complete and total impossibility of interpreting behavior from
    hypotheticals. Hypotheticals measure identity— who you
    think you are— not who you actually are, which is your
    behavior.

    I’m going to show you now how Player 2 would reject the
    $10M, consistently, as consistently as if he was offered $1
    from a $100 pot.

    If this experiment happened right now, in real life, the second


    person would more than likely refuse the $10M, because in
    real life there is a third person in the Game that we are not
    considering: the experimenter with the original pot of $10B. If
    such a person has $10B laying around to do this trivial
    experiment, let alone the money he has to repeat the
    experiment on other people, then $10M isn’t worth anything to
    anybody.

    Don’t frown; if this was simply a hypothetical question, then


    none of the dollar values have any meaning at all, especially at
    the point of large numbers (what’s the hypothetical difference
    between $10B and $100M?) You’re simply asking people,”
    what are your general beliefs about fairness?” We all have a
    belief in our levels of bravery, honesty, greediness, which we
    will use to answer the questions. At some big dollar value,
    we’ll believe that it compensates us for our sense of injustice.
    We’re honest enough with ourselves to admit that we’d take
    the hypothetical $10M— but that $10M is being compared to
    your ordinary economic world. But in real life, you would still
    refuse the deal, because you’d be living in a world of
    hyperinflation.
    III.

    What does this all mean?

    It means the Ultimatum Game is not a question of behavioral


    economics, it is a magic trick. Magic tricks play differently to
    different audiences, and you cannot generalize about how
    humans respond to this magic trick based on how it plays in
    Vegas. Worse, you cannot generalize to humans based on how
    a group of people say they would hypothetically respond.

    The Ultimatum Game yields different results in different


    cultures (a Mongolian group and another using ethnic
    Russians (Tartars and Yakuts) group both reliably offered
    50/50 splits; and the even rejected offers that were in their
    favor (e.g. 30/70.)). Evolution wouldn’t account for this. Are
    Mongolians a more just people? Do the Tartars have less
    envy? Or do they suspect that any third person who has the
    power to set up such a Game should not be completely
    trusted?

    Prior to being seated, subjects were handed a consent


    form and asked to read it. Our
    subjects were loathe to sign anything. They were
    guaranteed anonymity and they did not
    want to leave behind any signature that they felt could be
    turned over to authorities.

    Meanwhile, the Machiguenga people along the Peruvian


    Amazon, when asked by the experimenters to play “a fun
    game played for money” were “eager to play.” They average
    offer was a 75/25 split, and almost no one rejected any offer,
    no matter how low.

    The real question in the Game is whether it is worth it to you


    to play at all. When you reject the offer, you don’t get nothing,
    you are not back where you started, because there is a hidden
    cost in the act of playing the Game. You’ll never know what
    that cost is, and it will be different for everyone, and at
    different times. Playing the Game hypothetically does not in
    any way reflect real Game play.

    War is an Ultimatum Game, and winning may be losing and


    losing may be winning, and individual soldiers are all playing
    their own version, and anyway, imagining how brave you’ll be
    in the thick of battle does not reassure me.

    There’s almost an Uncertainty Principle to this Game:


    observing it changes the outcome. Or, more accurately, you
    can’t know both the “real results” and the “real costs” at the
    same time.

    Let us dispense with the belief that this Game has anything to
    do with evolutionary psychology, or much else.

    (A follow up here.)
    Another Round Of The
    Ultimatum Game
    January 15, 2009

    Let’s see if it’s fair this time.


    Go ahead and read Part 1, The Ultimatum Game Is A Trap.

    My issue is simply that the Ultimatum Game, which


    supposedly shows a sense of fairness, and is evidence that this
    fairness is an evolutionary trait that was selected, doesn’t
    necessarily show any of these things.

    The premise is that when people play a round of the UG, they
    generally do not offer a 99/1 split but something more “fair”
    (e.g. 60/40) and people repeatedly refuse to accept deals that
    aren’t “fair.”

    Ergo, it is fairness that this game tests, and fairness is what has
    evolved.

    Even if we grant that 60/40 is the ordinary split, why does this
    mean it is fairness that has been selected for?

    An easy counterexample is to rewrite the discussion in terms


    of envy: in the UG, people rarely offer 99/1 because they
    know it will be refused— because they know the other person
    would just as soon shoot his own foot to spite his hand. And
    Player 2 would refuse anything less than 70/30 not because it’s
    not fair, but because he is a jealous, deeply spiteful person
    who hates when other people have more, even if it is fair. Flat
    tax, anyone? No? Thought not.

    I rewrite this all as envy not to show that it is actually envy


    that the Game tests; or that envy is not evolved, or that even
    fairness is not evolved; but merely to demonstrate that the
    outcome of the UG can not be taken to be an example of any
    specific idea or behavior. People may choose the same results
    for entirely different reasons. Sales of guns are probably a
    good example of this.

    The best we can say— and even this isn’t completely accurate
    — is that the common choices of 60/40 have been selected for;
    that they multiply disparate and unconnected causes, yet by
    virtue of their overdetermination, this choice becomes the one
    humans pick. In other words, what has been selected for is the
    propensity to choose 60/40. Period. No cause can be inferred.

    II.

    Let’s look at whether the Ultimatum Game and Prisoner’s


    Dilemma actually measure fairness.

    A. If it were indeed fairness that was being displayed, then


    fairness should be immune to the payoff. Whether the pot were
    a billion dollars, or 6 silver coins, the outcome should be the
    same. Within cultures, this is generally true. What matters is
    that the pot consist of something valued, that does not have a
    self-imposed maximum (e.g. chocolates wouldn’t work
    because there’s a point when you actually don’t want any more
    chocolates.)

    B. Fairness presupposes an ability to value something. You


    can’t use a pot of dirt, not because it doesn’t have any value,
    but because it is impossible to value consistently (e.g. it may
    have personal value to one or the other but not a general
    value.) Also, you expect the representation of that value to be
    irrelevant, so long as we all know the value. The game can be
    played with pesos or dollars if I know the conversion rate.

    C. The value of something must be economic. Not monetary,


    necessarily, but in the simplest possible sense, more has to be
    more and less has to be less.

    But, sadly for the evolution of humanity and the hopes of


    millions who believe they are greater than their history, this is
    not the case.

    III.

    Imagine games with a pot of 3 cents, $3, 300 cents, or $300.


    Look at those carefully. If fairness was at issue, game
    outcomes should not vary substantially based on the pot. And,
    if they did, you’d at least expect very similar results for the
    300 cents and the $3 pots; they are, after all, the same, and the
    players are likely not retarded.

    This is the Prisoner’s Dilemma, a slightly different game, but


    the difference is not important here.

    Take a look at the results of “mutual cooperation.” Not only


    are they very much dependent on the size of the pot, but they
    are dependent in a way which makes no sense at all: not based
    on the amount of money, but the size of the number. 300
    (cents) was “bigger” than 3 (dollars.)

    Note that the results of 300 cents were in every case more
    similar to the results of $300 then of $3. Their brains saw 300
    cents and 300 dollars as more similar than 3 dollars. (1) I’ll
    save you the trouble of looking it up: none of the players had
    had strokes.
    The interpretation of nearly every UG and PD paper depends
    on assuming that the players are judging the value of the pot
    based on monetary value or its conversion, but it is quite
    apparent that they are (at least also) judging it using some
    deeper cognitive construct of “amount” or “size— that here
    overruled monetary value.

    A quick correlate from the stock market: people perceive


    Google ($300/share) as more expensive than Bank of America
    ($9)— that $1000 buys you “more” BoA, even though it’s the
    same $1000 invested either way, and, by most metrics, Google
    is cheaper.

    Given that these cognitive distortions— and who knows if


    they’re distortions, or don’t have some positive value after all?
    — exist, how can we believe that a 60/40 split using a $10 pot
    is an example of “fairness?” Is our sense of fairness so weak
    (despite millennia of selection) that it can’t withstand the
    presence of a few non-significant zeros?

    How do you know these games aren’t actually showing you


    the effect of a single cognitive constraint, and that constraint—
    not fairness or cooperation— is what has been selected for?

    IV.

    Even if these games did test fairness, why would we think they
    were defining fairness using Western standards— which have
    existed only for a fraction of humanity’s history, in only a
    small part of the world? People have had slaves longer then
    they have not had slaves, and had no moral problem with it. Is
    that fair? If the ancient Romans played the Ultimatum Game,
    would the split be the same? Or, if it was, would it have the
    same meaning?

    To assume the common outcome of 60/40 from a few studies


    applies to the general population independent of cultural
    effects; to assume the results are independent of the cognitive
    distortions of size, number, and value; and to extrapolate these
    results across different times in history— is such madness as
    to border on religion. To then believe this all as the outcome of
    the natural selection of a single complex behavioral trait is
    religion.

    And to be so mad as to believe we know the nature of this


    single trait— to know the the character of the god Fairness—
    brings us back to madness again.

    ––

    1 Not only that, but there is a trend towards overestimating


    300 cents— why? Go ahead and imagine 300 cents. That’s
    bigger than $300— bigger in terms of weight, volume, height,
    etc.

    2 Consider a number line, with numbers labeled one through


    ten. Now extend the line, place the number 100. Now place the
    number 1000. Then 10000. Etc. The distance from 1 to 100 is
    more accurate than your distance from 100 to 1000, and 1000
    to 10000. The larger the number, the more difficult it is to
    accurately.

    Similarly, consider getting punched in the face. The perception


    of the pain is related to you’re starting level of pain. A punch
    that is ten times as hard isn’t felt to be exactly ten times as
    painful.

    Not only is the error greater with each successive increse; it


    turns out that in specific cases, the error follows a
    mathematically demonstrable progression, namely, that our
    perception of is proportional to the logarithm of of the
    stimulus difference.

    P=k ln S/So, where So is the lowest possible perceived


    stimulus (Weber-Fechner law).

    I’ll let the awesomeness of that sink in for a moment. (3).

    Turns out this law may only be applicable in certain cases. For
    example, the perception of stimulus is also related to other
    variables like distraction, temperature of the body, etc. And
    maybe a power function rather than logarithmic function is
    more applicable. All this is for another day.

    3. But here’s a perplexing little conundrum. Fechner’s law


    shows that the perception of a physical stimulus is
    proportional to the logarithm of the magnitude of the physical
    stimulus. But our perception of magnitude itself— our
    perception of numbers— also follows such a logarithmic
    function. So choosing a number (“on a scale from one to ten”)
    to describe our perception, that number itself is related to the
    stimulus by a power function. In other words, the mere act of
    attempting to quantify a perception adds an additional level of
    complexity to the problem.
    The Enemies Of Promise
    Guard The Road To Success
    January 8, 2009

    Those enemies would be you yourself.


    I.

    This is how Malcolm Gladwell, author of The Tipping Point


    and Damn Right I Only Use A Mac, opens his The New Yorker
    piece on the different types of genius:

    Ben Fountain was an associate in the real-estate practice


    at the Dallas offices of Akin, Gump, Strauss, Hauer &
    Feld, just a few years out of law school, when he decided
    he wanted to write fiction….He decided to quit his
    job….He made a plan. Every day, he would write until
    lunchtime. Then he would lie down on the floor for
    twenty minutes to rest his mind. Then he would return to
    work for a few more hours…

    In this fashion, this young talent wrote a book which got a


    great review in the Times, won awards, etc. But as
    inspirational as this “quit your job and become a writer” story
    sounds, for Gladwell, the punchline is this:

    But Ben Fountain’s success was far from sudden. He quit


    his job at Akin, Gump in 1988. For every story he
    published in those early years, he had at least thirty
    rejections…His breakthrough with “Brief Encounters”
    came in 2006, eighteen years after he first sat down to
    write at his kitchen table. The “young” writer from the
    provinces took the literary world by storm at the age of
    forty-eight.
    Gladwell goes on to describe the two kinds of genius or
    creativity. The first, in the young, is conceptual. These people
    have a nearly fully formed vision in their minds that simply
    needs to be transformed into material reality. The other, in
    late-bloomers, is experimental. They’re not sure what they’re
    getting at, they have multiple iterations, and then
    suddenly/finally they’re onto something.

    He uses many such pairs of examples (e.g. Cezanne and


    Picasso.) The anecdote he tells at the beginning, the “quit your
    job as a lawyer and become a writer” depends on the latter
    type of genius/creativity.

    II.

    Right off the bat, I have a question. How come no one ever
    thinks a person a genius if they quit their job as a writer to
    become a lawyer? In fact, that’s always considered selling out.
    Before you laugh, consider that it is actually harder to do this
    then to go in the other direction. “The world doesn’t need
    another lawyer” is probably a popular answer, but I submit the
    world doesn’t need another Ben Fountain, let alone the
    thousands of Ben Fountains who have quit their jobs and
    never finished their novels. Why does our culture place a
    higher value on mediocre art that will never survive ten years
    then on a lifetime of grinding out the parts of the engine of
    society? And if/since creative art is so valued, why don’t they
    get paid more then the grinders?

    III.

    Gladwell is perfect for those who want still to believe they can
    be anything they want, even as they drive 45 minutes each
    way to the place of their slow suicide.

    I’m a fan of Gladwell too— how can you not be? He is


    compelling, fascinating, every sentence seems to have an
    implied exclamation mark, and for anyone under 50 who still
    has hope they’ll “do something” with their lives his books read
    like revelations, they make you feel as if he’s figured out the
    essential ingredients to success. Wanna be CEO of a major
    corporation? Knuckle pushups. It’s all so obvious, so easy.
    And yet, here I sit…

    An example here is illustrative. He compares Bill Gates of


    Microsoft to Bill Joy (who looks like Gladwell) of Sun
    Corporation to show how they achieved their success. You’ll
    notice they are both Bills. That’s not incidental to the
    comparison, it’s the entire pretext for the comparison: “These
    two Bills are similar because…” The “Bill” becomes a
    shorthand for the other similarities (10000 hours of work, etc).
    But just as the “Bill” itself gives you nothing useful to work
    with, neither do any of Gladwell’s conclusions. “One of the
    reasons Heidi Montag and Heidi Klum are so attractive to men
    is that they have big boobs.” Ok, so now what? Will either a
    name change or plastic surgery really make me look like
    them?

    Essentially— and I mean this with no disrespect or ill will,


    again, please remember that I do very much enjoy his books—
    they are a waste of time. You walk away thinking you learned
    something, thinking you have a new perspective, but you
    don’t. If you doubt this, try to summarize one of his books in a
    sentence and see what you get. Here’s The Economist:

    Mr Gladwell finds that being in the right place at the right


    time, having the right antecedents (affluent, caring
    parents are a big help) and seizing the chance to get in
    lots of practice (he calls it the 10,000-hour rule) are all as
    critical to success as raw talent.

    Outstanding. Do you want fries with that?

    IV.
    In contrast to this, to this approach “what makes a man
    succeed?” which is answered with “lots of things you have
    very little ability to replicate, so just get to work” it may be
    better to ask, “what makes a man fail?” and at least avoid
    those things.

    Enemies of Promise is a book in two parts (one third and the


    other two thirds). Part 2 can be appropriately called: I, Cyril
    Connolly, a man of considerable education and insight, have
    been unable to write the literary masterpiece that was
    assumed to be in me, so instead I am writing a book about why
    I was unable to write such a book. Anyone who hopes to
    accomplish anything artistic, or anything of merit, would do
    well to stop everything else they are doing— or not doing—
    and read Part 2.

    No summary does it justice. I am only going to mention key


    reasons I think immediately applicable— and changeable, in
    the hope it inspires you to read it yourself.

    Day-dreaming and conversation: “These harmless activities


    are more insidious [than drink and opium.]…. Daydreaming
    bears a specious resemblance to the workings of the creative
    imagination. It is in fact a substitute for it… This is even more
    true of conversation; a good talker can talk away the substance
    of twenty books in as many evenings… He will describe the
    central idea of the book he means to write until it revolts him.”

    Less talk, more write. No one should ever know you are
    writing a book, and it’s content should not be able to be
    inferred from past conversations.

    Journalism: For want of money and immediate gratification,


    the talented author may turn to… blogging. “By degrees the
    flippancy of journalism will become a habit and the pleasure
    of being paid on the nail and more especially being praised on
    the nail, grow indispensable….

    Promise: “…the burden of the oath under which we grew up


    becomes the burden of expectation we can never
    fulfill….Occasionally they win and the load of other people’s
    wish-fulfillments is cast off; they produce a book; more often
    after a struggle for breath they are stifled forever.”
    Admiration and criticism: “Butler said an author should
    write only for people between 20 and 30 as nobody read or
    changed their opinion after that. Those are the years when the
    artists are promising and the admirers full of admiration; by
    the time the artist has ceased to be promising and become a
    good writer, the admirer is a critic whose judgments are
    flavoured by his own self-hatred or who, taking the author as a
    symbol of his own youth, refers all his later books back to his
    earliest. When an admirer says, “Ah, yes! But if only he would
    write another Prufrock!” he means, “If only I was as young as
    when I first read Prufrock.” The sour smell of the early thirties
    hangs over most literary controversy.”

    (Not old) Age: “The shock, for an intelligent writer, of


    discovering for the first time that there are people younger
    than himself who think him stupid is severe… It would seem
    that genius is of two kinds, one which blazes up in youth and
    dies down, while the other matures, through long choosing,
    putting out new branches every seven years. The artist has to
    decide on the nature of his own or he may find himself
    exhausted by the sprint of youth and unfitted for the marathon
    of middle age. A great many writers die between those years…
    commit suicide; others succumb to pneumonia or drink or
    have nervous breakdowns…

    “Solvency is an essential.” “…otherwise he must become a


    popular success or be miserable.”

    Privilege: “It is the theory that the experiences undergone by


    boys at the great public schools, their glories and
    disappointments, are so intense as to dominate their lives and
    to arrest their development. From these it results that the
    greater part of the ruling class remains adolescent, school-
    minded, self-conscious, cowardly… Early laurels weigh like
    lead and of many of the boys whom I knew at Eton, I can say
    that their lives are over.”

    Etc. Now get back to work.


    The Chart Is Dead, Long
    Live The Chart
    January 9, 2009

    I. In the Annals of Emergency Medicine appears a short


    article called, The Chart Is Dead- Long Live The Chart.

    The article explains how the chart has regressed from a place
    to write down thoughts and ideas (“writing as thinking”) to a
    fee extraction device, simply templates specific to
    reimbursement guidelines, and not the delivering of care. This
    means that the chart does not aid in the work of the clinician;
    I’d add that it actually becomes the work. The chart is dead.

    Summarizing some of the author’s, and my own, observations:

    Default terms and ideas which go/don’t go into the chart


    — so all charts look pretty much the same. There is
    barely anything in the record that distinguishes one
    patient from another. It’s as if privacy laws are
    superfluous.
    Unreliability of the information. On day 3 of a
    hospitalization, does “+SI” mean he really had SI, or is
    that just there for the insurance? Does PERRLA mean
    P+E+R+R+L+A, or just “Patient had two Ps?” This isn’t
    a comment on clinical rigor. Let’s assume doctors are
    doing a thorough job regardless of documentation. The
    question here is that since PERRLA doesn’t actually
    mean P+E+R+R+L+A, why document it at all? Who are
    we really trying to fool?
    Research by retrospective chart review is therefore
    invalid. It is unreliable, misleading, and worse than
    useless. Please read that 100 times.
    The shadow chart— and any resident will know exactly
    what this means. “Sign outs” or “the list,” three lines
    long per patient but substantially more focused and useful
    than the entire actual chart. Often, information is there
    that would never dare be included in the regular record:
    “mother likely borderline as well.” Lawyers have no idea
    what they’re missing out on; and, here’s a secret— the
    sign outs are usually typed on the same ward computer.
    Let fly the subpoenas.

    Since doctors believe the chart to be a billing form or evidence


    in a malpractice case, they are not using it as a diary of clinical
    care. The irony, of course, is that both insurance companies
    and lawyers pretend that it still is the very thing that they have
    caused it not to be.

    II. How did it come to this?

    Another article in the Annals of Internal Medicine, entitled


    “The misinformation era: The fall of the medical record” also
    criticizes the uselessness and unreliability of the chart. The
    author observes that clinicians are often afraid to document
    things that might upset the patient:

    Physicians have become cautious of writing that a patient


    is paranoid, flirtatious, hypochondriacal, verbose, or
    homosexual. Possible demeaning comments about the
    patient’s manner, dress, speech, level of education, and
    intelligence are also omitted.

    If flow-chart medicine is what we strive to practice, than let’s


    imply dispense with charts— and doctors— fire up the
    Hippocratobot, and start billing Medicare. Otherwise we’re
    going to need to accept that, in order to be effective, a doctor
    is going to need to know even the things which are
    “irrelevant,” precisely because they are not. And he’s even
    going to need to write them down somewhere.
    The rest of the article will resonate with any clinician:

    In view of the flagging integrity of medical record


    information, it is particularly galling that medical records
    have been accorded such authority in our society.
    Physicians may spend as much time with records as with
    patients. Medical records dictate whether and how much
    physicians and hospitals are paid… Records determine
    our patients’ insurability, job qualifications, credit ratings,
    disability awards, and retirement. They are central in
    malpractice litigation…

    …But to restore the integrity of the medical record is


    more difficult. The manipulation of chart information
    physicians go through to protect private information
    about patients from public view and to satisfy the cost-
    control regulations are demoralizing and degrading to
    medical professionalism. This subterfuge will continue
    until confidentiality is restored to medical records and the
    regulations are revised to accord with the realities of
    practice, rather than requiring clinical medicine to be a
    mechanistic clockwork technology. In the meantime, all
    medical record information should be regarded as
    suspect; much of it is fiction.

    Boy, things are getting worse. Actually, no: this article was
    written 20 years ago.

    III. So if things have been this bad for a while, what is the
    real problem?

    The charts haven’t gotten worse, our ability to think has gotten
    worse, the chart now simply reflects that. I know we believe
    we chart differently than we practice or think, but the two are
    very connected; what you write causes you to think a certain
    way. Since we are not writing down dating history, therefore
    we are not thinking about dating history, it becomes secondary.
    We’re instead thinking about about “mixed episodes.” Get it?
    We’re trying to reduce “dating history” into a symptom cluster.
    What’s on our minds first is Lipitor and LDL, and only
    secondarily quit smoking and eat better, because we document
    Lipitor and cholesterol, our charts contain places to write those
    down.

    “But isn’t LDL important?” See? You’ve been contaminated


    also. The number is meaningless beyond low, normal, and
    high; and those three have relevance only as they correlate to
    other pathologies. But you have information bias, you feel like
    you need to know the actual number, you feel like it tells you
    something, you feel like “normal” isn’t informative enough.
    And I’m telling you “normal” is more informative because
    your mind is not cluttered with the uselessness of “one
    hundred and nineteen.”

    Knowing that certain info should go into the chart (Lipitor)


    causes you to think about that primarily.

    The second problem is this: the doctor is required to do two


    entirely contradictory things. First, he is supposed to do what
    he thinks is best for the patient. Second, he is asked to
    document the facts of his prosecution.

    No one looks bad if they don’t write, “told to eat carrots.” But
    you look sloppy if you write ““LDL high.”

    In other words, the medical chart is a college application:


    here’s what I did, to the best of my embellishment, knowing
    that you don’t care about what I actually did, but rather about
    the things you think are important— all of which I did only
    because that’s what you want from me. Can I get
    paid/dismissed now?

    IV. You’re kidding, right?

    No. Maryland State Board of Physicians v. Eist, 2007.

    A man— not a patient— complains to the Medical Board that


    Dr. Eist overmedicated his wife and son (Eist’s actual
    patients), which caused (supposedly) his wife to become
    psychotic and the boy extremely anxious.

    The Board, trying to get to the bottom of it all, told Eist, and
    I’m quoting,

    deliver immediately upon service of process a copy of all


    medical records of [the wife and son]; treated at your
    facility; which materials are in your custody, possession
    or control.

    His response was, and I’m paraphrasing,

    bite me.

    Slow down, Souter, Eist is right: the complaint was filed by


    the husband— he’s not the patient; and he was in the process
    of divorcing his wife and demanding custody of the kids. Get
    it? No? Once the Board gets the records, the man would then
    be able to demand those records from the Board as evidence
    for his custody hearing: “my wife isn’t fit to care for her kids.”

    Well, the wife eventually allowed Eist to release the records to


    the Board, so he did. In thanks, the Board slapped him with a
    $5000 fine for not having complied immediately.

    V.

    What do you think Eist wrote in that chart that he didn’t want
    the husband to see that— and this is important— the husband
    couldn’t have obtained from other sources? The husband has
    empty prescription bottles in the house; he has insurance bills.
    He knows she went to a shrink. Do you think Eist was doing
    dream work with her, and documenting it? Of course not.

    The state board, in its brief to the Court of Appeals,


    argues that the lower courts failed to weigh appropriately
    the state’s need for patient records when investigating
    alleged medical misconduct and the doctor’s ethical
    requirement to preserve patient confidentiality. The
    records sought from Eist concerned primarily the drugs
    and dosages prescribed by the physician, data which
    medical agencies routinely collect as part of their
    compelling interest in protecting the health of all
    residents who seek medical care, the board states.

    The Board itself expected there’d be nothing useful in the


    record.

    Eist’s, and all doctors’, dilemma is this: if he has written what


    he really wants to write in the chart, and the husband gets hold
    of it, he’s damaged his patient and can even be sued for doing
    so. So he shouldn’t give the Board the records. On the other
    hand, he’s punished for not giving the records— because the
    Board expects that he/you are smart enough not to put
    anything in those records, so why wouldn’t you give them up?

    So then why would he/you write something in the chart that, if


    it fell into the wrong hands, could damage your patient? You
    wouldn’t. Are we supposed to honor the confidentiality of
    medical records but assume they can be read by anyone at any
    time? Apparently yes.

    VI.

    Doctors have to document for billing and for malpractice, but


    at the same time not so much that it would damage the patient
    in the event of accidental disclosure. If these are the things on
    his mind as he is writing the chart, it is impossible for these
    things not to be on his mind as he practices medicine. To the
    exclusion of other things. It’s not just that it takes up time; it
    completely changes the way you think.

    Example: They’ll write in a progress note, “Lipitor 10mg PO


    qd.” But they’ll write that information also in the section
    called “Medication Record” and also photocopy the
    prescription. But no doctor would ever write only “Lipitor” in
    the progress note, because that seems incomplete. Try it, see
    how weird it feels. Is triple documentation useful? No. But it
    triply reinforces that that information is very, very important,
    while things you don’t write down— “needs to eat two carrots
    a day and one less donut” is less important.

    How we chart makes us worse doctors.

    VII. “It maybe makes you a worse doctor, but you’re a jerk
    anyway. I’m not like that.”

    Let’s all agree that I am not a person short on thoughts. But I


    notice in my own practice that I don’t think about things which
    are later obvious to me when I’m listening to music not
    writing in a chart, because my pattern is to write certain things
    down.

    Life is one big Stroop test. Don’t read the words— just say out
    loud the colors you see:

    It is very hard to attend to what you think is important when


    you are faced with competing informaion. Note that the only
    way to really succeed at this task is to avoid reading the words.

    These are just stupid colors and words. Do you really think
    you can block the effect of thrice documented Lipitor in your
    practice?

    VII. What’s coming?

    Easy answer that no one will like. Since it is evident that chart
    serves no useful purpose to the clinician; and it only serves a
    negative, or limiting purpose vis a vis insurance and litigation,
    and it adversely affects the way we think about patients and
    the way we treat them, it will, inevitably, be abandoned. What
    will replace it? The only thing that is objective enough to serve
    both science, billing, and forensics: video.

    Which is another reason why I am retiring.


    Treating Insomnia With Less
    January 14, 2009

    A grog of rum and an issue of The Economist should handle


    any sleep problems you may have. But, if you’re one of those
    who think drinking alcohol is wrong but drinking psychiatric
    medications is right, then this is for you.

    Most people think of sleep as the opposite of wakefulness, a


    line with two poles, you slide the switch back and forth.

    In fact, there are two regions in the brain, working at the same
    time. A wakefulness promoting region, and a sleep promoting
    region, battling each other, and your mind, for supremacy.

    Simply as a convenience to me for the purposes of writing this


    post, I’ll call the “wakefulness promoting region” the
    tuberomammillary nucleus, and the “sleep promoting region”
    the ventrolateral preoptic area of the hypothalamus.
    Explain yourself.

    The TMN sends histamine projections all over the cortex.


    Histamine causes arousal, increased attention, perhaps
    increased learning and memory. All of these are good and holy
    things. Antihistamines are competitive blockers of H1
    receptors; they block the histamine from binding and thus
    prevent arousal, etc. They are thus the work of Satan.

    The VLPO sends inhibitory GABA projections everywhere to


    turn down/off places which are aroused by projections from
    the TMN. It also sends projections to the TMN itself, to turn it
    down/off, to Dark City you.

    GABA agonists— benzodiazepines like Xanax, Ativan,


    Restoril, and the “non-benzo” Ambien and Sonata type, and
    alcohol, delicious, delicious, alcohol, all work this way.

    I like Xanax.

    No doubt.

    Is there a difference in the quality of sleep?

    No, not really, individual results may vary but the main
    difference is how you feel when you wake up.

    The problem with these GABA agents is that no matter how


    aroused you try to make yourself (through the TMN, coffee, or
    porn) you still have the effect of the drug lingering in your
    body. Hence, you can be an “awake drunk” or a “caffeinated
    masturbator.” People may feel completely refreshed after 8
    hours of sleep with Ambien yet still have decreased reaction
    times and impaired cognition as a result of the Ambien. It
    probably is mild enough not to be relevant unless you get up
    really early to perform surgery, but such people would never
    dream of getting drunk the night before or taking an Ambien.
    Right?

    And the longer the half life of the drug, the longer it is in your
    body, the longer the effect is there (again, even if not
    obviously apparent.)

    If, however, you are on a pure H1 blocker, then you could


    simply release more histamine (e.g. wake yourself up) to
    displace the drug from the receptor. An H1 blocker may be the
    way to go if you perhaps have to get up suddenly in the middle
    of the night.

    I tried antihistamines like Benadryl, and they don’t work.


    In fact, they make me feel wired.

    Ah, many people have this reaction. You’d be surprised to


    learn that this is due to, and a screen for, very low levels of
    testosterone.

    What?!

    Psyche.

    The real reason is that it isn’t actually an antihistamine. That’s


    misleading.

    What do you mean, misleading?

    You know how I hate the FDA, and most everyone else in the
    world, because they use words to distort the truth, and get girls
    to sleep with them that would never sleep with me?

    What?!
    Pay attention.

    Here is the affinity chart for Benadryl:

    (from CNS Spectrums)

    The drug has the most affinity for H1 receptors, sure, but look
    what else it does. M1 blockade (dry mouth, constipation,
    confusion.) It also has significant NE and serotonin reuptake
    blockade. Basically, the FDA decided to pick only one of these
    four properties and slap it on the box, in the same way as
    labeling a TV dinner as “Rice.”

    You’ll also observe that it looks like it works the same way as
    Effexor or a tricyclic. You’d be right. Think about that.

    So every time I take Benadryl, it’s an antidepressant?

    Depends on the dose.


    If you eat all of this TV DINNER, you’ll be getting several
    foods. But if you only take one single fork of the rice, then the
    only thing you ate was rice, even though the box says, “TV
    DINNER.”

    If you only take a low dose of Benadryl, then you are only
    getting H1 blockade. If you take a medium dose, then you are
    eating only the rice (H1 blockade) and the cogentin (M1
    blockade.) A high dose gets you all of the TV DINNER and
    receptors blocked (and also a heart attack— hey, the analogy
    holds!)

    If you imagine that the drug prefers H1>M1>NET>a1>5HTT,


    then you see that the mistake most people make with Benadryl
    is that they increase the dose when if doesn’t work. What you
    really want to do is decrease the dose, to get away from all the
    other things that could be stimulating (serotonin, NE,
    anticholinergic.)

    What about Trazodone? Elavil?

    Highest bar=highest affinity= “happens at lower doses.”

    Trazodone works best around 50, not 25, because he first thing
    trazodone gets you (at the lower doses) is serotonin, not H1
    blockade.

    Elavil is not a good choice, because there’s really no way to


    dose low enough that you’ll avoid the other stuff (serotonin.)

    So what’s the best?

    The best is tiny doses of Remeron (3.25-7.5mg) or doxepin (1-


    5mg).
    I took Doxepin all the way up to 200mg, it did nothing
    except give me dry mouth.

    Doubling the dose is not twice the sleep, it is the addition of


    entirely new drugs (receptor systems.) 3mg of Doxepin is 3mg
    pure H1 blockade. 100mg of Doxepin is 6mg H1 blockade,
    and some Cogentin (M1), Effexor (S/N) and Hytrin (a1).

    You’re saying less of these sleeping pills make you sleep


    better?

    It’s not just less. It is taking only a certain kind of receptor


    system, and avoiding others which wake you up.

    What do you use to sleep?


    I don’t sleep anymore.

    –-

    More on this concept.


    DSM-V Controversies
    January 19, 2009

    If the front page of Psychiatric Times ran a story called DSM-


    V Controversies, and it contained this picture, what would you
    think the article would be about?

    The picture certainly conjures up the concept of dogma.


    Maybe you’d think it was about what belongs in the DSM and
    what does not; what constitutes disease, where does normal
    behavior stop and pathology begin? Maybe it would be about
    the larger questions of the appropriateness of basing a science
    on epidemiology and inference.

    And certainly, those are the main controversies in psychiatry.


    But this article doesn’t mention any of those controversies.

    No. The entire article is about conflicts of interests, financial


    ties of the committee members, and setting up rules to prevent
    the undue influence of “for profit” entities on psychiatry. (As
    if psychiatry itself wasn’t for profit?)

    You’re thinking, so what?

    Be careful. This this isn’t an article about financial conflicts


    on interest in the creation of the DSM; it is an article about the
    controversies surrounding the DSM, of which this is the only
    one mentioned.

    The difference is subtle, but absolutely vital. The purpose of


    the article is to draw your attention away from the existence of
    the other more important controversies, and focus on the
    trivial one. It pretends to say, “here is one of the controversies,
    of which there are many others as well.” But by only
    hammering at the financial, it stops being an example and
    starts being a patsy.

    This is what can be a called a morality play. It doesn’t require


    thought, only feeling and intuition, and elicits strong reactions
    and emotions. All of this is to distract the masses from the
    fundamental problems, which require considerable intellectual
    sophistication and are anyways rarely settled, onto the more
    immediately rewarding moral opprobrium. Debating about
    whether a guy who earned $20,000 in Glaxo speaker’s fees
    should be allowed to weigh in on bipolar depression is a far
    easier and more satisfying argument than “what is bipolar
    depression?”

    You say: surely you aren’t suggesting that the authors of the
    DSM, and even Psychiatric Times, are engaged in a
    coordinated conspiracy to divert attention from the structural
    problems of psychiatry and on to meaningless discussions
    about payoffs and payouts?

    No. They’re not trying to distract us, they are trying to distract
    themselves. They’re the parents of little Jimmy, protesting to
    the school administrators that that the words have been
    changed to “We Wish You A Merry Holiday” so that they
    don’t have to contend with the fact that those carols are the
    only religious instruction the parents have bothered to provide
    him.

    It is endless Congressional debates about corporate jets and


    executive pay, so that…
    God’s Cheat Code For
    Accuracy
    January 20, 2009

    One reason why not having fixed and predetermined identities


    may be useful to us.
    I. The Wisdom Of Crowds

    How many M&Ms are in the jar at the bar? Wrong. So are the
    other thirty people playing the game. No surprise, it’s hard to
    guess. But take the median of the answers, and you’ll find it is
    closer than most of the people’s answers. Take the mean of the
    people’s guesses, and it is even closer to the truth.

    Unfortunately, you’re a narcissist, incapable of truly


    connecting with others. You fake it, posture the right emotions
    at the right times but even to you it feels unreal, disconnected.
    And so you find yourself alone, even if surrounded by others.
    You just don’t feel close to anyone, even those you are
    obsessed with, even to ask them their guess. It’s a shame. You
    really wanted some M&Ms

    It hits you: why not simply make several guesses youself, and
    then average them together? It’s better than nothing, right?

    Turns out, you are right: averaging multiple guesses increases


    accuracy. Not hugely— averaging two guesses increases
    reliability by, say, 0.3%. Hey, it’s not like it cost you anything.

    II.

    Yeah, but so what? Getting one other person’s guess and


    averaging it with yours would have increased accuracy by 7%.
    True, but you’re too self-absorbed to ask her how many
    M&Ms she thinks are in there. Let alone to ask her out. (You
    think it’s shyness. I know, I know.)

    What you need is a way of obtaining an educated second


    opinion without actually involving other people. One way is to
    do this:

    First, assume that your first estimate is off the mark.


    Second, think about a few reasons why that could be.
    Which assumptions and considerations could have been
    wrong? Third, what do these new considerations imply?
    Was the first estimate rather too high or too low? Fourth,
    based on this new perspective, make a second, alternative
    estimate.

    This is called dialectical bootstrapping, and, provided you are


    not an idiot, it works. A recent study found that doing this
    improved accuracy over simply guessing twice and averaging
    the results:

    I mention that you can’t be an idiot because your guess has to


    be rationally considered. Simply guessing, or using some
    crazy worldview, is not likely to work.

    But here’s a question: why does averaging with some other


    idiot’s guess still beat averaging with your best, most thought
    out second guess?

    III.

    The reason averaging two people’s guesses improves accuracy


    has nothing to do with the accuracy of the guesses— indeed, a
    moment’s reflection shows that both people could be idiots,
    and the average still gets you closer to the truth:

    –Guess 1––—Truth–––––––––-Guess 2–— (1)

    The accuracy of two people’s average is related instead to the


    qualitative differences in their errors. Two people do not make
    the same kinds of errors— systematic errors— and so
    averaging them will cancel those out. (In a simplified
    example: Bill tends to overestimate, John tends to
    underestimate. Now consider the numerous biases or cognitive
    heuristics that each person uses to make guesses, that may be
    negated by averaging.)

    Averaging two of your own guesses reduces the random error


    — so you get a small improvement— but without additional
    information or reflection, you’re likely to make the same kind
    of systematic error in your guesses.

    Dialectical bootstrapping is a way of reducing both random


    and systematic error. In order for this to work, your second
    guess has to be a thoughtful one, using either more
    information or at least reflection from a different perspective.
    This different perspective has its own systematic error, but less
    of your first guess’ systematic error. That’s why averaging
    with this second guess can considerably improve accuracy.

    But, as shown in the graph above, it’s still less accurate than
    averaging some other idiot’s guess precisely because that idiot
    is not you. There’s a larger difference in your systematic errors
    and Bill’s systematic errors than there is in yours and “yours
    from a different perspective.”
    If you follow this reasoning, then it suggests that God has
    included a Cheat Code to improving accuracy: pretend you are
    someone else.

    IV. The Wisdom of Narcissism

    Because narcissism is so dependent on the interplay between


    two people’s personalities, narcissists are quite excellent,
    through natural inclination or diligent practice, at empathy.
    Granted, they might not care what the other person feels, but
    they are amazingly perceptive when they choose to be.

    Everyone has narcissistic traits; the question is, how well can
    you tap into them?

    In theory, people who are perfectly able to get inside another


    person’s head— or were completely able to get out of their
    own head— could produce a second guess that would be
    totally independent of their first guess, and there’d be an
    increase in accuracy almost identical to actually asking
    another person. People who are less able to do this would get
    gains that were less. In other words, something like this:
    IV. Is that really narcissism?

    You might think my labeling of this trait as narcissistic is


    superfluous or exaggeration. But some teens hide behind
    irony; some people have excellent bullshit detectors; or the
    ability to “read” a person’s body language; all of these things
    are really the ability to look into yourself and determine what
    those things would mean if you said or did them. And that
    works because that’s how you learned to be a person in the
    first place: by incorporating various characteristics from other
    people into yourself. Healthy narcissism, self-aware
    narcissism, means you remember how and where those
    characteristics came from. “I’ve inherited my Dad’s temper.”
    So if your Dad was really mad, how many M&Ms would he
    think were in there?

    –––—

    1. You might ask, but what if my two guesses are both on the
    same side of wrong?

    ––––––––—Truth––-Guess1––––––––—Guess2–––—

    The average isn’t more accurate.

    However, in real life, you wouldn’t know which of your two


    guesses was better. You’d have to pick between them. The
    average of the two guesses may be worse than one of the
    guesses, but it is always at least as good as randomly picking
    one of them.
    Can Narcissism Be Cured?
    January 26, 2009

    The wrong question.


    A.

    “Dear Alone: I read your descriptions of narcissism, and it


    sounds exactly like me. I’m terrified I’m a narcissist. It’s just
    like you wrote: unlike other people, I can’t seem to make
    meaningful connections with people, and when I try it indeed
    seems unreal, scripted. Other people seem to have legitimate
    emotions, be happy, or in love, or angry, or guilty, and to me it
    always seems like I’m— just a little bit— faking it.”

    Narcissism says: my situation is different. I am not like other


    people, who are merely automatons, shuffling towards
    oblivion.

    B.

    “Why are you so obsessed with narcissism?”

    Describe the march of history over the past 100 years. Answer:
    Fascism, then Marxism, then Narcissism.

    What distinguishes the three? Technology.

    What followed fascism? War. What followed Marxism? War.

    C.

    “But I want to change, I want to get better.”

    Narcissism says: I, me. Never you, them.

    No one ever asks me, ever, “I think I’m a narcissist, and I’m
    worried I’m hurting my family.” No one ever asks me, “I think
    I’m too controlling, I’m trying to subtly manipulate my
    girlfriend not to notice other people’s qualities.” No one ever,
    ever, ever asks me, “I am often consumed by irrational rage, I
    am unable to feel guilt, only shame, and when I am caught,
    found out, exposed, I try to break down those around me so
    they feel worse than I do, so they are too miserable to look
    down on me.”

    If that was what they asked, I would tell them them change is
    within grasp. But.

    D.

    “So all is lost?”

    Describe yourself: your traits, qualities, both good and bad.

    Do not use the word “am.”

    Practice this.

    I.

    Instead of asking, “why do I feel disconnected?” ask the


    reverse question: “what would I feel if I wasn’t disconnected?”
    Be specific, say the answer out loud.

    Go ahead, take some time, think about it. What does


    connecting feel like? I’ll wait.

    Let me guess: you have no idea.

    All you have for an answer is images, fleeting thoughts.


    Nothing concrete. Some words, some phrases, bits and pieces
    of conversations you may have heard or that you daydreamed.

    Now ask yourself, where did you get these images and
    phrases?
    Imagine two people: real, or from TV or movies, that are in
    love. Pick two people whose love you’d like to emulate.
    Imagine them kissing, looking into each other’s eyes. Imagine
    them making love.

    You wish you had a love like that, but you don’t, and every
    time you try, to get it, it is failure. Here’s the reason: are you
    imaging real people, or TV characters?

    II.

    The 1980s said: “TV is a bad influence, pushing our children


    down the wrong path.” Of course, it’s Newton’s First Law: a
    body moves in the direction of the force unless it is opposed
    by another force.

    Where will they learn about love? They could learn from TV,
    or they could learn it from the generation adults with the
    highest divorce rates in history. They could learn about the
    difficulties of raising kids from an ABC/Disney Special, or
    from the generation with the lowest birth rates in history. They
    could learn about morality from Sesame Street, or… but Dad
    always remembered to send in his pledge to PBS.

    Parents had no time for any of these lessons. So instead, to feel


    like parents, they worried that too much sex on TV would turn
    everyone into sluts. That didn’t happen, I spent most of my
    twenties checking. What did happen, however, is that a
    generation of males started overtly, without shame, craving
    sluts, and a generation of women would often pretend to be
    sluts. Think about this: the act was that they were sluttier than
    they actually were, not more pure than they actually were.

    Parents were right: TV could influence kids. But not in the


    expected way.

    But wait— could TV be so powerful? No, of course not. But


    how much force do you really need to push a child in a
    polyester snow suit across a frozen driveway?
    People ask: “why do you focus on pop culture?” Because
    that’s all the culture 300 million Americans ever received for
    30+ years.

    III.

    Imprinting was famously depicted by Konrad Lorenz who had


    a gaggle of geese following him, behaving like him, in love
    with him. Less famously known: it took him only 48 hours to
    alter their identity.

    And without the use of TV.

    IV.

    So now what? TV taught you how to love, it showed you what


    love looks like, feels like. But when you’re actually in love, it
    doesn’t look like that, so you secretly suspect you don’t have
    the capacity for love, that there’s something wrong with you.

    Same goes for sadness. And it’s worse when you’re in the
    presence of someone else’s sadness, you have no idea what to
    do. All you really know about experiencing these emotions is
    the script you got from TV. “Oh your husband died!? Oh my
    God, that’s terrible! I’m so sorry for you!!” But you don’t feel
    any of that. Nothing.

    So you think to yourself, what the hell is wrong with me? This
    woman’s husband died— sure, I can fake it, but am I such an
    empty monster that I feel nothing?

    Of course you feel nothing. Why would you?— it’s not your
    loss. What’s wrong isn’t your lack of feeling, but that you
    think you have to feel something, that you have to tell this
    woman, remind this woman, how horrible is her loss. You
    think the only way to connect with people is to have their
    emotions. You think she wants to connect with you. You think
    she wants your help.
    The problem isn’t your lack of feeling, it is that you think that
    unless you feel it’s not real. You forget that she has a life that
    doesn’t have you in it.

    What you should say is, “I’m very sorry to hear that. Is there
    anything I can do?” and that’s it. But that feels insufficient.
    You think this because you think that there is something you
    can do, that the sadness is not real for you so it must not be
    real for her and you thus have the power to change it.

    She’s not looking for you to be sad, she’s not looking to you
    for anything, her loss is bigger than you. If she needs anything
    from you, it’s sympathy, not empathy.

    But no one taught you this. So you fall back on the character
    “man helping grieving widow.” Action!

    The problem isn’t that you don’t know how to connect; it’s
    that when you do connect at all, you don’t know what to do
    next. It’s your unrealistic expectations of what connecting is
    supposed to be. TV is always about beginnings, not middles.
    Like love. The love you feel doesn’t resemble the TV love
    because the TV love is the first three days of love, copied and
    pasted into a decade of episodes. But since you have no other
    reference point, after a real decade, you think, “I guess must
    not be in love anymore.”

    You are so unsure of your own identity that you don’t know if
    you are supposed to be feeling, what you are supposed to be
    feeling, when you are supposed to be feeling. This is the same
    trouble actors have when rehearsing a character. They want to
    get it just perfect— would Tom feel this? What’s his
    motivation? And similarly you ask: would I— the person I am
    pretending to be— feel this?

    V.

    Narcissism is imitating by being. It is method acting all the


    time.
    VI.

    The problem wasn’t TV, the problem was the absence of


    adults, real adults who took seriously their responsibility to the
    next generation, who lead not by words, but by behavior. Who,
    even if miserable or unfulfilled or unconnected had the
    decency to fake it for the next generation, for the people they
    touched. Who didn’t cheat on their wives not just because they
    loved them, not just because it was ethically wrong, but
    because what kind of an example would that be to their
    daughters?

    I know, everyone will disagree. Everyone, except daughters


    under 20.

    VII.

    I killed a mosquito yesterday, because it bit me and it hurt and


    I am not the Dali Lama.

    The narcissist, however, says, “It’s just a bug.”

    VIII. The Solution No One Will Like

    “I feel like I am playing a part, that I’m in a role. It doesn’t


    feel real.”

    Instead of trying to stop playing a role— again, a move whose


    aim is your happiness— try playing a different role whose aim
    is someone else’s happiness. Why not play the part of the
    happy husband of three kids? Why not pretend to be devoted
    to your family to the exclusion of other things? Why not play
    the part of the man who isn’t tempted to sleep with the woman
    at the airport bar?

    “But that’s dishonest, I’d be lying to myself.” Your kids will


    not know to ask: so?

    The narcissist demands absolutism in all things— relative to


    himself.
    IX.

    “But I had really good parents!”

    Sorry, Leonidas, you were simply outnumbered.

    The best of parents can’t beat the overwhelming influence of


    everyone else, of everyone else’s parents, of TV, of journalism
    — of a culture that says, “well of course! The old ideas were
    wrong, we know so much more now! We are touching up the
    last pages of history, from now on things are different…”

    18 years of the best parenting still can’t beat the morality


    lesson at the end of an 80s sitcom, presented as if it were a
    fundamental truth, known to all, incontrovertible.

    So what about the next generation, those under 25? If the


    problem was the unopposed influence of TV— not the TV, per
    se, but the lack of opposing influence— then the solution is
    some opposing influence.

    I am nervous about recommending “the Classics” because it


    sounds contrived and pretentious, but anything that has
    withstood the test of time and is not something that was
    created to be consumed by current narcissist adults is as good
    a place to start as any.

    Do the opposite of what the narcissists did. They wanted to


    know enough to fake it. They read just enough to use the book
    to build an identity, so they read about books, but not the
    actual books.

    If nothing else, reading will keep you out of trouble: every


    moment reading those books is a moment not doing something
    your current adults created for themselves that you’re stuck
    with by default.

    X.
    “Why do you waste your time with pop culture?” Because you
    may not be interested in pop culture, but pop culture is
    interested in you.
    Wrong About Obama
    January 29, 2009

    The most dangerous case of buyer’s remorse in history.

    I hesitate to write this. Honi soit qui mal y pense. But I fear
    someone has to.

    I.

    That Obama would win wasn’t a surprise. That people would


    feel a sense of history and, well, hope, was to be expected;
    indeed, that was the point of it all.

    But instead of the typical, “good game, guys” and hand shakes
    all around, I watched in amazement as my country went
    completely insane, on international TV, for everyone to see.

    I watched as the media dispensed with any pretense of


    impartiality. It was as if they were covering the Olympics,
    America vs. Russia, and the clock was ticking down 5…4…
    3…2… “Obama’s going to win! Obama’s going to win! We’re
    about to make history!”

    MSNBC’s Keith Oberman plunged headfirst into sycophancy,


    cheering how great a day it was for African-Americans. “We
    did it!” Really?

    Even CNBC reporters, who had all year made it clear they
    weren’t voting for Obama, joined the other stations in
    blathering about a new age in history. You are familiar with
    the platitudes, I hardly need repeat them.

    Victory celebrations are fine, but am I mistaken that 40% of


    the country did not vote for him? And that at least a sizable
    minority of those people do not believe we are now at a new
    dawn in history? Did these people suddenly evaporate?

    That a black man has been elected President is a testament to


    the power of the nation, yes, I get it. But there’s a certain
    oppressive feeling about it all, as if that mere fact precludes
    any dissent; as if to feel that this is anything other than a
    cultural reawakening of America is an outright violation of
    human rights.

    There is an almost complete sense of the moral rightness of the


    win, as if the 40% of the electorate that didn’t vote for him are
    anyway thrilled with the outcome of the election. 60% win
    may be a landslide, but it’s still an F. It’s not something you
    tape to the refrigerator.

    II.

    “But so what, let them gloat a while, as long as he does the


    right thing…”
    Let me be clear that there is more here than simply “our
    candidate won.” This is the belief that everything is different
    now.

    The problem is with two terms: “them” and “right things.”


    Without taking a side, at least accept that there are a lot of
    “thems” and a lot of “right things”— all of which have their
    Hopes for Change in Obama.

    What is different form other presidencies is that a number of


    people expect a number of things— and these things are often
    contradictory.

    Millions of people are not going to be just disappointed, they


    are going to feel tricked.

    A vote for Change— what if nothing changes? What if the


    Bilderbergers and ex- Carter administration people bring
    nothing but More Of The Same AND Less Of Everything? Do
    you say, “well, I guess that didn’t go as planned” or do you
    become so jaded about the political process that your anger
    turns generalized? Paranoid?

    Remember, this wasn’t John Kerry, the man chosen because he


    was supposedly more palatable than Howard Dean; this was
    everyone’s first choice, this is exactly the guy they wanted,
    with completely rational expectations that he was going to at
    least attempt to deliver.

    But— sit down, think about this for a minute— what happens
    if he fails? Not fails in his attempts, but fails to attempt the
    things everyone expects him to accomplish? What if he
    succeeds in doing the opposite of what you thought he would
    attempt?

    How long before people move away from scapegoats, and


    attack the system that (they believe) uses them, tricks them,
    tricked everyone into accepting Barack Obama, figurehead, so
    the “powers that be” can go on with their plans?
    Hating George Bush was a popular pastime, and often took the
    form, “if only he weren’t President…” How long before we
    decide that it’s the system that’s the problem? Then what?

    III.

    This isn’t a case of unrealistic expectations. These are


    expectations which deliberately ignore reality. The Economist,
    in its post election article “Great Expectations,” actually
    wrote:

    Mr Obama will not take office until January 20th, but he


    can use the next ten weeks well. A good start would be to
    announce that he will offer jobs to a few Republicans.

    Really? Could the writers of one of the most important


    periodicals actually believe this is a possibility? There had to
    be deep back room deals just to get Clinton people on his
    team. Old guard Democrats follow him everywhere. Really,
    Republicans? But not just Republicans:

    Mr Obama might even find a non-executive role for John


    McCain, with whom he agrees on many things…

    This is slightly less probably than Obama appointing Daleks to


    his cabinet, but the crucial issue is whether The Economist
    understands that its Great Expectations for Obama are exactly
    the opposite of the great expectations of a lot of the people
    who voted for him?

    People voted for Bush for a variety of reasons, but any two
    Bush supporters, while differeing in what they wanted him to
    do, did not have a different expectation of what Bush would
    try to do. When Bush said he was going to keep Guantanamo
    open, we expected him to try to keep Guantanamo open. He
    did not try to close Guantanamo— and no one expected him
    to.
    These aren’t unrealistic expectations, they’re both perfectly
    realistic. What they are, however, is incompatible.

    IV.

    Don’t listen to opinion polls that say 78% approve of Obama:


    the hatred on the Right is already seething. They’ll not admit
    it, they’ll avoid the topic altogether except amongst
    themselves, in hushed tones, always looking over their
    shoulder, cognizant that they are surrounded by enemies.

    If they hated Obama, it wouldn’t matter. They don’t hate


    Obama.

    The day after the election, Elizabeth Wurtzel wrote an op-ed


    inthe WSJ— let me repeat that, the WSJ— which began, “I
    must admit, I cried. I’m not perfectly sure why, but of course I
    was overjoyed.”

    Well, if she’s not sure why she cried, it’s going to be hard for
    half the country that didn’t vote for him to know either. But
    I’ll grant that the author of Prozac Nation may indeed have
    been so moved. “America itself,” she writes, “which is a
    menagerie of mutts, has been a mightier nation for its
    diversity.”

    All fine sentiments which can be used to pad any college


    essay. The problem for her, for the WSJ, and for all of us, is
    that the sentence she wrote immediately preceding that one is
    this:

    Most of the multiracial people I know seem more


    beautiful and talented than those of us boring folks who
    are just one dull thing.

    When you write that in the WSJ, when you expect people to
    understand it, to agree with it— when you ask people not
    simply to accept all races and cultures but to tacitly admit that
    yours is inferior, you are courting disaster.
    They don’t hate Obama, they hate Obama supporters.

    V.

    When a person heaps expectations and impulses on a person


    they don’t really know well, in psychiatry it is called
    transference. When multiply diverse groups heap contradictory
    expectations and impulses on a person they don’t know well,
    that’s celebrity. They’re the same process.

    Obama’s a celebrity, all right, I wonder if anyone has


    considered that this is not an entirely desirable role for a
    President. America has a love-hate relationship with all their
    other celebrities, why should this one end differently? Bill
    Clinton was the last celebrity President, a tenth of Obama, and
    you know what they did with him. And then they traded him
    for George Bush.

    “But the celebrity’s an accident, he didn’t deliberately set out


    to become one.”

    I’m not so sure. In this culture being a celebrity counts for a


    lot, as long as you are a celebrity we are willing to tolerate all
    sorts of nonsense, from nightvision sex tapes to Scientology to
    adopting 19 kids. We may even ultimately hate you, but if you
    say, “buy this,” we do— and on credit, of course. Celebrity
    and consumption are two sides of the same coin, and neither
    should be the purview of a President. Even if he didn’t ask for
    celebrity, by accepting it he is following a dangerous narrative,
    one that allows the inclusion of this sentence in Entertainment
    Weekly, delivered with no irony whatsoever:

    …but Obama was speaking to voters in a visual language


    they totally got: the celebrity-saturated shorthand of 21st-
    century consumerism.

    Right. Here’s $10. Keep the Change.


    Left of left magazine Mother Jones attempted to make a
    similar point in “The Audacity of Hype?” the idea being that
    his hype is overwhelming (and detrimental.) But other
    progressives would not tolerate such questioning from their
    own ranks, despite the fact that both sides really were arguing
    that there was more to Obama than just hype. (1)

    I’ll admit that hype doesn’t automatically mean there’s no


    substance at all; it means that there is so much commotion it’s
    hard to see what that substance is.

    But it’s hard to make the case that Obama isn’t hype when his
    own supporters— I think I can safely assume Entertainment
    Weekly counts among them— try their best to make him into
    hype. This is a distraction; the result is that you don’t know
    who he really is, and you are inevitably surprised when you
    find out.

    VI.

    I can see that the celebrity is a type of celebration, but there


    are consequences: it drives the 40% that didn’t vote for him
    completely bananas. I don’t mean “I hate the monkey fascist
    George Bush” bananas, either. People will disagree with me on
    this, but they’re wrong— this hype is more divisive than
    nearly anything George Bush has done.

    Much of what Bush did conveyed the perception that he didn’t


    care about your opinon, he answered only to himself and
    rubbed your nose in it. That made a lot of people hate him. The
    problem with these Obama covers and articles is that it is a
    whole half a nation saying, “in your face!” which makes
    people hate them.

    Remember the flap about The New Yorker cover that showed
    Barack and Michelle in Taliban garb, doing the fist bump?
    That was irony, and it still made some liberals angry. But when
    you make this cover, with no irony at all

    it makes people hate the people who voted for Obama. And if
    you do not believe this, then you are the one they hate.
    VI.

    The other problem with celebrity is it works only because it is


    lots of things to lots of people; it’s rare to find a celebrity who
    is something all the time; those static celebrities we tire of
    quickly. Celebrity requires constant reinvention of oneself—
    that’s why most celebrities are actors or musicians. And yet, a
    constant refrain from exasperated celebrities: “but that’s not
    really me!” Well, what did you expect when you posed for
    Entertainment Weekly?

    It is still astonishing that a country with out history of


    slavery could elect a biracial man who identifies himself
    as African-American.

    Unlike Ms. Wurtzel, I’m not going to pretend to know what


    Obama is or is not; but I think it’s axiomatic that how you
    choose to identify yourself has little to do with it. Things are,
    or things are not.

    But not for so many who want him to be so many things.


    Unfortunately for them, eventually he’ll have to be himself,
    and whatever that is, people will be surprised by it. And won’t
    like it. Honeymoon’s over: here’s me pooping.

    I earlier wondered how an Obama Presidency would alter race


    relations in the country, perhaps away from race as the
    dividing characteristic and towards class. I think I was wrong.
    That was an outrageously optimistic prediction made because I
    bought into the hype. What happens as unrealistic expectations
    are dashed?

    Here’s a prediction for you, put it in your calendar: within one


    year, people will be saying Obama isn’t really black. Here,
    Leno, I’ll even write the joke for you: “… American’s first and
    only black President, Bill Clinton.” Call me.

    VII.
    The hyping of the Obamyth has consequences for the next
    election as well. Republicans are likely to come out to vote in
    droves— think Newt Gingrich in 1994. Liberals, if
    disappointed, probably won’t vote Republican— they’re
    simply not going to vote at all. That means a Republican win
    by a larger margin.

    If we’re lucky, it’ll play out calmly. But the divisiveness of the
    Celebration of The Obamyth is not to be underestimated, it is
    making a lot of people very angry, a lot of people who you
    hear almost nothing about at all— it’s as if they don’t exist.
    But they’re there, the new disenfranchised, even if Time
    Magazine tells you they aren’t. They won’t take up arms,
    surely, but neither do bees, and it’s still probably best not to
    taunt them.

    Meanwhile, the contradictory expectations of so many of his


    supporters will inevitably result in some groups feeling duped.
    Not disappointed. Duped. At minimum they pull away from
    the political process, at maximum they riot.

    That seems unlikely to you? America’s too big to fail? Spain


    had to put down some violent protests just last week. France is
    “a social bomb waiting to explode.” And Greece was on fire a
    month ago. Are these third world puppet states?

    It would be a mistake to think these riots happened because


    their leaders didn’t get them what they wanted. That’s only
    what made them angry. They became violent because they
    believed the system— not Sarkozy or Zapatero or George W.
    Bush, but the system— was not listening to them. If the
    already disenfranchised whom Obama collected under his
    umbrella later feel spurned or tricked— look out.

    Obama reportedly hopes to fashion himself after Abraham


    Lincoln. It would be worthwhile to emphasize that Lincoln’s
    great accomplishment was not freeing the slaves or the
    Homestead Act but doing whatever it took to keep the republic
    together, at any cost— even if it compromised some of his
    own particular beliefs.

    Please, Mr. Obama, now that you’ve won the election, take my
    advice. If you get invited to the Oscars, politely decline. And
    if Vanity Fair wants to put you on the cover, the correct
    answer is no.

    –––––––––

    The other post: The Wrong Lessons Of Iraq

    1. Ahh, but isn’t Mother Jones really playing the meta card,
    sending a Manchurian Candidtate propaganda to Rush
    Limbaugh and his ilk: “we, the leftie communists at MoJo,
    aren’t really happy with this fake progressive, he’s not really
    that progressive…” making him more palatable to the right?–
    Who knows? But doesn’t that just support the contention that
    no one even cares what Obama is, just what he can be
    identified as?)
    Two Causes Of Autism
    February 3, 2009

    Ah, finally, a post about science only, that doesn’t offend


    anyone.

    Whoops, sorry, that’s my other blog. In this blog, I write about


    how the parents cause autism.

    I.

    First, let’s get this out of the way: that was a joke, ok? I do not
    think autism is caused by the parents. Science has already
    disproven that link. Science shows it caused by rain.

    Before any science is discussed here, take a minute and


    examine your prejudices, which run so deeply that I can’t
    write a blog about narcissism without getting accused of
    writing too much about narcissism.

    Why, when I wrote that autism was caused by the parents, did
    you think that was so offensively preposterous as to merit
    rebuttal in ALL CAPS? Yet when I said it is rain, you were…
    intrigued?

    Not that you actually believed it was rain, of course, you


    figured that was a proxy for something else; but you did not
    allow that “parents” might be a proxy for something else.
    Linking parenting to, well, anything, is so loaded with
    connotation that it is safely beyond consideration; yet a
    moment’s reflection reveals that of course that’s the best
    proxy.

    Science in psychiatry, or in any field that pretends to examine


    behavior, is a false god. It’s not just the results that are biased;
    the way questions are asked, the questions that are asked, that
    can be asked— and the ones that none dare ask— safely
    protect even the sexy calf of the truth from ever being
    revealed.

    Take a break, Diogenes, it’s going to be a long wait.

    II.

    Well, what about all that rain nonsense?

    In general, autism rates are higher in the norther U.S. than in


    the southern.

    Looking at three states, Washington, California and Oregon, a


    study found the counties with the highest precipitation in the
    1990s lead to the highest autism rates in 2005. Additionally,
    kids under three who experienced higher than normal rainfall
    relative to other years had higher rates of autism.

    What’s nearly incomprehensible about this article is the next


    sentence:

    There are a number of possibilities concerning what such


    an environmental trigger might be.

    It goes on to list their top four explanations, but in case you


    don’t see it, I’ll spell it out: this environmental trigger is one
    that occurs to the child after he is born, not before, or to the
    parents.

    They cite: rain means more TV watching; Vitamin D


    deficiency; household cleaners or some other indoor toxin; or
    the rain brings an atmospheric or ground toxin into play.

    The obvious problems with the study are myriad, but


    Because we do not provide direct clinical evidence of an
    environmental trigger for autism among genetically
    vulnerable children that is positively associated with
    precipitation, our results are clearly not definitive
    evidence in favor of the hypothesis. But the results are
    consistent with the hypothesis, and, therefore, further
    research focused on establishing whether such a trigger
    exists and on identifying it is warranted.

    No one on the planet is going to misinterpret this study as


    actually saying rain causes autism. What they will do,
    however, is hear your bias that it is something that happens to
    the child that leads to autism.

    Which is exactly what you wanted, isn’t it?

    III.

    Fortunately, there’s an editorial, “Do These Results Warrant


    Publication?” in the same issue that critiques the study (e.g.
    reporting bias, etc) and then argues

    that the authors’ analysis and the editor’s decision to


    publish it are to be lauded, despite the uncertain ultimate
    contribution of this work and the possibility (likelihood?)
    that nonprofessionals are going to misinterpret and
    misuse it.

    You can say a study should be published despite


    misinterpretation, but why would you say it should be lauded
    if it is likely to be misinterpreted?

    Not only was [cites numerous flaws in the study.]


    Nonetheless, I would argue, so what? The primary
    audience for the article of Waldman et al is not the
    practicing pediatrician, and certainly, it is not a member
    of the public at large. These individuals cannot take away
    any practical message from it.

    Because people are idiots?

    Of course, if a study’s findings are no more than tentative


    ones… responsible authors will stress this, just in case
    members of the lay public are “eavesdropping” on the
    exchange of information between scientists.

    He doesn’t get it, at all. Or maybe he does? Repeatedly saying


    that the results are tentative, stressing the problems with the
    methodology, this masks and reinforces the ideological bias—
    that autism is caused post-natally.

    I believe that Waldman et al have indeed reported their


    results responsibly. They have made it clear that the
    message the public should take from their data regarding
    precipitation and autism is the same one suggested by an
    editorialist commenting on a recently observed modest
    association between prenatal exposure to cell phone use
    and behavior problems in childhood: “No call for alarm,
    stay tuned.”

    IV.

    “Are you saying there can’t be a component to autism that


    occurs after birth?”

    How do I know? I have no idea. More importantly, they don’t


    have any idea, either. I have the very same evidence available
    that they do; the question is simply impossible to answer so
    far.

    I am aware, however, that there are plenty of possibilities, both


    post-natally and pre-natally. This study doesn’t test the
    existence of “environmental triggers” because it could easily
    be explained by completely genetic factors: for example, that
    parents who are predisposed to having autistic kids choose to
    live in Oregon. (What, is that so insane?)

    If his concern is misinterpretation and misapplication of a


    single study, then he should be aware enough to spot how it
    will be misinterpreted.

    So it isn’t misinterpretation that rain causes autism, but that


    this study has anything to tell us about environmental triggers
    at all.

    The worry about the eavesdropping public isn’t that they will
    read this study and hear, “rain might be involved somehow”
    but that they become convinced that there is an environmental
    trigger.

    The study will adds to the study pool labeled “Evidence For
    Environmental Causes” and it simply isn’t that. But when
    those studies are stacked up on top of each other, it looks like
    that.

    V.

    We can now reverse this discussion entirely.

    There is considerable evidence that advanced paternal age, but


    not maternal age, increases the risk for certain psychiatric
    conditions but not others (e.g. schizophrenia yes, depression
    no) and increases massively the risk of autism.

    I want you to take three seconds and come up with a plausible


    explanation for why that is.

    You picked: defective sperm. Me, too.

    However— and this is the point— you must recognize that


    there is nothing in the epidemiological evidence that allows
    you to jump to that conclusion. It is your bias that older
    father= defective sperm, i.e. that the older father is actually a
    proxy for a pre-conception risk factor, and NOT that he’s too
    tired to play with the kid; or that any man who had to wait
    until later to have kids is semi-autistic himself, etc. All of
    those are prejudices, biases, unfounded in science, but they are
    exactly the same as believing it has to do with defective
    sperm.

    There is circumstantial evidence, e.g. with mice, that older


    fathers produce progeny with various “problems”: decreased
    exploratory activity, worse performance on avoidance tasks,
    etc, but nothing that would hold up in court.

    Advanced paternal age could just as well be a post-natal risk


    factor as it could a pre-natal one; just as rain could just as well
    be a pre-natal risk factor as it could a post-natal one.

    However, both camps have chosen a side and fail to consider


    the other side. They’re already firm about when the problem
    started, or what kind of problem to look for. Dialogue is
    therefore impossible.

    VI.

    There is an additional twist to this story: the kind of autism (or


    schizophrenia) that is associated with advanced paternal age
    may be a different kind of autism or schizophrenia then the
    heritable kind.

    To illustrate this, consider the happy discovery that in


    monozygotic twins (identical) have a 50% concordance for
    schizophrenia. Dizygotic twins (fraternal, non identical) have
    much less— 10%— the same as any other first degree relative.
    (For autism it’s 60% MZ, 0% DZ.) This can easily be taken to
    mean, “it’s genetic.” End of debate.

    Well, it really depends on what “genetic” means. You’re going


    to want to sit down for this:

    When MZ twins are divided between monochorionic (one


    placenta for both fetuses) vs. dichorionic (each MZ twin gets
    it’s own placenta) you find slightly different concordances:
    60% for the same placenta twins, and 10% for the separate
    placenta twins.

    Remember, even though they have different placentas, their


    DNA is still completely identical. If schizophrenia was really
    mostly about DNA, then the placenta shouldn’t matter. But it
    appears that placenta matters more than DNA.

    The average reader will find this quite fascinating, but for me,
    the truly fascinating, jaw dropping part of it all is this: the
    article cited, above, was written in 1995. Since that time, no
    one has furthered this line of inquiry.

    Not because the study was debunked— no one tried to debunk


    it. It’s simply too hard to study twins in this way, and since it
    is to hard, we pretend that it isn’t important. The only analogy
    that comes to mind is a political one: it’s way too hard to track
    down loose Russian nukes, so instead we’ll continue to work
    on disarming ours.

    Autism is a spectrum; schizophrenia is a spectrum, and not


    only are multiple factors involved, but likely specific factors
    are involved in specific subtypes only that we currently lump
    all together.

    Add to that everyone’s camping out in different corners of the


    nature/nurture octagon, and if you’re wondering why over 40
    years of research into the causes of both disorders we’re still at
    the level of “rain,” well, that’s why.

    VII.

    It is my personal bias (emphasis mine and bold and


    underlined) that advanced paternal age is a proxy for
    both/either “defective sperm” or some diathesis of…
    developmental disorder… in the father. Either or both may be
    relevant for different cases. If someone wanted to do a second
    study, take the rain study and cross it against paternal age. Do
    older fathers live in Oregon?

    So where is the real money in genetic research in autism and


    schizophrenia? More generally: where are we most likely to
    find “genetic” explanations for complex behavioral traits that
    defy simple “gene model” explanations?

    Start by looking at the possible explanations for the genetic


    effects of advanced paternal age:

    There are three main lines of thought.

    1. Older sperm has longer time to suffer point mutations.


    Men’s sperm is constantly (24 times a year) undergoing cell
    division, each time brings opportunity for mutation.

    2. Expanding trinucleotide repeats.

    3. Imprinting.

    I believe with no hesitation that the money is in imprinting.


    Let me explain.

    Part 3 In one week


    Autism and The MMR
    Vaccine
    February 9, 2009

    Just as I was writing about the consequences of ideological


    bias in autism research…

    Mea culpa, I will admit that I never read the primary sources
    either. If I had, this blog would not exist, I would have quit
    psychiatry in 1998 and opened a bar called Cougars and made
    a fortune.

    In case you do not have kids or ears, there’s a controversy


    about whether the combination measles-mumps-rubella
    vaccine causes autism. The controversy arose from the
    observation that previously normal kids began to regress soon
    after receiving the vaccine.

    If you had only a rudimentary understanding of the facts (e.g.


    most doctors, including me) and were trying to create an
    explanation, you would have intuited that it is either the virus
    in the vaccine, or perhaps you would have recalled the word
    “thimerosal,” a mercury containing preservative in vaccines,
    which has also been linked to autism.

    And you would have left it at that; on the one hand is the
    association, on the other hand is “the published literature” (or
    what you heard is the published literature) saying there is “no
    evidence of a causal link.” (Well of course, they have to say
    that.)

    And then approaches the peon with the autistic child, who,
    recognizing the limitations on medical science doesn’t expect
    you to have a solution, but is hoping at least for a legitimate
    explanation. Your reply to this peon, who dares to ask a
    Medical Professional (expecting an insider’s view of the data
    and an educated opinion, and not expecting you to simply
    make stuff up based on what you heard on CNN) is: “there’ve
    been some reports, but we simply don’t know enough to blame
    the vaccine outright.”

    At this point, three things should have happened:

    1. You should have wondered if “there’ve” is really a word, or


    if you just made it up. Maybe you just threw two words
    together that sounded like they fit? That’s a metaphor for
    everything else you said.

    2. You should have realized that you don’t actually know if it


    is the MMR vaccine, or vaccines in general, that are the
    alleged cause of autism; and that you aren’t even sure if there
    was/is any thimerosal in the MMR vaccine to begin with.

    3. Your ignorance of contractions and medical information did


    not prevent you from spewing vague crap to your wide-eyed
    inquisitor; nor did it prevent them from believing you.

    II.

    It won’t be giving anything away to tell you that the evidence


    for the link is absolutely laughable. But take a step back and
    look at the controversy itself. “Is it vaccines?” –No, it isn’t. –
    Yes it is. –No it isn’t. The controversy is so powerful not
    because it’s about vaccines, but because engaging in the
    controversy serves a more important function: the
    reinforcement of an ideological bias: “we don’t have definitive
    evidence that the culprit is the MMR vaccine— it looks like it
    is, but it may be something else. But definitely it is something
    that happens after birth.”

    III.

    The controversy exploded with the publication of a single


    paper, Ileal-lymphoid-nodular hyperplasia, non-specific
    colitis, and pervasive developmental disorder in children. The
    title is not one that would be expected to herald a 10 year
    ideological war, but there you go.

    First: the title of the paper that launched a million other


    papers, you’ll observe, does not contain the following words:
    vaccine, thimerosal, MMR, combination. We’ll get back to
    this.

    The actual evidence is this case series of 12 kids who


    developed autistic features shortly after receiving the MMR
    vaccine. The entire basis for the link is this single sentence:

    In eight children, the onset of behavioural problems had


    been linked, either by the parents or by the child’s
    physician, with measles, mumps, and rubella vaccination.

    That’s it. If you’re looking for something more solid than


    “parents or the child’s physician” linking the two together,
    you’re going to be disappointed.

    You’d think that wouldn’t be enough to merit a publication in


    Lancet, let alone a controversy. Let alone a substantial
    decrease in vaccination rates.

    However, the focus on this extra, tertiary observation masked


    the real point of the paper, which was observing a relationship
    between— read the title— bowel inflammation and autism.

    Get it?

    No? Then it worked. You’re not supposed to focus on it— it’s


    supposed to become unconscious.

    Still confused?

    Bowel inflammation is not natural; in other words,


    Both the presence of intestinal inflammation and absence
    of detectable neurological abnormality in our children are
    consistent with an exogenous influence upon cerebral
    function.

    That something could be anything, and the bowel involvement


    suggests maybe it’s something you eat— indeed, the authors
    suggest the possibility that it is certain foods (grains), casein
    from dairy, B12 deficiency.

    They also list the other exogenous possibilities, including


    viruses. And then there’s the vaccine.

    But what’s important here is the understanding that the


    inflammation means it’s exogenous. What’s important is that
    the belief that it is exogenous become axiomatic.

    III.

    “But wait, couldn’t bowel inflammation simply be another


    sign of autism, not the cause? Couldn’t the, say, genetic cause
    of autism also cause coincident bowel inflammation?”

    Of course, but as long as the controversy is about the vaccine


    as cause, then it isn’t about bowel inflammation as cause; and
    as long as we are not arguing about whether the bowel
    infammation is the cause, then we are certainly not arguing
    about whether something exogenous is the cause. We are quite
    likely to simply internalize the something- exogenous- as-
    cause link.

    “You’re kidding, right? You think people are that stupid to fall
    for that?”

    IV.

    So what do we do? Well, it was one popular recommendation


    that if the vaccines must be given, they be given separately,
    not as the combined MMR. This recommendation came right
    from the lead author, Dr. Wakefield, in a press conference after
    the study’s publication.

    It’s sleight of hand; blink you missed it. He took it up a step;


    the controversy has now become whether the combined
    vaccine is the cause, not whether a vaccine is the cause—
    despite none of this appearing anywehere in the study.
    Wakefield made this the controversy, out of thin air. And
    everyone fell for it.

    “What do you mean? Not everyone believed it.” That’s not the
    point, right? The point is to make the MMR the focus,
    allowing an exogenous case to become our default
    understanding.

    It is so infective, this bias, this groupthink, that the highlighted


    CDC recommendations about the vaccine which are supposed
    to allay fears reads:

    The MMR vaccine protects against dangerous, even


    deadly, diseases.

    The most common adverse events following the MMR


    vaccine are pain where the vaccine is given, fever, a mild
    rash, and swollen glands in the cheeks or neck.

    No published scientific evidence shows any benefit in


    separating the combination MMR vaccine into three
    individual shots.

    V.

    “Surely the Lancet tried to do something about this?”

    Ha! Don’t be ridiculous. They were far too busy studying


    social justice and peer reviewing “America 2004: voting for a
    decent global society.” I’ll spare you the read: vote Kerry.
    Ok, that’s not entirely fair on my part. In fact, the Lancet and
    other medical groups/journals/individuals were highly critical
    of the paper. Not critical of the results, but rather of the fact
    that Wakefield didn’t disclose he had been previously retained
    as an expert in a lawsuit against the MMR manufacturer.

    Before you jump onto that wagon, ask yourself: is that the
    single piece of missing information that would have revealed
    this study to be silly? Knowing that would have made them
    reject the paper? Is not knowing he was connected to lawyers
    the reason the entire planet missed the lack of connection
    between his verbal statement “separate the three vaccines” and
    his own study to which he was referring?

    Is money the only red flag for these idiots?

    VI.

    If I had to come up with a punch line for all this, I couldn’t do


    better than this:

    According to the February 8, 2009 edition of a newspaper that


    is not written by or for doctors, Wakefield made up his
    findings.

    However, our investigation, confirmed by evidence


    presented to the General Medical Council (GMC), reveals
    that: In most of the 12 cases, the children’s ailments as
    described in The Lancet were different from their hospital
    and GP records. Although the research paper claimed that
    problems came on within days of the jab, in only one case
    did medical records suggest this was true, and in many of
    the cases medical concerns had been raised before the
    children were vaccinated. Hospital pathologists, looking
    for inflammatory bowel disease, reported in the majority
    of cases that the gut was normal. This was then reviewed
    and the Lancet paper showed them as abnormal.
    This would be a good place to ask the basic questions, such as

    why the Lancet and all journals peer-review manuscripts,


    but never ask to see the original data itself;
    why they allow the public to assume that the journal does
    scrutinize the original data;
    why original data is not public information anyway;
    why three idiots and an editor were not able to predict
    how a study would be used, and ask for the appropriate
    modifications;
    why the presence of “financial conflict of interest” is the
    only critical test of bias, such that its mere absence earns
    it the imprimatur of truth. This does not apply to NIH
    money, of course, which is is free of moral influence:
    Nihil obstat.
    Federal Judges Order
    California To Release 50,000
    Inmates
    February 10, 2009

    Oh, look, expediency masquerading as a constitutional issue.


    The story is

    SAN FRANCISCO (Reuters) - Federal judges on


    Monday tentatively ordered California to release tens of
    thousands of inmates, up to a third of all prisoners, in the
    next three years to stop dangerous overcrowding.

    California currently incarcerates 160k people at 188%


    capacity, and the ruling would cut it to 120% capacity.

    The obvious: the nonprofit Prison Law Office— “protecting


    the constitutional rights of California prisoners”— says the
    prisons are overcrowded, facilitating the spread of disease,
    there is inadequate medical facilities, it is a dangerous
    environment, etc.

    “There is no relief other than a prisoner release order that


    can remedy the constitutionally inadequate medical and
    mental health care,” the panel led by Court of Appeals
    JudgeStephen Reinhardt, wrote.

    No relief? If this was simply about the safety and dignity of


    the inmates, you’d ask the Obamyth for some TARP to “create
    jobs through public works projects” and build, I don’t know,
    100 more prisons.
    If it was about a broken criminal justice system, you wouldn’t
    incarcerate people for, say, marijuana possession, no matter
    how many times they “offend.” If the sociobiologists think it
    really needs to be criminalized, then make the punishment be a
    fine, or community service.

    If it was about a broken criminal justice system, you wouldn’t


    jail people pre-trial for six months and reschedule the court
    date over and over because it’s busy— with marijuana trials, I
    guess.

    That’s not what it’s about.

    It’s all about “mental health care.” Psychiatry is the new


    parole. What, you think they’re just going to release 50,000
    people with no job, prospects, or particular motivation into the
    wilds of California? They’ll get sent to psychiatry: some will
    go to outpatient; some will go to state hospitals; many of them
    will go on disability.

    Which is fine for some, maybe they need it. And sure, it’s
    better than prison, drinking lava is better than prison. But let’s
    not pretend this is about overcrowding.

    This is simply a re-characterization of a social problem as


    psychiatric. Society is faced with two choices: either there are
    a lot of bad people in the world, or there are a lot of sick
    people in the world. Society doesn’t really know how to solve
    either problem, but at least the latter is neither its fault, nor its
    problem.

    Reclassifying a criminal problem as psychiatric lets you do


    three things: lower your expectations that criminals will
    change (“biological diathesis, we still don’t have great
    treatments”); enjoy civilized society without having to wonder
    why it might be generating more bad guys, not less; not worry
    about all that tiresome speedy trial/ court appointed lawyer/
    due process nonsense, because in psychiatry, there is no due
    process, just utilization review.
    Congress Has Its Say, And It
    Says, “Hey, Did You Cashew
    Shells Loan Out All The
    Money We Told You Not To
    Dare Lose Any Of?”
    February 12, 2009

    If I told you you were allowed to spend $1.5 trillion dollars to


    fix the planet, would you then go take an 8 month nap?

    In the House hearings/whippings of the CEOs of the banking


    industry, Rep. Gary Ackerman (D, NY) rises to the occasion.

    A gourmand of self-righteousness, he says he hears from the


    CEOs that the banks are lending: “we listen to you and we
    hear words, words, words and no answers. It seems to me and
    some of us that this money hasn’t reached the street - that
    you’re not loaning it out.” What did you do with all the
    money? Jamie Dimon, CEO of JP Morgan, tries to give him a
    primer on banking and mortgages, but he doesn’t want to hear
    it, he wants to pretend he’s Law and Order, interrupting with
    the pointed questions. “Can you tell us what you did with $25
    billion [of TARP money JP Morgan recieved]?”
    And to further display his ignorance, he adds, “not what you
    did with all your other money, just that $25 billion.” As if the
    money is separated somewhere. His and hers bank accounts.

    Then he asks, “Why can’t people get mortgages?” That’s it. He


    means of course, why aren’t you out there giving people
    mortgages? What, to anyone who needs one?

    Dimon: We did $35 billion in mortgage originations [in 2008].


    Ackerman: What did you do the year before?
    Dimon: Approximately the same.
    Ackerman: So with $25 billion more, you gave out the same
    amount? There’s no increase.
    Dimon (while having a stroke): But…
    Ackerman: If you did $35 billion last time, you did $35 billion
    this time, we gave you $25 billion more to do it, nothing went
    out then.

    They must not have holes in New York. The reason they got
    $25 billion is because without it, they would have lent out
    zero.

    Of course they are hoarding the cash, tightening lending


    standards. They want to stay solvent. Or would you prefer they
    take TARP money and then go bankrupt? Are bank deposits
    up?

    Businesses want lines of credit, but what if they can’t pay it


    back? Hell, what if they actually tap their line of credit—
    that’s money the bank no longer has that it needs to keep up
    adequate capital ratios. They don’t want to lend, they want to
    hunker down and ride out the recession. Does Ackerman want
    them to lower the standards, lend to everyone who needs it—
    with the taxpayer money?

    Some of these banks are completely insolvent, no amount of


    money will get them to increase lending, the hole is too big
    and it happens to be on top of an even bigger hole.

    II.
    But all this is beside the real point, which is this: You might
    know how banks operate, that $25 billion in TARP is not
    automatically lent out, but he is supposed to know. That’s why
    he’s there. No one expects him to have been a finance expert
    before all this started, but he is supposed to be a finance expert
    now, that’s his job. But he didn’t bother, he didn’t think he
    needed to, he has his crazy paradigm that he’s sticking with,
    wrong or not. It’s like a doctor who chooses not to learn about
    a new medication because “I’m comfortable with what I
    already know.”

    He authorized $800b, gave out $300b, and never once


    investigated how money gets used.

    Worse than ignorance is that what he and Congress want are


    entirely contradictory things: on the one hand give out loans to
    prop up the economy; on the other hand, stay solvent and
    don’t lose the taxpayer money we’re giving you to loan out to
    everyone; on the other hand, you jerks loaned out too much
    money.

    Another Congressman actually looked at these CEOs, and


    said, “I don’t have much personal experience with bankers, so
    I rely on my impression of the old, conservative banker, like
    Jimmy Stewart.” That’s how he imagines the banking system
    operates. Fine, now that you know it doesn’t work that way,
    could you at least go look up on Wikipedia how it does work?
    Before you say we need more bankers like George Bailey,
    remember that he almost committed suide, and what saved
    him wasn’t a sense of duty to his family or a desire to atone
    for his life’s mistakes, but an angel. Maybe an angel will buy
    up toxic CDOs?

    That these men can be in Congress so long yet still be so


    ignorant not just of basic finance but of current events-… can
    anyone expect Congress to do the right thing, even assuming
    noble intentions, given that they do not understand what is
    happening and do not not feel any obligation to find out? But
    they don’t need to know all that new-fangled finance. They’re
    like Mike Birbiglia’s mother: “I’ll fax this to you, but you’ll
    have to fax it back when you’re done, it’s my only copy.”

    III.

    One more thing: would everyone please stop saying the we,
    the taxpayers, are on the hook for all this money? We’re not.
    Have your taxes gone up to cover all this spending? It’s no
    different than before, we want something for nothing, we want
    the lifestyle we deserve, not what we can afford. Our time
    horizon for anything is our lifespan or less, never about the
    next generation. “They’ll have to find their own way.” How?
    You’re not leaving anything behind. I have not met one person
    ever who was thinking in terms of saving enough to leave their
    kids something, anything, some legacy. People barely think in
    terms of retirement, let alone dynasty. Which is how we all got
    into this mess, and why we will not get out for another half-
    generation.
    Judges Accused Of
    Supporting Social Change As
    Per Script
    February 12, 2009

    Their main crime was that they got paid for it.
    The story:

    For years, the juvenile court system in Wilkes-Barre


    operated like a conveyor belt: Youngsters were brought
    before judges without a lawyer, given hearings that lasted
    only a minute or two, and then sent off to juvenile prison
    for months for minor offenses.

    The explanation, prosecutors say, was corruption on the


    bench.

    That’s one possible explanation, the other is that this is the


    way courts run nowadays.

    The short version is two judges are alleged to have received


    kickbacks from the private juvenile justice center for every kid
    they sent there; so they sent a lot of kids, for a lot of time. The
    center can bill $260/day.

    Leave aside whether the judges are guilty or innocent.


    Observe, however, why it was that the scheme worked. It
    worked because of the criminal justice system has been
    offloaded to psychiatry.

    I don’t know this particular facility, but I do know what a


    “juvenile detention center” is: it’s a place you go and wait until
    your court date, assuming you can’t make bail. So these kids
    were waiting in this facility, for however long the judge cared
    to make them wait.

    How can you do this? What about due process?

    You simply say they’re not competent to stand trial.

    There may have been some “prison” like housing as well, i.e.
    post-trial sentencing to be in that facility, but all of the above
    apply: it could be justified because it wasn’t just punitive,
    there was “treatment.” (If there actually was.)

    There was an older county juvenile jail, but it was shut down
    because it was “falling apart” but, more importantly, because it
    didn’t provide modern “services.” You can’t lock kids up for
    months for nothing; you have to provide them with treatment
    for their illness— obviously, that’s why they committed a
    crime in the first place.

    Note well that this scam was detected not because someone
    noticed large numbers of kids were disappearing into the black
    hole of the juvenile justice system, but because the owner of
    the prison was using company money to buy jets, boats, etc.

    As I said before: the only red flag of impropriety for anyone,


    anymore, is money. As long as you don’t get paid for it, you
    can pretty much go Zodiac, and no one will notice.
    MMR Vaccine Finally
    Cleared Of Assault
    February 13, 2009

    Listen carefully, medicos. It’s the sound of your approaching


    irrelevance.

    “Officials Say ‘Bad Science’ Links Vaccines, Autism”

    Officials with the U.S. Court of Claims said they


    sympathized with the families, but there was little if any
    evidence to support claims of a vaccine-autism link.

    The evidence “is weak, contradictory and unpersuasive,”


    concluded Special Master Denise Vowell. “Sadly, the
    petitioners in this litigation have been the victims of bad
    science conducted to support litigation rather than to
    advance medical and scientific understanding” of autism.

    etc. Now that this is behind us, it’s okay to ask why it took a
    court to examine the evidence for the link, even when the
    evidence was known to be fabricated. At what point in a
    civilization’s demise are the doctors so uninterested in their
    own work that they turn to lawyers to tell them what’s what?
    “But the doctors already knew, it was the public.” Oh, ok, I’ll
    rephrase: at what point in a civilization’s demise are doctors so
    uninterested in their work of informing the public of what is
    healthy and what is not, that they leave it to lawyers to decide
    and journalists to disseminate?

    Lawyers for the families said they were disappointed.

    No doubt.
    “I must decide this case not on sentiment but by
    analyzing the evidence,” said Special Master George
    Hastings Jr.

    “Unfortunately, the [parents of the autistic child who


    blame the vaccine] have been misled by physicians who
    are guilty, in my view, of gross medical misjudgment,”
    Hastings concluded.

    Wait, what? Decide not on sentiment? You mean you can


    make reasoned judgments without knowing who got paid how
    much? You mean doctors can make serious conceptual errors
    that aren’t the result of financial influence?
    The hell you say, sir. The hell you say.
    The Boy Who Cried Wolf
    February 13, 2009

    2600 years ago a fable was written, read by generations,


    understood by none.

    The boy cried, Wolf! and the villagers came, but there
    was no wolf. And the boy laughed, amused with himself
    and by their gullibility. He did it a second time with the
    same results; and a third time, each time to him more
    amusing.

    But the next time was not a joke, a wolf indeed came, and
    killed most of the flock, and almost killed him. Wolf!
    Wolf! But no one came, of course. It was too many times.

    Even when a liar tells the truth, they are never believed.

    II.

    The winter came, and the villagers were cold and hungry, and
    many died, for there were no sheep. An old man from another
    village shook his head: why was such an important aspect of
    their survival trusted to a boy? How much did you expect from
    a child?

    He seemed really mature, observed one man. And we’re really


    just children ourselves. We didn’t notice much of a difference.

    Why continue to leave him in place after the first lie? Or the
    second? Clearly he doesn’t take the job seriously. If you no
    longer trusted his call, why did you leave him there? “But we
    were busy with other things.”
    Perhaps you knew wolves were coming, inevitably; there was
    no stopping them. And rather than try and fail, you didn’t want
    to be the one blamed.

    Or perhaps you expected that because he lied about the wolf,


    that there was no such thing as wolves. Not: he lied because
    there are no wolves. Since he lied, therefore there are no
    wolves.

    Other than the solitary boy you left in the field to do a job you
    didn’t trust him to do, what other warning signals were you
    expecting?

    The boy grew up, resentful at the villagers’ resentment


    towards him, what did he do wrong? He called them and they
    did not come. They told him they would. They lied. And like
    the children they are, they took no responsibility— they tried
    to blame him.

    The adults in the village failed, the blame is theirs entirely.


    Wolves exist, you don’t throw a boy to the wolves. And when
    you send a boy to do a man’s job but still treat him like a boy,
    then the problem isn’t the boy, the problem is you.
    The Bubble In Academic
    Research
    February 16, 2009

    And history is quite clear on this: once a bubble pops, it never


    reflates. From Science:

    A controversial policy requiring researchers to make their


    papers freely available to the public at a U.S. National
    Institutes of Health (NIH) Web site is facing a potential
    roadblock. Last week, members of a powerful House
    committee held the first-ever congressional hearing on
    the policy and floated a proposal to overturn it.

    Breathe. Think about this. NIH sponsored research was


    supposed to be freely available in an open access format
    (PubMed Central), under the intricate logic that if taxpayers
    funded it, they should be able to read it. But

    Law professor Ralph Oman of George Washington


    University in Washington, D.C., argued that NIH‘s policy
    is a “dilution of the rights of the copyright owners” and
    “will destroy the commercial market” for science and
    technology journals.

    Well, duh. That’s obvious, and by obvious I mean, of course, a


    red herring.

    Don’t make the mistake of thinking this has anything to do


    with maintaining a journal’s revenue stream. They certainly
    didn’t complain when Pharma sponsored studies had to have
    their data open access. So why would they care about NIH
    open access?
    Apparently, it costs a journal $4000 per article to publish it, at
    50% gross margins. I have no idea where that money goes—
    the authors get nothing for writing the article, and peer
    reviewers get nothing for reading them— but that’s enough
    reason to destroy this unnecessary system.

    The mistake is thinking that open access is a threat to a


    journal. The trickis: subscriptions are paid by big buyers (e.g.
    universities), and they don’t get to choose what they are
    subscribing to. You buy the Elsevier Package, and you get
    whatever crap journals they happen to be offering. Say you
    want only American Journal of Obstetrics and Gynecology-
    $600/year. Too bad— it’s coupled to Brain Research, at
    $23,000/year. I defy anyone to disagree that there has never
    been, and never will be, a finding in Brain Research worth
    $23,000.

    Universities will pay whatever it costs to get the crap journals


    in which their NIH sponsored research is published, even if
    they also have to buy the other crap journals.

    Open access articles isn’t nearly as big a threat to publishers as


    simply unbundling the journals from each other, letting
    universities decide which ones to buy.

    So open access doesn’t threaten subscription revenues, it


    threatens the number of journals they can publish. It’s the
    multitude of journals, each with its inflated subscription rate,
    that brings in the real money. Also, each crap journal carries
    advertisements; even a crap journal with a small niche can
    have higher ad rates because of the bundling.

    Elsevier alone made $3B in revenue last year. That’s a lot of


    business to be at risk, by science.

    II.

    But wait: this is a bill blocking the block the open access
    policy of the NIH that was put in place last year. Why weren’t
    researchers putting their stuff up on the internet before that,
    anyway? Just for fun?

    Why didn’t each lab simply create a website and reprint


    everything? It would take no work— I assume they didn’t
    write out their findings longhand with a quill. It is technically
    a violation of copyright, but have you ever heard of a journal
    coming after the author of a paper for violating copyright? Me
    neither.

    The answer is that a lot of the payoff of research is the


    publication itself. Where it gets published often matters much
    more to the researcher than what was actually discovered.
    Research is often conducted with a journal in mind and
    “what’s hot” in a field– as decided by the members of the
    editorial board of the journal, who decide based on their
    particular interests (read: funding streams and prejudices.)
    BTW, these are often the same guys who are grant reviewers.
    This almost completely drives decisions “on the ground” on
    what to study and what not to study. (Or did science
    sufficiently crack the mysteries of lithium to warrant a
    complete move to Depakote?)

    Would anything in AJP be worth reading if it wasn’t actually


    in AJP?

    If you think about it, the entire past 15 years in psychiatry


    have produced no discoveries at all. None. We have different
    medicines, okay; but they’re not better, just different. We don’t
    have a better handle on the anatomic or genetic or anything
    causes of anything— we’re not even any further along in
    defining our terms. Thousands of articles rehashing the same
    old ground have kept thousands of academics employed, to no
    benefit whatsoever for mankind.

    Take away the journals and the system collapses. Force


    researchers with NIH grants to publish their findings without
    the marketing and packaging of a journal, and you’ve
    effectively halted half of the NIH research, until another
    generation of researchers with a different research model show
    up for work. For sure, unquestionably, you’ve killed off
    psychiatry as it functions today.

    The academic research system is flawed because it does not


    incentivize research, it incentivizes the process of research.

    Academic research is a bubble, money keeps flowing into it as


    long as it produces quality research. Who decides quality?
    Journals are the rating agencies, Moody’s, they keep it
    sustainable by giving it AAA rating. The ratings agencies are
    precisely what keeps the bubble inflated, just like with the
    mortgages, they are what keeps research money pouring into
    the system.

    If someone could look behind the ratings, and take measure of


    the actual value of the research, the bubble would pop faster
    than, well, you get the idea. Then there’s the “systemic risk.”
    Journals collapse, academic centers collapse from lack of
    funding, Pharma loses the AAA rating on their studies which
    are done by academics, published in journals, etc.

    Research would be forced to change completely— and for the


    better. But you’ll have a decade or so recession in science and
    education while the old generation dies out and the new one
    becomes old enough to start work.
    Platinum vs. Gold
    February 17, 2009

    God is telling you something

    You wait a couple months, then you gonna see


    You’ll never find nobody better than me

    In the night I hear them talk- the coldest story ever told
    somewhere far along this road he lost his soul
    To a woman so heartless

    That woman is credit, her power is flattery…


    Guess What Isn’t The Cause
    Of Physician Suicide
    February 18, 2009

    Don’t worry, the word narcissism does not appear in this post.
    A review article in Psychiatry finds that the suicide rate
    among physicians is higher than the general population.
    What’s interesting about the article is what they don’t find.

    What they do find is that the male rate is lower than the
    general population, but the female physician rate is not only
    higher than the general population, it is even than the male
    rate.

    Why? Cultural bias might suggest women would be happy to


    have advanced to the level of doctors; though that same bias,
    read the other way, might suggest that the unrealistic
    expectations of how awesome it is to be a doctor meeting the
    reality might drive them to suicide. Speculation, your Honor.

    The article then explored causes for physician suicide, and this
    is where it got interesting. The article cites a number of
    reasons: role conflicts, career dissatisfaction, personality
    stylings, morale— all the possibilities even a layman might
    suggest.

    But these aren’t laymen, they’re psychiatrists. What the


    psychiatrists do not point to as a cause is psychiatric illness.

    In any study about suicide, psychiatric illness, depression,


    bipolar, etc, is the main cause, if not the only cause, cited.
    Axis I pathology is the framework for interpreting the rates, as
    well as deciding what to do about it. Not “life got him
    depressed,” but “he had depression.” Not “lifestyle
    modifications, religion, family” but “there are a number of
    treatments available.”

    But in this article, only one paragraph is given to Axis I


    disorders.

    As an example of the prevalence of depression among


    physicians, according to a 2006 survey by the American
    College of Physician Executives, over two-thirds of
    responding physicians reported burn-out and nearly a
    third acknowledged current depression.

    Biologic predisposition need not be involved.

    The only Axis I pathology noted with any assuredness is


    alcohol abuse, but not as an independent diathesis for abuse,
    but as an outward expression of the distress.

    As with suicide in the general population, in addition to


    depression, alcohol and substance abuse are common
    factors associated with physician suicides.[16,23]
    Alcohol and/or substance usage affect anywhere from 20
    to 40 percent of physician suicide completers.

    The article cites the ten (1) studies on this topic published
    since 1973. None of them cite psychiatric illness as the major
    cause; social explanations figure more prominently than
    biologic ones.

    Indeed, even the title of this study belittles a psychiatric or


    endogenous cause: “Physician Suicide: A Fleeting Moment of
    Despair.”

    II.

    I don’t disagree with their analysis, but it’s funny/scary to see


    the very people who are biased towards the organic model
    basically disavow the link when it applies to themselves.

    Given the current climate of healthcare and the seemingly


    unending stressors in the practice of medicine, we
    physicians must be mindful of ourselves and our
    colleagues. We need to be sensitive to psychological
    distress in ourselves and others and be willing to obtain
    and offer support when needed.

    But what about an SSRI? The need for an adjunctive “mood


    stabilization from below?”

    In many cases, the suicidal impulse is a temporary


    phenomenon—one that will pass. We must be on guard
    not to lose ourselves or talented colleagues in a fleeting
    moment of despair.

    When was the last time you heard a psychiatrist suggest that
    suicidality was temporary or transient? Why assume our
    colleagues are talented?

    It appears to this blogger that when psychiatry has little direct


    information about the social factors impacting a group’s lives
    — for example, college students in China— psychiatric
    explanations are held as paramount. When they are intimately
    familiar with the group, they lose perspective.

    This is, essentially, the fundamental attribution error. We


    interpret the behavior of other people as the result of
    something about them (jerk, meanie, idiot), but we’d interpret
    the exact same behavior of ourselves as the result of
    circumstance.

    Psychiatrists are assuming doctors attempt suicide in reaction


    to situations; but assume that others that they don’t really know
    attempt suicide as a result of something about them.

    The key is the italicized part; the more you know of a person,
    the more likely you are to blame circumstance. The less you
    know of a person, the more likely you are to blame them. The
    question is which of those two is the error— not knowing
    enough about another’s circumstance, or not being able to step
    back and see ourselves from the outside, for who we are?

    There’s a term for the latter, but I cannot remember what it is.

    ––––––

    1. Three examples of the cited studies:

    Petersen’s study (2008) of 1984 through 1992 from 26 states,


    and looking only at whites, finding 181 male and 22 female
    doctors/dentists who suicided, the word “depression” does not
    even appear at all. Neither does Axis, etc.

    Scherhammer’s study of rates (2004): “depression” appears


    only twice.

    Aasland’s study (2001) found that being married is protective;


    but summarily dismissed the link to psychopathology with that
    depression and drug abuse are the most common psychiatric
    illnesses found in doctors, but that most people who are able to
    become doctors probably don’t have serious psychopathology.
    Ok— so suicide isn’t a marker for psychopathology?

    In Hem’s study (2005) only three sentences are given to the


    possibility of a psychiatric illness; and then it is explicitly
    minimized: “However, there may be specific reasons [why
    doctors commit suicide.]” The study cites over a dozen: stress,
    long hours, access to lethal medications, etc.

    More than 60 different risk factors for suicide have been


    described. Thus, suicide is a multi-determined event, and
    the search for a single explanatory factor is too simplistic.
    The Biggest Dick Ever
    February 19, 2009

    A true story about what happens when words lose their


    meaning.
    I’m in the gym, there are only two other people: Devastator,
    and The Kid. Devastator is black. You might guess why that
    will soon be relevant.

    Out of the corner of my eye, I see The Kid is stalking me,


    looking to talk to me, to anyone. I see this everywhere, people
    like a bomb on a hair trigger, the slightest contact explodes a
    full attempt at connection. I sympathize with women on this,
    they have it particularly bad. If they even let on that they are
    aware the guy is in the room, he takes it as a strong invitation
    to come over and talk about himself. They’re everywhere,
    bookstore stalkers and coffeehouse predators, empty, hollow,
    looking for something to fill them up, that something is almost
    always a woman. At 24 it’s sad but normal, at 34 it’s sad but
    dangerous.

    So there he is, weaving and hovering, looking for an in with


    me. I don’t like people, I don’t like being approached by
    people and truthfully I look like someone you’d never
    approach without air cover. I look like a mugshot, I look like I
    relapsed a week ago, when I walk past a church unseen dogs
    bark at me and when I walk into a store they call Homeland
    Security. Yet still, everywhere I go, strangers cross freeways or
    walk through glass to get to me, for what? To inform me that
    Karl Rove wants to destroy welfare or all these bitches care
    about is money or “oh my God, you look just like my ex-
    boyfriend’s Dad!” Broken people have a 6th sense for other
    broken people, I guess.

    I finish what I’m doing, which is nothing, and he pounces.


    “That guy…”
    “What guy?” I say it to make sure that the only guy he could
    be asking about is not standing behind me.

    “The big guy. The big…big guy.” So much for new post-
    election open dialogue about race. “He was huge—”

    “Oh, yeah?”

    He puts his hands out, palms facing each other, and uses it to
    italicize each word. “Biggest dick ever.”

    “Oh,” I say.

    “Huge. The biggest dick ever.”

    So now I have half an instant to decide whether this guy made


    an assessment of Devastator’s character based on some
    personal experience; or whether he is falling back on
    stereotypes about narcissistic weightlifters and is asking me to
    bond with him over a shared worldview? Or is he going with a
    racist perspective?—

    Or, did the The Kid see Devastator in the locker room and is
    now compelled as an instrument of natural selection to tell me
    that he has the biggest dick ever? And if so, then I’d have to
    figure whether The Kid has not seen many dicks and is just
    mystified that dicks can get so big, or if he isn’t in fact gay—
    or thinks I’m gay— and this is the best he could come up with
    as an opening line? Or is he so charged by the guy’s overall
    size that he is imagining that because he’s huge and black that
    he must have a gigantic penis?

    So I don’t know which one he means. Whichever I guess only


    indicates my own prejudices about guys, black guys, and
    dicks. No matter what I guess, if it’s wrong he’s going to think
    I’m a dick.

    Big dick. Why is dick a preferred insult? I get what pussy


    means, and at least asshole is anatomically logical, but calling
    a guy his most precious organ— what? A girl calls you a dick
    when you’re overly sexually aggressive, ok, I’m copilot, but
    what do you say when a guy calls you a dick? “You don’t
    know the half of it!”

    He spares me. “All I did was ask him how long he’d been
    training, you know, to get that big, and he blows me off!
    ‘Don’t talk to me, not when I’m lifting.’ “

    “Don’t take it personally,” I say, “some of these powerlifter


    guys are overly focused. I don’t know that guy, but I know
    what you’re talking about, I know the mentality.” Then, to
    discharge the anxiety he’s feeling about it all, I smile at him
    and joke, “now get away from me, I’m lifting.”

    He laughs, but I instantly regret saying it. Now he probably


    thinks I’m a big dick. Which is good or bad for me depending
    on who he tells next.

    II.

    Twenty minutes later I am in the locker room, and it happens:


    Devastator comes towards me. Completely naked.

    “Big dick, huh?”

    He stops inches from me. “Big dick?” He’s pissed off, and I
    realize immediately the Kid was right all around. I’ve only
    ever been assaulted with one other gigantic penis in my life,
    when I worked at the VA and a schizophrenic on the
    cardiology unit came at us firing in semi-automatic mode.
    How that nut got hold of a Do Not Resuscitate form I’ll never
    know, how he got hold of a stapler is less of a mystery, but he
    was walking and ejaculating and stapling the form to his bare
    chest, “I’m DNR-C, I’m DNR-C!”

    So now I’m back at the same question with different


    assumptions, is he angry because we talked about him being a
    dick or talked about his dick? Surely both have happened to
    him before. Is he a narcissist or a homophobe?
    I guess the former. I take my right hand and rub my left ear, I
    do this to get it up in case something happens.

    Something happens. He suddenly slams into my chest, pushing


    me back, I’m already against the lockers so there isn’t much
    room for me to go but I hit it hard. The wind gets knocked out
    of me. Oh, great, I think, I’m back in 9th grade. I hammer my
    fist into the side of his head above his ear.

    To my amazement, he drops to the floor, out cold.

    Now what, I think.

    III.

    There are soon/instantly six other people in the locker room,


    tending to and restraining Devastator, and through a process of
    semi-apologies, semi-praise for my strength, semi-
    acknowledgment of his prior neck injury and current self-
    respect, everyone agrees that everything is cool. We shake
    hands, he pulls me in for a hug. He is still naked. Everyone
    grabs their clothes. Two trainers and I head out.

    When we are well out of the locker room, one of the trainers
    glances behind and snickers. “What a dick,” he says.
    Chicago Tea Party
    February 19, 2009

    It makes a lot of Americans insane that Wall Street execs are


    paying themselves gazillions in bonuses, even as they
    demolish their own firms and the financial system. They
    blame Wall Street for the financial crisis.

    Then there are others who have a different explanation.

    Rick Santelli, former bond trader and now CNBC reporter.


    The highlight is 0:59-1:20.

    (Link to video here)

    It’s worth hearing for yourself, but here’s the punchline: “ask
    anyone here if they want to pay for the mortgage of their
    neighbor with the extra bath, who can’t afford the house.”
    Let’s leave aside whether he is right or wrong. I sympathize
    with his perspective, though it’s evident he thinks America is
    stronger than I think it is, he thinks it could recover without
    any government aid, he thinks people will just buckle down
    and ride it out like they did the last Depression. I disagree, I
    think they get guns.
    Let’s leave that aside. What you need to observe is that his
    sentiment, shared by millions and millions of people, has the
    same fervor and anger as the “put the Wall Street bastards in
    jail” camp. You just don’t hear about it very much.
    Note also that he isn’t angry at the government only, he’s
    angry at other Americans. While there are millions of people
    who think their government and capitalism have failed them,
    he’s speaking for the millions who think those people are the
    problem.
    These are personal attacks about American against American,
    this is a new level of divisiveness.
    Santelli knows enough about the stimulus package to criticize
    it on its merits, but what infuriates him is its symbolic
    meaning, a la Atlas Shrugged, that he’s responsible to pay for
    his fellow Americans simply because he has the money.
    On the other side, today you have South Carolina
    Representative James Clyburn saying that opposition to the
    stimulus package is a “slap in the face of African-Americans.”
    What he doesn’t realize is that saying it that way doesn’t make
    people support the stimulus, it makes people resent African-
    Americans.
    Maybe the best thing Obama could do is move as far to the left
    as possible. He will never be centrist enough, and certainly not
    rightward enough, to satisfy the Right. And he’ll meanwhile
    infuriate the Obamaniacs who won’t be able to recall if they
    were voting for Hope or Change.
    Who knows.
    But a prudent person will be less concerned with picking a
    side, and more concerned that sides are being picked.
    Class warfare is back in earnest.

    He calls for a Chicago Tea Party (he and the CBOE are in
    Chicago.) Before you jump with him or on him, a history
    lesson: the Boston Tea Party wasn’t a protest about the British
    raising taxes on tea; they were protesting the reduction of the
    tax on tea, which meant the East India Company tea was even
    cheaper than the smuggled tea provided by wealthy colonists.

    The British were using a low tax to seduce the colonists.


    Would colonists accept British rule— the right to set taxes— if
    it got them cheaper tea? Samuel Adams hadn’t read the Grand
    Inquisitor but he heard about it. They dumped the tea before
    anyone had a chance to say the words that destroy
    civilizations: please take away our freedom, it’s a small price
    to pay.
    Why No Progress Will Ever
    Be Made In Psychiatry
    February 23, 2009

    Do the past 50 years, post psychoanalysis, seem like marking


    time in psychiatry? A series of equally efficacious or toxic
    treatments being substituted for older versions that are
    ultimately not any different, all the while hearing the heralds
    proclaim the incredible advancements in “brain” diseases?
    Genetics, serotonin, BDNF!

    If it seems like countless billions in research money have not


    changed psychiatry at all over decades, it’s because they
    haven’t.

    The first question a fertility doctor asks when she can’t get
    pregnant: are you guys having sex?
    In an editorial in Primary Psychiatry, Dr. Sussman writes,

    I am constantly looking for sources of easily accessed


    information that may be relevant to clinical decision
    making, teaching, and writing…

    However, just last week I was pleasantly surprised when


    my colleague at the New York University School of
    Medicine, David L. Ginsberg, MD, alerted me to a
    Website I had never visited

    The site he had never previously visited turns out to be


    MedlinePlus. Let’s leave that aside.

    That it took a Vice Chair for Clinical Affairs to tell another


    Vice Chair about the existence of this website, leave that aside.
    That Dr. Sussman’s very first positive comment about
    MedlinePlus is:

    There is no advertising on this Website.

    which I assume is meant to indicate it is free of bias, even as


    the very journal in which he writes and is editor has
    advertisements that I guess are less threatening than those on
    websites, leave that aside.

    What he wants to do is stay current, as in this example:

    My search directed me to a very helpful article2 from a


    neurology journal that I would not otherwise run across. I
    read the following…

    That what he goes on to quote is actually from a consensus


    paper— in other words, a secondary source, someone else
    reviewing the data— leave that aside as well.

    No, wait, hold on: I understand the complexities of medical


    practice, and that up to the minute investigation of the primary
    sources is nearly impossible. But you must agree that the
    general public actually assumes we are incessantly
    investigating primary sources all the time, the same way they
    assume football players work out. If they knew that when we
    prescribed a medication we were not actually using the latest
    information, not even listening to a drug rep who has current
    information, but, well, winging it based on what we once
    thought we knew— they’d be beyond horrified.

    So to be surprised at a review paper must mean he was even


    more unaware of the primary sources that it reviewed. That’s
    not a problem unique to him, unfortunately, and if the public
    found out that doctors only half heard about reviews that were
    published a year ago… leave that aside.
    Let’s leave all that aside, res ipsa loquitur.

    II.

    “The finding of worse anatomic and neurodevelopmental


    outcomes following fetal valproate exposure in multiple
    studies suggests that it poses a special risk. Thus, it seems
    prudent not to use valproate as a first choice antiepileptic
    drug in women of childbearing age. When valproate is
    employed in women of childbearing potential, dosage
    should be kept as low as possible since its effect appears
    to be dose dependent…”

    This is the section in the neurology review he found so


    interesting. Admittedly, to the average psychiatrist, it is
    interesting. Despite awareness that valproate (Depakote) has
    significant teratogenic effects, the debate has been whether to
    stop it when she’s pregnant, not whether to use it first line with
    any woman of childbearing potential.

    In fact, the basic argument over the past ten years has been
    this: it’s first line for every bipolar, men and women, at any
    age. Even kids. And since the teratogenic effects happen in the
    first few weeks, by the time she discovers she’s pregnant it’s
    probably too late anyway, keep using it.

    So for a neurology journal to suggest valproate shouldn’t even


    be first line for epilepsy, let alone bipolar, I can see why he’d
    find it interesting. Fine. Do you know what he says next about
    this passage, these recommendations? Nothing.

    As if this was completely self-evident, no controversy at all.


    He doesn’t say, “hmm, we’ve been doing it differently for ten
    years, were we wrong?”

    This would be George Bush commenting in his autobiography


    that the American troops were not given biohazard suits as
    they were not expected to confront any bio-weapons. Oh,
    okay.

    There’s no advancement in psychiatry because there’s no real


    feeling of the validity of what came before. Medicine is
    fashion. No one would say, “we were wrong about Depakote
    in 2001” anymore than one would say “we were wrong about
    pantyhose in 1980” (NB: I said both.) What they say is, “that’s
    what we did then.” No apology necessary.

    The science part of psychiatry— serotonin, kindling, relapse


    rates— is only an excuse for marketing; it gives us today’s
    soundbites. Later we’ll say something else using the same
    science, like we make new fashions using the same materials.
    No one finds this disturbing.

    The reason no progress will ever be made is because no one is


    contributing to the advancement of science, or medicine,
    they’re contributing to their own careers. Not selfishly or
    meanly, just myopically. They’re masturbating. I don’t use that
    word flippantly, either. It is going over the same old ground,
    over and over, until a climax— then it is done and you move
    on as if it never happened. Then it’s the next time, and though
    the technique is mostly the same, the content of the fantasy
    mostly the same, this time is different, it neither contradicts or
    repeals, nor does it augment or enhance the previous work. It’s
    just different. But let someone today try and tell you you’re
    doing it wrong…

    Arguably, there should be at least a little shame at the end of it,


    but…
    The Action Movie Fairy Tale
    February 25, 2009

    The woman asks, why won’t my man have sex with me?
    I.

    80s and 90s action movies were often maligned not just for
    their violence, but also for their lack of depth and
    psychological sophistication. “They’re not important.”

    But these movies built a generation of men who are now in


    their 30s and 40s.

    They didn’t learn that killing is cool, which was the worry of
    people who didn’t watch those movies and didn’t understand.
    This violence was central to the cinematic experience, but
    incidental to the story.

    The complainers ignored the story because they thought it was


    basic, trivial. Wrong. Write down the plot synopsis of every
    action movie, and awareness will come over you:

    A marginal guy must save a hot chick from bad guys; when he
    does, he gets the girl

    II.

    A generation of adolescent boys learned immediately three


    things:

    1. marginal guys are the real heroes.


    2. heroes never die.
    3. bad guys exist as bad guys, not as good guys who went bad,
    or bad guys with some good in them also. Darth Vader was
    unquestionably bad starting in 1977, unimaginable that he was
    once a sweet young boy with good in his heart. That story had
    to wait a whole generation to be told.
    4. in order to get (active verb: to obtain, procure, convince) a
    hot woman to fall passionately in love with you, you have to
    do do some extraordinary things: take out thirty terrorists,
    master kung fu, be in the special forces, etc.

    III.

    Focus on #4. The question for today is, why do men have
    trouble having sex with the women that they are committed
    to? Why does it seem that women have higher sex drives than
    men?

    This is not a complaint I recall hearing in the 1970s or 80s.

    Start with: there’s something eerily adolescent about men


    today.

    The movies say: until you do something extraordinary, or


    “save” the girl, then the love you feel isn’t true love. Women
    may be the ones looking to feel “explosions” inside telling
    them they’re in true love, but men externalize those explosions
    in to real explosions before they know it’s love.

    How did you meet? Was it a good story? Did it involve


    defying the odds or secrecy? You’ll make it. Did you meet in a
    coffeehouse or a bar? Then you’re dating your future ex-
    fiance(e).

    The male libido falls not because he’s not interested in the
    woman he’s with, but because he’s not interested in the movie
    he’s in.

    Women say: you’re wrong, it’s porn, it’s TV and magazines


    and airbrushing and implants and impossible figures…

    Nope. Consider that the serial monogamous relationships of


    these guys are with women who are actually quite attractive.
    Other men want them. If the guy’s friends knew she wanted
    sex more than he did, they’d knife him. And it’s not boredom,
    either— what, is masturbation so exciting?

    For a man in a committed relationship, the porn is a


    distraction, not an ends. They’re not looking at porn to get off,
    they’re avoiding sex. Actual sex is exposure. It reveals that he
    is not the fantasy man he thought he was. He’d be a better
    lover if he was. Ha. And women thought it was that they (the
    women) didn’t measure up to the fantasies. As an aside:
    jealousy is directly proportional to sexual desire in these men.
    That’s not advice, just an observation.

    The men love their girlfriends/wives, and are loved, but there’s
    the feeling that it’s not “real,” she’s not “the one.” Women
    have fantasies about what a relationship is like; men what a
    beginning is like.

    A few points: first, for men, love is tied with a sense of


    accomplishment. They can’t imagine a woman would really
    want them if they weren’t accomplished, so when a woman is
    interested, they think it’s not the real thing. Everything is a
    stepping stone. But accomplishment isn’t what makes him
    “good enough for her.” It’s not even to entice her. It’s not for
    her at all. It’s acquiring the pieces to his identity, like a Star
    Wars collection. Success— check. Money— check. Woman—
    check.

    This man goes through the motions of love: he is present, he


    doesn’t cheat— he doesn’t even have the motivation for that!
    — he is warm, loving, dutiful, respectful—

    but he isn’t there, he is always elsewhere, he has the thousand


    yard stare of someone who is expecting, any moment, his real
    life to come marching through the tree line.

    IV.

    “But then you are saying that the problem for these men isn’t
    sexual attraction or commitment issues, but a psychological
    inability to love another person?”
    What other person? How can you love a person who doesn’t
    actually exist?

    V.

    “I think I’m one of those people, how can I change?”

    You don’t have to change, you look away from the pool.

    VI.

    It’s similar to the complaints about fairy tales and girls: rigid
    gender roles and depictions of false success. And now women
    are waiting for a white knight to sweep them off their feet.

    Well, I don’t know any women who feel this way, they learned
    quickly that those stories are only beginnings— what happens
    next? An example is the movie that wrecked a decade of
    young women in the 80s: 9 1/2 weeks. 20 years later, I still
    have yet to meet one woman who saw it and obtained the
    message, “be careful of charming men, they may seem great in
    the beginning but..” Instead, women connected with it, wanted
    it, they’d describe their own relationship like
    Rourke/Basinger’s, proudly, they sought it out, they’d create
    it. What they wanted about it was the passion, “I wish a man
    were that into me!” What they learned from that movie is that
    in order to have a relationship as passionate as that one, with a
    guy as good looking and successful as him, you have to lose
    part of yourself, do things you don’t really want to do.

    Ah, but she left him at then end. Wrong. He’ll be a part of her
    forever. That’s really what he wanted— do you think he
    wanted to be with her when she turned 60? Do you think she’d
    want him if she were 60? She wants to know she was worth
    that much passion.

    Too many women learned the wrong message, not that they
    should wait for a white knight, but that keeping a white knight
    may involve a heavy cost. And they paid it, with abusive 80s
    and bicurious 90s, whatever it took.
    VII.

    The action movie was not about glorifying violence. It was a


    manual: how to get an identity, how to get people to like you.

    You disagree. Twenty years of media studies and


    postmodernism says I’m wrong, “the action movie is catharsis
    through contradiction: death brings life; bad is good. The
    action movie is says the hero must become antihero, take on
    all the bad, become bad, so that good can be saved and no one
    else has to be bad.”

    Well, reality says I’m right. Ask: what would happen if a man
    saved the hostages by taking out out thirty terrorists in a LA
    skyscraper in real life? He’d end up interviewed on TV, he’d
    get a makeover, and he’d get a million dollar book/TV deal. In
    short, he would be rewarded. The money and the interviews
    mean: you finally see me for who I always knew I was.

    This is a possible explanation for why depression and suicide


    is so high among combat vets today. They fight a battle and
    then— nothing. They only get on TV if they do something
    wrong. “I did all this, and I get nothing?” One of the only 80s
    action movies that didn’t have a damsel in distress was First
    Blood, in which Rambo, who actually was a Green Beret,
    came back to the world only to find that not only did no one
    reward his identity, they hated him for it. But even that was a
    sort of confirmation. You don’t need a girl when enough
    people hate you for who you are.

    VIII.

    The 80s adolescent hits the 90s full force, then 2000, and with
    every passing year it becomes more certain he will not learn
    kung fu or join the special forces. Now what? How is he
    supposed to find true love if he was never in the special
    forces?

    Answer: go find a girl who was in the special forces.


    Just in time for the first midlife crisis, Hollywood has our
    back: Alias, Underworld, Lara Croft, etc. You think we like
    those women because they are sexy? Then why wasn’t Pamela
    Anderson’s Barbed Wire the ultra-popular? Was Jennifer
    Garner a Playmate? It has nothing to do with sex, it is all about
    love. The movies say: my reality is becoming increasingly
    limited by my uncooperative body. It’s probably impossible
    that I can take out thirty terrorists and save the girl. But it’s
    slightly less impossible that I could meet a woman who could
    do it. Phew.

    IX.

    But at some point, a man has to grow up, and this is where it
    gets interesting. At some point you realize the action movie
    isn’t going to happen in real life. You’re going to have to
    confront reality, have to meet a girl and fall in love with her
    for real, and try to be happy, and know that you don’t get to try
    on several different wives to find one you like. Nor do you get
    to keep trying on identities. You’re going to have to face life
    as an accountant or a product manager, and not as a CIA agent,
    or music producer, or pro-ball player— all of which are the
    exact same thing. Then what? Three choices:

    1. alcoholism and depression, especially the subtle variety


    called ennui
    2. accepting reality and finding one’s place
    3. the schizotypal condition

    The one to focus on is #3. What modern middle aged narcissist


    wants is to find a way to put one foot in reality, and keep one
    foot in fantasy. A solution that lets him keep fighting the
    traffic twice a day without blowing his brains out. To have just
    enough hope that one day the fantasies could come true that he
    keeps on going. That a 30 year old man could suddenly know
    kung fu.

    Fortunately, we find ourselves at the tenth anniversary of just


    such a solution.
    Part 2 here.
    Good Game, America
    March 2, 2009

    Way to play D. Let’s get together and do this again next


    generation.
    Impulsivity In Kindergarten
    (Does Not) Predict Future
    Gambling
    March 4, 2009

    Here’s how (not) to read a study.

    Most people read this (Reuters):

    Distracted kindergarteners [sic] become gamblers: study

    or perhaps the actual study:

    Results A 1-unit increase in kindergarten impulsivity


    corresponded to a 25% increase in later self-reported child
    involvement in gambling (SE = .02). This was above and
    beyond potential child- and family-related confounds,
    including parental gambling.

    and ask critically, “well, I wonder how they define


    impulsivity?” or “are there other variables that could explain
    why distractiveness or impulsivity predict gambling?”

    That’s not where the money is: we can confidently assume


    psychiatrists have plenty of measures for impulsivity. The real
    question is whether psychiatrists know anything about
    gambling.

    Typically, people question the causes of pathology; I want to


    know, what are they labeling as pathological nowadays?
    So, I check:

    cards; bingo; bought lottery, instant lottery (scratch and


    win), or sports lottery tickets; played video games for money
    or video poker (eg, at arcades); and placed bets at sports
    venues with friends or on games that require skill (eg,
    billiards, pool, bowling)

    Let’s all agree that this is precisely not at all what anybody
    thinks about when they think about gambling. You might say,
    “well, it still counts!” but it’s hard to say you can predict X
    when everyone thinks X means something different from what
    you do.

    Or another way of saying it: even if the results are accurate,


    why should we care what predicts playing?

    The answer is, we shouldn’t— and neither do the authors.

    II.

    Psychiatrists, by which I mean residents, who actually spend


    any time reading journal articles often despair. They hit
    something like this:

    The equation also controls for child (sex and early


    emotionally distressed behavior) and family (maternal
    education and family dysfunction) factors. Our results bear
    on this fully controlled model: CGBi6GR = a1 + β1 IMPiKE +
    β2 PGi6GR + 1 CHILDiKE + 2 FAMILYiKE + eit, where a and
    e represent the intercept and stochastic error, respectively,
    CGB indicates sixth-grade gambling behavior (6GR), IMP
    indicates kindergarten impulsivity, KE indicates kindergarten
    entry, and PG indicates parental gambling involvement, for
    each individual i.

    and succumb to self-doubt. “I don’t know enough to interpret


    studies, I guess. How am I going to learn this stuff?” But while
    wondering if this study was a good one or not, something
    sneaky happens to them: the premise is absorbed, implicitly.
    They don’t realize they’ve just been infected by a mind virus.
    “It’s so hard to tell if this study really showed what we all
    know to be true….”

    P values and ANOVA are red herrings. The single most


    important question to ask when reading any scientific paper,
    ever, anywhere, is this question only, pay attention: what do
    the authors want to be true?

    Nothing else matters. If you think there’s a scientist


    somewhere publishing a paper that says, “son of a gun, I’ve
    devoted my life to this question and it turns out I’ve been
    wrong all along” you are beyond a crack pipe. Even if the
    research comes up negative, the scientist’s thoughts inevitably
    turns to, “that study was flawed.” The premise is never
    questioned.

    Don’t be fooled: “well, in our lab we looked at the serotonin


    receptor, and it didn’t pan out. So we accepted that we were
    wrong, and changed focus to the dopamine receptor.” Do I
    need to tell you that that is the exact same thing?

    III.

    The mistake is thinking the purpose of the study is the


    outcome of the study. The issue is not problem gambling,
    otherwise we would be limiting it to people with a gambling
    problem. The issue is not trying to predict which child will
    become a gambler. The issue is ADHD:

    “Attention problems are a public health issue,” she said.

    That’s what the study is about. The gambling is just another


    excuse to say ADHD needs treatment.

    IV.
    Once you ask the key question, you’ll know exactly where to
    look for inanities. The Introduction is usually full of them.

    Data suggest that in most cases, youthful recreational


    gambling predates pathological gambling in adulthood.
    (1,2,8,9)

    The authors cite four studies for this premise. Usually, a


    reference means a primary source that has direct data about the
    issue. I know without looking that none of those four
    references are that. I know this not because I know anything
    about gambling or pediatric studies, but because I know that if
    they’re going to count bingo and bowling as gambling, they’re
    not going to be too careful with their references in the
    Introduction. “But it’s stuff everyone already knows.” My
    point exactly.

    NB: I’m not saying they knowingly pick non-supportive


    references. They absolutely think those references are
    supportive. They’re caught in a self-reinforcing groupthink.

    To illustrate my point, I looked up the four references. Only


    reference 9 had direct data on how many adult gamblers
    started as kids. The other three references (1,2,8) were about
    related issues (e.g. psychiatric comorbidities in gambling).
    They simply asserted the child-adult link in their respective
    Introductions. They, too, referenced their assertions: references
    2 and 8 both used the same other reference to support that
    claim— reference 9! Reference 1 and 2 both cited the same
    author, who wrote in two different venues.

    Reference 9 found that 20-30% of adult pathological gamblers


    began “wagering” before age 15, as defined by 10 types of
    gambling, including “stockmarket, sports, and games of skill.”
    Not only is this not really the definition the average person
    uses for gambling, it also isn’t the definition used in this
    kindergarten study.
    V.

    I want to emphasize that studies are never about discovery,


    they are about confirmation. Researchers already know what
    they want to find. This is why I have long argued that financial
    biases in research are trivial, if for no other reason than they
    are obvious. Ideological bias, institutional bias, personal bias
    — these are far more difficult to detect. There’s no disclosure
    for them. They matter much more. If a researcher’s son is on
    Depakote, how will he interpret a study he does that finds
    Depakote doesn’t work? Would it really matter at all whether
    Abbott paid him or not?

    None of this means that research is corrupt, or that it isn’t


    valuable. But it does mean that you can’t accept conclusions as
    written, and the Discussion section is basically an op-ed.

    Nothing wrong with that either, except that everyone thinks


    it’s journalism.
    The Special Circumstance
    Which Causes The Wisdom
    Of Crowds To Fail
    March 5, 2009

    Maybe 300 or so psychiatrists, gathered at the meeting. Why


    the Wisdom Of Crowds works. Now why it doesn’t.

    The audience was shown 8 multiple choice questions as a pre-


    test. Everyone entered their response into their personal
    keypad, and after each question the presenter showed and
    explained the correct response.

    We were also shown the audience’s answers distribution. In


    half of the questions, the majority chose the right answer. In
    the other half, the correct answer was tied for most responses.
    I was a little surprised, thinking that the wisdom of crowds
    would clearly result in the right answer every time. So it goes.

    The presenter then went through his lecture, and then showed
    the same 8 questions.

    Wow. This time the majority never picked the right answer.

    I want you to stop and think about this. We had all seen the
    questions before; we had been told what the right answers
    were; and we were given a presentation on the material. Not
    only did “the wisdom of crowds” fail, it did worse than it had
    initially.

    It did worse than worse. The wrong answers weren’t randomly


    distributed. Each time the majority chose the same wrong
    answer.
    What happened? Say what you want about psychiatrists,
    they’re not retarded. So?

    II.

    Review: the reason the wisdom of crowds works is because


    each person has their own systematic error (bias) that is
    usually different than someone else’s. It doesn’t matter how
    inaccurate your and his responses are, just that they have
    different kinds of systematic errors, which thus cancel each
    other out. By simple analogy: I think it’s small, you think it’s
    big, so our average gets us closer to accurate.

    And now you may get it: the audience abandoned their
    individual systematic biases, and took on the presenter’s. We
    stopped being critical, we stopped operating around our own
    prejudices, and tried to think of what he wanted us to answer.
    We all adopted his systematic bias. He thinks “it’s big,” so we
    all picked “big.”

    III.

    Except: when we willingly abandon our critical thinking to


    follow a leader, we also lose the ability to infer what the leader
    means, as opposed to says. This is the unintended
    consequences of leadership: we collectively misinterpret him
    the same way. There’s no chance for the “wisdom of crowds”
    to work because we’re following someone else; and without
    the benefit of our own critical thought and prejudices, we
    misunderstand him as well. “As you can see, this is very big.”
    Wait, whoa— did he say it’s a pig? He’s right, it is a pig!

    It would be great if people could abandon prejudice in favor of


    reason; but it’s far preferable for them to have their own
    prejudices (born out of context) than to adopt someone else’s
    (born out of TV). And, at least in a democracy, these
    prejudices should balance out.

    Political parties, leaders, influential books or movies— when


    we let them do the thinking for us, when we adopt their
    position, the balancing out never happens. We do worse for
    ourselves. (No, this isn’t a swipe at the President, I’m making
    a general point.)

    IV .

    This would be a sad enough commentary on the limitations of


    societies if this was the end of the story, but it wasn’t. After
    writing this post, two or three glasses into the rum, I had a
    realization: none of those questions really had right answers.
    “What percent of bipolars experience mixed states?” can’t be
    answered without qualification; even using DSM standards on
    Americans only, the answer varies widely. Not to mention
    what’s bipolar today is often depression yesterday and god
    knows what tomorrow.

    So not only had we followed a leader blindly into worse


    performance, but reinforcement from the leader when we got
    questions wrong (“no, no, no, this is the correct answer”)
    means we were blinded to the fact that there weren’t really any
    right answers.

    One man had negated the wisdom of crowds, and also failed to
    teach us anything about nothing.

    Biases and heuristics are part of how we think. We can


    abandon the use of a particular heuristic, but not the use of
    heuristics. My argument about the relative insignificance of
    financial bias in research isn’t that I think that it is actually
    insignificant, but that I am more worried about the bias I
    cannot detect but I know is there.

    Neither are heuristics necessarily bad or even wrong.


    Heuristics don’t prevent us from thinking critically, they are
    actually shortcuts which are supposed to save us from our
    better judgment.

    (from Dave Attell): “if you walk outside right now, and
    there’s a man running naked down the street, cock
    flapping in the wind, you run with that man.”
    Huh? Why?

    “Because there’s some scary shit coming the other way.”


    Biology Is Destiny
    March 9, 2009

    Palm up. Measure your index finger (2D) and ring finger (4D)
    from bottom crease to tip of finger (not nail).

    Question: does life begin at conception? Why, or why not?


    I. Nature:

    The study looked at 49 male futures traders (high velocity,


    high leverage). The mean age was 27, the mean annual income
    about $500k (range -$4000 to $8M.)

    The study found that low 2D/4D ratios (long ring fingers)
    were highly correlated to higher profits; the ratio also
    predicted the ranking of the traders based on of profits.

    2. Nurture:

    Chronological age was not a factor in profits, though years of


    experience was.

    So “nurture”— years of experience— and “nature”— the


    prenatal testosterone exposure, which causes long ring fingers
    — both affect performance.

    The study found that experience boosts profits by 9 times over


    inexperience; low 2D/4D (long ring fingers) ratios boost it 11
    times over high 2D/4D ratios.
    Having lots of experience only barely made up for having a
    higher finger ratio (short ring finger).

    The same authors had done a prior study with traders, and
    found that levels of morning testosterone (which fluctuates
    both intraday and interday) predicted that day’s profits; the
    higher the am testosterone, the higher the profits for that day.

    Taken together, some people may have a biologic advantage to


    making money in futures trading; this biologic advantage may
    be greater than having experience.

    II.

    Other studies have found relationships of 2D/4D ratios to


    everything from homosexuality to osteoarthritis.

    I don’t know why the 2D/4D ratio (intrauterine testosterone


    exposure) have an effect on such things. What interested me
    about the paper was this:

    The financial markets are made up of many sectors and


    types of trading, and each of these may select for
    different biological traits. But if markets select traders on
    the basis of their profitability and their occupational
    preferences (36), then low-2D:4D traders will continue
    to influence asset prices and equilibria in some of
    these sectors. Contrary to the assumptions of the
    rational expectations hypothesis, financial market
    equilibria may be influenced as much by traders’
    biological traits as by the truth of their beliefs.
    (emphasis mine)

    What the authors suspect— and what seems obvious once you
    say it out loud— is that not only are certain people better
    suited for certain work or environments, but that they then
    change the environment itself so that they are the ones best
    suited for it.

    A ha! the system is stacked for a certain group, against another


    group!

    But it’s no more stacked against us than our technological


    world is better suited to electrical engineers. This is why we
    have an economy that uses money; we can hire someone who
    is suited for that work, to act as our agent.

    But what about things that can’t be bought?

    III.

    If philosophy and ethics attract certain types of people, then


    those people go on to further alter the answers to ethical
    questions. It occurs to them to ask certain questions and not
    others; and those with a differing perspective or mindset do
    not naturally possess the equipment that allows them to join in
    the discussion. What do you think happens to ethics?

    Diversity of opinion is an illusion. The choices “it is ethical”


    and “no, it’s not ethical” are actually of the same form, they
    come from the same kind of brain. For example, they both
    presuppose that the question is an ethical one, and not a logical
    one, or a practical one, or even a religious one, or a
    mechanical one, or a mathematical one, or a…

    But once a field is dominated by a group, that group reinforces


    its groupthink. It decides the form of the discussion. For
    example: the question for everyone is about ethics. Those who
    think it is, say, a logic problem are forced to remold their
    logical argument into a quasi-ethical one, just to be able to
    participate in the discussion. And their intellectual
    compromise is thus both less ethical and less logical. This
    reinforces for the ethicists that their perspective is the rigorous
    one. When you hear someone speaking broken English, you
    assume you’re smarter than him; it sounds like he’s dumber
    than you.

    These compromisers die and are never heard from again. It is a


    bat talking to a bumblebee about what color a flower is.

    A student of history knows that history repeats; what is


    different is the people living it, and how they frame their
    present.

    Since this dialogue is absolutely impossible, then the only kind


    of change that is possible is a paradigm shift.

    Paradigm shifts cannot occur without a change in biology: it


    requires a completely new generation of human beings.
    What Was The Matrix?
    March 12, 2009

    What are you telling me, that I can dodge bullets?

    I’m telling you that when you’re ready, you won’t have
    to.

    (Part 1 here: An Action Movie Fairy Tale)

    No, no, it doesn’t end like this. Not like this. [she dies.]

    With every passing day, you realize you will not fight bad
    guys, not join the CIA, not be in a band, not throw the winning
    touchdown.

    You will not know kung fu.

    Your body sickeningly, boringly confirms it. You breathe


    harder when you run. You don’t run anyway. Hair missing,
    appearing.

    Women your age are better looking than men your age. Wait,
    wait, what?

    Hopes and dreams are now only dreams. You start to care
    about office politics because nothing else is happening.
    Clothes matter more because very little else does.

    Drinking helps. You don’t know why, you aren’t an alcoholic,


    but you need it.
    “I will never be in love.” You love the sister you’ve married,
    but there’s no hunger, no need. There never really was. This
    was supposed to be temporary until… she came along. The
    woman with the dark hair tied loosely in a bun, wearing a
    scarf, glasses, stunningly beautiful (no one had noticed her but
    you, of course)— lost— needing to be saved–

    But wait, you’re still young. Ish. You still have some time—
    something could still happen.

    What modern middle aged narcissist wants is to find a way to


    put one foot in reality and keep one foot in fantasy. A solution
    that lets him keep fighting the traffic twice a day. Providing
    just enough lack of self-awareness that he doesn’t reach for a
    bazooka and blow his brains out. (If only he had even energy
    for that.) To have just enough hope that one day the fantasies
    could come true that he keeps on going. That a 30 something
    year old man could suddenly know kung fu.

    Fortunately, we find ourselves at the tenth anniversary of just


    such a solution.
    The Matrix: the natural, necessary end to the action movie
    generation, temporarily postponing a tripling of the suicide
    rate.

    What Is The Matrix?

    No one can be told what the Matrix is. You have to see it
    for yourself.

    The Schizotypal State

    It wasn’t supposed to be like this. By this age, things were


    supposed to have happened for you. You were supposed to be
    somebody. Someone was supposed to have fallen in love with
    you.

    What is called the “world” doesn’t seem like what you thought
    it would be…. there’s a lack of emotional connection; a lack of
    highs and lows, of change, of either growth or regression. No
    energy. There’s no real love. Instead is trudging, boredom….
    ennui. There’s nothing happening in your life; yet you feel like
    it’s out of control.

    Neo: I don’t like the idea that I’m not in control of my


    life.
    Morpheus: I know exactly what you mean. Let me tell
    you why you’re here. You’re here because you know
    something. What you know you can’t explain, but you
    feel it. You’ve felt it your entire life, that there’s
    something wrong with the world. You don’t know what it
    is, but it’s there, like a splinter in your mind, driving you
    mad…

    You walk through life diligently performing the tasks assigned


    to you, automatically. But always the thousand yard stare, the
    tiniest expectation that it is all about to change. More than
    fantasy but less than delusion, you hold active the remote
    probability that you are more than your current appearance.
    You’re not unfinished, you’re undiscovered.

    If, in the preposterous situation of alien invasion or talent


    scout or ninja attack, you’d know exactly what to do. You’d be
    able to do it.
    It seems that you’ve been living two lives. One life,
    you’re Thomas A. Anderson, program writer for a
    respectable software company. You have a social security
    number, pay your taxes, and you help your landlady carry
    out her garbage. The other life… where you go by the
    alias “Neo”… One of these lives has a future, and one of
    them does not.

    It is the reverse of Nausea, it’s Constipation. You have a


    completely defined, detailed identity, but it never got a chance
    to come out. The world wouldn’t cooperate. The problem is
    the world.

    You know you don’t really know kung fu. You know ninjas
    aren’t going to attack. But you know a secret: that the
    impossible thing is a ninja attack, not that you would know
    kung fu if ninjas attacked. In a reality which would permit the
    existence of a ninja attack, it is inevitable that it would allow
    you to know kung fu.

    What kind of a reality is it that blocks impossible scenarios,


    but treats them as prerequisites?

    Boy: Do not try and bend the spoon. That’s impossible.


    Instead… only try to realize the truth.
    Neo: What truth?
    Boy: There is no spoon.
    Neo: There is no spoon?
    Boy: Then you’ll see, that it is not the spoon that bends, it
    is only yourself.
    A reality that is still, partially, under your influence.

    The Anchors of the Schizotypal State

    You say: but no one seriously believes reality is fake, that


    we’re living in a computer. Correct; but the issue isn’t the
    reality of reality, but under what circumstances would reality
    change for you? What are the necessary requirements for you
    to suddenly know kung fu?

    God is one. God lets the world run as it is, but if ninjas
    attacked, God would make sure you’d know kung fu. But
    there’s no religion here, you don’t need to go to church for
    this, you just need to believe that God is watching out for you.
    This is why organized religion is in serious decline. There’s no
    way a Catholic God will upload kung fu when you need it.
    Access to that kind of transcendent knowledge requires
    Buddhism, or agnosticism. It requires you not to know who He
    is, so you can make Him into whatever you need Him to be.

    You’re not going to subject yourself to His rules; you’re going


    to subject Him to yours.

    Do you remember the movies that had the Devil as the bad
    guy? The hero never had special powers; he had to perfectly
    execute Catholic rituals or incantations that exist independent
    of himself in order to stop the Devil. That was back when we
    still believed in something outside of ourselves. They don’t
    make those movies anymore.

    Credit is another one. No, credit won’t change reality, but


    credit solidifies your identity in preparation for a change in
    reality. Credit says: buy this coat, it signifies that you could
    know kung fu.

    Girlfriends are another. Girlfriends say: I pretend to believe


    you when you say you know kung fu, because I love you. The
    boyfriend says, not hearing anything she said: I’ll stay with
    you until either I know kung fu; or you realize I don’t really
    know kung fu, and my shame makes me hate you. What does
    it matter? None of this is the real thing anyway.

    Some Lessons of The Matrix

    1. Information Is Knowledge.

    After a gunbattle, Trinity and Neo need to fly a chopper.

    Neo: Can you fly that thing?


    Trinity: Not yet. [Dials a phone.] Tank, I need a pilot
    program for a B212 helicopter.

    Poof— she now knows how to fly a chopper.

    Fine: how did she even know that it was a B212 helicopter?

    Presumably she learned it “on the job.” But knowing that fact
    is pointless: none of it is real anyway, and Tank “sees”
    everything, he would know what programs to upload, she
    could simply say, “I need to fly that thing over there.”

    It’s the accumulation of trivia, the same as a guy who learns all
    the different kinds of handguns but never shoots one; they
    know minute details of rock music, when something was
    performed, who produced it— but never played an instrument.
    It is the substitution of information, easily acquired, for
    knowledge. Knowing about it makes you think you are so
    much closer to knowing it. But, as any virgin on the internet
    will know, knowing about and knowing are different things.
    2. Love Is Waiting For You To Become.

    Trinity loves Neo, even before he becomes The One. She’s


    waited her whole life for him. He doesn’t (yet) know kung fu,
    but she knows he will. And she does know kung fu— and
    chooses him, saves him. That’s love.

    But Neo doesn’t return the love until he becomes who he has
    always known he is. He has to know kung fu first.

    Only then can could someone really love him.

    3. Self-Identification Transcends All.

    Agent Smith has Neo (“Mr. Anderson”) in a chokehold on


    the train tracks; the subway speeds towards them. Agent
    Smith is— satisfied.

    Hear that, Mr. Anderson? That is the sound of


    inevitability. It is the sound of your death. Good bye, Mr.
    Anderson.

    Agent Smith has it figured right: Anderson’s life was a


    pointless struggle. All the dreaming and all the expectation are
    doomed to end in failure, in death.

    Faced with the absurdity and unintelligibility of life, but the


    inevitability of its end, there is only one answer that today’s
    man— the narcissist— can give that makes his life
    meaningful, and he gives it:

    My name is Neo.
    That’s all he needs to say to escape the inevitable.

    II. It’s Just A Movie

    Someone says: oh, come on. There’s no real philosophy in The


    Matrix, it’s homeopathic doses of Kant and Derrida.

    HA! What are you, German? No one’s read Kant, what the
    hell is the matter with you? No one’s even read A Christmas
    Carol. There was more philosophy in those two hours than
    people had passed in a bookstore over their entire lives.

    If you’re 50, you say: really? a movie is that powerful that it


    can affect the consciousness of people who didn’t even like it?

    I know, I know, such power is given only to the Beatles… or


    Pink Floyd… or the Dead… or On The Road. All these things
    are the same. They all say: stay young with me as your life
    washes away beneath you.

    “But I didn’t even see the stupid movie!” Look around: they
    did. It’s enough. Or did you buy an engagement ring because
    of three thousand years of tradition?
    III. Narcissism Beats Reality, Again.

    The Matrix was the articulated solution to a growing


    existential crisis. It gave us hope: “Unless there’s solid reason
    not to, I’m just going to allow the possibility that there’s more
    to reality than what I see, and so there may be a valid reason to
    hope that my real life will kick in any time. And then someone
    will love me.”

    I know kung fu.

    “No, but when I need to, I will.”

    The Matrix could have carried us, could have kept the
    Schizotypal state active, maybe for another ten years. It gave
    Narcissism the strength to look reality in the face and say, “my
    identity is bigger than you, I don’t care what you do, if I
    needed to, I could control you.”

    Two years after The Matrix, reality responded.


    Reality Responds To The
    Matrix
    March 19, 2009

    And it says, time’s up.

    (Part 1: An Action Movie Fairy Tale; Part 2: What Was The


    Matrix?)

    9-11 should have marked the end of the postmodern era, and
    of the cultural narcissism we were all a part of.

    This was an external reality vigorously asserting that it was


    not going to be the setting of anyone’s personal movie.

    It caused three narcissistic injuries:

    (Recall: a narcissistic injury is when the narcissist learns that


    his preferred identity is not accepted by others.)
    First, it defied the size and time. Some things never get
    destroyed. Remember WTC bombing 1993? Shrugged off
    because there was a feeling that the Towers could never really
    fall; see? They didn’t. Neither could Reagan really die; neither
    could we have a real war (Falklands, Beirut, Gulf I.) There
    were doomsayers and crackpots, of course. But the real world
    plodded along averagely.

    Interesting: we accused the media of hyping things because


    what we understood is that such big events can’t really
    happen, but the media needs a story.

    We were satisfied with our postmodern explanation because


    for most people’s life spans, nothing gigantic happened. Cold
    War ended: meh. It was all hype anyway, government bluster,
    invented to keep us scared and subservient. Not real. Not like
    global warming.

    The narcissist says: if it can’t happen to me, it can’t really


    happen. 2500 Americans can’t just die in one day.

    But 9/11 was different. It didn’t respect the rules.

    Second, it violated the most important aspect of postmodern


    narcissism: story. Not only was the attack a surprise— no
    warning, no buildup, no exposition, no rising action— but
    even the characters were a surprise.

    At least if it had been the Russians, or even aliens, it would


    have followed a previously understood narrative. Has anyone
    seen this movie before?

    We didn’t know they even existed. Tali what? Did anyone


    know the backstory? Was there a movie with them as the bad
    guys? Back To The Future!— wait, weren’t they Libyans?

    Turns out we are just bit characters in someone else’s movie.

    Third: we were revealed to be powerless. No heroes. No one


    knew kung fu. Who was there left to fight, anyway?

    Were they any heroes? Anybody? How about… firemen?

    Ultimately, 9/11 contradicted The Matrix. We weren’t more


    than we appeared, but less.

    We were so psychologically paralyzed that the very first thing


    we did was change the language to minimize the narcissistic
    injury, the discovery that other people were able to affect us.
    We called Oklahoma City a bombing. This was just a date.

    On one sunny, cloudless Tuesday, postmodernism was


    obliterated. Two days short of Neo’s thirtieth birthday.

    Narcissistic Injuries Result Always In Rage…

    If you are under 23, this probably won’t have the same
    significance: the government, the media, and the American
    public were seriously debating the use of nuclear weapons.

    We got Iraq, say whatever else you want. Right or wrong, it


    would never have been possible pre-9/11.

    … Or Denial

    But 9/11 didn’t take. I cannot explain this. Within a year, two
    years, we were back to the same old narcissism. “Everything
    changed after 9-11” turned out to be exactly false. The stock
    market went back into familiar bull run mode, and in 2006
    Time named “You” it’s Person of the year, a laughable move at
    any time in history, let alone post-9/11 and waist deep in Iraq.
    9/11 should have changed everything. It changed nothing.

    And The Matrix is Good For Another Two Sequels

    So we went back to the teachings of The Matrix. Back to


    individualism, back to defining yourself based on what you
    believe rather than what you do. Self-entitlement, self-
    fulfillment, and until then the thousand yard stare of hope. The
    ideas in The Matrix should have given us ten more years of
    narcissism, until the “next thing” came along. And, indeed, it
    did.

    You might say that the Great Recession we’re in now should
    end postmodern narcissism. Nope. Amazingly, all I hear and
    read are calls for punishing those who got us into this mess
    (Wall Street), “fixing the system,” “solving the housing crisis.”
    People are waiting for things to “get back to normal.” People:
    this is normal. The past twenty years— easy credit, college for
    everyone that leads to a job at Starbucks, unemployment under
    6%— that was abnormal. We associate the word
    “unemployment” with steel workers, but do you think any
    economy not top heavy with credit can afford to pay 600 extra
    Starbucks stores worth of baristas $8/hr? Or computer
    programmers $50k? Don’t yell at me— I’m not saying they
    aren’t worth it— I’m saying this economy cannot, and could
    never, afford it.

    I know, greedy companies are outsourcing to India because


    they want to maximize profits. You say that thinking that if
    they stayed in America, they’d make less profits. Wrong.
    They’d close.

    “You don’t know what you’re talking about. Why would


    Toyota build plants in Alabama and hire American workers if
    it wasn’t profitable?” Because it gets them two senators and a
    bunch of congressmen, that’s why.

    Instead of having that discussion, the one we’re having is


    whether we should tax AIG bonuses at 90%. I know I’m alone
    in this, but someone has to say it: this is idiocy. Sure they
    don’t deserve those bonuses, but really, is this the best use of
    Congress’s time? Really? “But it’s about perception.” Isn’t it
    time we focused on something more than perception? Isn’t our
    obsession with perception exactly what is wrong with us?

    So: two huge historical realities have had no impact on our


    cultural narcissism.
    This is further support to my contention that meaningful
    cultural change can’t happen to a society while it still lives. It
    requires a change in generation, in biology.

    Thankfully, we are setting them up very nicely.


    When Lilly Pays Out $800M,
    Where Does That Money
    Go?
    March 16, 2009

    It’s easy to get confused by big numbers and health care


    reform by subterfuge.

    [Judge] Kelly immediately imposed sentence, ordering


    [Lilly] to pay $615 million, including a criminal fine of
    $515 million and $100 million in forfeiture.

    Not for me to judge the criminal sentence. Next:

    The charge against Eli Lilly was announced earlier this


    month simultaneously with a civil settlement in the
    amount of $800 million. The total monetary settlement
    totaled $1.415 billion.

    What civil settlement?

    In the civil settlement agreement, Eli Lilly agreed to pay


    the United States approximately $438,171,543.58 to settle
    allegations that it caused invalid claims for payment for
    Zyprexa to be submitted to various government programs
    such as Medicaid, TRICARE, [etc] for unapproved off-
    label uses. Also, Eli Lilly agreed to pay various state
    Medicaid programs more than $361,828,456.42 to settle
    similar claims.

    A.
    First, an aside: why is it called “Zyprexa” in legal documents
    but “olanzapine” in medical journals? Is anyone fooled by
    this? This idiocy also extends to reporting about the drug:
    Psychiatric Times, same issue: FDA considers pediatric
    labeling for olanzapine; Lilly Off-Promotion of Zyprexa.

    Richard when he gives you money, Dick when he doesn’t, I


    guess.

    B.

    So $800M gets paid to the government because Lilly caused


    doctors to write Zyprexa off label.

    Think about this. I’m not arguing the sentence. If the


    government simply wants to create a law that says off-label
    promotion is subject to a billion dollars in penalties, ok. Again,
    I’m no judge.

    But under what logic can the marketing Zyprexa off- label be
    considered causing a false claim for payment? This isn’t a
    clever legal trick: the False Claims Act is the explicit
    mechanism for policing off-label promotion.

    Yet it’s lunacy. The doctors wrote the script. Therefore it can
    never be a false claim, unless they’re accusing the doctor of
    making the false claim, which they’re not. If a doctor saw in a
    dream that Lipitor can calm an agitated demented patient and
    they try it, that’s not a false claim. It’s probably not even
    negligence.

    The reason this matters is that we are in America, not Greece,


    or Spain, or Russia. Either we’re upholding the law, or we’re
    devising stratagems to go after whoever is currently politically
    unpopular. How you police something is more important than
    catching bad guys. This is why cops can’t plant drugs on a
    suspect that they know is guilty. Right?

    So if you’re saying that Lilly caused doctors to unknowingly


    file a false claim, then you have to pick between one of these
    two choices:

    a) either doctors were actually deluded by Lilly and thought


    that Zyprexa was FDA approved for “agitation in dementia,”
    in which case it is very likely that their entire medical practice
    is one gigantic false claim; or

    b) they knew that it was not approved for that, but were
    convinced by Lilly’s marketing that it might actually work for
    that, so they prescribed it.

    If you chose b), it should be immediately obvious that Lilly


    “caused” only Day 1 of the Zyprexa Experiment; everything
    else after that was the doctor’s determination of whether it was
    working, worth it, etc.

    Before anyone argues with me, understand what’s at stake:


    physician autonomy. Anything that “causes” doctors to do
    something against their will or judgment; anything that
    “helps” physicians “practice better”— all of these things
    presuppose that doctors are not able to figure things out for
    themselves. So then why have doctors in the first place? You
    may as well boot up a few Prescribatons and upload the Texas
    Algorithm 2.0 and let them medicate the consequences of the
    rest of the government’s failed social policies.

    Why resort to saying that off-label promotion is bad because it


    does something to doctors instead of saying it is bad in and of
    itself?

    Oh: because when the government says a doctor was caused to


    do or not do something, what’s soon to follow is the
    government telling a doctor to do or not do something.

    Also interesting/horrifying, is this allegation:

    Eli Lilly trained [its reps] to promote Zyprexa by


    focusing on symptoms, rather than FDA approved
    indications.

    If we can just put aside our hatred of Big Pharma for one
    second, can anyone explain the difference between
    “symptoms,” and an “indication” having no other objective
    characteristics except those symptoms? Oh, I hear the arguers
    clicking the caps lock. Be careful what you wish for. Would it
    have been better if doctors were “taught” to recognize
    “dementia related psychosis” as a schizophrenia-spectrum
    disorder? Oh, like you can tell them apart on MRI? Dementia
    praecox, after all.

    I may be quick to point out the idiotic things doctors do; but
    none of those things, none of them are more idiotic than the
    things doctors are told to do, under the pretense of science
    (e.g. clinical guidelines) or the law.

    C.

    BTW:

    The qui tam relators will receive $78 million from the
    federal share of the settlement amount.

    Those would be the 6 or so former reps turned whistleblowers.


    No honor among thieves, or something.
    Are Schools Breeding
    Narcissism?
    March 18, 2009

    Comedian Todd Barry:

    The guitarist for Third Eye Blind was on MTV Cribs,


    showing off his house. He picks up a guitar and says,
    “this is my favorite guitar. With this guitar, the songs just
    write themselves.” Yeah, sure. Blame the guitar.

    “Warning over narcissistic pupils:”

    The growing expectation placed on schools and parents to


    boost pupils’ self-esteem is breeding a generation of
    narcissists, an expert has warned.

    Dr Carol Craig said children were being over-praised and


    were developing an “all about me” mentality.

    Dr Craig is chief executive of the “centre for confidence and


    well-being” in Scotland. What? What are you looking at?

    She told head teachers the self-esteem agenda, imported


    from the United States, was a “a big fashionable idea”
    that had gone too far.

    She said an obsession with boosting children’s self-


    esteem was encouraging a narcissistic generation who
    focused on themselves and felt “entitled”.

    I wanted to investigate this further, so I went down to the local


    elementary school, I grabbed one of the Zach Effron looking
    bastards by the neck, and I shook him like a dog, I said, “listen
    you North Face wearing organ donor, why is self-esteem so
    important to you? Why do you have to feel good about
    yourself all the time? Huh? Huh?”

    Well, Zach ran off, bawling, and then I realized: he’s not the
    one who cares about self-esteem.

    Right? The kids didn’t sign up for the self-esteem classes


    because it was pass/fail and fit in 3rd period. Adults made a
    collective decision that this was going to be the core
    educational philosophy from which everything else would be
    derived. So? What did adults think was wrong with the way
    they were raised that they thought self-esteem was so
    important to teach their kids?

    I agree with: schools shouldn’t be in the psychology business;


    emphasis on “feelings” paradoxically (read: not paradoxically)
    increases the likelihood of depression and anxiety; the more
    schools dealt with emotional well-being, the less parents
    would take responsibility, etc.

    But she misses the cause. She sees the teaching of self-esteem
    itself to be the source of the problem; but the real problem is
    the cultural mindset that thought up self-esteem training— and
    a million other things. Even if we stopped promoting self-
    esteem in schools, the kids are still going to have to watch TV
    created by these same adults; learn about other cultures from
    them; learn how to manage money from them; learn that the
    worth of the individual from them; learn whether killing is
    right or wrong, and when, from them. Not directly from them,
    of course, which would actually be a dialogue worth trying
    out; but by osmosis, from living in the world that adults have
    created for themselves, that kids have no choice but to live in.

    In short, they’re still going to have to go home to their parents.

    Here’s an example. I’m down at the playground stalking


    pedophiles, and I observe that all of the kids are there with a
    parent, and most of them are with both of their parents. The
    parents are actively playing, too, they’re not just sitting on the
    benches socializing.

    Wow, I think, there are actually more parents than kids on this
    playground. My parents would never have played with me/us
    like that. If they actually came (they never would have) they
    would have sat on the benches. Socializing.

    And then I observe that there are 15 or so adults, all crowded


    around on this playground; however, none of the parents are
    talking to each other, they are talking only to their kids.

    But they are so physically close to each other that it is visibly


    weird that they are not talking to each other; they must each
    have made a conscious decision not to interact. And then, it
    hits me: the reason these parents are playing with their kids
    and not on the benches is in order not to interact with the
    other parents. They’re using their kids as human shields. They
    don’t know how to have a personal but not intimate interaction
    with another adult, they can’t figure the boundaries. All they
    know is stranger, friend and sex. All they know are roles.

    Self-esteem training is besides the point: how are kids going to


    not become narcissists when their parents train them on
    purpose to avoid meaningful interactions with strangers?

    It boggles the mind how adults complain about how “kids


    today” are soft, or narcissistic, or impolite. What, is that due to
    sunspots? An oncogene? “Kids today” aren’t any wussier than
    their parents are making them.

    “Kids today are soft, when we were kids we didn’t wear bike
    helmets…” But the kid isn’t asking to wear the helmet, you’re
    putting it on their head.

    She said an obsession with boosting children’s self-


    esteem was encouraging a narcissistic generation who
    focused on themselves and felt “entitled”.
    She means the kids; yet the focus on children’s self-esteem is
    the mechanism by which the parents protect themselves. If my
    kid is happy, then I have a happy kid; I don’t have to do
    anything. It’s the parents who feel entitled- to having a happy
    kid.

    “Narcissists make terrible relationship partners, parents


    and employees. It’s not a positive characteristic…” she
    said.

    Nice call. A generation too late, but nice call.


    What Happens To Fake
    Studies?
    March 21, 2009

    What, you think they go back and fix them?


    Here’s the setup, from Scientific American:

    Over the past 12 years, anesthesiologist Scott Reuben


    revolutionized the way physicians provide pain relief to
    patients undergoing orthopedic surgery for everything
    from torn ligaments to worn-out hips. Now, the
    profession is in shambles after an investigation revealed
    that at least 21 of Reuben’s papers were pure fiction, and
    that the pain drugs he touted in them may have slowed
    postoperative healing.

    A doc on various Pharma payrolls authors studies promoting


    Neurontin, Celebrex et al, and they turn out to be fakes. There
    are plenty of people who will/want to make the obvious points,
    so I’ll restrict my comments to the less obvious.

    I.

    Reuben managed to trick some othopaedic surgeons to be


    coauthors on his paper. One such orthopod, Evan Ekman, was
    reviewing one of Reuben’s studies.

    Ekman agreed to review a Reuben manuscript on surgery


    on the anterior cruciate ligament (ACL) in the knee. But
    when [Ekman] asked the anesthesiologist [Reuben] for
    the name of the orthopedic surgeon on the study, Reuben
    ceased communication with him.
    Undoubtedly, everyone is focusing on the identity of the
    unknown orthopaedic surgeon as a red flag. But here’s a
    question that will become obvious once I ask it: how did
    Ekman know the identity of the author of the paper he was
    reviewing? This is “anonymous peer review,” right?

    Next: even if he was alerted by 9 pixies that it was Reuben


    who wrote the paper, why would he think he was further
    entitled to know the rest of the authors’ identities?

    I’m not saying he should/should not know; I’m saying that this
    had become so commonplace to him that he doesn’t even think
    twice about asking; or telling Scientific American that he
    asked. He actually forgot to pretend peer review is
    anonymous.

    You may also ask why Ekman was chosen as a peer reviewer
    in the first place, since Ekman had previously coauthored
    other papers with Reuben. Oh, yeah: when you submit a paper
    to a journal, you choose people you’d like to review it. This
    way there is no chance whatsoever of institutional bias.

    II.

    Then, last year, Ekman was invited by Pfizer to give a


    talk. While there, he was handed a version of the very
    manuscript Reuben had asked him to review, which had
    subsequently been published in Anesthesia & Analgesia.
    To his surprise, and horror, he was listed as a co-author:
    Reuben had forged his signature on the submission form,
    Ekman says.

    If a tree falls in the forest, and no one hears it, does that mean
    everyone is deaf?

    Ekman is an academic doctor who also speaks for Pfizer— in


    other words, he’s a “thought leader.” Does he not read the
    journals? Do none of his friends read the journals, to send him
    an email, “hey, saw your study…” If he’s not reading them, is
    anyone else?

    What is the impact of a fake study that no one reads? Think


    about it for a moment, here’s my answer: volume. “There is
    some evidence that…” It doesn’t matter if the study is wrong,
    or silly, or fake; just as long as it exists, to be able to get away
    with that sentence.

    III.

    You think I’m kidding.

    The faked article that Ekman reviewed and then “coauthored,”


    purported to discover that Celebrex helped reduce pain, and
    consequently promoted more vigorous participation in rehab.

    It also found that patients used a lot less oxycodone:

    Casual readers of this blog will perhaps be thinking, “hmm,


    20mg less oxycodone, does that seem possible?” But astute
    readers of this blog will ask the larger question: where the hell
    did you find the graph? It’s not still on PubMed, is it?

    Oh, yes. It’s also free direct from the journal. Here’s a follow-
    up study, also fake, also free.

    “But surely the article is labeled as fake, or something?”


    Something being like a big red watermark that says,
    “RETRACTED”? No. The only hint is at the bottom, under
    “This article has been cited by other articles:” and one of the
    12 citing articles is the retraction notice by the editor.

    It’s hard to explain why the article isn’t simply deleted; or,
    better, loudly labeled as a fake so that we can learn even from
    fakes.

    But it is very easy, very very easy, to explain what will happen
    to a large number of doctors who never read journals, let alone
    Scientific American, who may perhaps be motivated just to see
    how many articles on Celebrex there are in the world— “wow,
    that’s a lot”— or read a review article that cites these articles
    — reviews that will never find a forum for retraction or
    explanation.

    It’s even easier— sit down for this one— to explain what will
    happen to new research on Celebrex— “does this thing work,
    or not?”— now that Pfizer has absolutely no incentive to pay
    for it.

    Good luck.
    To The Brain, God Is Just
    Another Guy
    March 24, 2009

    The most important question about any scientific study, that must
    be answered before any others are asked:

    What do they want to be true?

    Per NPR:
    etc.

    The study did make some interesting findings, but of course not
    the one heralded in the title or in the article.

    The only true statement in the NPR article is this one:

    A study of 40 people — some religious, some nonreligious —


    found that phrases such as “I believe God is with me
    throughout the day and watches over me” lit up the same
    areas of the brain we use to decipher the emotions and
    intentions of other people.

    NPR, and the study’s author, unfortunately concluded more than


    this:

    Grafman says the finding, published in the Proceedings of the


    National Academy of Sciences, shows that there is no special
    circuitry in the brain that deals with religious belief. It also
    suggests that religion developed as the human brain evolved
    its capacity for complex social interactions.

    Nope.
    It’s no stretch of the imagination to say that the majority of the
    NPR devotees— and likely members of PNAS— may not be
    outright atheists, but they’re hardcore agnostics. They occupy that
    space preferred by the self-absorbed who aren’t sure what they do
    believe, but fervently confident about what they don’t believe:
    anything their parents were into. They’re skeptical, but lazy; they
    “know” which things are not true, but can’t be bothered to learn
    what is true, or at least make something up that is logically
    consistent. The exception to this is evolution: they are passionate
    about evolution, though woefully ignorant of any of its principles
    or mechanisms. Their zeal is partly in reaction to established
    religion, and evolution becomes a substitute for religion.

    Articles like this one fortify them. They don’t need the details; it’s
    enough to know that science is discovering, bit by bit, that much of
    the intellectual or religious history of mankind over the past, say,
    6000 years, is all crap. It only took the sophisticated, post-Nixon
    mind to figure out what Kant couldn’t. “Whatever, man—
    evolution has a billion years on you.” Indeed.

    The study itself isn’t too hard to explain. Subjects were asked to
    agree or disagree with certain god related statements (“People go
    to hell,” “God protects all people”) while their brain was scanned.
    The study found that the same regions were ones associated with
    understanding the intentions and emotions of human beings. Ergo:
    God is just another guy.

    The obvious criticism is that this didn’t study the religions


    experience at all; what it studied was what regions of the brain
    interpret statements that relate to intention. If they asked, “Jabba
    The Hutt thinks Leia is hot” it would have lit up the same regions,
    allowing the title of this article to be, “To The Brain, God Is Just
    Another Hutt.”

    Furthermore, it is very likely that many of these regions are only


    involved in linguisitic interpretations; if they had shown videos of
    people intending to do something, different regions of the brain
    would have been used.

    But a more subtle criticism, and likely the most relevant one, is
    that this study was done on Americans born after 1970— the
    Dumbest Generation of Narcissists In The History Of The World.
    Even if this was a valid test of how the brain deals with the
    religious experience, it’s probably not applicable to how human
    beings in general, or over time, deal with the religious experience.
    If they tested, say, Carmelite nuns “thinking about God,” you’d
    probably get different regions. (They did.)

    In other words, the study emphatically does not show that “to the
    brain, God is just another guy.” At best, it shows that American
    30-somethings are not able to see God as anything other than just
    another guy; but who knows how 3rd century Romans saw God?
    Given that the study was done at NIH, by cognitive
    neuroscientists, published in PNAS and then reported on NPR, you
    would think that someone would have thought of this. Or perhaps
    they did, which is why they wrote it this way.

    Of course not.
    Is A Brain Glitch To Blame
    For Financial Crisis?
    March 30, 2009

    Yes, but not that one.


    CNN reports on a study:

    “the real cause of the financial crisis could actually be


    down to a quirk of the human brain.”

    Take a moment a speculate on what you think that glitch might


    be. Nope:

    According to a new neurological study by Atlanta’s


    Emory University, expert financial guidance causes the
    brain to switch off, disengaging from its usual rational
    decision-making process.
    “It’s almost as if the brain stops trying to make a decision
    on its own,” Professor Gregory Berns, who led the
    research, told CNN.

    “Normally, the human brain uses a specific set of regions


    to figure out the trade-offs between risk and reward, but
    when an ‘expert’ offers advice on how to make these
    decisions, we found that activity in these regions
    decreases.”

    Why would it be surprising to him that we trust experts?

    I.

    The study doesn’t just find what brain regions are involved in
    decision making, it even quantifies the effect of expert advice
    on a person’s choice. But as good as the study is, the
    interpretation is flawed. The brain glitch isn’t that we trust
    experts. The real brain glitch is the one that made him put
    scare quotes around the word “expert.”

    “Our brains will make the assumption that other people


    know more than we do,” he said.

    He isn’t saying, “hey, isn’t it far out how our brains switch off
    in the presence of experts?” He’s saying, “why would you
    blindly follow these so called experts?”

    The irony of he himself being an ‘expert’, and people blindly


    following him, is lost on him.

    II.

    He can’t possibly be saying we shouldn’t listen to experts, can


    he?

    The point of having an expert is to trust his judgment. If your


    judgment is nearly as good as his, than either he’s not an
    expert, or you are.
    Being an expert entails more than simply amassing
    information; this is why having an internet connection and the
    first season of House does not make you a doctor. It is why a
    Prescribatron will be a worse doctor both at the individual and
    the population levels (more on that someday.)

    He must know that the average person could not hope to learn
    enough information on finance (or medicine, or law, etc) to be
    usefully critical of an expert’s opinion. (Or, the reverse: if you
    could, you’d be an expert.) In keeping with “a little knowledge
    is a dangerous thing,” not trusting the experts and doing it on
    your own could be more disastrous. (e.g. crash of 2000.)

    So why is ‘expert’ in scare quotes? Does he think those guys


    really don’t know anything about finance?

    Berns says his research highlights how we should pay


    more attention to financial advice and question the
    motives of so-called experts, assessing their
    trustworthiness before submitting to their opinion.

    Of course: financial experts aren’t dumb, they’re corrupt.

    The real brain glitch is the one that assumes that anything that
    is attached to money is corrupt. Or, more precisely, we can
    best judge the truth by knowing a person’s financial biases.

    This is how the CNN piece ends:

    “Frankly, we should have everyone in the finance


    industry submit to brain scans,” he says.

    Ha! That’s hilarious, especially since it was the exact opposite


    of the point of his study— wasn’t it the people seeking advice
    that were the problem? See how much fun it is to distort
    science, even good science that you yourself conducted and
    has value up until the “Discussion?” Here, he flips it around to
    say that the problem is with the experts. Which is, of course,
    what he wanted to be true all along.

    I’ll wager he would never put “neurology expert” in quotes,


    because he isn’t tainted by money. (Well, government money,
    but nihil obstat.)

    Meanwhile, because he doesn’t “make money” on his studies


    (which of course he does) we’re supposed to assume this is
    pure science— accept it at face value. “Well, it uses MRIs.”
    The MRIs are a rhetorical trick. They make it so you don’t
    notice the political/institutional/personal biases. How much
    money a guy gets paid is all we need to know to judge his
    honesty.

    “No, it’s the source of the money that matters.” Oh. If I do a


    study on Geodon that fails, I have to disclose if it was paid by
    Pfizer. If I do a study on Geodon that fails and I am sleeping
    with the Lilly rep, I have to disclose if it was paid by Pfizer.
    Solid.

    It’s a little scary to think that science can be used by scientists


    to reinforce a populist bias, but there you go.

    ––––

    I’m on twitter

    http://twitter.com/thelastpsych

    if enough people sign up, I’ll (try to) make it worth it.
    How To Destroy A Marriage
    April 2, 2009

    This has nothing to do with psychiatry. Or maybe it’s the only


    thing that has anything to do with psychiatry.
    The writer of ShrinkTalk writes about an experience as a
    marriage counselor. He lists 7 reasons why marriage becomes
    difficult for some people.

    He comes up with his reasons based on his experience with


    couples. Interestingly, however, all of those reasons are
    generally of the type “unrealistic expectations” or at least “the
    wrong impression.” In other words, the marriages failed not
    because of what went on in the marriage, but because people
    were oriented wrong before they even got married.

    This may partially explain why arranged marriages or


    marriages “in the old days” lasted so long. Everyone knew
    precisely what marriage was all about, there were no illusions
    or confusions.

    If this is true, than perhaps the role of counseling is to quickly


    reorient disoriented people’s expectations; or, perhaps people
    should go into counseling before they get married in the first
    place.

    I thought about this, and came up with my own observations,


    all of which are post-marriage accelerators of divorce.

    Contempt.
    This statement is 100% accurate: cheating on your spouse is
    less detrimental to your marriage than rolling your eyes,
    looking away, and saying, “oh my God, you’re so annoying.”
    I’m not saying you can get away with cheating. But contempt
    in the marital interaction is the most important predictor of
    marriage failure; and, probably, those marriages should be
    dissolved as soon as possible anyway. No good will come of
    them.

    Bring work home with you.


    And I don’t mean the quarterly reports.
    You have another bad day at work, you come home and she
    asks about your day. You answer from a 15 year olds
    playbook: “fine;” “nothing;” “same stuff.” And so she asks
    you to cut the carrots, and you snap. “God damn it!”
    You’ve brought your suppressed work-emotions home, and
    you let them out on your family. Why? Because you can; you
    don’t need to suppress at home. You’re curt and irritable and
    withdrawn. Maybe your wife understands. For now.
    I know, it’s hard to keep those emotions in check after your
    boss has been riding you all day. Yet then the UPS guy comes
    to the door and you are instantly nice, bright, warm. “Hey,
    thanks, have a good one buddy! Go Raiders!” You’ll say it’s
    an act, but the other way of looking at it is that you think it’s
    worth faking politeness to the UPS guy, but not to your family.
    See? Does your family need to see the real, irritable you?
    Oh, I hear you, my special, special, generation, the one that
    counts hypocrisy the greatest of all possible sins: “if I can’t be
    myself at home, what’s the point?” Because that isn’t the real
    you, there isn’t a you. Who you are is what you do. If you
    come home and are cranky and curt and bossy at home, then
    you are a jerk. You don’t get to say, “I’m a nice person, but I
    just happen to be irritable every day.”
    Even if you aren’t a jerk, what your family sees is a jerk.
    Leave work at work; leave work emotions at work. They have
    no place at home, they are not useful and they serve no
    purpose. Of course you can talk about your crappy day, you
    can show her the schematics for the bomb you want to build.
    You can be angry at your boss, but don’t be angry at your
    spouse because you can’t get angry at your boss.
    No time to yourself.
    Self help guides get this wrong. They say that to preserve
    sanity, you need some time for yourself; they say new moms
    need some “adult conversation.” That is counterproductive.
    You rush through dinner, through clean up, through idle
    conversation ; you’re checking off your “responsibilities” so
    that you can get a moment to yourself. The result is you are
    not there, you’re passing through, emotionally, until you can
    get to what you think you want to get to.
    Life is what happens while you’re trying to get to the
    computer.
    A lot of people are going to disagree with me, and they are
    wrong. First, understand that your family is all there is. There
    is no break, there is nothing else, there is no “adult
    conversation.” It is possible you may never golf again. The
    kids aren’t the distraction— everything else is the distraction.
    If golf is a pleasant diversion that doesn’t cause you to rush
    through family life in order to get to it, then it’s ok. Otherwise,
    it’s out. Otherwise you will be rushing through family life to
    get to course. And you will miss out on the family, and will
    still not get any real relief from golfing.
    Once you have accepted this, you can then proceed to step 2:
    decide on two or three “distractions” you really like, and put
    them into your routine, with dedication and commitment. If
    you are truly committed to them, your spouse will understand
    (and they’ll have their own.) But if you pick, say, going to the
    gym MWF, but you yourself aren’t dedicated, it will appear to
    your spouse that you use it as an escape only when things get
    tough. (Because that’s what it will be.)

    Loyalty over truth.


    This is going to be controversial: no matter what happens,
    your family is first. That doesn’t sound controversial? Read
    on.
    If I have a kid on the lam for a series of crimes he did coked
    up on heroin, and he asks me for some money to hide out in
    Uganda, guess what? I’m giving him the money. I may take
    some corrective actions; but no one else gets to.
    I know this doesn’t work within the framework of a just
    society, but I do not happen to believe we live in a just society.
    The only thing I do know is my family is all I really have. I
    may want to kill them, but you can’t.
    Knowing that many won’t agree with that posture, I’ll soften it
    a bit:
    The same loyalty code applies to your discussions with
    outsiders about your family. No jokes at your spouse’s
    expense. Ever. You never tell your coworkers about your kid’s
    drug habit, or your wife’s porn addiction, or that you wish
    your wife had a porn addiction. Certainly you have a best
    friend that you can commiserate with, but even within that
    relationship you cannot tell them anything permanently
    damaging. No facts, only feelings. For example, “my husband
    doesn’t listen, he doesn’t understand, he ignores me, etc” is ok
    on special occasions. But “my husband punched a window, he
    takes Zoloft, he has a shoe fetish, etc” is definitely out. Honor
    means: shut your trap.
    First, it’s disrespectful to your spouse. Second, more
    practically, it changes the other person’s relationship to your
    spouse, and consequently to you. Telling your coworker
    you’re divorcing your husband because he’s sleeping with a
    cheerleader also tells your coworker things about you, e.g.
    “what the hell is going on in that house?” and “she talks a lot.”

    Communicating through kids.


    If most of your conversations with your spouse are about your
    kids and not about each other, you’re normal. If all of your
    conversations are about your kids, one of you is probably
    cheating.
    Couples end up talking with each other, towards the kids; but
    not to each other, about each other. At some point you forget
    your spouse is an individual; you forget they had a past. You
    forget they have a future. All you know is that they are in your
    present.
    Have you thought about what it will be like the day your kids
    go to college? Sure. Have you thought about what you’ll do
    next? Sure. Have you thought about what your spouse will do
    next? (“Be sad” means you haven’t thought about it.)

    Refilling Hedonic Supplies


    See above. You know how most sleights roll off you because
    you have a fairly stable sense of self, and a stable position in
    your family? Awesome. Now the same should go for
    complements. Especially for complements.
    You should say, “thank you” and move on. If you find yourself
    flattered; or find yourself fishing for complements; then
    something is lacking at home which needs to be addressed, but
    more urgently you need to fix yourself that these complements
    have any power.
    Remember the hot girl in high school, and you said to her, “I
    like your jacket” and she maced you? She did that because she
    doesn’t need your complements, and immediately senses that
    you’re only doing it because you want something from her.
    You need to adopt a version of this stance once you are
    married.
    Every Lifetime Original Cheating Movie has the following
    line: “he made me feel alive again.” I know, that’s the
    problem. Your husband’s problem for not making you feel
    alive-ish ordinarily; and your problem for needing that from
    someone else in the first place.
    Marriage means: not having to look elsewhere for affirmation
    of identity.

    –-

    I’m on twitter. If enough people sign up, I’ll try to make it


    worthwhile.
    http://twitter.com/thelastpsych
    This Is Why Medical Care Is
    Expensive
    April 2, 2009

    The article explains:

    AUSTIN, Texas - Just nine people accounted for nearly 2,700


    of the emergency room visits in the Austin area during the past
    six years at a cost of $3 million to taxpayers and others,
    according to a report.

    Activate populist outrage: ready, go!

    The average emergency room visit costs $1,000. Hospitals and


    taxpayers paid the bill through government programs such as
    Medicare and Medicaid, Kitchen said.

    After we get home from setting a few car fires, we can then ask the
    relevant question: what, exactly, do they mean by “cost?” Do they
    mean “cost,” or do they mean “bill?”
    I.

    A frequent lament against the Obama bailout plans is that the


    taxpayers are footing the bill. Really? So your taxes have gone up?

    Until they go up, you’re not paying for nothing. The problem with
    the bailouts is precisely that our taxes haven’t gone up: we’re living
    on fake money again. If they had gone up, then we would be
    emotionally motivated to make real decisions about how we want to
    spend our money. In other words, once we start paying, we’ll start to
    ask if it’s worth what they billed.

    II.

    Healthcare may be the biggest racket in history. I don’t mean it


    pejoratively. Quoting Charles Tilly: a racketeer is someone who
    creates a threat and then charges for its reduction.

    This ER study can be translated: “holy crap, healthcare costs are


    spiraling out of control! Pay us, and we can fix it for you.”

    You’ll see this in many forms, the most evident are this one, and
    electronic medical records.

    Minimizing healthcare is the new healthcare.

    III.

    Focus on the cost: how did these patients rack up “an average of”
    $1000 per visit, exactly?

    I once stood on a small hill and looked at an ER, and from what I
    could see with my B&L 10x binoculars, nothing that occurred there
    costed $1000. You might legitimately ask me who am I to judge
    what an ER visit costs; I’d submit that the only legitimate answer to
    what costs what is the market. But medicine isn’t a market, because
    two parties don’t agree to terms either by negotiation or by repeated
    bids and asks. One party makes up the terms, and the other party just
    pays it, or doesn’t. Period.

    College tuition is the same. I’m sure Harvard has some equation that
    spits out a $40k/year bill, but that number has no bearing on the
    actual costs. Case in point: if it did, they wouldn’t suddenly be able
    to make tuition free for 20% of their students without gigantifying it
    for the other 80%. Perhaps tuition actually costs more than $40k. My
    point is that what we are asked to pay has very little to do with the
    actual cost.

    Hospitals traditionally use the tuition model on patients: indigents


    can’t pay, so Blue Cross is charged $300 for a guaze pad. Blue Cross
    knows perfectly well it is being “scammed” but they make it up
    from employer contributions, etc, etc, so no one complains. The only
    person who complains is an actual individual, with an income but no
    insurance, when he is asked to pay the Blue Cross rates. He doesn’t
    realize he’s being overcharged gigantically. He just knows he’s about
    to go into bankruptcy. The problem simply is that he’s caught in the
    healthcare racket that hospitals, the government, and private insurers
    have agreed to.
    IV.

    The article doesn’t link the actual study, because the actual study is
    not available. Solid. I did find last year’s study, which explained
    precisely how they arrived at the costs:

    Calculating Estimated Costs

    Because no cost data exist for charity care provided by ICC


    members, a method of estimating costs was selected based on a
    review of healthcare literature. The method chosen for this
    study, Diagnosis Cost Groups (DCG), uses patient diagnoses to
    estimate each patient’s health status, or predicted need for
    healthcare utilization. The DCG models used all diagnoses
    from the one-year study period along with demographic patient
    data to calculate a measure of the expected costliness of each
    patient relative to the average Medicaid patient. This measure,
    called relative risk (RR), was then converted into annual patient
    cost estimates through the use of a cost multiplier. Once cost
    estimates were established, the RR scores were rescaled to have
    a mean of 1.0 by dividing each RR score by the mean RR score.
    The rescaled RR scores show how costly a patient is relative to
    the rest of the study population.

    If you read something in a medical study that is confusing, it almost


    always means you are about to be misled. I’ll translate this:

    If the average Medicaid patient costs X, then each disease is


    weighted as a multiple of X. e.g. a diabetic patient “costs” 2X,
    according to the DCG.

    It should be obvious that this number could as easily by 9X or .1X,


    or anything at all. Leave that aside.
    See how hypertension costs $30M to treat hypertension in the
    population? It doesn’t. It costs $30M to treat all patients with
    hypertension and anything else they have. It doesn’t cost $56M to
    treat pregnant hypertensives.

    I’m sure this can easily be spun to mean “please give us more money
    so we can treat depression, because look how much it’s costing you
    guys!” but it doesn’t mean it costs $20M to treat depression, only
    that people with depression— and all their other infirmities—
    accounted for $20M. Of course, that’s $20M in estimated costs,
    estimated by simply multiplying some hypothetical figure by 3.9.

    Also note that even if we had the data for what each and every single
    patient spent that year, we’d still have no figure remotely close to the
    truth. $900 for an MRI? Please explain.

    I had once read on the internet that price fixing was illegal, but I
    guess not.

    V.

    All of this comes down to the central issue in healthcare reform:


    reducing costs. Absolutely no one is seriously interested in doing
    this. They may be serious about reducing the billings to Medicare; or
    reducing the flow of money to Pharma— all of which maybe
    legitimate goals. But these reductions in billings will inevitably be
    offset by increases elsewhere, because no one wants to get to the
    cost of anything. Aetna still needs to eat.

    Aetna won’t bother to cover anyone, and doctors wouldn’t bother to


    treat anyone, if medicine billed what it costed. Unless a hospital can
    bill someone $300 for a guaze pad, it’s going to close down and turn
    into a Dunkin Donuts.

    Nor is the government interested in closing down Aetna or doctors;


    Medicare is social welfare program for medical providers, just as
    Medicaid is a social welfare program for the poor. The government
    will keep its books open, and pay the populace just enough to keep
    them from rioting.

    Before you yell at me, understand why we’re in this mess in the first
    place: because medicine is believed to cost the sum total of the
    physical capital— procedures, guaze pads, and not the intellectual
    capital. (Lawyers have it the other way.) The solution to this is to
    value medical care as the actual cost (not billing) plus some
    reasonable amount for the intellectual thought that may go into it
    (assuming doctors agree to put some thought into it.) I’ll add that
    $60 per patient from medicare is probably not going to be enough.

    Certainly I am for “redirecting” the “frequent fliers.” No argument


    from me that we spend money needlessly, that there aren’t better
    alternatives. But don’t be fooled for a second that anyone wants to
    implement the actual alternatives. We’re going to spend money on
    electronic medical records.

    Put another way: do you think those Austin area ERs will ultimately
    bill $3M less if they sent those 9 patients to Neptune? Let alone if
    they got Aetna?
    One Should Note…
    April 4, 2009

    … that these are the same.


    So much easier for the government if they could put the two
    together.
    Violence Intervention
    Program
    April 6, 2009

    What does the government want to be true?


    From CNN:

    [Associate professor of surgery] Cooper created the


    Violence Intervention Program (VIP) at the Shock
    Trauma Unit of the University of Maryland Medical
    Center, the state’s busiest hospital for violent injuries. It
    became one of the country’s first hospital-based anti-
    violence programs.
    “We approached this problem like any public health
    crisis, like heart disease or smoking,” he said. “We tried
    to work on the root causes.”
    Since 1998, VIP has provided substance abuse
    counseling, job skills training and other support services
    to nearly 500 trauma victims.
    A 2006 study by Cooper and his colleagues, published in
    the Journal of Trauma, showed that people in the program
    were six times less likely to be readmitted with a violent
    injury and three times less likely to be arrested for a
    violent crime.

    Six times? Ok, so I’m in. This is a program which speaks to


    my personal biases: social problems solved by social methods.
    You take a group of people who got shot, stabbed, and help
    them “get out of the game” (their words.)
    No one here got diagnosed bipolar, no one was put on
    Depakote. Some hands-on intervention by a support team, and
    boom— people die less often (and are jailed less often.)
    Sounds like an innovative program with solid efficacy data.
    Sign me up.
    Oh, wait…
    I.
    Why does it work?

    One might surmise that the fact that Dr. Cooper is black might
    have something to do with it, perhaps by encouraging more
    positive transference from the trauma victims. But how long
    does he spend with them ,really? Milliseconds? Yes, his race
    may be helpful; but no it wouldn’t be enough to explain a six
    fold reduction in violence.
    It is, however, undoubtedly the only reason CNN chose to
    report on this program, and not any of the dozen others I found
    searching the internet.
    So now the question becomes, why CNN? Why now?

    II.
    I had to review the actual study a few times to find the
    explanation, and yes, it saddened me.

    The patients randomized to the intervention group then


    met with a social worker or case worker and a parole and
    probation officer assigned to the program. After the
    patient was discharged, the social worker or case worker
    and parole and probation officer met with the patient
    (now client) at scheduled intervals. Home visits were also
    performed by members of the VIP team.
    The control group received no organized support from the
    VIP team and continued with the parole and probation
    agent who was previously handling their case.

    These victims were all supposed to be on probation/parole.


    What’s changed is that now they are going to see new
    probation/parole officers who are actually going to do their
    job, regularly, and someone will be coming to the house to
    check on the parolees. Victims. I mean victims.
    In other words, they’re now on probation/parole.
    The program doesn’t represent an innovative way of
    decreasing violence; it represents a failure of the regular
    system, that doesn’t monitor anyone, ever, except when it’s
    convenient (e.g. they want a pretext for incarceration.)
    III.

    Two points. First, this represents another example of social


    policy being offloaded to medicine, for the usual reasons:
    medicine has more money than social programs do; it taps into
    the intellectual expertise of doctors, instead of police, etc.
    You might say, well, what’s wrong with all that? Nothing, nor
    am I saying the program shouldn’t be implemented, but doing
    so avoids the question of why it has come to pass that it needs
    to be implemented; why are we fixing a broken social program
    by adding a new medical program, instead of fixing the broken
    social program? In other words, why not simply make
    probation more accountable, and save everyone the trouble
    and the cost?
    Which brings me to the second point, the unspoken truth: the
    point of the programs is precisely the increased cost. It is
    wealth transfer; Dr. Cooper just employed two new probation
    officers, a social worker, etc, etc. I’m sure somewhere there’s a
    billing code for it. The victims are poor people, so government
    money is involved.
    One way or another, doctors are going to get paid. And social
    workers are going to get paid. And hospitals are going to get
    paid. And UNH and Wellpoint are going to get paid. And etc.
    If it means medicalizing crime and welfare and climate change
    and Darfur to do get at some of that government money, so be
    it.

    IV.

    No, no, no, I’m not saying the doctors are trying to suck
    money out of the government. I have no doubt that Dr. Cooper
    had the absolute noblest of intentions here, motivated entirely
    by a desire to help. I’m saying the government wants to give
    its money away, this is how it keeps the system running. You
    have the problem of black youth violence anyway, why not
    pay medicine to handle it? Keep doctors happy enough that
    they don’t notice they get paid next to nothing for actual
    medical care; shift the focus away from “failure of society” to
    “biological underpinnings”; convert “misguided social
    programs” to “coordinated medical care to decrease the
    problem of youth violence” and prevent some riots?
    Everyone’s a winner.

    Like an idiot, I’ve been yelling about the encroachment of


    medicine into social policy, and now I think that’s been the
    point all along.

    I’m on twitter, if enough people sign up I’ll try to make it


    worthwhile

    http://twitter.com/thelastpsych
    All Girls School Or Coed? Which Is
    Better?
    April 8, 2009

    "Graduates of all-girls schools show stronger academic


    orientations than coed graduates." What?
    The study is one of the largest of its kind. It also addresses a
    crucial flaw in many other studies, by comparing single sex
    schools to coed private schools, eliminating the “private is
    better” confounding variable.

    6500 women from 225 single sex high schools compared to


    15000 women in 1200 coed private high schools, across the
    country. It also separates out the Catholic schools, and controls
    for race, income, etc, etc.

    62 percent of s-s students spend 11 hours or more per


    week studying, compared to 42% of coed school’s female
    students.
    81 percent of s-s women graduates rate themselves
    “above average” or in the “highest 10 percent” for
    academic ability, compared to 75% of coed women
    graduates.
    60 percent of s-s women rate themselves “above average”
    or in the “highest 10 percent”with regard to intellectual
    self-confidence, compared to 54 percent of coed women.
    48 percent of female graduates of s-s women rate their
    math ability “above average” or in the “highest 10
    percent” compared to 37 percent of coeds.

    Two seconds spent staring at this lead to the obvious question:


    are they better students, or worse students who are also
    delusional? If they spent 11 hours or more studying, was it
    worth it?
    Higher SAT Scores. Women who attended single-sex
    schools tended to outscore their coeducational counter-
    parts on the SAT. Mean SAT composite scores (Verbal
    plus Math) are 43 points higher for single-sex graduates.

    I’m not sure if that was meant to be a joke or not. 43 points


    may be a lot (which it isn’t) but it’s hardly reason for a group
    of students to have such a bloated sense of self-esteem that
    they consider themselves in the top 10% (I look forward to
    your emails.) Or, the reverse: 43 points is hardly a reason for
    another group of students not to have an bloated sense of self-
    esteem.

    Clearly, there is merit in fostering intellectually curiosity and


    ambition, but things like this:

    Single-sex graduates also report more time talking with


    teachers outside of class, where 37 percent of single-sex
    graduates reported spending three or more hours per
    week meeting with teachers apart from class

    Seem to me a solid reason to home school.

    My point here is not to disparage single sex schools, there may


    be/are excellent reasons to send a kid to a single sex school. It
    simply appears, based on this, one of the largest and most
    important studies on the question, that self-esteem goes up
    disproportionately to any concrete metric of achievement.
    Contrasting opinions/information are welcome. I am entirely
    ambivalent on the question of same-sex education; my own
    was vigorously no sex, with the resultant negative effects on
    my own self-esteem. Now I write a blog. Plan accordingly.

    http://twitter.com/thelastpsych
    No One Noticed
    April 9, 2009

    sell in May and go away


    Hospitals Accused of Patient
    Dumping To Pay
    April 9, 2009

    A ha ha! No, silly, the patients don’t get paid. I.

    Two California hospitals are fined $1.6 million for dumping


    indigent psychiatric patients.

    City officials allege that over two years, as many as 150


    patients from the two hospitals were dumped on Skid
    Row, an area on the east side of downtown where
    thousands of homeless people live.
    “We will not stand idly by while society’s most
    vulnerable are dumped in the gutters of Skid Row,”
    Delgadillo said in a statement.

    Actually, that’s exactly what you’re going to do.

    For the uninitiated: indigent patients frequently come to


    psychiatric hospitals with quasi-legitimate complaints, looking
    for somewhere to stay. There’s no insurance, so the hospital
    eats the cost.
    $1.6M for 150 patients is $10666 per patient. Medicaid pays,
    what, $700 per day? That’s 15 days.
    These patients are likely to have used far more than 15 days
    each over two years, right? Not to mention any consults
    (medicine, surgery, etc) for other ailments, labs, meds. And
    potential liability issues, potential violence… in other words,
    they would have cost the hospital way more than $1.6M.
    So dump the indigent patients and pay the government their
    look-the-other-way money, you make it all back in two weeks.
    Faster if you get a private insurance patient in that bed. Solid.
    Sounds like the government and College Hospitals have
    reached a mutually beneficial agreement.

    II.

    College Hospitals attorney Glenn Solomon denied any


    wrongdoing by the hospitals.

    Well, there’s the rub. It’s not like these hospitals threw a black
    hood over their heads and Guantanamoed them to a
    waterboarding park. I wasn’t there, but I’m guessing it went
    something like this: “sorry, we can’t admit you. We can get
    you transportation to a homeless shelter, if you want. Hang out
    here, the van will come get you in about, oh, two and a half
    hours. Want some juice and crackers?”

    To the layman, it seems like hospitals are incentivized not to


    admit indigent patients; while that is only partly true in
    medicine, it is rarely true in psychiatry, especially psychiatric
    floors in multispecialty hospitals where they are accepted to be
    loss leaders. It is extremely rare that people who need
    admission get turned away; far more common is that people
    who don’t need admission get admitted anyway; for their
    convenience, for the doctor’s convenience, to avoid litigation
    or violence, etc.

    If the city really thought the hospitals did something wrong, if


    they really wanted things to change, they would probably have
    come up with something more powerful than this:

    College Hospitals will be required to develop protocols


    for discharging psychiatric patients to “ensure homeless
    psychiatric patients will have the dignity and the
    continuum of care that everyone leaving a hospital
    deserves.”
    Now that’s Change We Can Rely On.

    What it comes down to is that no one knows what to do with


    these people, and no one wants the responsibility— but they
    don’t want to lose all of the access (because there’s money
    there.) Hence a passive-aggressive shifting of responsibility,
    back and forth. If the city really pushed the hospitals, the
    hospitals would push back— “hey, you want us to handle it,
    reimburse us better.” Meanwhile, hospitals don’t want to
    offload all of the responsibility because they need what little
    revenue is derived from indigent patients.

    It’s like a married couple, both have secretly cheated, both


    suspect the other knows, so neither ever brings it up. And so it
    hangs like a fart over the relationship, toxic. But the only way
    the relationship can survive is by never having a frank
    discussion about what to do.

    If the hospital pretends to accept that the fine has any


    legitimacy— i.e. they are partly responsible for the homeless
    people even when they are not in medical crisis, then they can
    get away with a small fine. The city, meanwhile, gets to
    pretend that the homeless problem is a psychiatric problem—
    and appear active on the homeless issue by asking for the
    hpspitals to change.

    What’s the outcome? Don’t ask what benefits the homeless.


    Ask what benefits the city and the hospitals: a new billing
    code and reimbursement for the additional service of
    “coordinated post-hospital care.” And the return of state
    hospitals.

    Before you judge these outcomes either way, go back and find
    out what happened the last time we did that.

    http://twitter.com/thelastpsych
    the fun starts on fake Easter Sunday
    The Near Death Of A
    Salesman
    April 10, 2009

    The barbarians are coming. He was in really good shape,


    except for the belly. At home he could eat right, exercise, go to
    church, raise two sons and a daughter, but three out of seven
    days he was in a car or in a hotel. Real life was on hold. So the
    cheesesteaks, the corn chips, and the sodas belonged to a
    different reality, and when the doctor asked, “do you have a
    good diet?” he answered yes and he wasn’t lying.

    He didn’t take any medications, the only thing he took was


    Lipitor and a blood pressure pill, that’s it. He had some
    Percocets for his back pain from a fall nine years ago, he got
    Xanax off the internet, he took one or two of those a day, but it
    was just to help him relax when he was traveling, he didn’t
    really have a disorder so it didn’t count. Also Ambien. He also
    had some Plavic or Plavix or something, but he didn’t really
    need it, he only took it because his doctor didn’t want him to
    get any more clots, but he hadn’t had any clots for three years.
    So.

    Really, in real life, if he didn’t have to work or travel, he


    wouldn’t really need any of this stuff. And this wasn’t his real
    life, anyway, he was still planning his real life. He was 47—
    three years of youth left. Three years to get his real life started.
    Three years before he had to get depressed.

    Drinking was part of that other reality, too. He had a couple of


    drinks at business lunches, one or two before dinner, then
    some wine, a few more before bed; and yes, ok, he drank when
    he was at home too, a bottle of wine with dinner and a few
    vodkas with Letterman, but he was never sloppy, always in
    control. He was sure his 12 year old son didn’t know. When
    the doc asked, “how much do you drink?” he truthfully
    responded wine with dinner. The rest was not planned, he
    never thought, “I got to get some martinis into me.” So it
    didn’t count.

    For twenty years, none of it counted.

    And there were the women. When he first met his then hot
    wife at a sales meeting, 20 years ago, they were young,
    making money, and sexually hungry. They drank, they
    smoked, they were naked in hot tubs. But after they had kids
    she “became” a prude; “became”, in quotes, because he didn’t
    actually remember the transformation; he just saw what she
    appeared to be, now. The rest wasn’t past, it was an alternate
    reality. He hadn’t forgotten that she had once tied for first in a
    bikini contest— and what happened after; it was just a
    different reality.

    So yes, years on the road he had had some one night stands.
    Come on. They didn’t count, they were not planned, he never
    thought, “I got to get some” and etc and etc.

    Besides, the women he slept with were not as attractive as his


    wife. But they looked at him like they knew he could dominate
    them, and that was enough.

    II.

    It wasn’t that he didn’t love his wife, or something.

    His wife was a lot like him. She was in sales and she could
    drink a good game, too. But she had a more stable view of diet
    and so while he had the belly, she was still built. But her face
    was gaunt: there comes a time in a woman’s life when she has
    to choose between her butt and her face. She chose. Anyway,
    men didn’t notice the faces of the women they wanted to sleep
    with, and certainly not the faces of the women they didn’t
    want to sleep with.

    She never flirted, but it didn’t matter. The only salesman who
    wasn’t trying to get her face down in Courtyard Marriott was
    her husband; the irony was that if he knew what other men
    wanted to do to her, it would have made him violently jealous
    and constantly erect.

    But he didn’t know-tice, because his wife wasn’t real. He


    didn’t see his wife as a person with a past. Or a future. She
    was just part of his ongoing present.

    Though he wasn’t particularly interested in having sex with his


    wife, he was very interested in imagining sex with this wife.
    His default masturbation fantasy was thoughts of his wife (20
    years ago) in all sorts of sex with all sorts of people. He didn’t
    really want it to happen— and he knew she would never, ever
    actually cheat on him— but he couldn’t help imagining it. He
    tried to fantasize about other women, why not? but it always
    came back that adulterous slut in a bikini, or in white heels, or
    both. His favorite fantasy was that they’d be on their
    honeymoon in Bermuda, he’d get drunk and pass out, and the
    couple they’d been having dinner with would take her out by
    the pool and work her over from both ends.

    III.

    His son’s homework was: give four examples of why FDR


    was a great President. His son had started a paragraph on how
    FDR got the country out of the Depression. But he knew that a
    lot of the things FDR had done had actually prolonged the
    Depression. He tried to explain to his son that news, and even
    schoolteachers, sometimes had a “liberal bias” but it was hard
    to explain what “liberal” meant to a 12 year old. And now he
    couldn’t remember the specific mistakes Rush had said FDR
    made, so he tried to intuit what John Kerry might have done.
    “He raised taxes on the rich, but that meant they didn’t have
    money to build factories and railroads, so everyone ended up
    being poorer.”

    He fantasized about having his own radio show. He’d be


    perfect for afternoon drive. He could do a Monday segment
    where he’d round up news from Asia and talk about how they
    were taking American jobs; and on Fridays he could lighter
    segment called “Hollywood’s Hoes” on how it destroying
    traditional family values.

    “Didn’t FDR defeat the Nazis?” the boy asked.

    “No, actually, he almost lost to the Nazis. He didn’t want to


    use the bomb because he was against nuclear war, see? He
    kept wanting to go through the UN, which at that time was
    called the League of Extraordinary Nations.. Meanwhile, the
    Germans got away with the Holocaust. It was only after FDR
    died that Truman— or Eisenhower, I can’t remember— did
    what had to be done.” He could also draw, and if he could just
    get some free time he could definitely do political cartoons. He
    imagined drawing Berlin and all the people running around in
    a panic— “Evakuate! Evakuate! Roosevelt bin kaput!”

    What would be better than a political cartoon would be to


    recreate that in a sketch, like for SNL. That would be hilarious.
    He’d play a worried Hitler who schemes to steal FDR’s body
    to resurrect him. Why not? He could act, he had great timing,
    he was pretty good looking, yeah he had the belly but if SNL
    tapped him he’d go hardcore to the gym so that wouldn’t even
    be an issue.

    If he could just get some free time, he could write them a


    pitch.

    IV.

    And then he had a stroke.

    That’s what his wife called it, but could he be driving across
    Oklahoma if he had had a stroke? His balance was off, and his
    right arm was definitely weaker, but he wasn’t slurring his
    words (only a little) and he wasn’t paralyzed.

    His wife had noticed these things that morning and tried to
    take him to the ER, but he said NO WAY. Finally she forced
    him to phone his doctor, who quickly set them both straight:
    “you do realize this is the fifth time this month you’ve had
    some odd physical problem?” They played golf at the same
    course. “You’re somaticizing. Take a Xanax. Stop drinking.”

    She pestered him, this was “serious”, not to be “ignored.” Yet


    she had a detached tone, she was talking towards him, not to
    him. How serious could it be if she wasn’t really worried? He
    didn’t know that after twenty years of marriage it’s easy to
    misinterpret not caring as not worrying.

    But it was odd how he wrote his name with small, scratchy
    movements; how he couldn’t grip a fork the right way. How he
    raised his arm tentatively and unnaturally as if his shoulder
    socket hurt badly, though it didn’t hurt at all. How it felt like it
    wasn’t his arm at all.

    He had a friend who was a doctor, one he could level with, one
    who’d be straight with him. He’d call him, get some real
    answers.

    Well, he wasn’t actually a doctor, he was a psychiatrist, but so


    what? He’d know a stroke, right? He knew him from college,
    no, he knew his wife from college. No, wait: his wife knew his
    wife from college. He had never actually met the psychiatrist.
    But so what? The wives were close.

    He left a message, the psychiatrist called him back. “Look, I


    don’t want to waste your time, but my wife has been nagging
    me, you know how that can be…” He explained his
    symptoms, and was very careful not to leave out any of the
    psychological aspects, the stress, yes, even the drinking, he
    wanted the psychiatrist to understand the complete picture, the
    complete man, so he could give a reasoned assessment, and if
    the psychiatrist thought he was nuts, well, all right then. He
    told even told him he had slept with a stripper in Kansas…
    could this be a guilt reaction? He just wanted the shrink’s
    honest opinion, man to man.

    “Ummm,” said the psychiatrist, “I’m pretty sure you’re having


    a stroke.”
    V.

    He sat down. Of course it was a stroke. He had known it all


    along, but he hadn’t wanted to admit it.

    A stroke. Oh my God, now what? He hadn’t died, but he knew


    the weakness would be permanent, and every moment he
    didn’t get treatment was risk of more weakness, more
    infirmity.

    All those things he had dreamed about, all the things he had
    wanted to to— a radio show, golf pro, the novel, losing
    weight, going back to school to become a lawyer— all those
    things would never happen.

    He wouldn’t be able to finally read The Federalist Papers with


    his son, wouldn’t be able to learn trigonometry to help him
    with his homework; he wouldn’t be able to wake up at 5am
    every day with his eldest son and help him train.

    The stroke had taken all that away from him. All he’d be able
    to do now as live day to day.

    VI.

    That evening, too drunk to work on a cartoon, he stumbled


    into his daughter’s room, sat on the bed. It crunched, he pulled
    back the sheets, there lay a spiral notebook. Poems, song
    lyrics, quotations. Kids still did that? He wondered why. He
    used to do it, too, because his parents were too self-absorbed
    to notice him in any meaningful way, and no one else would
    listen. He remembered his block capital letters: THERE IS NO
    PAIN YOU ARE RECEDING/OUT OF THE CORNER OF MY
    EYE.

    On one page was a song even he recognized as being by T-


    Pain, or one of those guys, and next to it another song he
    thought he might have seen performed on Letterman, or
    maybe it was a poem, and she had written out all the lyrics.
    His eye caught two stanzas:

    Why isn’t anything happening in the senate?


    Why do the senators sit there without legislating?

    Because the barbarians are coming today.


    What laws can the senators make now?
    Once the barbarians are here, they’ll do the legislating.

    VII.

    Three weeks later he went in for an MRI. Nothing. Ha. The


    psychiatrist was wrong, what did he expect from a psychiatrist.
    No stroke, it was stress after all.

    Now there was no reason he couldn’t do all those things he


    had wanted to do.

    He suddenly felt restless, confused; his face became serious


    with thought. Night had fallen, and he was still alive, still
    healthy. What was going to happen to him now?
    How Dangerous Is Academic
    Psychiatry? Ask David
    Foster Wallace
    April 13, 2009

    No, not negligence, but nowhere near informed consent, either.


    I’ve never read anything by David Foster Wallace, but I know
    he’s got an intense readership. I also know he ultimately killed
    himself after 30+ years (started when he was 16) of
    depression. He had been on and off meds, many didn’t work,
    and Nardil had managed to stabilize him for a while.

    Then, this:

    The New Yorker:

    There were other important reasons to get off Nardil. The


    drug could create problems with his blood pressure, an
    increasing worry as he moved into middle age. In the
    spring of 2007, when he went to the Persian restaurant
    and left with severe stomach pains, the doctor who told
    him that Nardil might have interacted badly with his meal
    added that there were better options now—Nardil was “a
    dirty drug.”

    This passage— especially the last two words— stayed with me


    for a while. I actually had a dream about it. “Dirty drug.” I
    could hear the “psychopharmacologist” (that’s apparently what
    the doc called himself) saying it.

    To me those two words symbolize everything that is wrong


    with psychiatry today.
    I.

    To a psychiatrist, “dirty” means the drug binds to what what


    makes it efficacious (e.g. serotonin receptors) but also a lot of
    other places that cause different side effects. For example,
    Pamelor is a dirty drug because it binds to histamine
    (sleepiness) and alpha1 (orthostasis/lightheadedness), M1 (dry
    mouth, constipation), etc. Prozac is an SSRI— a selective
    serotonin reuptake inhibitor— it does the one thing (serotonin)
    and nothing else.

    No one says Prozac is more efficacious than a dirty drug, we


    say it has less side effects (sedation, constipation, etc.)

    The problem is that there is no reason to make the distinction


    between effect and side effect. I get that constipation and
    sleepiness are “bad,” but how do you know the receptors H1,
    M1, and alpha1 are also working in some other way to
    generate efficacy? Or that you don’t need all of the receptors
    together with serotonin?

    The fact that we target serotonin for depression is a fact of


    marketing, not of science; thirty years ago we could have gone
    with dopamine reuptake inhibitors and bred a generation of
    Wellbutrin clones. I’m not saying serotonin isn’t relevant in
    some way; I’m saying when Abilify treats depression, don’t
    assume it was serotonin. Or the dopamine. You simply don’t
    know.

    II.

    My own observation: the words “dirty drug” are never


    preceded by the words “this is going to work awesomely
    because it’s a.”

    As far as biases go, one could speculate that the more


    receptors it binds to, the better chance it has to work. Right?
    Why not? But we have artificially chosen to believe the
    opposite.
    The only time a psychiatrist would say “dirty drug” is when
    they’re about to stop it.

    Nardil caused a bad side effect for Wallace, and I can’t fault
    the doctors for attempting a change. But why say the words
    “dirty drug” to the family?

    He’s saying it because he’s a cowboy, an idiot, he’s using the


    psych lingo to show he knows a lot about the drug— “there
    are a hundred things wrong with the drug, no time to explain
    now, trust me, I know what I’m talking about.”

    The family is hanging on your every word, but because of the


    high emotionality they don’t detect nuance. They don’t know
    what you really mean, and they don’t ask because they think
    it’s self-explanatory.

    But psychiatrists love to use the lingo with patients, and no I


    have no idea why: dirty drug, augment, mood stabilizer. Every
    time you use a psych term, even if it seems obvious, you are
    telling them something different than you think you are telling
    them.

    III.

    The article doesn’t make clear who had heard the words “dirty
    drug” spoken. Perhaps it is his wife, Karen Green; or it may
    have been his sister, Amy, who in another article seems to
    have finished the thought:

    “So at that point,” says his sister Amy, with an edge in


    her voice, it was determined, ‘Oh, well, gosh, we’ve
    made so much pharmaceutical progress in the last two
    decades that I’m sure we can find something that can
    knock out that pesky depression without all these side
    effects.’ They had no idea that it was the only thing that
    was keeping him alive.” (emphasis mine, sarcasm hers.)
    The doc said, “dirty drug.” Amy heard: “what kind of nut put
    David on such a dangerous drug? Hello, it’s 2008, we have
    way better drugs than that! Thank God you came to us.
    Nardil? Are you f-ing kidding me? What 1860s phrenologist
    came up with that? Did he try exorcism, too?”

    Do you think Amy had any confidence to try and suggest that
    the Nardil be continued?

    Note the importance to Amy of this exchange. They were


    nervous about changing, and I’m sure the doctor gave his
    reasons why he thought a change would be beneficial. But he
    then said “dirty drug” which conveyed incredulity and
    contempt. That’s not me speculating, that’s Amy saying it.
    That, my friends, is real undue influence. This happens all the
    time. If they had any reservations about changing the Nardil,
    that obliterated them. As a family member, there is nothing
    you can say in defense of a drug that a doctor has casually
    dismissed as dirty.

    No doubt, it reinforced her guilt that she hadn’t been doing the
    right thing for him; it reminded her of her stupidity, how could
    she not know Nardil was dirty?

    I’m not saying I wouldn’t have changed the Nardil (or that I
    would have). But the family never had the chance to decide if
    Nardil was worth the risk, or not, because the doctor made it
    very obvious that it wasn’t.

    NB: he was wrong.

    –—

    Don’t be a twit— sign up today

    http://twitter.com/thelastpsych
    Cinco de Mayo Is Not
    Mexican Independence Day
    April 14, 2009

    (from Wikipedia)

    History

    In 1861, Mexico ceased making interest payments to its main


    creditors. In response, in late 1861, France (and other European
    countries) attacked Mexico to try to force payment of this debt.
    France decided that it would try to take over and occupy
    Mexico.
    WSJ: Did December Ever Happen?

    What else ended in November and started in January?


    On September 21, 2008, Goldman and Morgan Stanley changed
    their status from investment banks to bank holding companies—
    and thus submitted themselves to the oversight of banking
    regulators and the Fed.

    So December went missing with the government’s approval. The


    same approval that allows the release of earnings that are of the
    form: “if you exclude our losses, we’re making a ton of money.”

    When this earnings season ends, I would recommend being no


    where near a stock market. Cinco de Mayo seems an excellent
    time to sell.
    The Woman Who Can’t Forget
    Is Awesome Because She Can
    Forget
    April 20, 2009

    Here’s a question: when someone with OCD checks the stove twenty
    times, why wasn’t fifteen times sufficient?
    Wired runs a story about The Woman Who Can’t Forget, Jill Price.
    43 years old, unremarkable in most ways except that she can recall
    every (?) event in her lifetime, including events in the world. For
    example, ask her when a certain plane crashed and she can tell you
    — and also tell you what she was doing that day; as well as every
    other plane crash in the past forty years, as well as what she was
    doing those days, etc, etc.

    It works also in reverse: give her a date and she can recall what
    happened to her, and what happened in the world.

    She has a vivid, perfect autobiographical memory, and anything else


    that happened within the blast radius of her life experiences.

    She’s been the subject of newspaper articles, a 20/20 interview with


    Diane Sawyer, this Wired article. She is amazing in her skill— no
    one disputes that.

    However, interestingly, she has trouble with recent memory. She


    forgets an interview from a month ago. She cannot recall a list of ten
    words read to her; and, she can be tricked into remembering a word
    that she never heard (thread, pin, thimble but she remembers also
    needle.)

    She was a very average student. She has not won Jeopardy.

    But, she says that her memories are always running in the
    background of her mind, like a movie of sorts, that she can’t turn off.
    She is an obsessive journal taker, constantly jotting down the
    minutiae of her life— however, she says she rarely rereads these
    journals.

    Wired also reports that she collects/hoards all the memorabilia of her
    life; her stuffed animals, old TV Guides, etc.

    As I followed Price’s story, I was fascinated but doubtful. I am


    a cognitive psychologist, and to me something didn’t smell
    right.

    The writer suspects that she doesn’t have an impressive memory, per
    se, but rather OCD.

    Price has spent her whole life ruminating on the past,


    constructing timelines and lists, and contemplating the
    connections between one February 19 and the next. Dates and
    memories are her constant companions, and as a result she’s
    really good at remembering her past. End of story.

    Slow down, James Randi.

    It may indeed be true that she has OCD, but it is unlikely the cause
    of her impressive memory.

    II.

    First, let’s answer my opening question. If someone with OCD has


    to check everything “seven” times or else something bad will
    happen, then it is the ritual that is the point, not actually getting any
    information from your checking.

    But if someone is “neurotic” (vernacular) and has to check the stove


    twenty times in order to reassure himself that the stove is off, then
    something is not occurring between the eyeballs and the brain. He
    sees the stove is off, but then when he diverts his attention to
    something else, he does not trust himself— he has to go back and
    check again. We’ve all had this experience to some degree— tap into
    it, because there are three possibilities:

    1a. you do not trust your memory of what you saw (“Did I really see
    it off?”)
    1b. you do not trust your memory of the checking (“Did I really
    check it, or didn’t I”)

    2. you do not trust your attention to it (I know I looked at the stove


    itself and the flame was off, but perhaps I didn’t pay enough
    attention to the knob which was turned just enough to allow a gas
    leak)

    A few minutes reflection on these two possibilities will strongly


    suggest that both or either might be the explanation for the initial
    two or three checks. “I’m just not sure…” But why more than that?
    Is there a point when you feel totally satisfied? No— you force
    yourself away.

    3. the more you check— the process of checking itself— causes you
    to distrust your how well you performed the previous check.

    Number 3 is indeed so powerful that regular (non-OCD) people can


    come to doubt their checks by making them check multiple times.

    So a downward spiral forms: lack of confidence in memory or


    attention makes you check again, which in turn reduces your
    confidence in your attention to the check, which causes you to check
    again, etc, etc.

    Note that the actual content of the memory is intact, e.g. accurate. If
    I make you check a word list, and you check it thirty times (“are you
    sure those are the words?”) your confidence in the check will be
    poor (did I really look at the top five closely enough?) but your
    actual recall of the words will be good.

    Jill Price does not lack confidence in her memories. She doesn’t
    even need to check her journals. Going over her memories
    repeatedly may be what helps her remember, but it isn’t OCD that’s
    making her go over them.

    III.

    Lost in all the hype is an inconvenient fact: Price’s brain was


    scanned more than two years ago, and the results—not yet
    published—apparently don’t support the notion that she’s some
    kind of memory goddess. Her hippocampus and prefrontal
    cortex are reportedly normal. The one significant aberration,
    according to Price—who was told about the scans by doctors
    who won’t discuss them publicly—is that her brain resembles
    those of people with obsessive-compulsive disorder.

    If by “resembles” he means “is as squishy as” then I’ll concur. If he


    means something else, say, “smaller grey matter in BA6” then I
    dissent: the brains of people with OCD don’t even resemble the
    brains of other people with OCD. First, anatomical differences are
    invisibly uninformative. Second, functional differences (e.g. fMRI)
    are only visible when OCD is separated by subtype (e.g. checking,
    hoarding, etc) but these diffferences are useful only to distinguish
    between groups of people you already know have OCD, not as
    diagnostic tests. For example, the pic below shows significant
    correlations to activity in (checking) OCD patients vs. controls:

    But if Jill Price’s fMRI was any of the red circles, what would you
    deduce? Anything? In order for these scans to be useful, they have to
    be tied to the phenomenology, and even then, they aren’t worth the
    money.

    IV.
    There are some mechanistic explanations for her abilities: notable is
    the way she uses emotional cues (such as songs) to call up the
    feelings; and an intuitvely backwards calendar system to remember
    dates. That’s for another post (someday, sigh.)

    But let me leave you with a more general, social point, concerning
    her fame— why we should care about her.

    Oddly, the Wired writer does hit on the likely explanation for her
    memory:

    Why were Price’s abilities blown so far out of proportion? I


    wouldn’t blame Price; she’s as happy to tell what she doesn’t
    remember as what she does. But her story has taken on a life of
    its own. It started with that 2006 journal article: Although the
    scientists knew about Price’s diaries and compulsions, little in
    the paper speaks to the question of whether it might be
    personality, not memory, that makes her extraordinary.

    Wrong: it is precisely her memory which makes her extraordinary,


    and not anything else. the mistake the writer makes is the need to
    find a biological explanation for her extraordinariness, as opposed to
    simply the result itself. Is her memory any less extraordinary
    because she doesn’t have a gigantic hippocampus?

    Also, note the conflation of “personality” with OCD. The writer is


    an academic psychologist, and he absolutely knows OCD isn’t
    personality; but he uses the words interchangeably because they both
    mean “not related to specific memory modules in the brain.”

    This woman is 43, she lives with her parents, she is a school
    administrator, she looks like Janice from The Sopranos— none of
    these things would make Wired want to write an article about her.
    But here’s the point: if she was born with a gigantic hippocampus,
    then Wired wouldn’t care about her then, either. And if she was born
    with a gigantic hoppocampus but she didn’t have a superior memory
    — then again, no article.

    What’s amazing about her is that she can do this for no good reason.
    She is amazing by virtue of her personality— i.e. adaptation to her
    environment. If I was an amazing marathoner by genetics— boring.
    But if I was an amazing marathoner because for the first twenty
    years of my life I was relentlessly pursued by a puma, well, that’s a
    story worth writing about.

    She has caused to exist an amazing ability despite not having the
    biologic machinery one expects in these situations.

    Let me put it another way: she’s amazing because of what she has
    done, not of what she is.

    And that’s supposed to be the way it is for everybody.


    Yeah, Well, Cry Me A River
    April 22, 2009

    If you’re watching it, it’s for you.


    I can assume everyone has seen the clip of Susan Boyle
    singing I Dream A Dream on Britain’s Got Talent.

    “Your halo is a little two steps to the right.”

    Everyone loves an underdog. Everyone loves a high horse,


    too: “take that, you prejudicial prigs, who expect a good voice
    to only come out of slinky blondes with belly rings.”

    Myself, I don’t expect it only out of slinky blondes, though I’ll


    admit I like it better. But despite my fascination with slinky
    blondes, I have never bothered to find one that sang on
    Youtube. My lust cannot be monetized.

    I did, however, against all better judgment, go look for this


    clip. And there’s the rub.

    Let’s step back and ask some questions:

    1. Is it really surprising to anyone that a 47 year old woman


    can have a great voice? (Opera, Aretha Franklin, etc?)
    2. Is it surprising to anyone that an overweight or homely
    woman can have a great voice? (Madonna, Coldplay, etc?
    (Zing!))

    No. Which brings me to the 3rd question:

    3. Could it possibly be surprising to Simon Cowell? After


    seven years of Britain’s Got 10p Text Messaging, he was
    suddenly caught off guard?

    That I smell a rat is besides the point. My first instinct is that


    Simon had already heard her sing, or maybe even specifically
    recruited her to come for an audition because of her 1999
    single Cry Me A River.

    This doesn’t take away from her ability— she can sing a tune,
    that’s for damn sure.

    But what’s relevant point here is what is being done to you.


    Regardless of whether Simon knew about her beforehand, her
    performance has now been packaged and marketed in a
    different way, specifically for you, based on what they know
    you like. This further reinforces those preferences on your
    part. In other words, they are giving you what you want, and
    training you to want the next thing.

    Watch the clip, the editing, the story they are writing: how
    they contrast from shots of cynical audience members, then
    cut back and forth to the hosts and audience as they look on in
    amazement. That’s all done after the fact. That’s the
    performance. The live studio audience is legitimately
    impressed as it happens; but the Youtube viewers are
    compelled to be impressed by the slick Hollywood movie they
    are watching. If you had stumbled upon a clip of her singing
    into a webcam in her kitchen, you might say, “wow, whaddya
    know” and then gone back to porn or stock quotes. But when
    you are told “go see this (highly produced) clip” then you
    believe they hype. It’s putting a $100 price tag on a bottle of
    wine, and therefore liking it more.

    Britain’s Got Talent isn’t trying to eventually find the next


    winner so they can give them a record deal; it’s trying to get
    viewers now, ad revenue, and text messages. You don’t do that
    with another slinky blonde— to sell records yes; but to get TV
    viewers no— you do it with someone who is going to appeal
    to the show’s demographic.

    What you want is a shot of Simon— the eye candy for the
    target demographic— looking dreamy eyed.

    “I said, ‘my darling, you look wonderful to-night.’”

    It’s not a talent show, it’s a docudrama.

    Let’s peek at the meta-script’s next act. Boyle’s awesome, but


    where’s the drama? Who is going to be her nemesis on the
    show? You might first consider a slinky blonde— but that
    wouldn’t work because it’s not polarizing, there’s no tug of
    war. You want someone who pulls at the same viewer who
    likes Boyle, but in a different way, to create inner tension.

    In other words, you want a cute kid.


    And look, he wore a tie!

    A 20 year old wants to love someone who ultimately wins and


    hate someone who eventually loses. A 40 year old wants to
    love two people, and be sad when it ends for one of them.

    Part of this, as one clever reader emailed me, is that Boyle’s


    story fits the theme of my favorite generation: even at 47, you
    could still possibly have your life activated and assume your
    rightful place in your movie. Not through hard work or
    perseverance, of course, but simply by being discovered.

    “But hold on— she did work hard to be able to sing that well!”

    Sure— but notice that’s not part of this story that they are
    telling you. They deliberately emphasize her backwards, never
    been kissed, works in a diner persona. “Oh, I’ve just sung in
    my church choir.” Really? Is that all?

    She can be the undiscovered, “am I too old?” neglected talent;


    the kid can be the budding prodigy, “even if you lose kid,
    you’re going to be a winner.”

    Undiscovered is the new porn.

    To repeat: none of this detracts from Boyle’s excellent voice,


    or her chance to make from this what she can. But do not think
    the gods smiled on Susan Boyle and, lo, she has been
    discovered.

    Susan Boyle, plant or not, is a character in a well scripted


    movie, with the only theme that will get people to sit in front
    of the telly nowadays: everyone’s a winner, unless they’re a
    loser, and then they’re winners, too. And 47 is no longer too
    late. Everything you see from now on will have been carefully
    scripted and choreographed.

    Everything, that is, except the unfortunate crash that always


    seems to come at the end of these dramas. When everyone has
    to go back to real life.

    And by everyone, I mean you.


    What Should Count As A
    Disease?
    April 24, 2009

    Quick, look over there! Ronald Pies writes:

    What exactly is a “mental disorder”? For that matter, what


    criteria should determine whether any condition is a
    “disease” or a “disorder”?

    and attempts an answer. It is this:

    I know you can’t read the words in this graphic, but what’s
    important is that his answer isn’t an answer at all, it’s another
    hierarchical model, not a physics-style concrete truth. Nothing
    the “Wovon Man” guy would sign off on.

    This is not a failing of Pies; there’s no possible way he could be


    expected to come up with a concrete solution. But his answer is
    just as ambiguous, relative, and subject to individual prejudices
    as simply defining a disease as “anything in which the person
    or surrounding people feel suffering. Severity of illness
    correlates to amount of suffering.”

    I’m not saying my definition is better— it’s equally valid, or


    invalid, or whatever you want to believe this whole project is.

    It should be fairly obvious that “disease” is an entirely


    subjective term that can be applied legitimately to anything.
    “The disease of right wing conservative ideology.” See? 50% of
    you agreed. Not jokingly agreed, mind you— but found a
    serious element of truth to that diagnosis.

    Point is: people can’t be trusted to value anything. Remember


    that idiotic book Nudge? Look where it got us.

    II.

    You may want to ask whether “what constitutes a disease?” is


    something you really want the answer to. If it turns out that
    alcoholism is not a disease, then what? Close all the rehabs?

    Trying to determine what is, or what is not, a disease is a


    distraction, a red herring. The real question is, what are we
    going to do about that thing?

    The Average Joe is at a bit of a disadvantage. He feels


    something’s amiss with say, “ADHD is a disease” but doesn’t
    have the language to articulate it. So he says, “ADHD isn’t a
    disease because it’s too vague, not based on any physical
    pathology.” He says that, because he’s trying to argue like he
    thinks a doctor might argue, using the word “pathology” or
    using definitions. Consequently, his perfectly legitimate
    suspicion is dismissed, because his arguments seem weak to a
    doctor.

    He needs to be true to himself. He doesn’t need to argue it on


    doctors’ terms, doctors need to argue it on his terms, because
    it’s a social problem, not a scientific one.
    His real problem with the diagnosis is what he’s actually best
    suited to speak about: the social ramifications. “If you call
    ADHD a diagnosis, does that mean he gets extra time on the
    test and I don’t?” That’s the part that matters. Whether ADHD
    is “real” or not, whether there is a gigantic gaping pus hole in a
    “patient’s” brain where something important should be is not
    what matters to Joe. What matters is, “he got this far even with
    the pus hole, why should he get a leg up just because he can’t
    do as well as I can?”

    Pies tries to argue like a doctor, because he thinks this is going


    to be decided by doctors. He doesn’t realize that it has already
    been decided, by forces larger than him and Joe.

    As if to reinforce that point, here is the advertisement found


    between Pies’s article:
    There’s a social problem masquerading as a medical problem.
    Oh, you think it’s a Pharma ploy to make money? Nope.
    Society wanted Pharma to take this problem off their hands. If
    you’re wtaching it, it’s for you.

    So what if it’s true? Do we believe that treating ADHD will


    lower the divorce rate? Should having ADHD mean you get to
    keep the boat?
    No one would dispute that the symptoms of ADHD exist, or
    even that they cluster together, or that they respond to
    Dexedrine. It’s probably likely this is related to some physical
    change. But? What does having this mean? Does it mean
    society is obligated to pay for it? Defer to it? Those are the
    questions that matter, not whether it is a “disease.”

    The word “disease” is a safe house, it’s “base.” It’s a clever


    accounting trick. Since “diseases” are defined to be value
    neutral and require both money and deference, rather than
    argue whether ADHD is worth our money and time, instead
    argue whether it is a disease. Once it gets labeled as a disease,
    no further arguments are necessary— it’s a disease. Don’t be a
    heartless jerk. Step aside.

    That drives Joe bananas. And it should.


    Written Authority For
    Standard Of Care
    April 28, 2009

    A doctor gets sued for an adverse Zyprexa outcome.


    The case involves an outpatient with depression who received
    Zyprexa. One week later he had neuroleptic malignant
    syndrome.

    Important elements:

    It was July (e.g. hot.)

    The patient had originally been given various antidepressants


    for recurrent Major Depressive Disorder. Final regimen was
    Effexor XR 150mg/d, Zyprexa 10mg/hs, and Klonopin 1mg
    twice a day. The psychiatrist documented extensively the risk
    of diabetes, and sent him for initial blood work, but did not
    document any discussion about the risk of NMS.

    The first symptom was a high fever and malaise. The man
    went to a medical ER but in reporting his symptoms (fever,
    weakness), he did not disclose he was on any psychiatric
    medications (he thought it not pertinent.) Triage nurse took his
    temperature (103) and gave him Tylenol. By the time the
    doctor saw him, he felt a little better and the temp was 99.7
    The ER discharged him with “fever of unknown origin” but
    reportedly told him it was “probably the flu.”

    Continued to feel worse with consistent fever. He called the


    psychiatrist and told him he had been evaluated by the ER.
    Importantly, he did not tell the psychiatrist that he had not told
    the ER that he was on Zyprexa. Psychiatrist told him to
    continue with Tylenol, etc, and if he got worse to go to the ER,
    etc, etc.
    The next day he collapsed, and brought by ambulance to
    another ER, where he was ultimately diagnosed and treated for
    NMS.

    The plaintiff alleges, among other things:

    1. NMS is a well known, extremely dangerous, albeit rare,


    side effect of Zyprexa.
    2. Psychiatrist failed to inform him of the risk of NMS with
    Zyprexa.
    3. Psychiatrist failed to properly evaluate the patient during
    the phone contact.

    No suit was brought against the first ER, as the plaintiff(‘s


    attorney probably) felt the case against them was not as strong
    because the patient didn’t mention any psychaitric
    medications.

    Let’s go through some of the points:

    Informed Consent:

    The patient was not informed of the risks and alternatives.

    I’d argue that it’s not unusual that a psychiatrist not mention
    the risk of NMS. There are simply too many side effects (for
    any drug) for complete “informed consent.” Neither is there
    much room or time for a complete discussion of alternatives.
    Not disclosing the risk of NMS does not violate the standard of
    care because reasonably prudent psychiatrists, indeed, the
    vast majority, do not either. However, it is up to the doctor to
    be aware of the risks.

    Clinical point: the fact that the doctor had extensive


    documentation about diabetes is a bad thing, not a good thing.
    Just on number of words alone, it appears that diabetes carried
    more importance than anything else that happened in that
    session, let alone NMS. Consider that all notes are real estate:
    if you devote ten times as much space to diabetes than to “-SI”
    (no sucidal ideations) then it appears that diabetes was ten
    times more important to you.

    Zyprexa is not indicated for depression.

    Irrelevant, of course, but in a trial it is brought up to show the


    doctor is a cowboy. Remember, a jury of laymen think FDA
    approval means much more than it does; they are already
    heavily biased towards this thinking. Try answering this
    question on the stand: “So the FDA spends millions of dollars
    deciding indications just so you can ignore it?” This is why (in
    my opinion) the doctor’s defense should not be that he tried
    approved treatments first, and then tried unapproved
    treatments, because it confirms that FDA approval means
    more than it does.

    The doctor’s argument should simply be that there is


    considerable evidence supporting it’s use, most of psychiatry
    already does this quite commonly, and is thus well within the
    standard of care. Period. Otherwise you’re expanding the
    issue to include not just “did you miss NMS?” but “do you
    even know what you’re doing?”

    Failure to diagnose NMS:

    Doctor says that NMS was “on his mind” as part of the
    differential diagnosis, but was dismissed because the ER had
    evaluated him; had he known the ER did not know about the
    Zyprexa, he would have stopped the Zyprexa and sent him
    back to the ER.

    Is reliance on another doctor a legitimate defense? Only if you


    are confident the other doctor’s care. Would you let your kid
    stay over some father’s house just because that father had kids
    of his own? Additionally, even if the patient did actually have
    the flu, it would not preclude having NMS. So the ER’s
    evaluation was an example of information bias: a block of
    information that seems useful because of its size, but is
    actually uninformative— and misleading.
    The doctor also stated in his deposition that NMS was unlikely
    because the patient was already on Klonopin, which, as the
    treatment for NMS, should have prevented it.

    This was bad. Not only is it factually untrue— Klonopin


    wouldn’t protect against NMS— it portrays the doctor as
    uninformed and dangerous. It’s an easy attack for the
    plaintiff’s expert. Teaching point: don’t say anything at a
    deposition that can be fact checked unless you’re sure of your
    facts. Leave all that to your expert. Most doctors think they
    can create such a good defense for themselves at the
    deposition that the case will be dropped, but that is very
    unlikely to happen.

    Doctor also stated that the patient did not have any other
    symptoms of NMS: he was clear and logical in the phone
    interview; the ER also did not note any confusion, nor did the
    ER note any rigidity The patient complained of nothing else to
    the doctor.

    This is the defense. Is the standard of care to work up every


    case of fever (but without confusion or rigidity) for NMS?
    Would a reasonable psychiatrist send a person to the ER for
    possible NMS if the only symptom present was a fever? It’s
    also helpful to work backwards: it’s unlikely most psychiatrists
    would have worked up NMS based on fever alone even if the
    drug was Haldol, which has higher rates of NMS. Ask it
    another way: how many times do psychiatrists confront fevers
    in their practice for which they do nothing?

    II.

    In the course of deciding what is standard of care, plaintiff’s


    will (and should) ask what determines standard of care? What
    books and journals do they rely upon?

    Think about your response. Think about what the plaintiffs are
    really asking. They want to make sure you are a real expert,
    using real science, etc. Saying “November 2008 issue of
    Wired” is not going to work. So how do you respond? How do
    you convey to them that what you are saying is grounded in
    established psychiatric knowledge?

    You don’t. The question is a trap. If you say, “The Textbook of


    Psychiatry” then you are holding that book up as the standard
    bearer for everything. “So you’re saying he did everything
    right according to the NMS chapter, but doesn’t the other
    chapter say Zyprexa is not indicated for depression, and has
    the potential to worsen depression? So why would anyone use
    it?” Etc.

    Here is what I would respond:

    No text or person decides “the standard of care.” Standard of


    care is the care ordinarily given by at least a respectable
    minority of competent practitioners. Psychiatry has guidelines,
    but they must be interpreted in the context of individual
    patients. Insurers may have certain requirements for
    reimbursement, but these are not de facto standards of care;
    nor should the denial of reimbursement be taken to imply
    substandard care.

    Some regulatory bodies, such as JCAHO, also have


    guidelines, but these are definitionally “best practices,” not
    “ordinarily used practices.” They are at a higher standard;
    and consequently care that meets JCAHO standards is
    therefore well within the standard of care.

    Importantly, JCAHO standards are about procedures, not


    judgments. For example, JCAHO has a policy on how to
    implement restraints and seclusions, but not when to
    implement them. If an adverse event occurs during a restraint
    episode, and JCAHO standards were met, then standard of
    care on how to use them was definitely met (though, again, not
    meeting JCAHO standards does not necessarily mean
    standard of care was not met.) However, the decision to use
    restraints might not be standard of care.

    There are many texts psychiatrists use to inform their practice


    (Gutheil’s Clinical Handbook of Psychiatry and the Law,
    APA’s Textbook of Psychiatry, etc) but none of those determine
    standard of care, ever. This is why we use experts in
    malpractice cases. Courts use expert testimony for the purpose
    of determining what is standard of care, and whether care
    delivered met that standard. An expert will also assist in the
    determination of whether, to a reasonable degree of medical
    certainty, the care delivered was the cause of the patient’s
    injury.

    Opposing experts will often disagree as to what is standard of


    care.
    Where Are They Now?
    April 29, 2009

    From April 3, 2008:

    how the mighty have fallen…


    …sideways
    Cinco de Mayo is coming. It is inevitable.
    Four Things Not To Do To
    Your Kids
    May 1, 2009

    Apart from letting them watch Japanese horror movies.


    John Gottman, from the University of Washington, has a
    “marriage lab” in which he videotaped/s married couples
    disagreeing about something minor, in order to study
    predictors of divorce. He came up with four.
    You might think they’re obvious, but if you actually try to
    avoid them during an argument, it’s harder than you think. Try
    it.
    It then occurred to me that these often some of the same
    reasons why some kids “hate” their parents. Again, you’ll
    think it’s obvious; but again, try to avoid it when talking to
    your kids.

    Disclaimer for the sensitive: the below are inflated examples;


    these are done to varying degrees, of course, sometimes it’s
    unavoidable, etc, etc.

    Criticism:
    The most difficult to avoid. Parents may not realize how a
    majority of their interactions with their kids are comprised
    entirely of criticisms.

    “Did you put away your backpack?” means “I know you


    didn’t put away the backpack.” It’s worse when mom doesn’t
    even bother to check, she just knows it. That drives kids
    bananas. “What is it about me that you just assume I don’t do
    anything right?” What it is, of course, is history— he hasn’t
    done it the past 20 times. Kids are empiricists though not
    statisticians. Past doesn’t count: if you don’t check now, then
    you can’t know now.
    The kid thinks, mom just assumes I do things wrong.
    Ultimately, this means he stops trying.

    It teaches one other awesome message: it doesn’t actually


    matter what I do, only what people think of me.

    Stonewalling:
    Stonewalling means: “I am not going to discuss this with you.”
    It means the kid has no say, no voice, there’s no one to appeal
    to, even logic. When a kid doesn’t feel people will seriously
    consider their position, they’ll go find someone else who will.
    That person will have weed.

    Stonewalling teaches kids that those who have more power


    simply don’t care to hear you. So they avoid the attempts at
    dialogue and try… alternative means of communication, e.g.
    not through words, but actions or the creation of emotions.
    And weed.

    Defensiveness:

    NB: this is done by the parent.

    In a marriage, defensiveness takes the form, “hey, don’t blame


    me, you’re the one who told me to do this.” But you can’t look
    at that defense and deduce who is actually at fault.

    But when a parent does it to a kid:

    1. the kid is criticizing the parent.


    2..the parent is actually in the wrong, caught by the kid;
    3. the kid has latched on to this single instance of parental
    wrongdoing to unload all of their pent up hostility, in the form
    of criticism about this single issue.

    And so, the parent, defensively, tries to flip it: “the only reason
    I did that is because you….” That’s disaster.

    Kid: you always break your promises!


    Parent: no I don’t, but if you would just give me a moment to
    myself, I would have been able to…

    Kid: you lied to me!


    Parent: I didn’t lie, but you were going to X, so I had to Y— if
    you hadn’t done X, I wouldn’t have had to Y.

    The kid understands that even when he is right, no one will


    care. He realizes he’ll be used as a scapegoat, forever, by those
    more powerful than he. Now where’s that weed?

    Contempt:

    It is said (by me) that rolling the eyes is a more reliable way to
    divorce than recording yourself cheating and then asking your
    wife to pull some highlights clips. Seriously, this is true.
    Anyone want to fund a clinical trial?

    Why is the toy store a reliable place to hear a parent screaming


    at a kid? It’s a toy store, what did you expect he’d want to do
    there?

    I sense your frustration. It’s the same frustration you have with
    the toll booth operator who can’t count the money correctly,
    you think, “what an idiot!” but you don’t think it through: you
    expect the toll booth guy to function at the same intellectual
    level as an engineer. Is that reasonable? If he was smarter, he
    wouldn’t be working in a toll booth.

    Yet frustration is released on the kid as contempt: the speaking


    with disgust, the sneering. “Jesus Christ, what is the matter
    with you? Are you retarded? Is this what you do in school,
    too? No wonder you can’t read.” You don’t see you do it,
    because you think it’s a brief interaction out of your day. But
    the kid feels the full force of it, and it represents a significant
    minority of the interactions he has with you. “I’m going to
    beat the crap out of you!” even though you’ve never actually
    done it. The kid knows you’re not actually going to hit him, so
    he figures, “this nut hates me.”

    If you roll your lips inwards while you yell at your kid, you’re
    pissed at him. If you find yourself jutting out your bottom jaw,
    you hate him.

    I know, I’m sure you don’t hate your kid, but like I’ve said a
    thousand times, you don’t get to decide who you are, your
    actions decide. If the kid, most of the time, hears contempt,
    then you hate your kid.

    Go ahead. Write on a piece of paper the tone of every


    interaction you have with your kid for one day, and tally it up
    at the end of the day.

    Have a good night. Sweet dreams.

    I’m going to add one more of my own:

    Ultimatum/Consequences:

    You can’t say to a four year old, “if you don’t put that down,
    you’re not going to watch TV later tonight.” That cannot
    possibly work, ever— do you really think the kid can process
    this consideration of the future, especially since you’re not
    really rigorous about applying it after all?

    In truth, you want them to do something only because you


    want them to— which is fine. So say it that way: “Put that
    down.” That’s it. Teach them they have to do what you say
    because you said it, period. Don’t subsume your authority to
    some other power in a reflexive attempt to make things
    happen: “If you do that again, you’re going to your room!”
    Now the room has more authority than you do. And it gives
    him the opportunity to test: “I’m not afraid of my room.”

    Instead, say only: “Don’t do that again.” And if he does, then


    send him to his room.

    Some things are wrong, regardless of consequences. The


    sooner a kid learns he has to behave certain ways not because
    of anything, but just because, the sooner he’ll be able to
    develop his own superego strength.
    According to Time, The
    World’s Most Influential
    Person Is…
    May 4, 2009

    You don’t know who moot is? Moot is the red pill.
    From the issue:

    It should be obvious that the poll was rigged: moot got his
    followers to vote him up. Even if that isn’t obvious, a search on
    “Time influential people” gives up half a dozen articles explaining
    precisely how the poll was rigged.

    Why would Time leave the poll up— let alone publish it in the
    print edition long after it is known the poll was rigged?

    Does this mean they know, or don’t know, the poll was rigged?

    I.

    If this is an online poll, can one actually argue that the results are
    invalid? It’s based on votes, and more people voted for moot.
    More people were influenced by moot enough to vote for him.
    Right?

    This is just like a medical study, which is why so many people


    misinterpret medical studies. The poll does not measure who is
    influential. It measures who people believe is influential. So did
    the poll accurately measure what it was supposed to? Yes. So does
    it matter that you don’t like the results?

    II.

    But it wasn’t so simple as moot running the best campaign. moot


    and his friends hacked the voting so that people could vote
    multiple times (for moot). So no, it wasn’t a valid poll.

    So back to question one: if it isn’t valid, why does Time still


    decide to publish it? Or did they really not know?

    III.

    Ok, let’s everybody settle down. Time published it because it


    knows readers will be smart enough to ignore moot at #1, and just
    look through the rest of the poll. Right?

    Time knows Americans are smart. No, no, no, not the Americans
    more than 200 miles inwards from the coasts— they’re all idiots,
    of course. I’m talking about the real Americans, the urban post-
    nationalist Americans who know we are eventually going to have
    a one world government, like on Star Trek, if we can just get
    global warming under control. They know Rick Warren isn’t more
    influential than Angela Merkel, obviously. The point is to use the
    poll to discuss what’s wrong with the landlocked Americans that
    they think Rick Warren is more influential than Angela Merkel.
    And what does that say for our (read: not their) society?

    The debate that will ensue will confirm for them that they are
    deeply interested in the world, that they are intelligent, that they
    have valuable and valid opinions. That they know better.

    Time published the poll precisely so we could look down on it,


    “that’s who those idiots picked as most influential?”

    IV.

    All this would be would be fine for Time if it was just the #1 spot
    that was rigged, not the entire poll:

    “Marblecake Also The Game.” Don’t worry about what it means.


    Just realize 4chan’s people voted simply to make it spell out
    “marble cake also the game.” In other words, Rick Warren is more
    influential than Angela Merkel because they needed an R before
    they needed an A.

    V.

    So the question stands: does Time not know, or not care? Not
    know would be awesome, and by awesome I mean absolutely
    terrifying, that a major international news magazine with their
    own journalists would not be aware of… the internet…

    Not care would be amazing, and by amazing I mean (again)


    absolutely terrifying— that a major magazine would be so
    contemptuous of its readers that it would not cancel the poll, or at
    least explain what happened. Because the poll, as it stands now, is
    now who 4chan— not anyone else— thinks is influential.

    But they don’t care. Not at all. They still might not actually know,
    either— but they clearly do not care. They do not care because the
    poll actually isn’t about who people think is influential; the poll is
    actually a tool for Time to tell you who is influential and who
    isn’t. They already know who is influential and who is not. They
    decide, they have already decided. Because they are smarter than
    you. They will tell you who is influential and who is not; they will
    tell you what is good and what is not; and they will not tell you
    anything that you don’t need to know, e.g. reality.

    It doesn’t matter if the poll was hacked or not, all that matters is
    that any 100 names appear in some order so that Time can then
    say, “see? This poll is wrong, whatever it says. Here’s what’s
    right.”

    That’s why none of the pictures that lead this story


    actually are of moot. Or anyone in the poll, for that matter.
    Merck Publishes A Fake
    Journal
    May 5, 2009

    Oh, The Last Psychiatrist wrote another conspiracy article.


    That must mean it’s wrong. So I don’t have to deal with it.
    Phew. Pass me the Blue Pill, I’m feeling anxious again, for no
    reason at all.
    From The Scientist:

    Merck paid an undisclosed sum to Elsevier to produce


    several volumes of a publication that had the look of a
    peer-reviewed medical journal, but contained only
    reprinted or summarized articles—most of which
    presented data favorable to Merck products—that
    appeared to act solely as marketing tools with no
    disclosure of company sponsorship.

    The journal is called the Australasian Journal of Bone and


    Joint Medicine. No, I’m not kidding.

    Cue populist rage: “Pharma is tricking people! There needs to


    be a separation between Pharma and medicine! Don’t let them
    in our medical schools to corrupt our impressionable 30 year
    old students!”

    Go to bed satisfied; no sex necessary.

    I.

    I have a question: is anyone accusing Merck of faking the


    data? Are the studies all lies? No. This journal contained
    research previously published (and I assume therefore peer
    reviewed) elsewhere, and review articles. I’ll grant that the
    review articles are hardly cutting edge, but no one can say they
    are false or incorrect. Isn’t it possible that Merck might have
    something useful to say on the subject of bone loss?

    “But they’re misleading, in that you don’t know Merck is


    sponsoring them.” I see. So what you object to, actually, is not
    the content, but the impression. What matters to you are
    appearances.

    II.

    Any doctor who couldn’t sense something is amiss with a


    journal called “Australasian” anything is an idiot. And a
    danger to the public. He is much better off doing exactly what
    Merck tells him to, and not thinking for himself. I’m
    absolutely serious. Do you really think such a doctor is in any
    position to critique the methodology of a clinical trial? Make
    reasonable distinctions between treatments? Of course not.
    You know what he’ll do instead, as a shortcut? Look for the
    financial disclosure.

    III.

    “I’ve seen no shortage of creativity emanating from the


    marketing departments of drug companies,” Peter Lurie,
    deputy director of the public health research group at the
    consumer advocacy nonprofit Public Citizen, said, after
    reviewing two issues of the publication obtained by The
    Scientist. “But even for someone as jaded as me, this is a
    new wrinkle.”

    New? Hey Ponce De Leon, what did you think the past fifteen
    years of throwaway journals were?

    III.

    All together now: What does the author of this story want to
    be true?
    The point of this story is to direct your outrage onto Merck
    publishing a biased journal, so that you are not conscious of
    the fact that all of the journals are even more biased.

    I can, and have, published an entire journal by going to


    Kinko’s at 3am, and I did it drunk. And it was in physics. So
    why would Merck need to partner with Elsevier to get a
    limited run of a fake journal? Obviously it is because having
    the Elsevier imprint makes the journal appear more legitimate.
    Fine.

    So why would Elsevier partner with Merck? You think it needs


    the money? Elsevier can get the money for the journal this
    way, or it can get it from selling ad space, or it can get it via
    the study authors who are funded by Merck (“publication
    costs.”) It’s the same money. What’s the difference to them?
    Why do it this way?

    Here’s why: by publishing a fake journal, it can then apologize


    for making a fake journal, thereby reinforcing that its other
    journals are not fake: “sorry, this does not meet our otherwise
    high standards of integrity.”

    IV.

    Oh, the other journals aren’t fake? Then, knowing nothing


    about osteoporosis and without looking, I shouldn’t be able to
    tell you that all the articles about Fosamax published in the
    past year will say it’s good; except for any published in NEJM,
    which will say it’s bad. Wow, what do you know, I was right.
    (NEJM: 1 2 3 4)

    Of course I don’t want Merck publishing journals. But they


    have been publishing the content of all the other journals for
    decades. They control you practice, and you don’t even know
    it, because you think, “I’ve never received anything from
    Pharma!” Yes you have, you received their message. Or did
    you prescribe Vioxx (and Depakote and blah blah) because
    you analyzed the data and you thought it was better/safer than
    the alternatives?
    You think there’s any difference at all to the patient between
    getting paid to prescribe Fosamax, and prescribing it in good
    faith based on hearing about the studies conducted by
    academics who were paid by Merck, reviewed by three other
    idiots/academics also paid by Merck, and published in a
    journal with ads paid by Merck; and while medical students
    are taught in school that Fosamax is useful for X and Y, based
    on those journal articles?

    Do you think the elderly are on 8 meds at a time because


    they’re all necessary?

    And at least I have a good idea of the bias Merck has on


    Fosamax, I know how to interpret their results. Do you think I
    have any clue what to do with anything published in NEJM?
    Do you think a layman has any chance when the regular media
    reports, “scientists have found that…”

    You’re worried about Australasia?

    The question isn’t whether Merck should be able to publish a


    journal; the question is why no one is rioting.
    No Bias Anywhere Here: The
    Future Of Bias
    May 11, 2009

    If Carrie at the end of Carrie and the melting Nazi guy at the end
    of Raiders had a kid, and then set him on fire, that’s what I look
    like right now.
    A study on “prior authorization.”

    Some drugs are covered by insurance, some are not; insurance


    companies have medication formularies. e.g. Zoloft may be
    covered, Lexapro might not be. If a doctor wants to use Lexapro,
    he has to fill out a prior authorization form detailing his reasons
    for choosing the non-formulary drug. The request can be allowed
    or denied. The point of it is simply to— nudge— the doctor
    towards the formulary drug.

    BACKGROUND: Prior authorization is a popular, but


    understudied, strategy for reducing medication costs. We
    evaluated the impact of a controversial prior authorization
    policy in Michigan Medicaid on antidepressant use and
    health outcomes…CONCLUSIONS: Prior authorization was
    associated with increased use of preferred agents with no
    evidence of disruptions in therapy or adverse health events
    among new users.

    What do the authors want to be true?

    I.

    First, let me explain why the conclusions of this study, (prior


    authorization leads to a “substantial public health benefit and cost
    savings” (as the editor summarized in his editorial entitled, “The
    Change We Need In Healthcare” (yeah, that’s what he called it;
    soon we’ll see “Dopamine Blockers in Schizophrenia: Mission
    Accomplished”))) are completely misleading.

    Despite what you and logic might think, insurance companies and
    Medicaid do not pick their formulary based on what is most
    efficacious, or even what is cheapest. They put things on based on
    the deal they strike with the drug companies. By “deal” I mean
    “payoff.” By “payoff,” I mean “kickback,” in a mechanism so
    needlessly complicated it can only be on purpose. Many “non-
    preferred agents” are cheaper/better/safer than the “preferred
    agent.”

    If we move to a single payer model (BTW: will never happen,


    ever, I’ll explain why) that payer may be able to negotiate lower
    prices overall, but it will be because of the “deals” and not because
    of judicious evaluation of safety or efficacy. If the FDA can’t
    competently evaluate safety and efficacy, do you think Medicare
    can, and still account for the third variable of cost? And what
    would we need doctors for?

    And think about the way the clincial decision is made. These deals
    occur outside and before the doctor-patient interaction. The doctor
    has no choice but to use the products available to him. He has the
    option of going off-formulary, but it is so difficult that it is
    impractical. In other words, Pharma and the insurance company
    have colluded to control the market. You didn’t like it when
    Microsoft did it. Isn’t this the definition of racketeering?

    II.

    What do the authors want to be true?

    I know what a “Department of Ambulatory Care and Prevention”


    is. But do you know what a “Harvard Pilgrim Health Care” is?
    Oh, they’re the same thing.

    III.

    Imagine if Harvard’s department of surgery was sponsored by


    Intuitive Surgical; or their psychiatry department was sponsored
    by Pfizer. Imagine those pairs then went on to make policy
    decisions, like teaching residents that the DaVinci system is first
    choice for surgeries; or teaching med students that Zoloft is first
    line for depression. Those would seem like conflict of interests
    that would never happen in today’s anti-bias climate. But there
    you go.

    You might not think this is as bad as Pfizer running the Harvard
    Psychiatry, but it’s actually much worse, because there are
    competing alternatives to Pfizer but there are no alternatives to
    insurance— especially if we get a single payer.

    I’d like to point out that Harvard has banned drug pens from the
    school because that influences prescribing.

    What are the chances that an academic at Harvard on the brink of


    becoming Associate Professor is ever going to “discover” that
    preferred drug lists aren’t a good idea?

    If you want to see what the next ten years in medicine look like,
    stop looking at Astra Zeneca. The next unholy alliance is between
    academic medicine and insurers/providers. The placebo controlled
    trials on the treatment of bipolar will no longer be controlled by
    Abott (Depakote off patent 2008), but by United Healthcare.

    Academics won’t be scrambling to get Pharma grants; they’ll be


    looking for Aetna grants. And ten years from now, when we
    finally wake up, we’ll be asking how we let insurance companies
    and government ever get so close to medical education, how we
    let them “corrupt” our residents.

    While we were distracted by Carlat for repenting his Big Pharma


    ways, no one noticed the answer:

    The answer is: some spots opened up, and they were available.
    If You Have To Ask, The
    Answer Is Neither
    May 12, 2009
    How To Lose Weight,
    Method #394
    May 14, 2009

    P.S. If you can’t tell, this has only very little to do with losing
    weight.
    Strategy: after every single meal or snack— anything at all—
    floss and then brush your teeth. Both.

    Why it works: Self discipline often fails because it is counter to


    your impulses. Telling yourself not to eat that snack is pitting
    what you want now against a different thing you want for
    incomparable reasons that occurs later on. Good luck.

    A better strategy is to exert self-discipline over something with


    no real opposition, a positive action. It takes much less self-
    discipline to force yourself to do something you don’t want to
    do (e.g. flossing), then it does to not do something you want.
    (Furthermore, flossing and brushing, while not fun, have a
    reward in their completion.)

    It’s 9pm. You’ve already flossed and brushed after dinner, and
    now you see a cookie. You could easily eat that cookie, but…
    ahh, forget it.

    Make it part of your life: after any food, floss and brush. Make
    the feeling of unbrushed teeth be unusual, uncomfortable—
    not you.

    Don’t try to stop being something (a snacker); try to start


    being something else (a person who flosses and brushes a lot.)
    Shhh— Don’t Tell Anyone
    Cheerios Lowers Cholesterol
    May 22, 2009

    FDA criticizes Cheerios maker for health claims.

    The primary business of medicine is business.


    So I think, come on, eating Cheerios may be healthy for you in
    that you are not eating a bacon bits donut, but “lowers
    cholesterol?” Isn’t that a bit of a stretch?

    At the same time, is this really a good use of the FDA’s time?
    Don’t they have Abilify ads to police?

    I.

    Imagine my surprise: the FDA doesn’t dispute that it lowers


    cholesterol. The claim that Cheerios can cut your cholesterol
    by 4% in 6 weeks is apparently backed by a real study
    (cheerios.pdf) in a real journal that is not available anywhere
    on the Pubmed. Of course. Pubmed’s too full of fake studies
    that are still online.

    But you can’t accuse Cheerios of being misleading about the


    extent of the effect: it doesn’t say “gigantosaurously,” it says
    “4%,” right there on the box. And that’s been there for ten
    years, the FDA just noticed it?

    So why now? And if they don’t have a problem with saying it


    lowers cholesterol, then what are they upset about?

    II.

    If Seroquel says it is good for “bipolar,” that’s a violation,


    because it isn’t indicated for “bipolar” but only certain phases
    of bipolar. Lexapro is indicated for Major Depression, but they
    can’t say it’s good for post-partum depression, or dysthymia,
    even if there is good data, because it doesn’t have FDA
    approval. The FDA is very rigid about language. You can only
    claim to do the thing that the FDA agreed you could do, even
    if it is established by everyone else that it can do something
    else. No extrapolations.

    Here are the claims that upset the FDA:

    Specifically, your Cheerios® product bears the following


    claims ort [sic] its label:

    • “you can Lower Your Cholesterol 4% in 6 weeks” ”


    • “Did you know that in just 6 weeks Cheerios can reduce
    bad cholesterol by an average of 4 percent? Cheerios is
    … clinically proven to lower cholesterol. A clinical study
    showed that eating two 1 1/2 cup servings daily of
    Cheerios cereal reduced bad cholesterol when eaten as
    part of a diet low in saturated fat and cholesterol.”

    I’ve taken the liberty of underlining the words


    “hypercholesterolemia” and “coronoary heart disease” in the
    above claims. I did this, because the very next sentence in the
    warning letter is:

    These claims indicate that Cheerios® is intended for use


    in lowering cholesterol, and therefore in preventing,
    mitigating, and treating the disease hypercholesterolemia.
    Additionally, the claims indicate that Cheerios® is
    intended for use in the treatment, mitigation, and
    prevention of coronary heart disease through, lowering
    total and “bad” (LDL) cholesterol.

    Got that? The FDA is upset because Cheerios improperly


    made claims that it never actually made in reality.
    Consistently, over the past ten years.

    III.

    If you’re confused, this may help:

    the label of your Cheerios® cereal claims a degree of risk


    reduction for coronary heart disease by stating that
    Cheerios® can lower cholesterol by four percent in six
    weeks. High blood total and LDL cholesterol levels are a
    surrogate endpoint for coronary heart disease; therefore,
    the cholesterol-lowering claims on the Cheerios® label
    attribute a degree of risk reduction for coronary heart
    disease because if total and LDL cholesterol levels
    decline, the risk of coronary heart disease declines as
    well.

    Translation: saying it lowers cholesterol is the same thing as


    saying it lowers coronoary heart disease, because everyone
    knows they’re the same thing.

    First, this isn’t even true. I’m not an Atkins nut, but the
    cholesterol connection is one of correlation, not causality.
    Lowering your cholesterol if it is high is a good idea, but we
    don’t know why; and simply lowering it does not equate to
    awesome reductions in heart disease. Lipitor is undisputedly
    good at lowering cholesterol, but only reduces heart attacks
    from the baseline rate of 8% down to 4%, which may not be
    worth the price of Lipitor.

    Second, Cheerios isn’t overreaching— the FDA is. Since


    when does the FDA allow conflating endpoints? It doesn’t let
    antidepressants say they reduce the risk of suicide; yet here it
    puts those words into Cheerios’s mouth.

    IV.
    Still confused?

    Based on claims made on your product’s label, we have


    determined that your Cheerios® Toasted Whole Grain
    Oat Cereal is promoted for conditions that cause it to be a
    drug

    Not that Cheerios is pretending to be a drug, or comparing


    itself to Lipitor. The very expression of a claim of health
    makes it a drug.

    Again, the FDA does not have any issue with the veracity of
    the claim; only that by making the accurate claim Cheerios
    becomes a drug, which it isn’t, so it can’t make the claim.

    There are a quadrillion “chemicals” that make explicit drug-


    like claims (penis enlargement, calming, cleaning your colon
    of spackle and paste, etc) that are much more egregious than
    Cheerios. Compare to the previous FDA warning letter for
    claims by Tropical Traditions that also “cause it to be a drug:”

    “[C]oconut oil is converted by the body into


    “Monolaurin” a fatty acid with anti-viral properties that
    might be useful in the treatment of AIDS:”

    See the difference? Tropical Traditions is actually saying it is a


    drug; Cheerios is merely describing what it does, and the FDA
    conflates that with a completely different clinical outcome.

    Next would be saying fish is good for your heart; milk is good
    for teeth and bones; chicken soup is good for the soul, etc.

    If the hypocrisy here is not sufficient, I’ll give you this: if the
    FDA agrees with the claims, but says the claims make
    Cheerios a drug, then why wouldn’t they mandate that
    Cheerios get approval as a drug? Instead, they prefer that
    people keep eating Cheerios but be unaware that it is a drug.
    Now: ponder all the “supplements” out there. The FDA
    knows; it doesn’t care. It has Abilify ads to police. Do you
    know why? Because Abilify has a lot of money to pay in fines.

    All agencies, private or public, have survival as the primary


    outcome. No agency exists to close itself.

    Don’t believe it?

    Yes, that’s the same Minneapolis FDA that sent the Cheerios
    warning letter.

    The [FDA] has nearly doubled the number of inspectors


    in its Minneapolis office over the past year, marking a
    rebuilding of its local presence.

    …The “surge” in FDA operations doesn’t mean,


    however, that the agency is gearing up for a crackdown
    on local businesses, said Charles Becoat, director of the
    regional office, at the meeting in February. “We’re not the
    big bad police,” he said.

    So what was the hiring for, then?

    FDA’s Minneapolis office has also had a reputation of


    being “rational and sensible,” he said.

    He’s got a point; this is an entirely rational approach to


    transferring wealth from one party to another.
    The Difference Between An
    Amateur, A Scientist, And A
    Genius
    May 26, 2009

    Around 1800, Herschel wanted to look at the Sun with his


    telescope, so to keep from going completely blind used
    different color filters to darken the image enough to be able to
    look at it.

    What appeared remarkable was that when I used some of [the


    color filters], I felt a sensation of heat, though I had but little
    light; while others gave me much light, with scarce any
    sensation of heat.

    Almost anyone could have made this observation. The point is


    what do you do next.

    An amateur might think about this for a while, might even


    come up with a hypothesis involving an inverse relationship
    between “brightness” or “color” and “heat.”

    An amateur, if he is sufficiently motivated, might even be


    tempted to investigate this, which is what Herschel did.

    Herschel refracted light through a glass prism.

    And measured, with a thermometer, the temperature of each


    color.
    Conducting the experiment this way would be sufficient for an
    amateur; he might even be pleased with himself for taking it
    this far. But Herschel wasn’t an amateur, he was a scientist. If
    you’re going to do it, do it right: he knew he needed a control.
    An amateur is satisfied with relative comparisons, “active
    comparators”, “this color hotter is than this one.” But Herschel
    wasn’t going to fall for those shortcuts to hell. He placed
    another thermometer, outside of the spectrum, as a formal
    control. Actually, that’s my mistake: he put two thermometers
    outside of the spectrum, as controls.

    He found that each color had a different temperature, the red


    being the hottest, violet the coolest.

    Take a moment and consider to what extent you knew (or did
    not know) this, today, with these principles firmly established
    in our everyday life. Think about what this finding would
    mean to Herschel. What kind of questions would he ask next?

    Because Herschel wasn’t an ordinary scientist. He was able to


    ask questions others would not think to ask. He looked at those
    colors, the ones that he had measured, and he asked, what is
    the temperature of the region after the colors?

    He wasn’t satisfied with what would have been an otherwise


    worthwhile experiment, nor was he constrained by what he
    could see and observe.

    So? What do you think was the temperature of this region?

    He found it to be even hotter than the red.

    It’s 2009, so you can guess that what he discovered was the
    infrared region. But you’re putting that together already
    knowing about infrared light. He had to come up with a whole
    new explanation for why something that wasn’t there was
    hotter than everything else.

    An amateur is full of wonder and speculation, tinkering


    towards the truth but suffering from a lack of knowledge and
    idleness; he’s not even sure if someone else has already made
    these discoveries. “Is this a worthwhile pursuit?”

    A scientist performs experiments to confirm or disprove a


    hypothesis, and in that way he grinds out the truth.

    A genius has three abilities, which are actually the union of


    amateur and scientist: 1. to know the state of the art, what is
    known and what is not known. 2. To be able to think “out of
    the box”. 3. To be disciplined enough to concentrate on the
    tedium of a formal investigation of his wondrous speculations.

    1. To know the state of the art. That’s not genetic. You have
    to devote time to the reading and the learning. This is the
    second biggest problem with the speculation of amateurs, who
    may come up with a brilliant idea but suffer from self-doubt:
    “well, somebody must have already thought of this.” Its
    corollary is accepting that what everyone knows is true,
    because better minds than yours have checked.

    Herschel discovered Uranus, which had probably been


    observed by a billion people over 6 millennia. But he knew
    that everyone “knew” it was a star, so was able to ask a now
    obvious question: if it’s a star, how come it gets visibly bigger
    when you magnify it, unlike all the other stars? Hello?

    2. To be able to think “out of the box.” This may be genetic,


    but I doubt it. More often it is the result of using one mode of
    thinking and training from an unrelated discipline. Not to call
    myself a genius, but if I was a grade focused pre-med, then
    med school, then residency guy, this blog and its ideas
    wouldn’t exist. Herschel wasn’t a mathematician or an
    astronomer; he was a professional musician. Not amateur
    musician- professional, as in that’s how he earned his living.
    Raised by a professional oboist father, played oboe, cello and
    organ, composed 20+ symphonies, director of the Bath
    orchestra, etc. And then decided to discover Uranus. Sweet.

    NB: age is also likely irrelevant. He discovered Uranus at 43.


    The infrared experiment was at 62. But most scientists, doing
    the same kind of thinking, year after year, are much more
    likely to get an endowed chair than make a novel discovery.
    (Interesting experiment: what if all Chairmen at Universities
    had to rotate disciplines for six months every five years? Can’t
    be worse than what goes on today.)

    3. Discipline and work. This would be the biggest problem


    with amateurs. Scientists have it in gigantic proportions, but
    often to the exclusion of free thinking and speculation.

    Sure, it took Herschel half a second to ask, “what about the


    temperature in the dark zone?” but it misses how much work
    he put into his “amateur” investigations.

    The old sayings “success is 1% inspiration, 99% perspiration”


    or “90% of anything is just showing up” really speak not to the
    necessity of work, but to the point that most ideas are
    mediocre and it doesn’t matter. Diligent application can make
    almost anything a success.
    Ramachandran’s Mirror
    May 27, 2009

    And I don’t like what I see.


    For three years I had been seeing her for “Major Depressive
    Disorder” and been treating her with Effexor and Restoril and
    thought I was doing a good job of it, too. Proud of myself, you
    see, that I had reduced her symptoms AND managed to keep
    the number of pills she was on to well under the psychiatry
    average of 19. I rule.

    Also and by the way, she had an above-elbow amputation from


    a bus accident ten years ago. She had phantom limb pain, in
    this case feeling that her missing hand was bunched up into a
    fist, cramping. Occasionally, she’d even get a charlie horse in
    the forearm which wasn’t there.

    Sometimes if she was distracted, or if she distracted herself,


    the pain would go away. Other days, it was terrible.

    etc, etc, you get the idea.

    The New Yorker had a recent article on Ramachandran, the


    neurologist famous for discovering that phantom limb pain
    wasn’t the result of damaged nerve endings in the stump, but
    of a brain malfunction: the brain had rewired itself to think
    that a stump was there. What needed to be done was to teach
    the brain that it wasn’t there; or, more immediately, trick the
    brain into relaxing the fist that isn’t there.

    He did this by putting a large mirror in front of the person,


    facing/reflecting the good arm. Looked at from that side, it
    looked like you had two good arms. You would then clench
    and unclench your “two” fists, and you/your brain would “see”
    the other hand (that wasn’t really there) also unclenching.
    You’d feel as if the fist was relaxing, and the cramp would go
    away. Apparently, the results were sudden and profound.

    So.

    I.

    I was a little nervous, I don’t mind telling you this up front.

    I set up the mirror just as Ramachandran had described. At


    first she didn’t really get it, she wiggled her fingers, and
    nothing was happening.

    “What I want you to do,” I ad libbed, “is look in the mirror,


    and imagine that your left hand is doing the exact same thing
    as your right, simultaneously.” I showed her by opening and
    closing my fists. “In other words, open and close both of your
    fists.”

    I barely finished my sentence when her eyes popped wide.


    “Oh my God. Oh my God.”

    My eyes popped open, too— it actually worked!

    We did that for a minute, and I asked her to then play a scale
    on an imaginary piano, 1-2-3-4-5-4-3-2-1, with “both hands.”

    She started crying. This isn’t an exaggeration. “I can’t believe


    this. I can actually feel my hand…”

    This, I thought with immense pride, is awesome.

    II.

    Well, it’s a wonderful story, I guess, and if this was the end of
    it it would be suitable for Good Housekeeping or maybe one of
    the medical journals that we pretend to read. Maybe I could
    sell the story to TV. A Lifetime Original Special: Reflections
    Of A Physician.

    But it’s not the end, there are some hard questions to be asked
    that no one will ever ask:

    Sure, it worked, sure, she feels better, sure, she thinks I’m
    awesome. Why did it take me three years to try something I
    had known about for ten years with her?

    Ramachandran’s mirror technique is medical school stuff.


    Everyone knows it. Everyone. If you don’t know it children on
    the street kick you in the shins. If you were in a coma during
    medical school then you still would have picked it up from a
    trillion other places, from Scientific American to Discover to
    Time Magazine.

    Of course I knew the significance of the mirror. Of course I


    knew how to do it. I just never did. It never even occurred to
    me to do it.

    The mirror occurred to me; doing it never occurred to me. I’ll


    tell you that every single time I saw her stump, the theoretical
    implications of Ramachnadran’s mirror immediately came to
    my mind, I imagined the mirror. But I never tried it.

    Not just me, but it also never occurred to the ten years of
    doctors she’d seen in her life. Absolutely every single doctor
    knows about the mirror. Not one tried it.

    And it wasn’t that I was lazy or didn’t care— I had tried


    Elavil, Neurontin, Lyrica, Cymbalta— no, I didn’t expect
    much from them, but I tried them, I thought, why not? Maybe
    it could help?

    But I never even considered using the mirror.

    I can’t understate this: I was thinking about the mirror in her


    presence, but never thinking about using the mirror. I wasn’t
    asleep, I wasn’t drunk, I wasn’t inattentive, I wasn’t bored. I
    was just too much in my world.

    So I ask you: did I help her? Or did I make her suffer


    needlessly for three years?
    III.

    Without ducking responsibility, what’s wrong with medicine


    today is that it is predicated on providing treatment, not on
    reducing suffering. Not on solving problems.

    The reason it never occurred to me to use the mirror is because


    the mirror is not something doctors do. Never mind it is fairly
    safe. What we do is offer treatments. Medications. Procedures.
    Not maneuvers.

    Do you know what every single one of my patients who lives


    in Flavor Country have in common? They’re on Lipitor. That’s
    what doctors do when confronted with the results of smoking.
    Not nicotine patches or wellbutrin or talking them through
    becoming a different person. They treat the results. The
    smoking is an afterthought.

    Think about how much controversy there is over using


    medications that are already approved off label for something
    else. Where, then, is the cognitive strength to do something
    that isn’t even considered a treatment?

    Most residents fantasize about doing something like the mirror


    on a patient, partly because it sounds cool, but unfortunately
    really because it puts them on an equal footing with their
    supervisors. They’ll never know as much about Treatment
    Guidelines For Bipolar XVI as their supervisors, but they can
    know more about this. This is how they can distinguish
    themselves.

    Once they grow to the point where they are knowledgeable


    about the Guidelines, then there’s no reason to use mirrors.

    IV.

    Also— and again not to minimize my own responsibility—


    part of the problem with all of the popularizers like Oliver
    Sacks, NPR, The New Yorker, is they trivialize the information
    to the point of uselessness. “So that’s why the Kurds hate the
    Sunnis! I’ll have a latte.” There’s a sense among doctors that if
    it appeared in, say, Wired, it’s not real medicine.

    When I was a resident I tried the Sacks insights. None of them


    ever worked. It wasn’t either of our fault: there’s a big gap
    between practicing medicine and watching Awakenings.

    What I didn’t do, of course, is watch Awakenings and then go


    back and research how I might actually apply it.

    V.

    Now, all you patients, think about this: there is more than a
    slight chance that your doctor knows how to help you, but
    isn’t trying it. Maybe it’s another medication, maybe it’s an
    intervention, maybe it’s information he’s simply not telling
    you. Not on purpose— it doesn’t occur to him to tell you.

    Not because he’s bad, of course. I don’t think I’m bad, not a
    bad doctor anyway. But hell, if I had to sit with every patient
    and think out of the box on every issue with them, and
    individualize the treatment while still maintaining scientific
    rigor— drawing not just medicine but from all possible fields
    that might be applicable to the current problem, being
    “conscious of the patient’s spirituality” not because that’s what
    doctors are supposed to pay lip service to, but because I might
    be able to use it in a clever manner to obtain results, spending
    time proportional to what is actually going to matter (like
    smoking) and less on treatments I am conditioned to provide
    reflexively—

    — then what kind of a doctor would I be?


    They’re Going To Get Paid
    No Matter What
    June 2, 2009

    If we reduce the costs of tests, visits, and medications to 20%


    of their current price, how much will overall healthcare
    expsenses be reduced? I. Is the security technology of
    electronic healthcare records good enough?

    The security problem with electronic health records isn’t


    encryption or firewalls, it is nothing that can be fixed with
    better technology.

    The real issue issue is the people who already have access to
    the records: the 10000 people who work for a university
    hospital system— or the 2000 that just got laid off, looking to
    make a fast buck.

    The real risk is if you are in a divorce proceeding and your


    spouse wants to use your mental health against you; or your
    boss/employee wants to know if you’re gay; or your
    insignificant other wants to know etc etc. So someone makes a
    call to that guy they know who works there…

    How could I not be tempted to look up my nurse-girlfriend’s


    medical record… just to see? How could my brother not be
    tempted to ask me to look up his girlfriend at my hospital?
    How could janitor #7 not be tempted to ask secretary #895 to
    look up… for the purpose of…?

    All this goes on already, and so far the records are only
    accessible within the system. Imagine what will happen when
    they are nationalized.

    The analogy for electronic health records is not financial


    records.

    If you want a working analogy for the world after electronic


    health records, it’s facebook.

    II.

    I hope I don’t need to point out that there’s a billion— 19


    billion, actually- dollars behind EHR; about $10k/year for five
    years goes to the doctors, and the rest, I assume, goes to
    lobbyists. No, I haven’t done the math, it’s an estimate.

    Most of the content in the record is information bias. It seems


    important because it exists. Do you need to know your
    fiancee’s driving record before you finally pop the question?
    Of course not. But if some guy says, “I’ll tell it to you for free
    —” would you say no? Information bias.

    All medical information is redundant. That means each doctor


    has to find out for himself. Sure, we use them as a shortcut,
    but we would never act on them. To do so would be
    negligence. In other words: trust, but verify.

    III.

    Here’s a hilarious story about EHR:

    At the same time (that Farrah Fawcett was fighting to


    prove someone at UCLA was selling her medical records
    to the media) UCLA repeatedly asked her to donate
    money to the hospital for a foundation to be set up in her
    name.

    The university went so far as to give her a prewritten


    letter that she could sign and fill in a dollar amount for
    the foundation, documents show. It also created an
    official-looking proposed announcement that said, “Ms.
    Farrah Fawcett has established a fund in the Division of
    Digestive Diseases with the expansive goal of facilitating
    prevention and diagnosis in gastrointestinal cancers.”

    See? They think that having a wing named after her will make
    up for the fact that she’s dying and that one of their employees
    sold the records.

    But a hospital is a business, they’re going to get paid


    somehow. Anyhow.

    (For a million reasons and this one, you do not want


    nationalized electronic health records.)

    IV. EHRs Are Really About Pretending To Reduce Costs


    Without Actually Reducing Costs: That’s Why The AMA
    Is Behind Them

    The point of EHR is, of course, that it will “reduce costs.” Oh


    my God.

    The cost of healthcare has nothing at all to do with the value of


    healthcare.

    If you cut the reimbursement for tests, procedures and visits,


    and the cost of medications, to 20% of their current cost—
    you will not reduce the total spent on healthcare even one
    cent.

    Got that? No? I will repeat it, for emphasis:

    If you cut the reimbursement for tests, procedures and visits,


    and the cost of medications, to 20% of their current cost—
    you will not reduce the total spent on healthcare even one
    cent.

    The simple reason for this is basic economics: supply and


    demand. The reason people can’t see this is that they have
    misidentified the supply and the demand. They think demand
    for healthcare comes from the patient, and the supply is
    allocated by insurers via doctors. Wrong. Doctors are both the
    supply and the demand.

    Do you think that if reimbursement goes down, doctors will


    say, “ok, I guess I’m in a lower tax bracket?” They will simply
    ramp up their business. See more patients, order more tests,
    whatever. Maybe they’ll buy the test machines for their office
    and bill the insurer for the services (e.g. an x-ray machine.)

    They’re not unethical, they’re not trying to mismanage


    patients, they are just trying to survive. Why should a
    Goldman Sachs trader make three times more than him?
    They’ll do whatever is necessary to help the patient, and
    whatever necessary to get paid.

    Healthcare is a business. The business of healthcare is


    business.

    V. What’s the solution?

    The solution is nuanced.

    Part 1 is that you have to remove the incentive to increase the


    utilization of healthcare: doctors have to be salaried. I can’t
    believe I just said that, but it is true.

    The second part is the tricky one: you have to change the
    culture of medicine, the mindset of doctors. You have to make
    the natural reflex of doctors not to try to make more money,
    but to use less healthcare. That’s nearly impossible, which
    means that it will fail in this generation.

    So, President Obama, take the long term view: doctors become
    salaried starting 2020.

    Face it— doctors today are smart enough to find a way to beat
    the system. I am smart enough to beat the system, and it is
    impossible to expect me not to try to beat the system because I
    believe that I am not acting against the interests of society in
    doing it, even though I am.
    But eventually I will die. The idea of a 2020 start date is that it
    will change the type of person who decides to become a
    doctor. Like academic researchers: no one goes into it for the
    money. I didn’t go into it for the money, either, but when I got
    here there were opportunities to make money. How could I not
    take them? All of those considerations have to be removed.
    Then you will get a new kind of person trying to become a
    new kind of doctor.

    Yes, this new kind will have problems of his own (apathy,
    institutional bias, etc.) But it will cost less. That’s what you
    wanted, right?
    Delaying Gratification Is
    Easy If You Don’t Try
    June 4, 2009

    One marshmallow or two?

    The New Yorker has an article about the famous Mischel


    experiments.

    A researcher offers a four year old child a marshmallow. He is


    told he could eat one now, or, if he is willing to wait until the
    researcher returns from running an errand, he can have two
    marshmallows.

    Some children eat the marshmallow as soon as the researcher


    leaves. Others can delay for varying amounts of time. About
    30% are able to patiently sit there for up to 15 minutes,
    holding out for two marshmallows. How?

    I.

    Mischel doesn’t see this as a test of willpower, but as a test of


    the cognitive ability to determine what works, and what
    doesn’t, to delay gratification.

    Breaking it down, there are two actions in play here: the first is
    the action of waiting for the man to return. The second action
    is not eating the marshmallow. It is this second action that
    Mischel thinks is important in succeeding: “strategic allocation
    of attention.” The best way to avoid eating the marshmallow is
    to not to think about it.

    Kids who can delay gratification have an intuitive


    understanding of this. So they cover their eyes, sing a song,
    etc. The kids who can’t delay do/did the wrong thing: they
    stare at the marshmallow, trying to beat it in a battle of wills.

    To emphasize: it is not that some kids have more willpower,


    but that they have a better ability to think about something
    else. More precisely: they have a better ability to know that
    distraction is what will work.

    II.

    Mischel describes ways to improve delay, e.g. watching videos


    of other kids successfully waiting.

    “This is where your parents are important,” Mischel says.


    “Have they established rituals that force you to delay on a
    daily basis? Do they encourage you to wait? And do they
    make waiting worthwhile?” According to Mischel, even
    the most mundane routines of childhood—such as not
    snacking before dinner, or saving up your allowance, or
    holding out until Christmas morning—are really sly
    exercises in cognitive training: we’re teaching ourselves
    how to think so that we can outsmart our desires

    III.

    It occurred to me that a more obvious way of delaying


    gratification would be to show the kid what the reward is.
    Staring at one marshmallow but having to imagine the future
    reward of two marshmallows perhaps is too abstract for a 4
    year old. Better to make the reward real: show him one
    marshmallow and a pair of marshmallows and tell him if he
    waits he gets the pair. Show him what he has to look forward
    to.

    I dug up Mischel’s papers, and it turns out Mischel did show


    them both choices (e.g. two cookies vs. five pretzels; one
    marshmallow vs. a pair of marshmallows, etc) so the reality of
    the reward was not an issue.

    However, I was in for a surprise:

    The results were the opposite of those [we researchers]


    predicted: attention to the rewards consistently and
    substantially decreased delay time instead of increasing
    it. Preschool children waited an average of more than 11
    minutes when no rewards were exposed, but they waited
    less than 6 minutes when any of the rewards were
    exposed.

    Showing them “what they could look forward to” consistently


    sabotaged them. Take that, “anything but” virgins waiting for
    marriage.

    I wasn’t the only one fooled; mothers of preschool kids also


    erroneously predicted that seeing the future reward would be
    helpful. Reality, apparently, doesn’t encourage you towards the
    future; it’s a reminder that you are hungry now.

    (So if parents are trying to teach their kids how to delay


    gratification, then they should be doing it with the
    temptations/rewards in plain sight, so as to make the training
    more difficult.)

    IV.

    If seeing the reward makes it harder to wait, what does help?

    What helps is seeing an abstraction of the reward.

    This would mean seeing a picture of the reward; or thinking


    about (in the case of marshmallows) clouds, or (in the case of
    pretzels) long sticks. This is subtle, but important; doing any
    of these is even better than completely distracting oneself from
    the reward. It’s almost pornographic; you’re entertaining
    yourself with abstractions of the thing, which is sufficiently
    interesting to you that you’re not actually thinking about the
    real thing. (Virgins, start your laptops?)

    The longest delay time (almost 17 minutes) occurred


    when suggested thoughts were also about [non-reward]
    objects but with regard to their arousing qualities (for
    example, children waiting for marshmallows who had
    been cued to think about the salty, crunchy taste of
    pretzels.)

    But it all comes down to distraction. In order to get the better,


    but delayed reward of two marshmallows, instead of just the
    immediate one, don’t look at any of the marshmallows.

    V.

    But then I had another thought: why doesn’t the kid just eat all
    three marshmallows?

    Think about this. The game here is to maximize the reward;


    the delay is specifically for that purpose, it serves no benefit in
    itself. A child looking at this scenario should be able to see
    that the choice is really between eating all of them vs.
    participating in some bizarre nonsense contrived by an adult
    that always results in getting only some of the marshmallows.
    Even a puma knows not to play this game.

    Any kid who holds out for two isn’t choosing two over one,
    but two later over all three now— and that part isn’t even
    conscious.

    This means that the marshmallows are not the only motivators.
    There is a value to obedience, that exists in four year olds but
    not in pumas. This value may be less than the marshmallows,
    but it isn’t negligible, it isn’t even small. In fact, to some it is
    worth two marshmallows. and fifteen minutes of time.

    Evolutionary psychology, economics, and behavior studies in


    general often fail to account for what may be an innate, or
    strongly socialized, motivating variable. “Rational people will
    seek to maximize their gain.” Sure. Now define gain.

    In many discussions about behavior and economics, we do not


    account for obedience and social pressure. This is a mistake,
    as it is evident that it is a highly significant, though invisible,
    determinant.
    Most Common Cause Of
    Bankruptcy Is Catastrophic
    Medical Bills
    June 8, 2009

    Why I drink.
    Here is the simple reason while there will never be any kind of
    serious healthcare reform in this country absent a war: no one
    cares. About healthcare itself— it’s just a proxy for ideology.
    Everything you hear are lies, damned lies, and Harvard.

    WASHINGTON (Reuters) - Medical bills are behind


    more than 60 percent of U.S. personal bankruptcies, U.S.
    researchers reported on Thursday in a report they said
    demonstrates that healthcare reform is on the wrong
    track.

    I’m puzzled by the term “U.S. researchers.” They are Harvard


    academic researchers funded by the Robert Wood Johnson
    Foundation. Is this to distinguish them from “French
    researchers” who presumably have more/less credibility
    depending on your politics; or is it a slip of the tongue
    suggesting they are actually working for the U.S. government?

    …Harvard‘s Dr. David Himmelstein, an advocate for a


    single-payer health insurance program for the United
    States…

    What do the authors want to be…. oh, never mind.


    II.

    60% is a big number. Wow. I didn’t realize it was so high!


    What I need now is a striking metaphor that will move me
    solidly towards populism:

    “Unless you’re Warren Buffett, your family is just one


    serious illness away from bankruptcy.”

    Nice. Sounds a lot like

    “Unless you’re Bill Gates you’re just one serious illness


    away from bankruptcy.”

    which is what the the same guy said four years ago. Either
    Gates got richer, Buffett got poorer, or they haven’t learned
    much after 4 years of careful study into this problem.

    That would be a sign that numbers are less important than


    ideology.

    III.

    I get conflicted because I’m for the same thing he is for, a


    single payer system (with modifications), but studies like this
    one and people like this guy make me react negatively to it. It
    actually makes me want to drink. I realize it’s shooting my
    face to spite my teeth, or something, but these academics who
    stagnate in their sycophancy drive me straight to the rum.

    The study is not published yet, so I have to rely on the news


    report, which is like relying on your wife’s lover to tell you
    which bottle isn’t the cyanide. But here goes:

    Using a conservative definition, 62.1 percent of all


    bankruptcies in 2007 were medical; 92 percent of these
    medical debtors had medical debts over $5,000
    I realize I may be out of touch with the common man because
    I’m a wealthy industrialist who wears a monocle and a top hat,
    but are you telling me that 60% of all of the bankruptcies in
    the U.S. were because of $5000?

    It’s a good guess that people were in debt with other things as
    well, right? Credit cards? Car loans? Home equity loans? But
    blaming it on medical expenses is a more politically lucrative
    spin. No, I can’t prove it. I can, however, prove the authors are
    up to nonsense: in their last study (four years ago) with similar
    findings, they conflated “medical bills” with missing work due
    to illness even if there were no medical bills. They didn’t have
    high bills; they had no income.

    This isn’t an argument for universal healthcare; it’s an


    argument for disability insurance. Which, by the way, even
    doctors don’t bother to get. It’s expensive and complicated and
    boring.

    Disability insurance doesn’t lend itself to ideological battles.


    You can’t get self-righteous about it. You can’t hate Pharma
    for it. You can’t get a Harvard faculty position for studying it.
    Truth doesn’t come from God or physics, it comes from the
    potential of grant money.

    It’s good to keep this in mind as you hear people argue


    violently about something they neither understand, nor really
    care about.

    IV.

    Here’s what was buried in the paper, towards the end:

    Many debtors described a complex web of problems involving illness,


    work, and family. Dissecting medical from other causes of bankruptcy
    is difficult. We cannot presume that eliminating the medical
    antecedents of bankruptcy would have prevented all of the filings we
    classified as “medical bankruptcies.”

    It’s hard to know how you’ll end an article once you permit
    yourself to ignore the facts and make them submit to your
    worldview. But a good guess would be:

    In 1591 Pope Gregory XIV fell gravely ill. His doctors prescribed
    pulverized gold and gems. According to legend, the resulting
    depletion of the papal treasury is reflected in his unadorned plaster
    sarcophagus in St. Peter’s Basilica. Four centuries later, solidly
    middle-class Americans still face impoverishment following a serious
    illness.

    Do any of these clowns realize that this example is precisely


    why universal healthcare is the wrong solution to the problems
    they are describing?

    (also, see my response to a comment, below; then final word


    here)

    –––––––––—

    http://twitter.com/thelastpsych
    Children With ADHD Drugs
    Score Higher on Tests
    June 10, 2009

    CHICAGO - Children on medicine for attention deficit


    disorder scored higher on academic tests than their
    unmedicated peers in the first large, long-term study
    suggesting this kind of benefit from the widely used
    drugs.

    Wow. WOW. I get more actionable information from porn.


    1. The comparison isn’t between kids getting meds and
    “unmedicated peers” but kids with ADHD who get meds, and
    kids with ADHD who don’t get meds.

    1b. “Both groups had lower scores on average than a separate


    group of children without ADHD.”

    2. The study indicates that the kids derived a benefit on test


    scores equivalent to 1/5 of an academic year, by 5th grade.
    That would be two months. (Still below non ADHD kids,
    though.)

    2b. In order to derive this benefit, kids needed to be on the


    medications for about 3 years consecutively; in other words,
    they had to “learn” while on meds. Risk-reward?

    3.

    Our objective was to determine if reported medication use


    for attention-deficit/hyperactivity disorder is positively
    associated with academic achievement during elementary
    school. CONCLUSIONS. The finding of a positive
    association between medication use…and test scores is
    important, given the high prevalence of attention-
    deficit/hyperactivity disorder and its association with low
    academic achievement.

    You say, “the study did find that stimulants were effective.
    Wasn’t that the whole point?”

    II.

    So that’s the kind of study analysis they talk about in medical


    school but don’t bother to teach. See how awesome it is to
    look critically at the methodology of a study, differentiate
    clinical significance from statistical significance? (Never mind
    that the study produced nothing new.)

    This kind of analysis is the intellectual equivalent of turning a


    gun sideways. Looks cool to anyone who’s never actually held
    a gun, but dangerously unreliable when it matters most.

    The question: what do the authors want to be true?

    III.

    First of all, was this study really necessary, let alone important
    enough to end up in Pediatrics?

    There are already plenty of studies examining, specifically,


    stimulants and school performance. Here are seven: 1, 2, 3, 4,
    5, 6, 7.

    I’ll admit that this study is unique in that it is prospective and


    long, but do we need a unique, prospective and long study of
    what we already know? It isn’t even important research in that
    it has been pretty much established that there aren’t significant
    effects on academic performance overall in ADHD kids. So
    why bother doing this study?

    Or, you might ask me: “why does this study, in particular,
    bother you?”

    The author names aren’t important here, it’s their degrees that
    are important. 6 authors— only one an MD. The rest are PhDs.

    Do you think PhDs care about ADHD drugs? The study isn’t
    about the efficacy of medications; it’s about the validity of
    ADHD. “See? We’re studying a medical problem. Can we get
    some grant money now?”

    Don’t send me back to my pirate ship yet. The authors are


    from the Petris Center, which receives funding to examine
    healthcare policy. They got $900,000 from NIMH to study
    this. Was it worth it? But if there’s a million dollars out there
    to study something that could have been done with a review
    paper (or a blog post), then you’re going to do it.

    This is the basic problem with academic research. Covering


    the same old ground, over and over, focusing on whatever is
    institutionally (or politically) popular.

    Given this kind of research, I have no expectation that any


    progress will be made in the “treatment of ADHD,” let alone
    in improving anyone’s academic performance. I am entirely
    confident, however, that this lack of progress will cost millions
    and millions of dollars.
    Where Did The Title Come
    From?
    June 11, 2009

    I’m sure you’ve read The Catcher In The Rye. Why is it called
    that?

    And a few more that came to mind.

    The Catcher In The Rye

    Here’s a little self-test for narcissism:

    if you think Holden Caulfield “gets it” and sees through


    people’s pretenses, you’re a narcissist. Unless you are
    under 25, in which case you are completely normal.
    if you think Holden Caulfield is really just sad and
    alienated, but afraid to take the dangerous steps towards
    adulthood and meaningful connections with other people,
    then you are perceptive; unless you are under 25, in
    which case you are a perceptive girl.

    “You know that song, ‘if a body catch a body comin’


    through the rye?‘ I’d like to be—”

    “It’s ‘if a body meet a body comin’ through the rye!‘ ” old
    Phoebe said. “It’s a poem. By Robert Burns.”

    “…Anyway, I keep picturing all these kids playing some


    game in this big field of rye….and nobody’s around—
    nobody big, that is— except me. And I’m standing on the
    edge of some crazy cliff. And what I have to do, I have to
    catch everybody if they start to go over the cliff…I’d just
    be the catcher in the rye and all. I know it’s crazy, but
    that’s the only thing I’d really like to be.”

    Robert Burns also gave us Auld Lang Syne, which I have never
    once attempted to sing sober. Partly a metaphor for how
    Holden Caulfield sees adulthood (the cliff) and saving kids
    from it; but also an escape from any responsibility towards
    progress. He doesn’t have to grow, or help kids grow, all he
    has to do is just be a little older and smarter. That’s enough.

    His absorption with phoniness is the inner conflict of one who


    is discovering that the world doesn’t bend to his wishes.

    Narcissism is normal in 17 year old boys, especially the quasi-


    idealistic kind embodied by Holden. They eventually grow up.
    Hopefully, they then can remember what it was like so they
    don’t destroy their kids when they’re 17.

    One day, a 17 year old will look at you and think you’re a
    phony. That will mean either you are old, and he’s wrong; or
    you’re old, and he’s right.

    Atlas Shrugged

    The book that was once dismissed as high school level


    sophistry has suddenly become the second most prescient
    book in modern history. The first is 1984. (#3 is Debt Of
    Honor.)

    “If you saw Atlas, the giant who holds the world on his
    shoulders, if you saw that he stood, blood running down
    his chest, his knees buckling, his arms trembling but still
    trying to hold the world aloft with the last of his strength,
    and the greater the effort the heavier the world bore down
    upon his shoulders—what would you tell him to do?”

    “I…don’t know. What…could he do? What would you


    tell him?”

    “To shrug.”

    Originally entitled The Strike, the book describes a future


    dictatorship where the dictators have created an artificial
    altruism: the productive are required to sacrifice themselves
    for others— i.e. their output is taken from them and
    redistributed. The book describes this altruism as a trick; the
    society has convinced people that “it’s the right thing to do,”
    that it is just. It is a moral code and thus the productive
    members are coerced by guilt.

    It could occur to Atlas that just because he is the strongest, it


    doesn’t have to be his lot to hold up the world. He could
    simply shrug it off.

    NB: such state control through a moral code would not have
    been possible if the productive people were narcissists (as our
    current crop of Wall Streeters seem to have been)— they don’t
    feel guilt. Only shame would have worked. The government
    might want to consider psychology before it sets up the next
    round of oversight.

    Notes from the Underground

    Quick test: give this book to your girlfriend. If she says, “it
    kind of sounds like you” then you’re both in trouble.

    There in its nasty, stinking, underground home our


    insulted, crushed and ridiculed mouse promptly becomes
    absorbed in old, malignant and, above all, everlasting
    spite.

    A man who imagines himself an acutely conscious mouse, in a


    world of men who never bother with self-reflection, who seem
    all the happier, more capable because of it.

    And he’ll think about these happy, stupid men, and all the
    misery that their happiness has caused him:

    For forty years together it will remember its injury down


    to the smallest, most ignominious details, and every time
    will add, of itself, details still more ignominious,
    spitefully teasing and tormenting itself with its own
    imagination. It will itself be ashamed of its imaginings,
    but yet it will recall it all, it will go over and over every
    detail, it will invent unheard of things against itself,
    pretending that those things might happen, and will
    forgive nothing.

    But why do it to yourself? Why stay underground and… fester


    in spite?

    But it is just in that cold, abominable half despair… in


    that hell of unsatisfied desires turned inward… that the
    savour of that strange enjoyment of which I have spoken
    lies.

    Enjoyment? Better to consider it validation: in the suffering, in


    being the mouse, in being Underground is an identity, an
    individualism, a defining of the problem as you vs. them. You
    are not-them, and so you are better.

    This is narcissism; sometimes despair is the only pleasure you


    have.

    The lesser read Part 2 describes his relationship with a


    prostitute. He more than insults her; like a psychic he astutely
    identifies her inner dreams and external hardships, and then
    predicts the misery that is her future. He later says he did it to
    have power over her, which is only partly true. He does it
    because he wants her to see him as knowing. The power over
    her was to get her to see him the way he wanted to be seen.

    But she has a good soul, she’s a woman, and she’s a prostitute:
    she’s three times more perceptive than he is. He knows she’ll
    eventually be able to see right through him— to see him as he
    really is— not even as a bad person, just not as he wants to be
    seen. This is the worst thing that can happen. To preempt this,
    he degrades her: to cause her to leave.

    And of course, she does.

    One of the best depictions of narcissism, ever. Study it.

    The Sound And The Fury

    Wherefore was that cry?


    Seyton:. The queen, my lord, is dead.
    Macbeth: She should have died hereafter;
    There would have been a time for such a word.
    To-morrow, and to-morrow, and to-morrow,
    Creeps in this petty pace from day to day,
    To the last syllable of recorded time;
    And all our yesterdays have lighted fools
    The way to dusty death. Out, out, brief candle!
    Life’s but a walking shadow, a poor player
    That struts and frets his hour upon the stage,
    And then is heard no more; it is a tale
    Told by an idiot, full of sound and fury,
    Signifying nothing.

    Macbeth, Act V, Scene V

    Life is absurd; time is an abstraction humanity applies to it to


    help make sense of it, but it’s artificial nonetheless. Quentin
    Compson goes to his suicide, Sartre once observed, not by
    passing through the present, but rather looking backwards, in
    retrospect, as if he is remembering his suicide in the past.
    Make plans if you want; your death came already. Six more
    thousand years of future people won’t know or care about you.

    A more modern interpretation, from the movie that ended a


    century:

    Agent Smith has Neo (“Mr. Anderson”) in a chokehold on


    the train tracks; the subway speeds towards them. Agent
    Smith is— satisfied.

    Hear that, Mr. Anderson? That is the sound of


    inevitability. It is the sound of your death. Good bye, Mr.
    Anderson.

    Agent Smith has it figured right: Anderson’s life, like all


    humans’, was a pointless struggle even if it was a happy and
    successful one. It always ends in failure, in death.

    Faced with the absurdity and unintelligibility of life, but the


    inevitability of its end; lacking God or country or dynasty,
    there is only one answer that today’s man— the narcissist—
    can give that makes his life meaningful, and he gives it:

    My name is Neo.

    The only solace is to define oneself, otherwise you become


    aware that your brief life is all just sound and fury, signifying
    nothing.

    One Flew Over The Cuckoo’s Nest

    three geese inna flock, one flew east, one flew west, one
    flew over the cuckoo’s nest… O-U-T spells out, goose
    swoops down and plucks you out.

    Which (I think) comes from the Louis Untermeyer poem


    “Rainbow In The Sky” which begins, “Wire, briar, linder-
    lock…”

    A story (that can be) as much about racism and the Soviet
    Union as it was about psychiatry, many of these themes are
    underdeveloped in the movie.

    The story’s narrator is the Chief, whose grandmother used to


    sing the above nursery rhyme.
    The Chief knows that the outside world is controlled by the
    Combine, and Big Nurse Ratched is its inside agent. Patient
    Randle McMurphy is her nemesis (or she his)— she is control,
    he is freedom; she is conformity, he is a cowboy individualist
    who must become a self-sacrificing hero. He rips her uniform,
    exposing her breasts— look, she’s not a machine, she’s just a
    person— and he gets lobotomized.

    Though it must be said: even a harsh, controlling, artificial


    world, like the Matrix or any good conspiracy theory, provides
    comfort because it says what every free floating individual
    wants to hear: you’re powerless because someone else is
    controlling everything. But at least someone else is controlling
    everything.

    The Last Psychiatrist

    …the time of the most despicable man is coming, the man


    who is not able to despise himself….

    –––––––––
    http://twitter.com/thelastpsych
    Radio Host Has Drug
    Company Ties
    June 16, 2009

    No, not Rush Limbaugh.


    NYT (11/08) reports:

    An influential psychiatrist who was the host of the


    popular public radio program “The Infinite Mind,”…
    earned at least $1.3 million from 2000 to 2007 giving
    marketing lectures for drugmakers, income not mentioned
    on the program.

    The psychiatrist in question is Fredrick Goodwin. As far as


    contemporary psychiatrists go, he is gigantic. He invented
    bipolar disorder. That’s a joke, of course, by which I mean it
    isn’t.

    I.

    He has a radio show? Are you listening, NPR? I want a radio


    show, too. (Disclosure: I get Pharma money. Is that going to be
    a problem?) If you hire me I’ll stop making fun of you.

    II.

    But [the producer] said that he was unaware of Dr.


    Goodwin’s financial ties to drugmakers and that, after an
    article in the online magazine Slate this year pointed out
    that guests on his program had undisclosed affiliations
    with drugmakers, he called Dr. Goodwin “and asked him
    point-blank if he was receiving funding from
    pharmaceutical companies, directly or indirectly, and the
    answer was, ‘No.’ “

    I’m not sure what to do with this. Is it possible the producer


    didn’t know Goodwin got Pharma money? Who did he think
    paid for all that research?

    Unless he’s specifically worried about the lecture money he


    got; in which case the implication is that that money is
    magically more biasing then the grant money, or the
    government grant money. That would be, well, retarded, right?

    III.

    He said that he had never given marketing lectures for


    antidepressant medicines like Prozac, so he saw no
    conflict with a program he hosted in March titled “Prozac
    Nation: Revisited.” which he introduced by saying, “As
    you will hear today, there is no credible scientific
    evidence linking antidepressants to violence or to
    suicide.”

    That same week, Dr. Goodwin earned around $20,000


    from GlaxoSmithKline, which for years suppressed
    studies showing that its antidepressant, Paxil, increased
    suicidal behaviors.

    I happen to agree with Goodwin that the data on suicide is


    tremendously weak. (But since I get Pharma money too, I’m
    biased…) However, he was never pushing antidepressants
    anyway; he didn’t believe in them. Not because of flimsy
    evidence about suicide risk, but because of (even more flimsy)
    evidence of antidepressant induced mania (among other
    things.) For him and his devotees, it was mood stabilizers all
    the time.

    But what’s the controversy? He didn’t ignore the data, he


    didn’t hide it. If the money biased him he could have just kept
    quiet, never mentioned it. Instead, he took his views straight to
    the public; on the radio, for an hour. And, by the way,
    antidepressants shouldn’t be used in the first place…

    He wasn’t biased because of Pharma money; he was biased


    because he believed it.

    IV.

    To illustrate this, imagine if, instead of debating the suicide


    risk of a drug for an hour on the radio for everyone to hear, he
    simply dismissed it— even when he was one of the guys who
    discovered it:

    …risk of suicide death was 2.7 times higher (95%


    confidence interval [CI], 1.1-6.3; P =.03) during
    treatment with divalproex than during treatment with
    lithium.

    What would be even more amazing is if no one cared about


    him dismissing it.

    He wrote that in 2003. 2.7 times higher? You would think that
    someone (i.e. him) would have made it priority #1 to explore
    that further. Nope. It is never mentioned again. Certainly not
    on the radio.

    And you would have thought that the public, upset about him
    openly discussing for an hour on public radio the 2x risk with
    Effexor and Lexapro, would have been even more upset about
    not ever mentioning a 2.7x risk with Depakote. Also nope. We
    had to wait 5 years for the FDA to make a federal case about
    it.

    He interpreted the results as lithium preventing suicide; but, as


    this is science, can you really afford to assume that?

    Nobody cares because he didn’t get Pharma money for this, so


    there was no outrage and an assumption that it couldn’t have
    been biased. His career since the 70s has been lithium; no
    Pharma money there. Yet it was precisely his devotion to his
    research on lithium, to his career, which made him blind to his
    own discovery. It wasn’t compatible with his worldview.

    Maybe the finding is wrong; maybe the suicide increased


    because these drugs decrease REM sleep. Maybe a million
    things. 2.7x. Worth a mention?

    Money corrupts; but it is always weaker than personal identity.


    Even though he was getting an extra $185k/yr from Pharma,
    which I assume is more than he was getting from his actual job
    as a researcher, he didn’t think of himself as a Pharma lecturer,
    he thought of himself has a researcher on bipolar and mood
    stabilizers. That’s who he is. That’s the real bias, the one that
    counts; the one that makes him unable to see the very digits he
    types into a Word file.

    And since there is no financial bias, we just eat it.

    This is the same problem with Himmesltein’s analysis of


    bankruptcies. When your data are screaming for alternative
    explanation, but you instead focus only on what you want
    them to say, everyone loses.

    V.

    That article was 11/08. It’s now 7 months later. What has the
    outrage over Pharma money got us? He still gets paid for
    Pharma lectures. Psychiatrists still think of him as gigantic.
    I’m still neck deep in a field that thinks four drugs at a time
    makes sense. But he doesn’t have a radio show. Problem
    solved?

    If he didn’t get Pharma money, would he have been able to


    afford the time to do a radio show?

    I don’t know how else to say this so that I’m not


    misinterpreted: if we persist in using money as a shortcut for
    critical interpretation, we are lost. And if we fail to appreciate
    insitutional biases— “well, this is already established, no one
    seriously thinks otherwise”— then we have already embraced
    despotism.

    Addendum: Bill Lichtenstein, producer of the above radio


    show, comments.

    –-
    http://twitter.com/thelastpsych
    It’s Not A Lie If It’s True
    June 24, 2009

    Starring Megan Fox. The Brown University


    Psychopharmacology Update (“The Premier Monthly Forum
    About The Use Of Psychotropic Medications”) reviews
    studies. Their angle is that they don’t have an angle, they are
    objective, they don’t take Pharma money, and the editor has a
    beard.

    “We don’t usually report on industry-funded studies…”


    but “the findings are compelling.”

    Dig deeper, my friend, dig deeper.

    I.

    Randomized double blind multicenter trial of Zyprexa vs.


    Abilify. The study found that Zyprexa 15mg was better than
    Abilify 20mg, but that (from the study):

    More patients experienced significant weight gain at


    Week 26 with olanzapine (40%) than with aripiprazole
    (21%; p < .05 [weighted generalized estimating equation
    analysis])

    Brown University Psychopharm Update writes:

    And the bonus point: the sponsor of the study, Bristol-


    Myers Squibb, is the manufacturer of aripiprazole
    [Abilify]. So, no surprise that olanzapine [Zyprexa]
    results in more weight gain than the sponsor’s product,
    but surprising indeed that it is more effective.

    Does he mean he’s surprised that BMS didn’t fudge the study?
    Come on, does he think that somehow BMS can alter the
    results of a double blind trial? How? Remote viewing? If the
    CIA couldn’t get that to work, what chance does BMS? And if
    they could, do you think they’d be wasting their time with
    Abilify?

    What’s probably surprising to him, I think, is that untouched


    data that was negative for Abilify actually got reported for all
    to see. Yes, that is surprising.

    Turns out, he was right to be suspicious.

    II.

    I had a thought: this is a study that exists— e.g.in a public


    database— but it was sponsored by BMS. It shows Zyprexa is
    better but Abilify is safer. In which company’s marketing
    materials does this study appear?

    The answer is, in Lilly’s. The Zyprexa promotional materials


    show Zyprexa’s slightly better efficacy, but considerably
    higher rates of weight gain. Take a look:
    Notice anything weird? The slide data doesn’t match the study
    data.

    The impulse is to say Lilly found a way to minimize the


    weight gain. 10% difference may not seem like much, but it is
    a reduction of 25% over the published study. Companies kill to
    get that kind of reduction. But, believe it or not, that’s
    impossible: Lilly is not allowed to exaggerate or lie. The FDA
    signs off on these materials— a dozen scientists at Lilly and
    the FDA have reviewed this slide and the data. They wouldn’t
    be able to get away with fancy spin to drive the numbers down
    in their promotional materials.

    It took me a long time to figure it out: the slide assumes an


    LOCF analysis (common in psychiatry), while the study uses
    “weighted generalized estimating analysis”/MMRM. Do you
    know what the difference is? Exactly.

    Because here’s the thing: the FDA reviews and signs off on all
    promotional material, but they do not have any say at all into
    the actual published study. For all they know it could be
    written in crayon or sheep’s blood. I know I’m going to sound
    like a broken record, but the weak link in the chain of science
    isn’t Pharma, it’s academia.

    III.

    LOCF— last observation carried forward— means that even


    when a patient drops out of a study, whatever data he did
    generate stays in. “If it happened, it happened.”

    Psychiatry studies typically use LOCF, it is the default


    standard. More importantly: psychiatrists assume LOCF is
    being used in the study they are (not) reading..

    No one knows what “weighted generalized estimating


    equations” are. Take this study to the nearest psychiatrist, ask
    him if he knows. If he says he does, smack him in the face
    with it, he’s lying. In fairness, doctors don’t expect this kind of
    a curve ball; and study authors must be aware of their
    audience. The purpose of the publication— not the
    promotional material— is to inform us. It is to tell us what
    really happened. They are supposed to make it as easy to
    understand as possible, and not trick us.

    “It’s not a trick, we told you right there in the study.”

    Telling me is not the same as telling me.

    Exhibit A:

    A post hoc longitudinal mixed-model analysis was


    performed for mean change from baseline… A spatial
    power covariance matrix was used to model the
    correlation between measurements…

    Exhibit B: Brown University Psychopharmacology Update


    didn’t notice it either.

    Viagra may have good efficacy, but if the results are published
    in The American Journal Of Geriatrics I don’t expect you to
    have tested it on a sample of 17 year old boys who just
    watched Megan Fox in anything. And if you did test it in
    them, you should probably include a picture.

    A picture of Megan Fox, for no reason at all

    Oh, it’s honest: the study authors certainly weren’t lying. But
    everyone must know that no one is going to figure this out on
    their own, right?

    IV.

    Someone will inevitably email me to correct me that MMRM


    is completely legitimate, betting I don’t understand clinical
    trial design and statistics. That would be a sucker’s bet.

    The authors of the study didn’t design a study with an unusual


    analysis; they designed a perfectly ordinary study, the kind
    everyone would expect, using LOCF, that they then later
    decided to analyze differently using something most people
    have never heard of. You would only know this if you went to
    the BMS clinical trial registry— the thing everyone was
    demanding Pharma do that now no one bothers to use— and
    looked it up (138003.pdf), then spent time comparing the two
    documents. Good luck to the rest of you people who actually
    have a life.

    Or— and this is sort of the point, sad in its own way but true
    nonetheless— you could have just looked at the Lilly slide.
    Why Do Politicians Cheat?
    June 26, 2009

    You all are not going to believe this— the answer is not
    completely narcissism.

    One possible explanation, said Stanley Renshon, a


    political psychologist at City University of New York:
    “Narcissism is an occupational hazard for political
    leaders. You have to have an outsized ambition and an
    outsized ego to run for office.”

    or

    Fred Greenstein, a Princeton University professor


    emeritus of politics, suggested adrenaline as the common
    denominator, saying, “For some individuals, the
    excitement of illicit sexual activity might feed the same
    desire” as “the excitement of politics.”

    or

    These are men who love themselves deeply, need to be


    recognized and relish approval. These are men who adore
    getting praise and who often are surrounded by swarms of
    sycophants. These are men who, in some cases, need to
    exercise power and sometimes can become drunk from it.
    These are men who think the rules don’t apply to them
    and who think they’re untouchable.

    These all sound plausible, but only if you don’t look too
    closely at the details of each case. These men had obviously
    different psychological forces at work in their infidelity.

    Simple examples: Mark Sanford appears genuinely to have


    fallen in love (or something) with “Maria,” while Eliot Spitzer
    and Bill Clinton saw the dalliances as… recreational. So while
    narcissism may have explained a single individual’s cheating,
    it doesn’t apply to all.

    Some affairs were homosexual. Sometimes the wife was


    surprised, sometimes she suspected, and sometimes (as in the
    case of McGreevey’s wife) she was allegedly a participant.

    No consistent motivation attributable to “power” or


    “dominance” or “thrill of the chase” can be generalized here.

    Neither is there much to grab onto with the standard variables.


    Some women are younger, older, good looking and bad
    looking. There’s no relation to length of time married, or
    number of prior marriages.

    There is, however, one important unifying characteristic of


    political infidelities that makes them very different from the
    average joe on AshleyMadison.com: everyone knows these
    guys are going to get caught.

    II.

    So instead of asking, “why do they cheat?” ask, “why don’t


    they simply not cheat?”

    Seriously consider this question. Unless we are positing that


    these men are all addicted to infidelity, or compelled by
    genetics or voodoo to make that specific gigantic mistake and
    not others; a mistake which other people can’t empathize with
    — “he destroyed his career and marriage— for her?!?!”—
    then they should be able to resist the temptation, if for no other
    reason than self-preservation.

    Neither are these drunken accidents at a snowed in convention


    hotel. There was no impulsiveness. They had plenty of time to
    consider their actions. They decided that this was a good idea.

    They slowly and methodically planned it, and did it. For them,
    there is no element of resisting temptation. They didn’t do it
    despite themselves; they did it because, in their mind, this was
    worth it.

    III.

    In other words, there must be some other benefit beyond the


    sex act itself.

    An interesting paper explored the reactions to infidelity. As


    you might expect, men would be more upset by a woman’s
    sexual infidelity and women by a man’s emotional infidelity.

    However, when men and women are first asked to contemplate


    their own death, sexual infidelity was even more important to
    men, and even less important to women:

    For men who already place a high value on having sex, being
    reminded of one’s mortality makes the sex even more
    important.

    None of these guys think they are dying, but they do see
    themselves at the end. You might think being Governor is a
    major accomplishment, but he sees the next 40 years as all
    downhill. What’s he going to do after Governor? Last July he
    was meeting with McCain to be VP— we know how that
    turned out. His life is over, and he’s only 49.

    IV.

    An identity crisis of sorts kicks in around 40: “for the past


    forty years I was the guy trying to become something. Now
    what am I going to be? The guy who was something?”

    When your memories outnumber your dreams, you’re getting


    old.

    Meanwhile, your wife doesn’t particularly want you to grow,


    or change, or evolve. She wants you status quo. Even
    innocuous attempts at change are met with bemusement: “oh,
    God, he suddenly decided he wanted to take up biking, and he
    bought all this biking equipment…”

    But an affair lets you be someone new, and get seen by new
    eyes. Politicians spend so much energy maintaining a constant
    public persona. And their family also has a constant perception
    of them. And now suddenly someone else sees you differently,
    and you even get to penetrate her…

    Having an affair is a creative act. No one leaves an affair


    saying, “oh God, I feel ten years older.” When someone sees
    you, experiences you, in a different way, you feel more alive.
    It’s all illusory, of course, but that doesn’t seem to stop people
    from feeling it.

    V.

    If I go to Moldova and have a fling with a woman and choose


    not to put it on my blog, I’m probably going to get away with
    it. This is partly because I figure no one is monitoring me, and
    partly because I had the common sense to go to Moldova
    where I am absolutely sure no one is monitoring me.

    Yet these men take absolutely no precautions against


    detection. Why don’t they go to Moldova? They don’t even
    take ordinary precautions. Instead, these men are ludicrously
    indiscreet, clumsy, and careless. They may as well write an op-
    ed in the Times— “I will now penetrate this hooker.” Who
    disappears for days and doesn’t even attempt an alibi? Who
    emails their mistress from their government email account?
    Who uses airport bathrooms for anything? Who names a boat
    “Monkey Business?”

    Neil Thigpen, a political science professor at South


    Carolina’s Francis Marion University, said that judging
    from Sanford’s behavior, the governor wanted to be
    caught.
    “I almost feel like he did this whole thing with the
    intention that it would all come out,” Thigpen said. “It’s
    like the guy wanted it out. Why did he draw attention to
    himself in this fashion? Even with rudimentary scrutiny,
    he should have known something would bring it to a
    head.”

    Not quite caught; but if so much of their identity comes from


    public perception of them, then “getting caught” is external
    validation that they are still alive, still growing. Cheating
    wasn’t the point: getting caught was the point. It is trying to
    show the world that you are actually what this new woman
    thinks you are. It is a form of exhibitionism. It’s a four year
    old: “look what I can do!”

    And when they apologize on TV, that isn’t analogous to


    pleading guilty at a criminal trial. It’s analogous to releasing a
    sex tape. “In case there is anyone out there who wasn’t aware
    of what I can do, let me now apologize for it, slowly, over the
    next few months, in every possible media outlet I can use.”

    ––––

    This is unrelated to the above, and I have no idea what to


    make of it, but I made an odd discovery about the famous
    political sex scandals since Clinton:
    SC Governor Mark Sanford (R) 5/28/60

    Nevada Senator John Ensign (R) 3/25/58

    Idaho Senator Larry Craig (R) airport bathroom nonsense.


    5/28/60

    Louisiana Senator David Vitter (sigh, R) admits to having


    been involved with an escort service. 5/3/61

    Senator John Edwards (phew, D) 6/10/53

    Gov. Eliot Spitzer (D) 6/10/59

    Gov. David Paterson (D) 5/20/54

    Gov. Jim McGreevey (D) 8/6/57

    Bill Clinton (D) 8/19/46

    Newt Gingrich (R) 6/17/43

    Rudy Guiliani (R) 5/28/44

    Louisiana Rep. Bob Livingston 4/30/43

    OK Rep. Gary Condit 4/21/48

    All of these men were born in late spring-summer. No fall or


    winter births? Any astrologers want to tell me why 8/13 are
    Geminis?
    It’s Either Narcissism Or
    Dementia
    June 29, 2009

    Michael Jackson’s father gets interviewed.

    I’m not making a diagnosis here, I’ve never heard him talk
    except in this interview, he could be so overcome with grief
    that he’s not thinking straight…

    … so allowing for that, observe how he makes the interview


    about himself. Narcissism doesn’t mean you think you’re the
    greatest person on earth, but rather that all things in the world
    are relevant only as they impact you.

    CNN interviewer: The father of Michael Jackson, Joe Jackson


    joins us here tonight. How are you doing, sir, how is the
    family holding up?

    Joe: I’m great. My family’s doing pretty good.

    CNN: Yeah?

    Joe: Yes they are.

    CNN: The last couple of days have been really tough…

    Joe: … yes, it has been tough, really tough. Remember, we


    just lost the biggest superstar in the world.

    CNN: How is Mrs. Jackson?

    Joe: She’s fine, thank you.

    CNN, clearly stumped: umm… is there anything you’d like to


    share with the world about your son and his legacy?

    Joe: Yeah, I’ve got a statement here… give me this statement..


    (publicist reads this statement while he watches:)

    “Our family sincerely thanks all of you around the world for
    your love and support during our time of grief. Our beloved
    son Michael Jackson loved you all. Michael’s children are our
    first priority. We will have further announcements to discuss
    our plans going forward. Until such time however, we have the
    personal and legal authority to act and solely Katherine and I
    have authority for our son and his children. We wish to handle
    his memory and legacy with dignity”…

    CNN: How are Janet, and your wife, and the rest of your
    family, the daughters?

    Joe: They’re all doing fine. But I want to make this statement.
    This is a real good statement here. Marshall and I, we own a
    record company called… tell him… (Marshall finishes:)
    “Ranch Records, it’s distributed by Blue Ray, and that’s his
    next step.”

    CNN: That’s the next step.


    Bait And Switch:
    Surveillance Movie Review
    June 30, 2009

    I saw the movie Surveillance.

    As bad as it was, the movie wasn’t the problem. The problem


    was the trick they used to get me to see it.

    I spoil nothing in telling you that if you can’t guess the entire
    plot in the first nine seconds of the movie then this review
    won’t help you because you probably have had a stroke.

    It is about two masked serial killers, the kind whose main


    ability is to remain totally calm the way no one ever is even
    when asleep, while their victims cry, stumble, make
    astounding errors in judgment and never, ever fight back.

    Two FBI agents travel out to interview (the only three)


    surviving witnesses of a 6 person gore fest mediated by
    stupidity. The agents place the three stereotypes— a cop, a
    junkie, and a little girl, what else— in separate rooms, and set
    up cameras to monitor all three simultaneous interviews. The
    idea is that witnesses are unreliable, or, as the director put it in
    an interview— and you’re going to want to sit down for this—
    versions of the truth change when you are being watched.

    I know, I know.

    So why tell this story? Why should the audience want to see
    it? The director explains:

    I haven’t seen a serial killer film the way I want to see a


    serial killer film and I want to confuse people about what
    good and bad look like. I want to break that ‘book by its
    cover’ mode and play with that.”

    Because no one ever suspects “the guy you least suspect.”

    II.

    The problem is we aren’t watching it because we think the


    director made a new kind of serial killer movie. We aren’t
    even watching it because we like serial killer movies. We are
    watching it because the director is David Lynch’s daughter,
    and David Lynch himself is the executive producer.

    We’re hoping this is going to be like Twin Peaks II.

    “But the funny thing is, he had nothing at all to do with


    it,” Jennifer Lynch says.

    It’s your movie, I get it. I know it’s hard to come out from a
    famous parent’s shadow and find your own voice, and I’m sure
    she doesn’t want people assuming this is a David Lynch
    movie, but can you blame us? It’s not like anyone makes any
    attempts at hiding David Lynch’s involvement. In fact, they
    take extra special care to bludgeon you in the face with it.

    Here’s how a woman who wants to be her own kind of director


    with her own creative vision distances herself from her father:
    first, she would change her and David’s name to pseudonyms
    or hide them altogether and make the movie posters as
    different as possible:

    She would cast people who are as un-David Lynch as possible,


    who invoke in your imagination completely different kinds of
    movies. Actors who have never even seen a David Lynch
    movie, let alone been in one. As an example, she would be
    very careful to not cast Bill Pullman and Julia Ormond
    because, well, you know.
    She would be careful not to shoot scenes or images that call to
    mind any of her father’s work:
    or choose to feature objects that have symbolic importance to
    her father:

    guess which movie I belong to


    And putting a haunting image of a disfigured/masked face
    coming out of the darkness; ethereal sounds, inaudible
    whispers— all those are completely out of the question

    Whose movie did she think we were going to see? I’m not
    saying that Jennifer Lynch has to make movies like David
    Lynch; nor am I saying I expect her movies to be like David
    Lynch’s, except in the single circumstance that she goes out of
    her way to tell me it is a David Lynch movie, and make it look
    like a David Lynch movie.

    Which, again, is fine— but then actually make a David Lynch


    movie. No. Instead, she doubles back and makes the most
    obvious, conventional movie possible given the budget. This
    movie is more linear and predictable than The Honeymooners.

    Again:

    “But the funny thing is, he had nothing at all to do with


    it,” Jennifer Lynch says.

    I can see that. That’s the problem.

    In fact, the key stylistic difference between the two Lynches is


    that Jennifer shoots careful, focused scenes that are
    incomprehensibly irrelevant to the story.
    At first I thought such shots were simply mistakes? but then I
    read her description of the two killers:

    How did you want to see a serial killer film in ways we


    hadn’t seen a serial killer film before?

    JENNIFER LYNCH: I hadn’t really seen one that had


    what I considered to be a real examination of how messed
    up violence and sex and stuff get because the people who
    hurt have been hurt themselves. Although I don’t pinpoint
    those moments for our characters, I felt like I got an
    opportunity in the end to examine just how awful and
    confused that moment became for both of them and that
    these two killers were never thought of, in my opinion, as
    anything other than wounds or failures or victims or
    criminals until they saw each other and then they met
    each other and decided this was how they were going to
    live their lives until they couldn’t anymore and what a
    nightmarish thing that is and yet how in love they are and
    just that dark mess.

    I don’t know what movie she is talking about, maybe Natural


    Born Killers or Finding Nemo, but it certainly wasn’t
    Surveillance. Is it possible the actors and camera guys were
    working off a different script?

    What kind of back story did you envision for these


    characters? How long do you think they’ve been at it?
    How do you think they met?

    JENNIFER LYNCH: I think they’ve been at it for about 8


    months in my head. They’ve been in love for a while but
    it’s a new love. I wanted each of them to write a love note
    to each other in case something went terribly wrong. If
    not literally keep it in their back pockets, then imagine
    that note in their back pockets.
    I’d like to see that movie if she ever decides to make it, it
    sounds awesome. Meanwhile, what? The Transformers? If this
    is really about understanding the characters, getting into their
    heads and asking questions they might ask, then explain why it
    is that a 8 year old girl who watches her family get butchered
    and then figures out the killers are the FBI agents shows no
    emotion whatsoever? She’s not sad, she’s not terrified. She
    actually says this: “I can go to the bathroom by myself— I’m
    almost 9!” Maybe she’s in shock? Maybe she’s retarded? We’ll
    never know.

    At one point— right after she asks to go to the bathroom,


    amazingly— she has the FBI agent/killer bend down so she
    can whisper, “I know who you are” in his ear. She does not
    bite it off and run.

    When she escapes, she does not use the police radio or the
    phone or a hand grenade. She does, however, teleport herself
    out of the police station and into a field far away, taking only a
    white bag that I must assume contains oranges. Why oranges?
    Exactly.

    III.

    I know playing “here’s what would have made the movie a


    thousand times better” is a fool’s game, but if you’re making a
    movie called Surveillance, it should occur to the characters,
    not to mention the director, to make some use of the actual
    surveillance cameras which are mounted in the police cars.

    This is my blind spot

    You might say, “well, maybe she didn’t know cop cars had
    cameras in them.” This isn’t a comic book where the author
    has to imagine what might be in a police car, in the same way
    he has to imagine what a woman looks like in spandex. Unlike
    said comic book guy, the director and the actors have physical
    possession of a cop car.

    I hope the camera doesn’t capture me missing an unarmed guy


    five times and then getting hit in the head from behind by the
    other guy who snuck up on me in this wide open field on a
    clear day with no noise

    The problem with Surveillance isn’t that it is a bad movie—


    the story will be formulaic and predictable for anyone over 16,
    but the directing is solid— but that it, she, is suffering from an
    identity crisis. Who does she want to be? Carry on her father’s
    work, or go a different way? How does she want other people
    to think of her? This movie was less a character exploration of
    two killers than a “trying on of identities” for the director.

    Many of David Lynch’s movies can be thought of, and


    interpreted as, dreams. The events, people, and objects are
    symbols for other things. The movie/dreams don’t tell a story,
    they convey emotion, resistances, information about the
    dreamer.

    Maybe this is a David Lynch movie after all.

    –—
    Another movie review: Wanted
    Another sort of movie review: Halloween

    http://twitter.com/thelastpsych
    Happy Fourth Of July
    July 4, 2009
    Time Magazine Asks
    Cleveland Clinic What To Do
    About The Healthcare Crisis
    July 8, 2009

    This would be like Jimmy Carter asking Leonid Brezhnev


    what to do about Soviet military power, which, like this issue,
    actually happened.
    They had a slideshow, but I was pretty sure they weren’t
    labeled correctly. So I fixed them.

    phew
    “Not too much, now” (this suite will get paid for by your
    heart disease)
    the new business of healthcare is business
    A Surprising Number Of
    Teens Think They’ll Die
    Young, Or Live Forever,
    Whichever Comes First
    July 13, 2009

    An unsurprising number of adults don’t care either way.

    CHICAGO - A surprising number of teenagers — nearly


    15 percent — think they’re going to die young, leading
    many to drug use, suicide attempts and other unsafe
    behavior, new research suggests.

    The study, based on a survey of more than 20,000 kids,


    challenges conventional wisdom that says teens engage in
    risky behavior because they think they’re invulnerable to
    harm. Instead, a sizable number of teens may take
    chances “because they feel hopeless and figure that not
    much is at stake,” said study author Dr. Iris Borowsky

    15% is surprising— because it’s smaller than I would have


    guessed, no? How many teens did you know in high school
    who thought they’d die by 30 (their parents’ age when they
    were 4…?) or 33 (Jesus?)?

    The really surprising thing is the logic: how do they make the
    jump from thinking you’ll die young, to using drugs? Is it only
    those 15% who use drugs? Do the majority of those 15% go
    on to use drugs? etc.

    How many teens think they will live forever? Not like
    vampires, but how many can’t imagine their lives three years
    into the future, let alone 30, and this finds expression in the
    sentence “I’m never going to make it to 35”? It would be
    equally (in)valid to conclude, “teens belief that they will live
    forever leads to risky behaviors.”

    II.

    Borowsky said the magnitude of kids with a negative


    outlook was eye-opening. Adolescence is “a time of great
    opportunity and for such a large minority of youth to feel
    like they don’t have a long life ahead of them was
    surprising,” she said.

    Yes, I’d expect someone of my generation to say something


    that obtuse.

    III.

    Adolescence is supposed to be an identity Schrodinger’s Cat:


    multiple simultaneous states which eventually collapse into
    only one. The goal of adulthood is to let go of the other
    possible existences and to make the best of the one. A
    successful adult is one who understands that it doesn’t matter
    which life you ultimately pick, only that you live it well. The
    same potential for, say, happiness exists whether you are a
    construction worker, porn actor, or wealthy industrialist.

    Meanwhile, it is in no way contradictory for a teen to think


    he’ll die young AND live forever; or that he’ll become a chef
    AND be an infantry colonel; that he’ll raise his kids on a farm
    AND roam the earth celibate like Kung Fu.

    But the idea that kids are having multiple potential lives,
    simultaneously, doesn’t sit well with adults, especially when
    the adult is more concerned with how the kid impacts their
    life, not the other way around.
    IV.

    As an aside:

    The study suggests a new way doctors could detect kids


    likely to engage in unsafe behavior and potentially help
    prevent it, said Dr. Jonathan Klein, a University of
    Rochester adolescent health expert who was not involved
    in the research.

    Of course it does. Because in the new era of healthcare, there’s


    no money in the treatment, only in the detection. Question:
    once detected, what do you propose we do about it? It’s a
    deadly serious question, I want a serious answer. You can’t
    give them Zoloft, they’re not yet “sick.” Will you put them
    into therapy against their will? Monitor them? Social services?
    Outsourcing the parent? It takes a village, etc?

    You are witnessing the nationalization of parenting.

    Question: why would a parent want their parenting


    outsourced? Oh, yeah.

    VII.

    Does the study really show that kids who think they’re going
    to die young engage in riskier behaviors? No. Not even close.

    First, the trick of the study— and it is most certainly a trick—


    is to present the strongest data first, but report the weakest data
    in the press, and conflate the two.

    Here’s the strongest data in the study— not found in the press
    story:
    In adjusted models, illicit drug use, suicide attempt, fight-
    related injury, police arrest, unsafe sexual activity, and a
    diagnosis of HIV/AIDS predicted early death perception
    at time 2 (1 year), time 3 (7 years), or both (adjusted odds
    ratios: 1.26-5.12)… Adolescent involvement in risk
    behaviors predicted a belief in premature mortality 1 and
    7 years later.

    See it? I’d call this “Bait And Switch,” but I already used that
    for another post title. Here, the data shows that kids that are
    already being risky will later on in life believe they are going
    to die young. But the press reports it the other way.

    Look at the study more closely, or once anyway, and you’ll


    observe that

    1. although 15% of kids said they probably wouldn’t make it


    to 35, only 3% actually voted as having “no chance” or
    “probably would be dead.”

    2. Six years later— when they’re no longer adolescents— only


    17% of the 15% still thought they’d be dead at 35.

    3. There was no difference in actual death rates.

    In other words, very few kids actually believed they’d be dead,


    most kids grow up eventually, and it doesn’t matter what they
    think.

    VIIb.

    Hard data for early pessimism predicting individual risky


    behaviors:
    I’ll grant you that predicting a suicide attempt makes sense;
    and I’ll grant you that the relationship to HIV seems strong
    with no clear explanation. But beyond that, there is very little
    you can predict from early pessimism; and certainly nothing
    that justifies the article quote at the top.

    “Oh, the press misunderstood our study…” Sure they did.

    The best way to create a public health problem you can bill for
    is to allow a journalist to report your findings.

    VIII.

    “But even if the reporting isn’t accurate, surely the data


    themselves are valid? Numbers are numbers, right?”

    They used to be.

    Here’s an example: in the study, they make a big deal about


    separating out the races of the kids, because of course different
    races can have different perceptions about their futures. Fine.
    Meanwhile— think about this— they question as
    “adolescents” all kids grades 7 to 11. Do you remember the
    gigantic difference between 8th grade and 10th grade, let alone
    7 to 11? Well, they can’t. To them, it’s all just “adolescence.”

    One of you is right now thinking, “well, how could this study
    have been done better?” You’re asking that because you’ve
    been brainwashed: there was no need to do this study at all.
    This is not a question that needed to be answered. What if
    100% thought they’d die by 35? Or 0%? Do any of these
    results tell you anything? This is another one of the quadrillion
    self-referential, running-in-place studies that constitute
    academic research. They tell us nothing about the world
    around us, they are solely masturbation.

    FYI, someone funded this study, and it wasn’t Pharma.

    IX.

    But even masturbation can be beneficial if it is done with a


    pure and selfless heart. So let’s be fair: does this study and
    story contribute to the understanding and betterment of
    adolescents?

    Turns out the answer is mocking laughter followed by scorn.


    The researchers, and the press, have no actual interest in
    helping adolescents or even understanding them. Their
    interests lie first in themselves, and the kids only in how they
    impact that interest. For example, based on her comment, what
    Borowsky finds interesting about her study isn’t the ability to
    predict future risky behaviors, but that kids don’t share her
    optimism. “Wow, would you look at that!” If all adolescents
    were optimistic about their future, she’d have thought that was
    completely normal.

    Here’s another example: the authors of the study cite


    references and make hypotheses about the causes or meaning
    of the kids’ pessimism. This is strange, and by strange I mean
    it figures, because when they did this study they could simply
    have asked the kids themselves. It, apparently, never occurred
    to any of them. That’s precisely the point.

    You might say, “well, maybe the study was such that they
    couldn’t get kids’ feedback…” Then why do this study at all?
    The core question everyone would want answered you don’t
    even ask!

    To trade a generalization for a generalization: they, The


    Dumbest Generation Of Narcissists In The History Of The
    World, does not care about their youth. They care about them
    as a body, as a construct, but not as individuals, not as people
    with their own lives, hopes, wants, etc. That’s definitional
    narcissism, in case you thought you were on TMZ.com.

    Oh, they care about them in societal or general terms. “What


    should we do about these kids today?” the way someone might
    ask about penguin overpopulation or the quality of bottled
    water. It’s too much hard work to look at each individual kid,
    in the context of their own environment and their own lives—
    hard work previously undertaken by parents, but as I’ve said
    we’re in a new era— and then deciding if there’s any
    pathology. It’s much easier to use, as a shortcut, the extent to
    which a kid disrupts the life of the nearest adult.

    Adults have virtually no interest in teens as human beings;


    they are voyeuristically consumed with knowing what they’re
    up to, and love chatting about why they do things. To them,
    understanding is parenting. Let someone else do the actual
    work; they have a Time Magazine waiting.

    X.

    One last example. Teens like movies, they identify with


    characters, for better or worse sometimes those characters are
    the blueprints for their current or future identity. In other
    words, the characters matter.
    When Time did a story on Borowsky’s study, this is the movie
    they chose to depict this new generation of pessimistic
    nihilists:

    If you want to show how completely oblivious you are to the


    perspective of today’s teens, this is how you do it. Why not
    throw in Jethro Tull? They didn’t even make an attempt at
    finding a current reference.

    I’ll say that last part again, because it’s the key: they didn’t
    even make an attempt, because it wasn’t important to them or
    their readers.

    ––––––-

    http://twitter.com/thelastpsych
    Was Brontosaurus A
    Herbivore?
    July 16, 2009

    I.

    1a. George Washington is the father of our country, the


    Revolutionary War general who helped free the colonies from
    their British rule. In what country was George Washington
    born?

    2a. What modern animal is most genetically similar to a


    triceratops?

    3a. T or F: The majority of the available scientific evidence


    strongly suggests that nicotine increases the risk of cancer.

    4a. Your best friend in the whole world, Tom, sends you a
    letter which begins with the first two lines of Richard III:
    “Now is the winter of our discontent…” That’s bad, right?

    5a. Galileo, the scientist famously remembered by his first


    name, invented the 3x telescope. What, if anything, was going
    on in America at the same time?

    II.

    1b. Could someone born in another country become President


    of the US?

    2b. Does a rhinoceros lay eggs or have live young?

    3b. Do nicotine gum and patches have the surgeon general’s


    warning?

    4b. Does Tom like Shakespeare?

    5b. What was Galileo accused of?

    III.

    Why did the b questions help you answer the a questions?


    Because they made you think from a different angle. You were
    first trying to remember the answer, but then trying to deduce
    the answer.

    These questions should have been the stuff of elementary


    school education, but somewhere between learning that
    Washington had wooden teeth and “brontosaurus ate plants”
    we missed lessons that could be applied.

    What we were taught was facts. We were also taught never to


    question the facts. No one thinks a 7th grade textbook is
    wrong. The results of a study may be questioned, but the
    Introduction section isn’t. What makes a statement in the
    Introduction true is that it is in the Introduction. And go look
    how often studies reference the Introduction of another
    study…

    Unfortunately, even these facts, tested in exams and backed by


    certainty were wrong, but there was no public apology. No one
    ever says, “wow, we were wrong.” They just move past it.
    Some of these facts ruined lives. For me, infuriatingly, some of
    these facts resulted in worse grades in high school. Do I get to
    go back and reapply to a better college?

    Brontosaurus ate plants (there’s no such thing as a


    brontosaurus)
    introns “do nothing” (not: “we don’t know what they do”)
    giraffes evolved long necks because it helped them reach
    higher leaves (the giraffe did it?)
    Everyone thought the world was flat in Columbus’s time
    etc

    By focusing on facts, we learned a way of thinking which is


    not generalizable to knowledge or useful for its application.
    Worse, the isolation of these facts outside of context makes it
    difficult for us to detect them as wrong.

    Education is at the convenience of the educators.

    God Wouldn’t Have Made The Same Thing Twice For No


    Reason

    Most people know that birds are the closest relative to most
    dinosaurs; and they definitely know that dinosaurs are reptiles,
    but they pick rhino— a mammal— anyway. A triceratops is
    closer to a snake than to a rhino; indeed, a rhino is closer to a
    unicorn than a triceratops and unicorns don’t even exist.
    Similarly: an eel isn’t a snake or a worm, it’s a fish.

    They learned about evolution wrong(ly.) For most people 1)


    evolution is about morphology and not genetics; 2) they don’t
    believe evolution is a random, sometimes redundant and
    repeating process, but rather a process of refinement, of
    moving towards something better.

    Do you know why they think that? Because they were taught
    that.
    “Conventional Wisdom Is Wrong”

    Everyone knows cigarettes are bad, and that they have


    nicotine. So perhaps it’s not surprising that 70% of smokers
    think that nicotine increases the risk of cancer— because that’s
    the one the evil tobacco companies spiked the cigarette with.

    In fact, out of the 60 carcinogens, tar, arsenic, lead and CO


    inhaled with each puff, nicotine is one of the few chemicals
    that doesn’t cause lung cancer or heart disease.

    But, be honest, break the fourth wall: reading this blog, you
    quickly reasoned that the mere fact that the question was asked
    suggests it’s a trick. “Aha!” you may have figured. “Nicotine
    patches!” Which is fine; The Princeton Review actually
    formalizes this way of approaching the SAT test (e.g. for the
    first third of questions the obvious answer is correct; last third
    of questions, the obvious answer is always wrong…)

    Now, you have never once in your life said to someone


    “nicotine causes cancer.” But it is 100% certain that within the
    next 5 days, you will repeat this question to others, and teach
    them that nicotine doesn’t cause cancer. Knowledge is rarely
    offered freely; debunking of conventional wisdom is shouted
    from the rooftops.

    I’ll repeat: you’ve never told someone that nicotine causes


    cancer, but it is certain that you will now tell people that it
    doesn’t. Because it’s cool.

    Unfortunately, nicotine does increase the risk of cancer— just


    not in the same way that other carcinogens do it. (It facilitates
    the development of lung cancer, and possible breast cancer.)
    The evidence for this is not substantial but it isn’t
    inconsequential, either. So telling people it doesn’t cause
    cancer— the information you were motivated to disseminate—
    is absolutely, and dangerously, wrong.
    Science is no different. Is a 2000 calorie diet the same as a
    2000 calorie diet?

    Everyone Else Is So Wrong That You Can Never Be Right

    Look at the “decimate” cartoon at the top. You know deci


    means ten and you never applied it. You follow the herd, the
    herd that used decimate in the comic book sense: “we will
    decimate our enemies!”

    But because decimate has taken on the common usage ‘kill a


    lot of”, it’s not actually wrong to use it that way; indeed, if you
    try to use it the other way, you will confuse people. So the
    meaning that is actually conveyed will depend on your
    audience, not on you. You don’t get to decide what you meant.

    Now is the winter of our discontent


    Made glorious summer by this sun of York;

    Line 1 sounds bad, but line 2 flips it: things that were bad have
    been made good by the king. So what does it mean in the letter
    you received, bad or good? What matters is what Tom thinks it
    means.

    That requires you to know Tom. And requires Tom to assume


    you’re going to think it means what he does, i.e. that he is not
    aware that it means different things to different people, even
    though it really only means one thing.

    This is knowledge claimed by misuse, anyone who wants to be


    understood should simply steer clear of the word decimate and
    Richard III. Take a minute and you’ll come up with a thousand
    other words and concepts that have been murdered by
    misinterpretation.

    Expression affects thought. When there are restrictions on


    expression, there are restrictions on thought.
    Compartmentalization of Information

    Even if you didn’t know that Washington was a 3rd generation


    American, you should have been able to reason that since all
    Presidents must be born in the U.S., Washington had to be
    born in the U.S. (1) You possessed all of the necessary
    information; but you could not apply it. It’s not your fault.

    Galileo lived around the 1600s, and was found suspect of


    heresy by the Inquisition for supporting heliocentricism— in
    1632. This made it a decade after the Jamestown Massacre and
    Plymouth Rock. Consider, therefore, that the Pilgrims had
    guns and still believed the sun went around the earth.

    Consider that the Age of Exploration— Magellan, Columbus,


    et al— happened 100 years before Galileo— with a wrong
    understanding of solar system and before the invention of the
    telescope.

    It’s a game you can play all day: King Arthur (500AD) was
    twice as far from the time of Leonardo Da Vinci (1500AD)
    than to Jesus; Jesus was 500 years closer to us than to the
    building of the Pyramid of Giza.

    Learning famous dates is of no value if they can’t be used to


    contextualize events. Which, of course, wasn’t the point of
    learning them.

    And by learning so many bits of disconnected factoids, you are


    fooled into thinking you know something.

    The Solution To The Problem Of Useless Education:

    Where did George Washington, Benjamin Franklin, and


    Abraham Lincoln go to college?

    ––––––

    1. Actually, this isn’t true. Article II of the Constitution says


    the President must be natural born or a citizen at the time of
    the adoption of the Constitution. But it’s safe to assume if you
    had any trouble with this question, you didn’t know about that
    caveat.

    ––––—

    http://twitter.com/thelastpsych
    Who Should Pay For
    Continuing Medical
    Education?
    July 19, 2009

    The money is in the C, not the E.


    Dr. Nasrallah, editor of Current Psychiatry, has an editorial
    “The $1.2 billion CME crisis” asking the above question.

    Everyone wanted Pharma out of it. Now they’re gone, leaving


    a large bill unpaid. Oops. Probably should have thought of that
    first.

    (An aside: no one thinks twice about asking unemployed


    college kids or their parents to pony up $150k of after tax
    income for tuition alone for medical school, but asking
    employed doctors to put up hundreds of tax deductible dollars
    for CME is somehow drunken buffoonery.)

    But the real question is, do we need CME at all?

    Don’t roll your eyes at me, Superfly, I’m serious. If we really


    need an artificial system to force doctors to stay current, does
    this do that?

    Here’s this month’s CME post-test, worth 1/20th of the yearly


    state requirements:
    What does this question teach you? Nothing.

    Time is not infinite— whatever time and energy was spent


    learning this meant you didn’t learn something else. So I ask
    you again— does this help me stay current and
    knowledgeable, or less so?

    “Ok, some of it’s trivial, but it’s the best option we have.”
    Again, brainwashing: if something doesn’t work, it doesn’t
    matter that it’s better than the other things that don’t work.
    Doing nothing is better than doing the wrong thing that costs
    money.

    It isn’t evident that this stuff leads you to be a better doctor.


    There’s a case to be made— and I’m making it— that this
    actually makes you a worse doctor.

    II.

    Docs pay for CME because it absolves them of having to learn


    what appears to be an overwhelming amount of information on
    their own. But then CME becomes the exportation of the
    particular biases of the isolated class of CME writers. I have
    ten years of Depakote CMEs that were not funded by Abbott
    to prove it. Do you have any Dilantin or Neurontin ones? No?
    “But those drugs don’t work.” Do you know why you know
    that? The Depakote guys told you.

    You know these CME guys are called, without any irony,
    “thought leaders”, right?

    Imagine you paid money for a newspaper that selected and


    organized the information they thought was important, and
    trivialized/marginalized anything that didn’t fit into the
    “accepted” paradigms— for example, a third party candidate
    during an election. Or, imagine you paid a bunch of guys you
    don’t know $100k to select and organize what they think is
    important to your child’s development, based solely on the
    reputation of the corporation that hired them.

    Imagine that.

    II.

    Here’s why you’ve never questioned the need for “continuing


    education”: it is designed to self-reinforce the impression of
    ignorance. The focus is on continuing— which means you’re
    never done. You must always be left with the feeling that you
    are actually quite ignorant about the “current” information.

    An example of this idea is Dr.Nasrallah’s very editorial: the


    full title is “The $1.2B CME Crisis: Can eleemosynary replace
    industry support?”

    Well, he got me on eleemosynary, I’ll admit. But then again,


    he probably got lots of people— so why use the word?

    In that same way, Nasrallah uses eleemosynary in a post about


    continuing education to convey an impression of refinement
    and knowledge— you’re not as smart as him. So it would
    never occur to you to question the need for further education;
    you’re hooked into his musings about who should pay the bill.

    IV.

    The argument about CME is structured similarly to the general


    healthcare debate: what ways can we make this affordable but
    free of bias and misuse? But the focus on cost vs.
    commercialism ensures no one notices that a lot of this stuff
    simply isn’t necessary. The number one branded drug in the
    U.S. is Lipitor and you don’t need it. But because CME is a
    $1.5B industry, no one will allow that question to be asked,
    not by conscious suppression but because of groupthink and
    brainwashing. Go ahead, try. You’ll be dismissed with the “of
    course” fallacy (“of course, we need some system for
    continuing education,;of course, we need to keep doctors
    current; of course, we need a way to track it; of course, the
    system’s not perfect but it’s the best we have”).
    These are the responses given by those anchored in the system,
    in the Matrix. They never question the premises. Never
    question the textbook, the Introduction.

    And they are the ones you will pay to have as your teachers
    and leaders.
    The Twilight Movie Review
    Your Boyfriend Doesn’t
    Want You To Read
    July 22, 2009

    If you’re watching it, it’s for you.


    It’s not hard to see why Twilight is popular among teen girls.
    The plot is a simple one— teen girl falls in love with her teen
    classmate who is actually a 100 year old vampire named
    Edward Cullen, can they be together? It captures the thrill of
    first time love, when every little gesture or word always had a
    magnificent subtext. A caress of the face more stimulating
    than any orgasm. Etc.

    The actress who plays the ambivalent Bella really nails the
    dazed, depressive vulnerability of this demo of teen girl, jerky
    head movements conveying emotional confusion, lips
    permanently parted trying to form words for feelings she can’t
    sort out:

    and she has it right down to the borderline sleeve:


    Personal aside: in my life, the borderline sleeve meant two
    things: the girl would like me, and I would regret it.

    II.

    Thing is, the movie might be for teen girls, but it was watched
    by a lot of other people. Opening weekend, half the audience
    was women over 25.

    Perhaps it reminded these older (?) jaded women of a more


    honest love, where a man was willing to devote himself
    entirely to the woman. All of his history and all of his
    development are just prelude to this love, to this relationship.
    And he’s willing to be a man, he’s going to be the strong one,
    he’s going demand full devotion back, he’s going to be jealous
    but never lay a hand on you; he’s going to respect you, care for
    you, he’s going to pay for all of the dinner and yes, he’s going
    to drive, dammit.

    Men are wusses. Got it.

    But let this movie serve also as a warning to the women who
    felt it touch them: if you actually meet an Edward Cullen in
    real life, quickly contaminate yourself with the AIDS virus—
    because it is already too late to run.

    III.

    Here’s the basic problem with the movie vis a vis the longing
    women in the audience: vampires don’t exist.
    Duh, you say, I don’t want a vampire, I want an Edward
    Cullen.

    Actually, you don’t, here’s why.

    Take the movie and delete any scenes— and there aren’t that
    many anyway— in which Edward shows supernatural powers.
    You will think this an odd directoral maneuver, but I promise
    you it’s quite revealing.

    Doing this changes the movie to the story of a boy who says
    he’s something, but the objective audience never gets to see
    any evidence for it. He convinces this lonely, awkward,
    identity-less girl that he is a vampire, and he does this not with
    proof but by force of personality. They then act out the rest of
    the same movie.

    Now what’s the movie about? It’s about a guy manipulating a


    vulnerable girl.

    The movie then becomes exactly what it really is already,


    though confused by the distraction of vampirism. She’s
    looking for a boy to be a man for her, in the absence of a father
    for that role. But it’s 2009— there aren’t any such men,
    because the existing young men weren’t raised to be men, they
    weren’t raised to track accepted roles. Because the fathers
    checked out on them, too, emotionally if not physically. So the
    best any boy can come up with— lacking any model for
    identity— is to make it up.

    IV.

    Edward seems always ambivalent: on the one hand he’s a


    vampire, on the other hand he loves her. “You don’t know how
    much I want to kill you.” That’s touching. He spends the first
    third of the movie enraged/disgusted/infatuated with her.

    The explanation in the movie is that he’s a vampire and she’s


    an innocent. The explanation in real life is that she’s searching
    for something that gives her meaning, and he’s faking it. He
    never hated her, he was never disgusted by her. You get
    distracted by the vampire photo on the cover, that part is
    irrelevant.

    Here’s an example. In the early part of the movie,


    brooding/dangerous Edward tells Bella, “I don’t think it’s a
    good idea for us to be friends.” This is supposed to show his
    ambivalence towards her, which some also take as a sign of his
    disrespect of her. Except that when he says this, at this point in
    the movie, they aren’t actually friends. In fact, she wasn’t even
    talking to him— he literally ran across the parking lot, came
    up behind her, and opened up with that statement.

    I know you weren’t talking to me, but I have something to tell


    you

    Anyone other than me ever been 15? You only do that when
    you want to start being friends. It’s a move. He has no
    ambivalence at all.

    Here’s another example: he (again) sneaks up behind her—


    after eavesdropping, mind you— and says all broody, “what’s
    in Jacksonville?” and she says, “How did you find out about
    that?” To which he responds, even more broody, “you didn’t
    answer my question.”
    Most people’s response to him would be to stab him in the eye,
    who does this jerk think he is? And hence I can see why some
    audience might see him as a disrespectful misogynist.
    However, I’m not sure girls are aware of this, but if there are
    any honest men reading this blog they’ll know— it’s also a
    move. He doesn’t actually want to know what’s in
    Jacksonville,— he just wants to talk to her. He’s not annoyed
    she didn’t answer his question; what he wants is to convey the
    impression of a deep, brooding intellect who doesn’t have time
    for “games.” (Not having time for games is itself a game.)

    She doesn’t stab him in the eye because he knows she won’t
    stab him in the eye. He acts like that and says that because he
    knows she’ll respond like that. He’s performing scripted
    dialogue, he’s trying to get her to say her part that he wrote for
    her.

    A few scenes later— yup, sneaks up behind her again, ladies,


    if a guy comes up behind you and says, well, anything, then he
    wants to bone you— he says some brooding/dark things and
    then says, “…it just means if you were smart, you’d stay away
    from me.” Oooooh. That statement is factually correct, as it
    stands. But what he meant is, “I’m very mysterious, even
    though I’m not. Can I touch your boobs now?”

    “Your mood swings are giving me whiplash.” Ah, so you’ve


    been paying attention to me.

    V.

    Vampires don’t exist, so there’s little danger in 15 yo girls


    falling in love with them. The real danger is a 15yo boy tries
    to emulate Edward. You take a semi-lost 15yo boy, he looks
    around and perhaps he’s written off the cheerleaders or the
    prom queen because he figures they’re out of his league. He
    has an instinctive pull towards someone like Bella, pretty but
    attainable, attainable because she’s semi-lost herself. And the
    boy says to himself, if I want to get a Bella, I guess I have to
    be an Edward.
    In the movie Bella says to Edward, “I can see what you’re
    trying to put off, it’s to keep people away from you, it’s a
    mask.” Adolescents love to talk about masks and fronts,
    “that’s not the real you.” Because if the mask isn’t the real
    you, then there is a real you after all. Looked at this way, the
    real mask— i.e. the fake identity— is the one the boy is
    consciously putting off for her to discover, the brooding artist
    only she can see.

    All of this is typical of adolescence and therefore normal. But


    to you >25 year old women who liked the movie, the guy you
    met who seems a little Edward Culleny is a fraud, and a
    dangerous one.

    Bella says to Edward: “this stuff doesn’t exist, it isn’t real.” He


    responds: “It does in my world.” Yeah. That’s the problem.

    VI.

    Here’s a part of the movie no one else seemed to have any


    problem with: her acceptance into Edward’s family. Edward’s
    family is “perfect”— rich, loving artists who play baseball in
    the rain. Edward brings Bella home to meet them, and they
    welcome her warmly with no reservations. (Only one daughter
    objects.)

    Edward’s father says, “she’s one of us now.” Well, of course,


    she’s not, right? On some level Bella must know she’s not one
    of them, she’s someone else, right? For example, she already
    has a family, remember them? and she’s not a vampire.

    But if her identity isn’t tied to these real things— Bella is the
    main character of the story, but I’ll bet you don’t know her last
    name— then it’s not a big leap for her to become one of them.

    It’s not hard to see how a girl like this gets lost— her parents
    either don’t exist or are near perfect narcissists. Her mom has
    decided to roam the country with her baseball player
    boyfriend. On a phone call, the mom asks Bella if she has a
    boy in her life, and Bella says yes. Here are the next three
    questions, word for word, that the mother— 2000 miles away
    but still parenting!— asks Bella to best characterize the
    relationship: “is he a jock? Indie?… Are you being safe?” I
    almost expected her to ask if he voted for Obama. Are these
    really the most illuminating questions you ask a 17yo with her
    first boyfriend? If she said he was a jock, does that give the
    mom any real understanding into what that boy might be like,
    what he might mean to her? Of course not, but the boy’s not
    real to the mother, so she can’t imagine him as a person with
    his own existence. She can’t really comprehend her own
    daughter’s existence outside of her own.

    Meanwhile, Dad is physically present in the way a quark is


    physically present, it’s there, I guess, it does something but
    God only knows what.

    So when a young girl’s family is this hazy, it is natural that a


    teen might fantasize about hooking up with a more defined
    family— even if it’s made of vampires.

    For you middle aged folks, the analogy is 80s sitcoms. There
    was always a friend coming over the house, and that friend
    was almost an extension of the family. Skippy could walk in
    without knocking, and mom was always happy to cook him
    breakfast. She counseled him, hugged him; he’d open the
    refrigerator like it was his house and no one shot him. I used to
    think, wow, doesn’t Skippy’s real mom mind he’s never at
    home? But I wasn’t mature enough to understand that the fact
    that Skippy could be away all the time meant precisely that she
    didn’t care. The friend’s real family was loose and uninvolved.
    So he found a new one.

    In the final act, bad vampires are trying to kill Bella, so


    Edward brings her to his family for protection. Edward’s
    father says, “I’ll defend her like family.” That sounds
    awesome, but here’s a bit of reality: any father who so readily
    admits a stranger to the family at the risk of death to the other
    actual family members is whacked.

    But that’s not how a young girl might see things, because she’s
    not just hiding out in her BF’s house, she’s becoming part of
    his family. I sympathize with this kind of magical thinking in a
    teen with no strong family bonds of her own, I really do, I
    have no beef with your fantasies. My beef is with the boy who
    thinks nothing of putting his family at risk in order to save his
    girlfriend. And even that’s not as romantic as it sounds— any
    guy who would do this is doing it for himself, not for the girl.
    He’s not doing it because he doesn’t want her to die; he’s
    doing it because he doesn’t want to live without her.

    The movie— and the boy— are already showing that


    established family bonds can be quickly restructured to suit the
    passions of the boy. He’s willing to alter reality and family for
    what he wants. What if his passions change? What if she gets
    fat? What chance does this kind of a relationship have long
    term? Zero. Here’s my point: we are raising those exact kids
    right now.

    VII.

    No one hands kids identities anymore, no one says, “this is


    who you are, now start acting like it.” You’re a man, here’s
    what men do; your last name is X, that’s who you are. Etc.

    What we’re teaching kids is to make it up as they go along. So


    they do. Or, they just morph into someone else’s life.

    The patterns will stay: she’ll go on to have those kind of


    relationships, because that’s the method she’s learned to get
    that kind of passion. And he’ll go on to pretend he’s
    somebody/something— different each time, perhaps, but each
    time with conviction— because that’s how he’s learned you
    score a chick. And why would he learn anything different? His
    parents aren’t any kind of role model in this regard. TV is
    death. No one reads books— except Twilight, apparently. Even
    porn is infested with MILF nonsense, obviously directed
    towards middle aged adults. Those narcissists are so focused
    on their own world that they only have the imagination to
    fantasize about people who are already exactly like their
    wives; but they are too disgusted by themselves to penetrate
    them. Easier to fantasize that someone else is doing it.

    Tell me, please, how can any teen boy respect or learn from an
    adult who not only bookmarks porn, but bookmarks MILF
    porn?

    Twilight is an accurate depiction of the moves and sensations


    of first time love. By second time love, by age 30, there should
    be some maturity.

    This is what it looks like when you don’t.

    –-

    http://twitter.com/thelastpsych
    What Healthcare Reform
    Means To Hospitals
    July 23, 2009

    You’re all going to miss Big Pharma.


    The Atlantic Recommends
    Abandoning Marriage
    Because One Of Its Writers
    Can’t Keep It In Her Pants
    July 30, 2009

    It’s easy to criticize, harder to explain.

    Read the article here.

    Or, read the article with explanatory notes to the text.


    The Best Way To Improve
    Your Creativity
    August 3, 2009

    Moving only three circles, make the overall triangle point


    downward.

    Spend a few minutes on it before reading the hint.

    Hint: this is part of a psych test developed by University of


    Texas students enrolled in a study abroad program in China.
    Scientific American has an article An Easy Way To Increase
    Creativity, which describes the recent paper about the effects
    of psychological distance on creativity.

    The SciAm article is worth reading. Students were asked a


    series of brain teaser questions. One group of students was told
    that the questions were invented at their university; the other
    group was told they were invented in a far away university.
    Thinking that the test came from far away somehow raised the
    creativity of the subjects. They answered more questions
    correctly.

    But in this paper, the researchers told the subjects that there
    was a psychological distance involved. How would you do this
    to yourself?

    One way would be to imagine the question came from far


    away, or form another time. Another way would be to imagine
    you were far away from where you are now (e.g. answering
    while on a vacation in Hawaii).

    But I’m going to illustrate another way— the way I personally


    use on complicated problems and in writing a lot of the posts
    in this blog.

    II.
    Answer this question as fast as you can:

    Name ten animals.

    Note carefully your answer. Most likely, your first 6 or so


    answers are of one category of animal (e.g. farm), and the
    remaining ones are from another category of animal (e.g. zoo
    animals).

    Even dementia patients can name a lot of animals— “cow, pig,


    horse, sheep, umm, cow, no wait, ummm….” but what the
    demented can’t do well is switch to another category. They get
    stuck in the same box, looking around in there for more
    answers. They don’t lack fluency, they lack flexibility.

    So knowing the answer to “name 300 animals” isn’t about


    knowing 300 animals, it is about knowing 30 categories of
    animal, and being able to jump from one to another.

    Imagine you are on your 200th animal, and now you are stuck
    — you can’t even think of any new categories.

    Creativity advice is often of the form, “look at it a different


    way.” Ok, but I don’t even know what way to look at it to start
    trying for a new kind of solution.

    Here’s my trick: imagine you are someone else answering the


    question.

    Who that someone else is depends a lot on what you’re trying


    to do. Sometimes I pick a person related to question (e.g. The
    Crocodile Hunter guy); sometimes I pick a guy unrelated but
    clever person (e.g. Stewie from Family Guy). It can’t be a
    generalization of a person (“how would a biologist answer?”)
    it has to be a real person that I know enough about to model
    their thinking, but different enough from me that alternative
    answers are possible. But I don’t linger, I don’t force the guy
    to answer if he can’t; I cycle through multiple identities to get
    quick looks at the problem. (Why this method works is
    explained a little more fully here.)

    A prisoner was attempting to escape from a tower. He


    found a rope in his cell that was half as long enough to
    permit him to reach the ground safely. He divided the
    rope in half, tied the two parts together, and escaped.
    How could he have done this?

    This question is from the paper, and I couldn’t answer it— but
    Jack Bauer did. Silly, I guess, on some level, but I chose a guy
    who would know how to escape from towers, and the solution
    then came almost immediately. It’s more than just “what
    would Jack do?” It’s about being that other person, what
    would I do if I was him— I imagined myself harried and
    relentless, pausing only to say “dammit!” I need to get her out
    of here, and I need to get her out now—

    so I frantically split the rope lengthwise, tie the ends together


    and to the window, grab her by the waist, and jump––—

    II Addendum/clarification:

    (some have commented that splitting the rope wouldn’t hold a


    person. Others commented that “getting in someone’s head” is
    BS.)

    The idea isn’t to think, “what would Jack Bauer do?” It is to


    think, “what would I do if I was Jack Bauer” because the goal
    isn’t to get out of a tower, it is to answer a brain teaser.

    Trying to think like you as Jack Bauer allows your own mind
    to have one more method of thinking, it adds a new road.
    Taking yourself out of the process, “what would Jack do?”
    limits your thinking, it limits it only to the mind of Jack Bauer.

    For example: Jack Bauer himself wouldn’t split the rope and
    tie both ends, because Jack Bauer knows this wouldn’t work,
    because he knows ropes. I don’t. But allowing myself his brain
    gives me abilities to think of things and in ways I wouldn’t
    previously.

    Again, the point is to boost my creativity, to help my brain to


    think with additional software, not to replace the existing
    software.

    And you only do it for moments at a time. If thinking like Jack


    Bauer failed— after a few seconds, because I’m really looking
    only for flashes of inspiration— then I would have moved on
    to another person.

    III.

    Note also that my inclination is towards psychology; another


    person might be able to establish creative reference points by
    translating the question into a different language, or imagining
    it printed in different color, or font; or answering it using
    thinking from different eras, etc.

    But effective methods of adopting psychological distance or


    alternative perspectives have two important similarities. They
    are predicated on the idea that who you are, and how your
    mind works, can be artificially altered at will— you can
    actually think thoughts you were neither biologically nor
    environmentally primed to think; and they establish that an
    inability to see things from another perspective is almost
    always a failure of will, not of intellect.

    –-

    http://twitter.com/thelastpsych
    LA Fitness Shooter George
    Sodini Did Not Kill Because
    He Was A Misogynist
    August 13, 2009

    all of this has happened before and it will happen again

    click here for analysis of his blog


    Why Did George Sodini
    Shoot Women?
    August 17, 2009

    Assuming his log was actually written by him, here is my best


    attempt at using it to answer the obvious questions.

    Disclaimer: I never met him, didn’t do an evaluation of him,


    etc. Basing this entirely on the log.
    My markup of Sodini’s log here.

    What was the basis of Sodini’s rage?

    What does Sodini talk about most in his log? Not women, sex,
    or dating, but time. Time wasted and the lack of a future. He
    was realizing he had run out of time.

    Not only did he not attain his life’s goals; he was going
    backwards. He had had sex and girlfriends in the past; now the
    years had slipped by, no more “hot hotties” for him. He at least
    had attained a good job; but now there was a chance he’d be
    laid off. Even if he wasn’t, he realized that his skills as a .NET
    software developer were becoming obsolete. He had found a
    church to be a part of; he was then kicked out of the church.
    All the things in life that defined him were going, going…

    The “how to pick up women” books and courses were a Hail


    Mary longshot. Note that he didn’t try these in his 20s or 30s.
    This was a desperate last ditch attempt at achieving something
    long lasting. On the videos, it’s obvious he’s hopeful,
    optimistic, even excited that this might work— maybe he had
    a second chance at women? It failed.

    The only thing missing from this list would be being


    diagnosed with a terminal illness.
    All the real things which had defined him were disappearing;
    all his attempts at making real the things he imagined could
    define him were being stymied.

    At 48, George Sodini was watching himself disappear from


    the earth.

    If he didn’t hate women, why did he choose to shoot


    women?

    The note showed obvious anger towards specific people, e.g.


    family, “Andy,” pastor Rick Knapp.

    Despite how much anger he had towards them, however, he


    never confronted them. These individuals probably had no
    idea he even hated them. He wasn’t a confrontational person,
    he couldn’t muster the “balls” (his word) to say something to
    them. Instead, he vented in private:
    “That felt good,” he wrote after the Andy tirade. You wouldn’t
    write that if you just yelled at Andy. This is why he put their
    addresses in his log- the chance someone else would harass
    them. (Note the anger so many have towards Rick Knapp and
    religion now— they’re taking Sodini’s side, and they don’t
    even know Knapp.)

    In short, he was afraid of the people he hated, afraid in the way


    a 17 year old boy still fears his father, even though he might be
    stronger than him.

    He was resentful of women, but despite media proclamations,


    there is nothing in the log indicating he hated women. He
    repeatedly identified that his problem with women was
    himself, not them— but he didn’t know what exactly his
    problem was. Nor was he afraid of women— he wasn’t even
    particularly shy. He liked meeting new people; he was about to
    chat up to a woman at the gym. However, he didn’t really see
    women as people, as individuals, only as tools for his own
    validation.
    His family, however, were real people.

    Just to get the courage to kill people he wasn’t afraid of, Sodini
    had to make practice runs; he even “chickened out” of the plan
    at one point.

    George Sodini was likely too afraid to confront, let alone


    attack, people more powerful than him. It’s fairly typical of
    mass murderers to therefore choose a nameless proxy for his
    rage; in this case, the symbols of his wasted years.

    In the end, this was the closest level of intimacy he was going
    to get with them.

    Was Sodini a narcissist?

    No. Maybe. He had narcissistic traits, but many other traits


    were very non-narcissistic. It’s hard to know— but that’s not
    the question you want answered.

    This is the same problem with postulating any psychiatric


    diagnosis or label (e.g. autism or Asperger’s.) While possible,
    while it might explain his failure with women— who knows?
    — it does not explain why he killed people. That’s what you
    want to know.

    He seems to have been depressed; that might explain suicide,


    but not homicide.

    So whether he was a narcissist or not is less important than


    asking why he killed people.
    I can say with confidence that if he was not psychotic, the
    violence was the result of narcissism, that specific part of him.
    There are three characteristics of all narcissistic violence: 1. To
    the outside observer, it appears to be “first strike,”
    unprovoked, or disproportionate to the situation. To the
    perpetrator, it is the appropriate amount of response to a
    perceived attack on identity. (Think 9-11, Columbine, etc.) No
    one after a narcissistic rage says, “wow, I guess I went a little
    overboard.” There is no guilt. 2. It is a response to shame, to
    failure, to loss of identity. Killing your wife’s lover probably
    isn’t narcissistic rage. Killing your wife is. 3. Immersion,
    singlemindedness; obliviousness to outside factors. Whether it
    takes three seconds or three hours, all you think about is the
    violence. The violence is the only thing protecting your
    identity.

    Anger is not a necessary part of rage; euphoria, elation, and


    even orgasm occur during narcissistic violence.

    Did he have low self-esteem?

    The core of all narcissism is low self esteem, specifically a


    misunderstanding of the potential of one’s importance in the
    world, but in any case Sodini did not think he had low self-
    esteem. The log doesn’t say, “I’m a big ugly jerk.” It says: I
    look good, smell good, I have a good job, women like me.
    Given that all the pieces were intact— he couldn’t understand
    why he couldn’t succeed. The reason was that the intact pieces
    were not put together correctly. He doesn’t tan because he
    thinks he’s ugly, he does it because he thinks young women
    will like it. But he’s 48. Tanning isn’t going to make a 48 year
    old man look any better to young women than high heels on a
    48 year old woman is going to entice a young man. At that
    age, you’re either attractive to them, or not. Tiny details like
    that don’t change the picture. Worse, it looks bizarre to
    everyone else. That’s the part he didn’t get, though he had a
    brief glimmer of it: “young women were brutal when I was
    younger, now they aren’t as much, probably because they just
    see me just as another old man.”

    He didn’t overcompensate by inflating his ego, either: “i’m ok


    at what I do… not at the top of the class, but I do a good job.”
    No mention of how awesome his biceps are; no disparaging
    the women as too stupid to realize how awesome his biceps
    were. He’s fairly realistic about himself.
    Why didn’t he just go to prostitutes, or take one of the
    “meet a bride trips” to Russia or Southeast Asia?

    Prostitutes would have been a temporary physical thrill, but


    they wouldn’t have provided what he needed: validation. He
    knows prostitutes are in it for the money; likely he figured a
    “Russian Bride” would be faking it with him as well. The
    point wasn’t sex, it was finding someone to confirm he was
    worth it. Also, these “outlets” aren’t simply condemned by
    society, they’re made fun of. Disappearing is bad enough;
    being laughed into oblivion is much worse.

    If he had had a date with the mystery woman in the html


    code— or a date with any woman, could this all have been
    prevented?

    No.

    Nothing is predetermined, of course, but history serves as a


    guide.

    First, Sodini did have a date, at t least two confirmed, one a


    year earlier and another in May.

    Second, what George was looking for was someone to love


    him in spite of himself; e.g. unconditional love that he felt he
    didn’t get from his mother (don’t you roll your eyes, he pretty
    much said it himself.) If his mom didn’t love him, how was he
    going to get anyone else to love him? Answer: he’d have to
    convince them. By definition, anyone he managed to get to
    love him could not actually love him- because he had to get
    her to love him.

    Consider the “pick up women” books and courses. He looked


    at dating as a strategy; he needed to learn the tricks. But he has
    reasonably good self-insight, so what do you think he would
    think if the tricks worked? If he succeeded in “getting” a girl,
    he’d immediately diminish her as inferior: “I had to trick her
    to get her.” He wrote:
    He exudes confidence People believe bull shit if
    delivered WITH CONFIDENCE. Get it??

    He thinks the confidence is a trick, not something real. And


    the words one says to get girls, ahead, etc, are bullshit.

    Imagine after tanning for a month and lifting weights, he met a


    girl at the gym who fell in love with him. Part of his thinking
    would be that had he not tanned and worked out, she wouldn’t
    have liked him. Sodini was 48. How much longer could the tan
    and the muscles last?

    Was he a pedophile?

    Not exactly, though “regressed pedophile” might be


    technically accurate. His focus on getting girls “20 years
    younger”, or “finding it fun talking to young kids” is just
    looking for someone naive enough to believe his tricks. He
    clearly had a sexual interest in fully developed women. Of
    course, had he managed to convince a 16 year old to like him,
    he would have to declare to himself: “she’s so much more
    mature than her years.”

    Was he a religious nut? Did he believe that he would go to


    Heaven regardless of what he did on Earth?

    If we take him at his word, he did believe this. However, why


    did he choose to believe this, yet simultaneously dismissing
    everything else in religion as crap?

    He chose to believe it not merely because it justified his


    actions, but because it confirmed he, as an individual, had
    existed and was worth it. If going to heaven depended on what
    he did in life— well, he didn’t do anything in life, so he’d be
    sunk.

    But if God had selected him for salvation, then he existed, he


    was real, there was something about him other than his
    external life that made him worth saving. His individuality
    alone is what got him into heaven.
    Correct reasoning of the Christian logic would conclude that if
    knew he was saved— his identity validated— then he didn’t
    need to kill anyone. And if he did kill people, he did it from a
    selfish place that would imply he wasn’t saved after all. It’s
    hard to believe that 13 years in hat church and their bible
    study, he didn’t understand this. He “picked and choosed” a
    religious doctrine that fit his life, instead of the other way
    around.

    As Sodini insane?

    Insanity is a legal term, not a clinical one, and thus must be


    discussed using relevant laws, i.e. Pennsylvania.

    Pennsylvania uses the M’Naughten test to determine insanity:

    1. Does the defendant suffer from a mental disease? Who


    knows? I can say I find no psychosis in his log; and I’m
    certain that had he gone to trial, there’d be dueling experts
    saying he did or did not. I see aspects of depression, I don’t
    see bipolar or OCD.

    2. Did he know what he was doing, or that what he was doing


    was wrong? This seems incontrovertible. He planned, changed
    his mind, conducted practice runs, etc.

    In the interest of teaching and public discourse, I’ll concoct an


    insanity defense that fits the available evidence:

    An insanity defense would have to show that either this was


    not a rationally planned operation, or else that he was ill and
    deluded for over a year. So a defense might be that Sodini’s
    log was actually written all at once, on the day of the shooting
    (note the web address includes “20090804”). He gave no other
    hints to people, to internet forums, or even within his
    published google searches that he was thinking of shooting
    people. He had bought guns, but it isn’t even clear he ever
    fired them before that day. He appears to have snapped
    suddenly, all at once, and invented a delusional backstory that
    made him want to shoot people.

    He knew there was something wrong with him (he had


    googled Avoidant and Schizoid) and described himself as
    unable to find pleasure in things.

    He was 5′10″, 155 lbs- though videos and pictures seem to


    place him considerably heavier. Did he take steroids? Did he
    have a disease? In his photo he is waring a red or pink
    bracelet. Breast cancer, or AIDS?

    At some point, the depression was acutely exacerbated by


    either the physical changes, sleep deprivation (google searches
    have him up at 3am and again at 5am) and then a self-reported
    return to drinking, possibly marijuana.

    etc.

    If you could say something to the future George Sodini’s,


    what would you say?

    Murder is wrong. You know that, right? You may think it is


    less wrong than what you’ve suffered so far, but it isn’t.

    Next, with respect to committing mass murder: it won’t work.


    Mass murder is the violent expression of being a pussy. The
    people killed are almost never the people who actually hurt
    you— they are the nameless collateral damage of your fear of
    confrontation. Every person who Sodini felt hurt him is still
    alive. Every person he shot was nothing but polite to him, if
    they had any contact at all. This is almost universally true
    about mass murderers. In other words, the people who you
    think hurt you most got punished the least. Is that what you
    wanted?

    The problem is fear. Even with a gun, Sodini was too scared to
    confront the people who most sacred and enraged him. That’s
    probably where you’re at, too. Meanwhile, the scary people
    get to say, “whew!”
    In order to beat them you have to confront the people who are
    actually hurting you, when they hurt you. When the bully
    comes around, stand up for yourself. You may get beaten up—
    you will get beaten up— but you won’t be a coward. That’s the
    part that counts. Not only will you feel good about yourself,
    but you will eventually terrify the bullies. There’s nothing
    scarier than a guy who won’t stay down.

    Next, you should know that mass murder doesn’t earn you a
    place in history, you aren’t guaranteeing immortality. The only
    reason you think it does is because like most Americans, your
    view of history is tens of years. Do you know who Howard
    Unruh is? Killed 13 people with a Luger. But the crimes
    happened in 1949.

    Worse, the internet is the new arbiter of memory. A hundred


    years from now, a person is as likely to come across the name
    “George Sodini” as he is someone who posts a lot of pics to
    Flickr, which is to say, not that likely.

    The quest for immortality, like insomnia, is mostly in those


    who fear they haven’t accomplished anything. “I need more
    time.” No, you need to do more with the time you were given.

    Does media reporting of this cause more shootings to


    happen?

    Yes.

    How can the press effectively report without causing more


    of them?

    There’s not much, unfortunately. The problem isn’t the press,


    exactly; the problem is our changed relationship to the press as
    our defacto historians and thought police. They tell us the
    facts, but frame them in the historical context they think most
    applicable. But since there is no other “media”— most stories
    come from AP and Reuters, for example; and the type of
    people that go into journalism are of a certain mindset, etc—
    they establish the parameters and the language of discussion.
    It’s fourth generation warfare, played out on TV. We want to
    know about mass shooters because they have been telling us
    we want to know, and they produce the story in the way we
    want to hear it.

    There are some things the press can do better: report the story
    straight, like a boring day on Wall Street. No pictures of body
    bags, no sirens, no swat teams. All that stuff will get out, but
    don’t mainstream it because then those images become the
    point of the story, and thus the point of committing a crime
    like this. These things will leak out on the internet, of course,
    but that’s ok: no one is going to say, “I so want to do
    something that will be remembered only by crazy internet
    detectives on metafilter.” (Unless the perpetrator is a crazy
    internet detective on metafilter.)

    Never, ever, show a picture of the killer on the news (unless


    it’s a manhunt.) The public will find a picture of him if they
    want to, but by the media displaying it for us, it tells us we
    need to know it; it tells potential murderers that if they commit
    a murder, their identity will be the most important part of the
    story.

    In other words, they should report mass shooters the way they
    reported 9-11— gross generalizations about “terrorists” and
    little focus on the backstories of the individual perpetrators
    (other than Atta, name one hijacker), and massive focus on
    emergency personnel and victims. Hell, they don’t even
    celebrate it as an attack, they call it by its date. That kind of
    coverage doesn’t inspire copycats. (It doesn’t inspire very
    much of anything, actually.)

    Will this happen again?

    Yes. This is the generation that wants it to happen again and


    again. I defy anyone to tell me they overheard someone say
    the following sentence: “why would anyone want to shoot
    young women at a health club doing latin dance? It’s crazy, it
    just doesn’t make sense!” Anyone?

    No, this is what you hear, everywhere: “I don’t condone what


    Sodini did, but I can understand it…” That feeling is societal.
    It takes on different forms, sex, politics, etc, but the form is an
    illusion, the substance is “I’m not the person I thought I’d be;
    no sees me the way I want to be seen.”

    It may not be a shooting rampage— it could be a bombing, or


    a “politically motivated killing”— but it’s the same: “they”
    kept “me” down long enough…

    It’s social justice, narcissism style: everyone deserves what


    they get, and gets what they deserve.
    Michael Jackson Died Of
    Overdose
    August 26, 2009

    But the question is, an overdose of what?


    According to CNN, this is the timeline of drugs he received on
    the day he died:

    1:30 am.: 10 mg Valium

    2 am: 2 mg IV Ativan

    3 am: 2 mg IV Versed.

    5 am: 2 mg of IV Ativan.

    7:30 am: 2 mg of Versed; placed on pulse ox (measures


    amount of oxygen in blood— used in these cases when you
    worry they may be too sedated to breathe)

    10:40 am: “after repeated demands/requests from Jackson,”


    Dr. Murray administered 25 mg of propofol.

    I.

    We can say that this is enough drugs to kill a horse, but look at
    5am: Jackson is still awake. And at 7:30. And at 10:40. It may
    seem like a lot of drugs to you, but regardless, they were too
    weak to put him down. Therefore, you can’t say these were
    lethal levels of medications; half a bottle of rum is lethal to
    some people.

    So when CNN does that idiotic segment where they give a


    reporter propofol to show how strong it is, you should take
    that for what it is: pornography.
    II.

    Farily safe to assume: this isn’t the first time Jackson’s taken
    these drugs, at these doses.

    III.

    It’s extremely unusual for a doctor to be charged criminally in


    such cases, unless there was malice; they are usually dealt with
    in civil court (malpractice) and/or by a medical review board.

    It is going to be impossible for a prosecutors to prove, beyond


    a reasonable doubt, that Dr. Murray killed Jackson.

    First, the amount of drugs Murray administered was not


    only not lethal— it wasn’t even effective. Jackson was
    wide awake, all night.
    That amount of benzodiazepine drugs is not at all unusual
    for a benzo addict. If Jackson was used to that amount,
    it’s going to be very hard to show why that amount, on
    that day, killed him.
    Which brings us to the second point: we have no way of
    knowing whether Jackson was giving himself extra oral,
    or even IV doses of the same drugs, that Murray didn’t
    know about. Apparently, Jackson had 8 other bottles of
    propofol in the house, along with other Ativans, etc. It
    wouldn’t be surprising if Jackosn was taking extra
    Valiums throughout the night.
    Third: “What about the propofol? The coroner said high
    blood levels of propofol killed him.” If the coroner said
    this, he is a fool. Picking out one drug as the cause of
    death is like blaming one section of the ocean water for a
    drowning. The effect of propofol only lasts 5-10 minutes.
    If it was a single injection, it would have stopped working
    after that long. Propofol rarely accumulates to high blood
    levels because it clears so quickly; a high level would
    suggest either supplementation, or Murray was lying.
    Then the prosecution’s case falls apart: either Murray told
    the truth about the 25mg, and therefore Jackson was
    supplementing; or he was lying, which… good luck
    proving that.
    Unless Dr. Murray gave him a propofol drip and forgot to
    turn it off. That would be…
    In any event, unless you give a high dose all at once, in
    order to die you would have to maintain the propofol
    infusion, i.e. not turn it off. That wouldn’t be negligence,
    that would be retardation or murder. But that would be
    the only way propofol could have killed him.
    Fourth: administering propofol along with
    benzodiazepines is not unheard of, nor is using it outside
    a hospital with nothing more than a pulse ox. (e.g. used
    commonly in a doctor’s office for a colonoscopy.)

    IV. There is one way this could be an easy case of negligent


    homicide: if Dr. Murray administered the propofol but,
    contrary to what Dr. Murray said, he didn’t have any
    monitoring equipment. This is the part of the story that makes
    no sense to me. A pulseox is a simple machine to measure
    blood oxygen levels, you clip it on the patient’s finger and
    watch the readout display numbers from 0-100%

    In order to die, you must first fall asleep, and then your
    breathing slows and stops. This takes minutes, not seconds.
    Wasn’t it on after Jackson fell asleep? If so, why didn’t
    Murray hear the first alarm that goes off when the oxygenation
    fell below a certain, non lethal level? Did he have it off?

    It seems crazy to me that you would have a pulseox, put it on


    the patient, but ignore the readout for the crucial hour after the
    guy falls alseep? Especially after all those benzos?

    Of course, having a pulse ox to detect low oxygenation is


    pointless if you don’t have supplemental oxygen on hand.

    The simple explanation is that he either didn’t use the pulse ox


    (negligence) or he did use it but paid it no mind (negligence
    and stupidity); or he did use it, heard the alarm but was unable
    to save Jackson despite his attempts. This is all assuming he
    did give only a single injection of propofol, not a propofol
    drip.

    Murray says he did administer CPR and flumazenil (the


    antidote for benzos, but not propofol) but the timeline is hazy.
    Maybe Murray was scared of getting in trouble, so he lied
    about the times; but if he did use the pulse ox and diligently
    tried to save him, then there’s really no criminal case here.

    V.

    A small clinical aside, I neither expect Dr. Murray to know


    this, or even the majority of the doctors. There’s a difference
    between time of onset and peak blood level. Just because the
    pill doesn’t work in 30 minutes, doesn’t mean there isn’t
    another 70% of the pill coming in an hour.

    This is how famous people die: they take stimulants to party


    all night, and sleep very little. Finally, on day 3 they’re too
    wired to fall asleep naturally, so they take a few extra
    sedatives (because they feel so wired.) However, the full dose
    of the pills doesn’t happen until after they fall asleep; the
    sedation is worsened even further by stimulant withdrawal;
    and, of course, the natural exhaustion that comes with partying
    for three days and not sleeping.

    Smaller doses, more time. That’s the secret to not being ruled a
    suicide.
    District 9
    August 29, 2009

    The only thing I learned from two viewings of this movie is


    that South Africa is the stupidest person in the world.
    I know hating this is like hating Sophie’s Choice in that it
    brands me as some sort of anti-intellectual white supremacist,
    as opposed to an intellectual white supremacist, but this movie
    was so maddeningly stupid I actually had to leave early to
    light up a cigarette and stab out my eyes. Then I threw myself
    in front of a Prius.

    “But the CGI is awesome.” It was awesome in Tron, for its


    time, too. If you take out the CGI, you’re left with a movie
    written by Roger Hargreaves about characters whose behavior
    and choices make no sense at all, ever.

    II. Going For Oscar


    But reviews of the movie have been overwhelmingly positive,
    not “awesome fight scenes” positive but “scathing social
    satire” and “indictment of man’s inhumanity to man” positive,
    which makes me wonder if they saw a different movie? Or did
    I miss the real meat of the film because I left early when I
    realized this was not the sequel to V The Final Battle?

    So I decided to try again, I told myself that there was going to


    be porn at the end of it, took off my pants, and watched. No, I
    didn’t go back to the theatre; fortunately, the major studios
    have joined together and created a website called “The Pirate
    Bay” which allows you to watch a movie for free before you
    decide if you want to buy it from Amazon for 4 bucks.

    On the second viewing I was able to see what all the fuss was
    about: this is the kind of movie the Oscars love.

    Oscar Loves: Innocence Lost

    The movie is about a race of aliens who do not speak English


    but do, unusually, speak Bantu, who park their spaceship
    above the city of Johannesburg and do nothing. The U.S.,
    Russians, and Chinese choose not to get involved with this
    spaceship, respecting South Africa’s sovereign borders and
    trusting them to be the Earth’s ambassadors.

    The central story concerns a little alien boy, whom the humans
    disparagingly refer to as “District 9,” and his father, District 8,
    who escape to the set of Slumdog Millionaire and look for
    scraps to use to build a spaceship which will fly them back up
    to the mother ship. The kid has the technological know-how to
    build such a spaceship and later pilot it.

    However, his father has to explain to him what “fuel” is, and
    where it goes. That conversation occurs while the kid is
    actually synthesizing the fuel in their basement lab.

    Also, the kid doesn’t know how many moons Earth has. You
    could say that since he’s not from Earth he can’t be expected
    to know how many moons Earth has, but I’m not from France
    and I know how many moons France has. If it was his father
    who didn’t know, I could speculate maybe he’s nearsighted or
    doesn’t know how to count past zero, but the kid was born on
    earth, he’s been here all his life.

    At first I had thought this was a plot hole; but on second


    viewing I realized that the kid is meant to be retarded. Not full
    on retarded, not Down’s Syndrome or Brad Pitt retarded, but
    Forrest Gump retarded. In other words, Academy Award
    winning retarded. Smart enough to build a spaceship but
    retarded enough that women will secretly want a man like him,
    right after they finish getting boned by a football team. This,
    of course, is a pointed critique of the Bush Administration.

    Oscar Loves: Racism

    Everyone knows that this movie is complex allegory about


    apartheid. What they may not know is that since target
    audience for the movie is the Academy of Motion Pictures, the
    movie delivers this message with the subtlety of getting
    bludgeoned with a pizza oven.

    Or so I thought, at first; but then I saw the magic of the


    movie’s subtext. The movie is a cinephile’s Finnegan’s Wake,
    a movie full of dream-like connections waiting for a
    postmodern deconstruction, or two guys with some weed.

    The aliens, who in the movie like to eat cat food, represent
    blacks. If this thematic conceit startles you, you’re going to
    want to take a Xanax before you hear the rest of it. These
    aliens are descended from the original Predator alien, a
    Rastafarian originally named Snoop Dogg, originally played
    by action star Jean Claude Van Damme, who, of course, is
    originally from South Africa. He quit the movie because the
    mask was too heavy, and the role went to a black guy named
    Bigfoot who then died of AIDS. (1)

    The South Africans find that the aliens’ weapons can only be
    used by those with alien DNA; but they also quickly discover
    that their own DNA makes them hate black people, in this case
    aliens. So they decide to herd them into a ghetto and fence it
    off. The writers of the movie cleverly mask this devastating
    critique of the Bush Administration by naming the ghetto
    “Gaza.”

    “District 9” is an allusion to the 9th district of New Orleans


    submerged by the movie Hurricane Katrina almost exactly 4
    years ago; for this reason the aliens in the movie are referred
    to as “prawns.” As everyone knows, prawns are delicious; this
    is why some of the black people in the movie try to eat them.
    This entire subtext is a blistering critique of the Bush
    Administration who, as early as 2001, had advocated for
    eating Katrina victims. As the President of the Academy of
    Motion Pictures once said, “George Bush hates black people.
    Especially delicious Iraqis.”

    The aliens are largely forgotten and ignored in the slum,


    despite their being, well, aliens, a fact you could be forgiven
    for assuming would prompt some curiosity. Not in South
    Africa. Blacks there are rarely considered curiosities. The only
    reason the South Africans begin worrying about them after 20
    years is that the aliens start having sex with their women.
    Amazingly, that part isn’t a joke.

    Oscar Loves: The Secret Purpose of War

    Here’s a sure-fire plot to get an Oscar nomination: a story


    about the greedy South Africans, played by America, who try
    to evict all of the Districts out of their ghetto in order to build
    a Disneyland, as seen through the eyes of a child. This bit of
    eviction nastiness falls to Wikus van der Merwe, played by
    Blackwater USA (Best Supporting Actor nomination), who is
    so craven and petty that at one point he turns into a giant
    robot. This transformation is a scathing critique of the Bush
    Administration, who hate robots.

    District 8 and 9 have no choice but to turn to the underworld,


    the “black” market, for the parts they need to build their
    spaceship. Because there are absolutely no such criminal
    gangs anywhere in South Africa, the Districts must travel all
    the way to Nigeria to find thugs willing to sell them the parts.

    All the while, they are relentlessly pursued by Wikus and the
    Fox News team, who shoot and kill everything in sight just to
    feel the blood splatter on their faces. It nourishes them. They
    also want to get access to the aliens’ weapons, which are
    infinitely more powerful than human weapons and which are
    laying around discarded everywhere in Johannesburg. The
    Districts themselves never use the weapons that they brought
    with them from space on their human pursuers, because they
    are a peaceful race, abhor war, and just want to return to their
    homeland. They do, however, throw rocks at them as they’re
    being shot at by machine guns. Also, one dons a suicide vest
    and blows himself up in order to kill all the vampires. I’ll
    admit that I may be confusing this with something I saw on
    CNN, but it could have happened in this movie, too. And as
    anyone with enough weed will tell you, umm… what? Either
    way, I think we all know what it says about the Bush
    Administration.

    Oscar Loves: Finales That Make No Sense But Bow To the


    Political Fashion of The Academy That Particular Year

    In this movie, not only do many humans die— which


    prompted one not at all young but in all likelihood retarded
    moviegoer who had stumbled in from the next door Mrs.
    Field’s Cookies to agree, “blast those motherfuckers!”— not
    only are all humans depicted as corrupt Halliburton employees
    deserving of and receiving of death, but there is only one
    human in the whole movie who displays any goodness or
    nobility— but he does so only after he becomes an alien.
    Think about this. I wish that there was a joke in there
    somewhere, but there isn’t.

    (1) You’re not going to believe this, but that paragraph is


    almost completely true.

    ––––

    http://twitter.com/thelastpsych
    This Onion Clip Is Hilarious;
    Now Let Me Tell You Why
    It’s Scary
    September 2, 2009

    “This is our future,” wrote the linking email. McLuhan wrote


    The Medium Is The Message but due to a printing error, it
    came out Massage. Proving his point.

    Police Still Searching For Missing Productive, Obedient


    Woman

    I got this Onion video as a link in my email, and the subject


    heading was “this is our future.”
    Which makes it funny. But the more insightful, and scary, way
    of looking at the clip is to assume the clip is occurring not in
    the future, but in the present, now. Then the video isn’t a
    description of the future, but a study on how to manufacture
    reality.
    I.
    Imagine that American life is exactly as it looks right this
    second, but the Chinese bought one or two or nineteen news
    programs. (NB: this is not a post about how the Chinese are
    taking over the world, I have a different point. Follow with
    me.)
    Say they wanted to influence American culture to become
    more Chinese, and also convey an impression about the
    Chinese as hard working, etc. So, they create a news program
    like this one. Initially, you’d laugh, just as you have already
    laughed. But over time the program would appear ordinary—
    especially if all of the news programs were the same. You
    would watch this in your non-Chinese house, and slowly, over
    time, the media images would chip away at your conception of
    reality until it seemed completely normal that two white
    people are talking in Chinese-isms, judging a person by their
    industriousness, etc.
    You probably remember the name of the program, but not the
    name of the missing woman. See? A story about Chinese
    culture makes you consider the merits of Chinese culture. But
    a show like this, that is about something else, makes you
    assume that this is already known to be the way Chinese
    culture is.
    At some point the news version of China would contrast with
    your own life experience of China, and one would begin to
    dominate. Oh, you don’t have any actual life experience with
    China except from TV. Hmmm.
    How long before you start to accept the value system
    promoted on the news? In this case it’s industriousness, but I
    hardly need to tell you it could be anything at all.

    II.
    Look at the husband in the clip. He is confused by how the
    anchors are acting. His world is the real world, where very
    little Is Chinese. Now he’s crossed into this other world where
    everyone is acting like it’s perfectly ordinary to be Chinese.
    That’s what it would look like for the first year or so—
    confusion, dissonance. After that, we’d just accept it.
    Note well that the two anchors themselves also live in the real
    world. They are perfectly aware that what they are doing is
    fake, invented, or even exaggerated. But they don’t think
    they’re lying, they just think they’re doing their job. They
    don’t appreciate that what they are doing is literally altering
    reality, permanently, for 300M people.
    “How is the world ruled, and how do wars start?” wrote the
    journalist Karl Kraus. “Diplomats tell lies to journalists, and
    then believe what they read.”
    And onwards down the chain.

    III.

    Let’s pretend the news clip and station were real. I’m sure
    China itself isn’t like this news portrayal of China— they are
    creating an impression, a product, and packaging it for
    American consumption, which, because there are no serious
    alternatives, would become the default worldview of
    Americans. The Chinese could make us think whatever they
    wanted. They could actually not even exist— but we’d
    nevertheless believe that these newscasts are representative of
    typical Chinese life. Even if we went to China and found it
    completely empty, when we’d returned we’d still doubt
    ourselves: maybe we saw only a little part of China, surely
    those reporters have much more experience and information,
    it’s not possible that they could be wrong and no one has
    noticed…
    The image of this China is a product to be consumed. A
    product doesn’t find a market, a product creates a market. Or
    did I do some market research and learn we needed a critical
    psychiatry/movie review blog written by a pirate?
    In my description of this video, I’m pretending this is an
    organized effort by “the Chinese” to influence our culture; in
    other words they have a set plan. Our current media doesn’t
    have such an organized plan. Individuals might use the media
    to push their own agenda, but the heads of the news programs
    don’t meet in Switzerland to map out a plan of cultural
    propaganda.
    Which makes it worse. Lacking a direction, a goal, means that
    reality is subject to whim. We used to care about Renee
    Zellweger and Islamic terrorism. Now we don’t. Did they both
    disappear? Never exist? What?

    IV.
    There’s a correlate to this, I’ll explain by example: most
    people don’t know anything about China. So this video clip,
    while funny, also seems kinda accurate— based on what
    you’ve seen from other completely unreliable descriptions of
    China/Japan (e.g. The Simpsons, youtube clips, etc.) Or it
    might be dead on accurate, how would would you know?
    Your objective baseline would come from… that same media.
    Ok, not the same program, but the same station, the same
    biases.
    So the odd correlate is this: the media doesn’t just tell us
    information, it educates us. It does what one might have
    ordinarily assumed a school would do.
    Question: in what grade would a student nowadays learn
    about, say, the Carter Administration? Asked another way: if
    an 11th grader today knows anything about the Carter
    Administration, where would he have learned it?
    You’re all being home schooled, by the parents of someone
    else.

    V.
    First the sign describes reality. Then the sign replaces reality.
    The media creates a shadow reality that regular reality must
    adapt to. When a politician cheats on his wife, then gets on TV
    and apologizes, no one in their right mind believes that the
    apology is sincere— “it’s all for TV.”
    The news media make it sound like the “public demands an
    apology.” But the public doesn’t, the news media does— they
    need it to fill the time. The apology becomes TV segment;
    whether the apology was only for the benefit of TV becomes
    another TV segment; etc. No one believes it, yet there it is,
    filling up hours of TV news.
    But despite the public not wanting this apology, and despite
    the news media needing it to kill time, this bit of fluff changes
    reality, it changes the way you think. Consider what would
    happen if the politician did not apologize on TV. The media
    would flip out— “this guy doesn’t even apologize!” and you,
    the ordinary guy, would feel some level of anger, or at least
    incredulity, at the lack of a fake apology you’d never believe
    anyway. You’ve come to expect a fake apology— not even a
    real one— as necessary to the way politics is conducted. So on
    the one hand cheating signifies we can’t trust the guy, but on
    the other hand a fake apology means… we can?
    “But the fake apology is part of the image…” My point
    exactly. We agree the image is neither real, accurate, nor
    important; but we’ve also agreed to limit all of our dialogue
    and thinking to the image and nothing else.
    “But the image can stand in for the substance, it’s a proxy.”
    No, this is first grade semiotics. It doesn’t represent reality, it
    becomes reality. If it’s a proxy for substance, when do we
    actually talk about the substance?
    The news doesn’t just influence our values. It changes the way
    we think so that certain values become inevitable.
    VI.

    But what about issues that are too complicated for


    journacation? Then you create a proxy who says, “don’t worry,
    I’ll do the thinking for you.”
    Hence journalists and anchor people who break the fourth
    wall, become personalities and thus stand-ins for the complex
    analysis.
    (if you don’t see a video in this space, download Adobe Flash
    10 or click the link below.)
    I Am CNBC: Maria Bartiromo from Broadcasting & Cable on
    Vimeo.

    I have seen these promos hundreds of times, each CNBC


    reporter has one. I found them eerie, haunting, uncanny and
    unreal, and I didn’t know why I felt this. Now I know.
    1.
    The first question that any good post-postmodernist (e.g.
    mercantilist) might want to ask is, why, if they’re sitting right
    there for the filming, do they use a voice over? Why not
    simply speak the words into the camera? After all, that’s what
    they do all day anyway, right?
    The answer is that at that moment, in that promo, that isn’t
    their voice talking to you; it is your mind’s voice running
    through what you “know” about them. It’s the kung fu
    program in the Matrix. They’ve placed info into my head to
    use: “She’s a smart/trustworthy person…”
    So she’s a substitute for my own analysis— I can just adopt
    hers, because she’s like me, trustworthy, etc. Hence the use of
    TV news lingo (“socialized medicine”, “both sides of the
    abortion debate” etc) by regular people in ordinary
    conversations. Ok, nothing new there.
    But the switch is that she is extending her “legitimacy” to
    CNBC, not the other way around. CNBC has managed to con
    you into thinking that they aren’t the ones creating and
    analyzing the news, but that she is— and you can sure trust
    her, she worked in a restaurant! If there was truth in
    advertising, the producers of CNBC— not to mention the GE
    execs who own the station— should be doing “I Am CNBC”
    promos. But that would be contrary to the purpose of the
    videos. They make her more real so that their existence
    becomes less real.
    2.
    The second reason these promos were so eerie to me I only
    discovered months later:
    CJR:

    Gasparino taped the (“I am CNBC”) spot, and submitted


    to another hour or so of extended self-revelation for the
    CNBC.com Web site, on September 15, the day Lehman
    Brothers filed for Chapter 11 bankruptcy protection…
    Erin Burnett, the luminous mid-morning anchor… taped
    her spot that day too. All thirty spots were taped between
    the fifteenth and the eighteenth of September, arguably
    the most turbulent four days in the history of finance, and
    thus one of the stranger allocations of newsroom
    resources in recent media history.

    Of course. But the CJR writer is wrong on one point— this is


    exactly the kind of allocation of newsroom resources you’d
    expect when reality is about to be manufactured.
    District 9 Now Elsewhere
    September 5, 2009

    Maybe someday…
    Unpublished Lamictal
    Studies Left Us Thinking It
    Was An Antidepressant
    September 8, 2009

    If you cheat on your wife, and later learn she had cheated on
    you, can you say you cheated because she cheated on you?

    An great paper by Nassir Ghaemi, saying— and this is a


    quote:

    Some things we know, and know that we know. Other


    things we do not know, and know that we do not know.
    But perhaps the largest class involves those things we do
    not know, and do not realize that we do not know.

    That kind of thinking exhausts me.

    II.

    Thus I was surprised to discover the existence of several


    negative lamotrigine studies… Of the nine lamotrigine
    related bipolar disorder studies posted on the website, two
    were positive and published… Five other negative studies
    involving rapid cycling bipolar disorder, acute bipolar
    depression and acute mania have not been published and
    are only available on the GSK website. Failure to
    adequately publish these negative studies led to the
    creation of a clinical impression that lamotrigine is an
    “antidepressant,” a view innocently expressed to me as
    recently as last week by an academic colleague.
    At this point I need to take a nap. Ghaemi wrote one of the
    best books on statistics for psychiatrists; so I’m not defending
    the hiding of negative studies, but is this man seriously saying
    that the “hiding” of 2 negative bipolar depression studies is the
    reason an entire planet of psychiatrists thought Lamictal was
    an antidepressant when there never were any positive studies
    saying it was?

    This is like Pfizer coming out and saying, “sorry we hid the
    negative data on Viagra and telepathy.” Ok, what?

    In fact, there were already three negative studies about


    Lamictal as an antidepressant published: the same three that
    said it wasn’t an antimanic either, but only good for the
    “prophylaxis of mood states,” which is like the rock that keeps
    tigers away.

    The fact that his academic colleague called it an antidepressant


    means, simply, that he’s an idiot. No, no, no, I’m not being
    disrespectful, I mean it completely seriously. He’s an
    academic. He’s supposed to know what the (only) three studies
    say, especially since he’s teaching it to other people; and he’s
    apparently prescribing this thing thinking that it is an
    antidepressant based on nothing at all. Ok, maybe not nothing:
    based on the word of mouth from other people who didn’t read
    the same three articles.

    Does Ghaemi think that the unveiling of negative studies is


    going to change the behavior of a person who is making it up
    as he goes along anyway? It doesn’t stop astrologers, does it?

    III.

    Don’t look at me like that. Five years ago if I stood in front of


    a bunch of psychiatrists and told them that there was no data
    for the use of Lamictal as an antidepressant or antimanic they
    would have condescendingly shaken their heads and told me
    that Charlie Nemeroff had just been there, and he said…
    And if I challenged them to read the studies that I had brought
    with me to prove my point, they would have told me that of
    course these were only a select sample of studies, there were
    other studies showing that it was an antidepressant… and I’d
    say where? and they’d say well… and I’d say what? and
    someone would inevitably roll out the “if this is true, how
    come other [smarter than you] people haven’t said anything?
    And it would all degenerate into the DMZ of “well, my
    clinical experience has been…”

    I have managed to publish quite a few papers; but when I tried


    to publish papers critical of the existing Guidelines—I had
    experiences quite similar to Ghaemi’s:

    The paper was immediately rejected by one of the editors


    in July 2006, without comment. I asked for specific
    feedback, and received a letter with numerous complaints,
    such as what follows: “There is a considerable literature
    on this specific topic, almost all of which you failed to
    cite”. The editor goes on to note that some of these papers
    were co-written by the editor, which had “profound
    effects”. He continued: “This failure on your part
    indicates a naivety [sic] or ignorance of the broader
    picture….You thus fail entirely to give the paper
    context…As a psychiatrist, you will appreciate the
    annoyance any JAMA editor might naturally feel when
    the manuscript he reads has an abstract written in the New
    England Journal of Medicine style…” He dismissed the
    abstract as “classic…pretty much useless,” the methods
    as “wandering and discursive,” the results as “incomplete
    … trivial…If you had sent us a crisp paper that clearly
    stated a hypothesis, and a credible way of investigating it;
    if you’d given us the context, clear methods and adequate
    statistical analysis; if you had provided the relevant
    citations, and if your hypothesis and investigation had
    been on something that hadn’t been already documented
    by others: then we might have been interested. Unhappily,
    you did not. I hope this will help you in the future. Best
    wishes.”

    Here’s what you don’t know about peer review: it’s really peer
    pressure.

    IV.

    I have been too hard on psychiatrists who thought Lamictal


    was an antidepressant, or even a mood stabilizer. They were—
    pushed— into thinking it. If you only read the abstracts:

    Conclusions Both lamotrigine and lithium were superior


    to placebo for the prevention of relapse or recurrence of
    mood episodes in patients with bipolar I disorder who
    had recently experienced a manic or hypomanic episode.
    The results indicate that lamotrigine is an effective, well-
    tolerated maintenance treatment for bipolar disorder,
    particularly for prophylaxis of depression.

    it’s possible you might have misunderstood the paper and


    thought it was good for everything. Hmm. Maybe the peer
    reviewers missed that.

    V.

    Ghaemi has an optimistic bias: “had we known of these, we


    would have acted.” No, not in this generation’s psychiatry. If
    the overuse of Lamictal was due to hiding negative studies,
    does he think its rapid decline in the past two years has been
    due to the release of these studies? Did we stop using
    Depakote because we all finally read the article from 2000?

    They went generic. That’s all. And it’s not the absence of reps
    that made docs forget about these drugs; it’s the absence of
    “studies” and reviews in all the journals telling us, over and
    over, to use them.

    The problem of psychiatry isn’t the hiding of negative studies


    — even if they were available, it would make no difference,
    because we’re not prescribing based on science, we’re
    prescribing— like Ghaemi’s colleague— on word of mouth.
    Psychiatry is politics, and we basically toe the party line, no
    matter what common sense, logic, or even science tell us.

    Americans learn their civics from the TV news; psychiatrists


    learn their psychiatry from their newspeople, too. Those
    people are called thought leaders, and they have far more
    power to drive practice than any amount of data, hidden or not.
    “Are there really so many
    people with such troubles in
    your country to make such
    medicine such an important
    matter?”
    September 9, 2009

    A reader writes:

    “I’m from Europe, Romania…you speak about a


    medicine intended to declare/sell that medicine as “mood
    stabilizer”… However, are there really so many people
    with such troubles in your country to make such medicine
    such an important matter? I didn’t think of America as
    being such a sad/depressed country and a medicine called
    “mood” something seems to me such a stretch…”

    How I wish I had made this up. The email closes:

    I’d be glad if I knew you’d think about it for a moment…


    how sick your country appears from the outside when one
    reads about so many medicines and so many disorders
    and about medicine for …. anything slightly
    uncomfortable. And how all these trendy things migrate
    to other countries, where people don’t even know that
    their moods, sadnesses, uncomfortable moments, their
    life in a word, is a disorder.

    Here’s my answer:

    The short answer to your question is: yes, there are many such
    patients here in the U.S. However, most of these “patients” do
    not need these medications, most do not need psychiatry at all.
    Of course many do, they are truly sick and but for psychaitry
    their lives would be chaos. But the majority do not.

    But they come to psychiatry because they are told, almost


    constantly, that there is something wrong with them. That the
    fatigue they feel, the emptiness, the lack of interest or sexual
    appetite or sadness or irritability— all of these things could be
    helped by medications.

    It happens that these “symptoms” occur in the absence of a


    clear cause, and medicines do help. But the majority of the
    time these are symptoms only because they are compared to
    someone else. Testosterone patches are the new big thing in
    psychiatry. No, I’m not kidding.

    I’m not sure what a lack of sexual interest in a 40 year old is—
    but certainly in comparison to any TV show, it’s going to seem
    low. That preys on people— a man worries that his wife is
    judging him, even as she is worried he is judging her; so both
    are worried, essentially, that the other person has agreed to
    accept TV as normal and feels consequently inadequate. Etc. If
    you doubt this, watch two married people try to sit through a
    sex scene in an episode of Sex In The City, or Mad Men, etc,
    together. They’re both going silently insane.

    They are handed images of life— TV, etc— and they think that
    they are supposed to be that.

    The complicated answer to your question is that American


    society isn’t really capitalist, it’s mercantilist. Americans don’t
    want riches, they want what they are told to want. They don’t
    want a nice car: they want a Lexus. They don’t want a nice
    house; they want a Viking refrigerator, granite counters. They
    don’t want nice things: they want things that represent nice
    things. Americans want brands. While everyone was
    orgasming over The Tipping Point, they should have been
    reading this.

    As such, psychiatry isn’t a field serving a need; it is a product


    creating a market. They didn’t need treatment; they were told
    they needed treatment. Just like you don’t need Nike shoes,
    you’re told you do. Granted, having Nike shoes or psychiatric
    treatment can still be helpful, but most can certainly get along
    without it and, dare I say it, neither is worth the price.

    And when someone says, “I didn’t really want Nike shoes, I


    just got them because they were on sale,” they have
    inadvertently proven my point. You bought them and you
    didn’t even want them, they were the default. “But I needed to
    buy some kind of shoe.” Think it through…

    Psychiatry— medicine— is too gigantic of an industry to bend


    to the whims of reality. It will create a market because too
    many people’s economies depend on it. It’s too big for Obama
    or anyone else to change it. Fox News and MSNBC can yell at
    each other all they want, it’s already been decided: Wellpoint’s
    stock has soared since Obama rolled in. The “public option” is
    now Aetna.

    This is how it has always been throughout history. Did


    Europeans really blast cannons at each other in the 16th-17th
    centuries because people desperately needed more spices? Yes,
    they actually did. A third of the Triangular Trade was rum.
    People died over rum. Not depleted uranium or alien artifacts
    or the Spear of Longinus: rum.

    You ask whether it is worrisome that the rest of the world


    might see American as a bunch of invalids. Well, that maybe
    true: but what do we care? We’re the only people that matter,
    all other people are supporting cast.

    Your final point is the most important: All of this is coming to


    a town near you. All of this nonsense talk about whether
    American is losing its global dominance is a ruse. As long as
    America remains the largest current market, it sets the
    standards. The Chinese are going to want to need Viking
    refrigerators.

    True power rests in the hands of those who define our cultural
    models and decide what we want to need or who we want to
    pretend to be.

    The history of the world is the history of mercantilism; the


    history of men bending government to fight to the death for
    things they don’t really need and only barely want.
    Jay-Z Gives Ten Reasons
    Why Pop Culture
    Authenticity Is Real Only If
    It’s Fake On Purpose
    September 12, 2009

    “But that title doesn’t even make sense!” Exactly. Yet here you
    are.
    I watched Jay-Z’s video Death of Autotune, in which he
    disparages guys like T-Pain for using autotune (electronic
    modulation of voice) and generally for being pop “z100”
    music, and not authentic “hot 97” black rap music.

    No lyin, your niggas’ jeans too tight


    Your colors too bright, your voice too light…

    You niggas singin too much,


    Get back to rap you T-Pain’n too much
    I’m a multi-millionaire
    So how is it I’m still the hardest nigga here?
    I don’t be in the project hallway
    Talkin’ bout how i be in the project all day
    That sounds stupid to me,
    If you a gangsta, this is how you prove it to me
    Yeah, just get violent
    This is death of autotune, moment of silence

    Ok, calling someone less authentic than you is a standard


    combat maneuver. Nothing new there.

    So if Jay-Z wants to depict his authenticity, to show how and


    raw, honest, legitimate he is in comparison to the other
    “niggas” he would do this by placing himself in authentic,
    legitimate, true to his roots situations and settings.

    Here’s where it got interesting.

    Based on the video, Jay-Z is, deep down, a guy who dines
    alone in Italian restaurants.

    who pays his respects to the chef— or the other way around—

    etc, for more pics see any episode of The Sopranos.

    My first reaction was that maybe Jay-Z had had a stroke. Is he


    aware that he is not actually Italian?
    After this meal, he goes to the back of the restaurant with other
    legitimate Italians like Harvey Keitel and, believe it or not:

    Yes this is an all night poker game, yes it is played in the


    stockroom of the restaurant, yes they are sharing a bottle of
    wine and some pasta, yes that’s an olive oil sign, yes those are
    hundred dollar bills (“this ain’t a strip club”), yes they are all
    in suits, and no he’s not kidding.

    In a video about getting back to basics and authenticity, he


    chooses an entire persona that couldn’t be less authentic.
    What’s crazy about this is that music today tries to be more
    urban, more street, more black— things that he authentically is
    already, he’s technically won his argument just by waking up
    in the morning— and yet he instead picks a character that is
    utterly unrealistic, waves it in our face and and says, “this is
    me, keeping it real.”

    II.

    It would be easy to just say he’s an idiot, but this is a man who
    is hypersuccessful precisely because he can manipulate
    imagery to connect to his audience. He may be Italian, but he’s
    no dummy.

    The problem Jay-Z faces is that because all anyone knows


    about him is images, he has no way of signaling authenticity.
    If he’s shows himself in the projects or on a yacht or behind
    bars or on the moon, no one can know if it’s really him or if
    it’s hype. Maybe he owns a spaceship, who knows?

    So Jay-Z chooses to signal his authenticity not with


    authenticity, but with an already established symbol of
    authenticity: because otherwise, how would we know he was
    being authentic? Italian= authentic, traditional; black =
    masculine, strong. He already has the black part. And it
    doesn’t matter if the other actors are real Italians either, as
    long as they symbolize “Italian” which symbolizes
    “authentic”. Hence Harvey Keitel.

    There’s another major benefit from choosing a completely


    unrealistic symbol of authenticity. Note that his audience isn’t
    Italian mobsters or “kids in the hustle;” there aren’t enough of
    them. His audience is regular people, black and white, for
    whom authentic isn’t “being yourself” or “true to where you
    came from” because for those regular people, that would be
    unbearably boring. For them, authentic has to mean loyalty to
    the persona you made up. This video isn’t about Jay-Z’s
    authenticity, it’s about letting you choose your own
    authenticity.

    He does this not by being Italian— obviously no one believes


    he plays back room poker at Rao’s; but by reducing “Italian”
    to a symbol or commodity that can be acquired or put on, like
    an outfit, in order to convey information to others. In other
    words, he’s using Italian as a brand. He is more authentic
    branded as a TV Italian than if he was actually just himself.
    Read that last sentence again.

    That’s how you build the Matrix.

    III.

    This ain’t for Z100… this is for Hot 97…


    That may be true; and that may convey the impression that his
    music/this song is elite, not for everyone, it has some reserved
    status and/or artistic integrity, but it is not in reality any more
    difficult to get it from the free radio station Hot 97 than from
    the other free station Z100. In other words, it’s not really elite,
    it’s just branded as elite.

    This is anti-autotune, death of the ringtone


    This ain’t for itunes, this ain’t for sing-along

    Of course it is: here’s a ring tone, here it is on itunes, here’s an


    MP3 on Amazon, and I fully expect to see lots of guys
    performing it terribly through open car windows… but that’s
    the draw. That’s the business smarts of Jay-Z. Brand it, make it
    seem elite, make it an aspirational product— but make it
    easily available, everywhere. I’m surprised he hasn’t thought
    of selling scratchy, barely audible free underground bootleg
    copies of the song for $24.99.

    That’s Trading Up again (and I should tell you that book


    doesn’t describe it as a social critique but in all earnestness).
    That’s the two parts of profiting from effective branding. You
    have to make it seem elite and hidden, but make it
    easy/affordable to access it. Then— and this is the key— the
    consumer has to be able to show others that they’ve accessed
    it: that’s the only way other people are going to know who
    they are pretending to be.

    IV.

    This is how kids operate, but it is also how adults— who don’t
    realize they are adults but still think they’re kids— act as well.
    I hardly need to tell you what this phenomenon is called.

    Here’s a random coincidence for you: there’s a book called


    From Jay-Z To Jesus, and it has this sentence on the back:
    Acknowledging that young adulthood now encompasses
    ages 18-39…

    I’m shaking my head because they’re right.

    V.

    Guess what this picture is all about:

    This past July there was a panel called “Raising Him Alone,”
    part of the larger conference “Saving Our Sons.”

    Don’t miss Saving Our Sons! This free community


    event is open to everyone who is concerned about the
    educational crisis facing young men of color and wants to
    make a difference! Learn strategies for helping our young
    men achieve academic, professional, and social success.
    This event is for EVERYONE - parents, grandparents,
    educators, mentors and concerned citizens because real
    change can only happen when an entire community is
    informed and engaged.

    It’s in the Bronx, feel free to guess at the audience. This will
    include a

    a panel discussion featuring prominent women who have


    successfully raised their sons alone.
    There’s two ways to make this work. One way is to find
    women who have raised successful black men, e.g. doctors,
    teachers, etc, to offer advice about how to keep your son
    focused on boring academics. But no, it features the mothers
    of rappers.

    Well, ok. The other way to go about it is to find mothers who,


    like the audience, had to raise their kids in the same adverse
    circumstances, e.g. it’s hard to be a black single mom raising a
    son in the inner city. Drugs, guns— all of the stuff Jay-Z used
    to talk about before he bought a restaurant. However, there’s a
    bit of a problem with their panelists, see if you can guess what
    it is:

    Dr. Mahalia A. Hines (mother of rapper and actor


    Common), Dr. Brenda Greene (mother of rapper and
    activist Talib Kweli) and Sheron Smith (mother of
    Grammy nominated actor and rapper Mos Def.)

    Do these women have anything in common with their


    audience? Dr. Hines is nominally a “single black mother”—
    the words are accurate— but she’s also a woman with a Ph.D.
    who sent her kid to private school. Both of Kweli’s parents are
    college professors. But since their sons are pretending to be
    inner city youth forced to choose between rapping or dealing,
    they are therefore mothers of inner city youth almost gone bad,
    even though they’re not. But no sane person is going to
    question the ‘hood cred of the mother of Common.

    The tragedy of this conference is that Dr. Hines et al have a


    real and valuable contribution to make: how they managed, as
    black single mothers, to continue their own education and
    professions— but that’s a conference no one would attend. But
    shoudn’t the conference organizers have pushed for it anyway,
    for them to be role models in that way? Instead of letting the
    women be who they are, they turned them into symbols of
    something that they aren’t to no benefit of the community at
    all.

    And if this is a conference about educating black kids, then


    isn’t Ph.D. mother raising a rapper son the exact opposite of
    what you want? Oh, is that wrong to say? Imagine Eminem’s
    mom coming to speak to white parents about the importance
    of educating children.

    The unfortunate message of this program is the importance of


    raising sons to be famous (i.e. how they reflect on you) is
    more important than the example you set for your kids (how
    you reflect on them.)

    VI.

    “What’s with white kids today? Why are they pretending to be


    black?”

    They’re not, they’re pretending to be masculine. You may not


    believe this, but white boys/men have no symbol of
    masculinity or toughness— or of sexual power— that they can
    brand themselves with. The fictional white tough guys are
    either “black” or are flawed: strong in one way but weak in
    some other (broken men, depressed, drinkers, etc.) They have
    to pull it together to be tough. And white tough guy/heroes cry
    a lot. What’s up with that?

    If a white kid wants to project masculine energy, he better


    figure out a way to be black and make it look legitimate.
    Fortunately, Eminem and others have done the hard work of
    branding blackness, reducing it from something you are to
    something you adopt, turning it into apparel to wear when you
    need to convey information. Now it’s credible that white guys
    can be black without actually having to be black. Thanks.

    The odd problem that this presents is that though black kids in
    the inner city may legitimately need to project toughness, the
    white kids’— and many black kids’— accumulation of
    toughness brands is actually useless. However, if you brand
    yourself long enough you begin to believe it. At the expense of
    applying to graduate school and possibly your life.

    They’re going to find themselves one day, full of anger and


    resentment and rage at absolutely nothing at all— and middle
    aged.

    How are the 40 year olds who got caught up in the east
    coast/west coast battles faring today? Was it worth it? It was
    for rappers, I guess.

    VII.

    Back to Jay-Z. He’s probably in no danger of being deported


    to Sicily. But he’s definitely “drawn a line in the sand” (his
    words) about Autotune and rap in general.

    Well, maybe. Or maybe he realized, after making an album’s


    worth of songs that did use autotune, that it was becoming
    overused and hack, and so he dumped those songs, made an
    anti-autone song, and prepared to pretend to be the one who
    caused the demise that was coming anyway.

    Or maybe he’s creating a fake controversy that he himself


    doesn’t believe in, but that his audience can use to
    communicate to other people who they want to be: “I’m
    against autotune, I’m street and authentic;” “I’m for autotune,
    I’m artistic and fun.” Fake divisions that can be used as
    brands.

    In that way, both he and the Autotune guys can benefit.

    Here’s a picture of Jay-Z performing Death of Autotune this


    summer:
    See that guy next to him? That’s T-Pain.

    And he looks authentically pissed.

    –-

    Clarification on masculinity here.

    And then the VMAs.

    –-

    http://twitter.com/thelastpsych
    Kanye West And The Video
    Music Awards
    September 16, 2009

    I.

    This is what he said:

    I’m going to let you finish… but Beyonce had one of the
    best videos of all time! Best videos of all time!

    Hey stupid, this is the award for Best Female Video, not Best
    Video Of The Year. Best Video is at the end of the show.

    But you knew that, didn’t you?

    II.

    Question 1: Why would Kanye West jump up to support


    Beyonce? Why not Britney Spears? Slow down, racial
    profilers: would he have done that for any/every black artist?
    Why Beyonce?

    Question 2a: If one of the Jonas Brothers had taken the mic
    away from Beyonce and said “3OH!3 has the best video!”–
    what would have happened?

    Question 2b: Who would have beaten them up? Do you think it
    would have been Kanye West?

    III.

    The VMAs aren’t scripted, they are structured. Structured


    shows are particularly deceiving because the audience is
    focused/distracted by the reality/improvisation/story, oblivious
    to the underlying control.

    The structure of the VMAs isn’t the same as the Oscars, i.e. an
    award show culminating in the award for Best Video Of The
    Year. If it was the same, then why did my DVR say there was
    still another 20 minutes left in the show?

    IV.

    The Muppet Show was about a cast of muppet performers


    putting on a variety show at the Muppet Theater— the show
    you were watching. It had three perspectives.

    The backstage “unscripted” antics: Kermit trying to


    produce or direct; Fozzie practicing a joke on him, or
    setting up a bit; the drama with the guest star, etc.
    The onstage scripted “performance”— The Muppet
    Show that took place in front of the curtain. This included
    skits (e.g. Swedish Chef), Fozzie’s standup, and, most
    importantly, “the Big Number”— the live guest star’s
    performance at the end.

    Looking at these two elements alone, the TV show’s structure


    was: the first five minutes were backstage about starting the
    performance; then onstage the performance had its opening
    number; then a backstage issue; then an onstage skit, then
    another backstage issue, etc. Even though TV viewers saw a
    30 minute show, the onstage “The Muppet (Variety) Show”
    performance filled only half that time. The onstage variety
    show’s highlight was “The Big Number.” But the TV show’s
    story was about the drama of getting to the “Big Number.”

    This is an old set up. But unlike many other “shows about the
    show,” The Muppet Show had one additional element:

    The audience actively commented on the show, in the


    form of the two old men, Statler and Waldorf, in the box
    seats. “Look how stupid this performance is!”

    It’s not for nothing that the VMA artists are constantly
    reminding us that these awards are special because we, the
    fans, nominated them.

    If a show is scripted and an actor goes off script, you’re sunk.


    But as long as the structure of the show is protected, it doesn’t
    matter at all what happens within the show, the outcome will
    always be the same. People could get naked, curse, fight— it
    changes nothing. In fact, at some point, these unplanned
    outbursts become anticipated.

    All that determines a successful show is: can Kermit get us to


    the Big Number, or not?
    V.

    Another analogy: it matters to you how a football team plays,


    who gets injured, misses a catch. But to the people that
    directly benefit— the NFL— the money will flow no matter
    who wins, as long as the structure of the game is intact. If
    Michael Vick meanwhile wants to drown some puppies, that’s
    his lookout.

    The business of the NFL is not football. The business of the


    NFL is business.

    VI.

    One scripted VMA subplot was Russell Brand’s monologue,


    which was unsurprisingly horrible. Brand is a hilarious
    standup comic, but it’s impossible to perform something
    scripted when the audience is expecting something supposedly
    unscripted. That’s why every presenter’s stupid attempts at
    humor were stupid— they were scripted for an unscripted
    show, and it showed. The best jokes will still inevitably fail
    under these conditions.

    Another scripted subplot involved Eminem and Tracy Morgan


    trying to get Best New Artist. This evolved over multiple
    segments (waking up, training on a treadmill, singing with
    Cyndi Lauper) until they eventually gave up (“we’ll get ‘em
    next year, homey”) and presented the award for Best New
    Artist. It was funnier (though not much) than Brand could be
    because these were prerecorded segments; they took you out
    of “live performance mode” and you valued it as a scripted
    skit, e.g. no expectation of spontaneity.

    The visceral disgust most people felt at Kanye West was


    evidence that it was not a staged stunt. If it was, you would
    have smirked an “oh please.” This doesn’t mean West didn’t
    plan to do it, it means Taylor Swift didn’t expect to have it
    done.
    VII.

    The audience— people, Twitter, performers, Leno, The View,


    the President— are can’t help but comment on the show. They
    don’t understand that they are actually part of the show. They
    aren’t getting paid, but neither were Statler and Waldorf. And
    they were the funniest part of it.

    My DVR may have said there was another 20 minutes of show


    left, but it was wrong: there’s still another week or so.

    VIII.

    The VMAs, like The Muppet Show, are about getting to the
    Big Number. In that sense, The 2009 VMAs are really the Jay-
    Z New Record Release Party.

    This subplot— scripted but presented as spontaneous— was


    that Jay-Z was not in the house, but he was coming.

    Before commercial breaks, shots with subtitles like “Jay-Z’s


    motorcade on the way to the VMAs” were shown; Jay-Z was
    coming!

    On one of these breaks, the voice over was: “How will Jay-Z
    appear for his grand finale?” Yes, how? What will he have to
    say about all this?

    I am almost 100% certain that not only did Kanye West plan to
    do this, but that Jay-Z was in on it. Rappers regularly have
    other people do their “dirty work”— it makes them appear to
    have power. But that’s my opinion, and it is absolutely
    worthless: how would I know?

    But what I do know is that when you want to make a show


    called the Jay-Z New Record Release Party, here’s what you’ll
    need: an already established crazy person to say what you’re
    thinking, allowing you to distance yourself from the suicide
    bombing; you’ll want a sexy, gracious, generous,
    magnanimous wife who rises above the controversy and gives
    her speech time to Taylor (oh, look, Taylor happens to be right
    backstage ready to appear);

    you’ll want as much hype as possible pre-game; and the


    grandest of grand entrances.
    This is how it ends/begins. Walking from backstage to
    onstage, seen from his perspective.

    They don’t show anyone leaving.

    IX.

    “Why do we keep talking about this crap! Kanye West?! Who


    cares!”

    Do you think I’m unemployed, have tons of free time? Do you


    think I listen to Jay-Z records? I haven’t seen the VMAs for a
    decade. Yet here I am. Something made me write a post on
    Jay-Z this week… somehow I watched— looked forward to—
    the VMAs this this year. Oh, weird coincidence: this was the
    most watched VMA in history. We were all compelled before
    it was broadcast to want to watch it.

    “Not me.” You’re missing the point. Maybe the VMAs didn’t
    get you, but something is getting you, and those somethings
    are all the same thing.

    Pop culture controls you even if you think you’re separate


    from it. It is everywhere, from the clothes you wear to the
    language you use to the way you think. It is a viral pandemic
    that masks infection by pretending to be part of you. There’s
    no cure. But if you know the structure of the virus, at least you
    can recognize the infection as not-you.

    “No way, I’m not getting infected, I’m not exposing myself to
    all that trash. I’m going to think for myself.”

    That’s the virus talking.

    http://twitter.com/thelastpsych

    more on Jay-Z
    As The Population Ages, Will
    Suicides Increase?
    September 22, 2009

    Don’t bet your life on it.


    An editorial in AJP opens,

    In most countries of the world, older adults kill


    themselves at higher rates than any other age group.
    Given that the leading edge of the large post-World War II
    “baby boom” cohort will reach the age of 65 in 2011,
    demographers predict a rapid rise in the number of
    seniors taking their own lives in subsequent decades. The
    need for effective approaches to late-life suicide
    prevention is pressing.

    No.
    First, I’d like to debunk the prevailing belief that almost all
    suicides are due to a psychiatric illness, a belief he supports
    using an article he himself wrote that references studies that
    don’t actually show this.
    Construction Of Pathology
    Simply assuming anyone who commits suicide is therefore
    “somehow not normal”; or “only someone mentally ill would
    kill himself” is wrong.
    If a serial killer says, “kill yourself or I kill your kids” and you
    kill yourself, are you mentally ill? Was Ajax mentally ill?
    Consequently, the fact that you committed suicide is not proof
    of illness, in the exact same way that death cannot be proof of
    pancreatic cancer.

    Attributing causality to a complex behavior is masturbation


    with words. How is killing yourself from MDD different than
    killing yourself because of terminal pancreatic cancer? Note
    that the syntactic construction forces me to say “from MDD”
    but “because of pancreatic cancer.” But is that a real, existent
    distinction?

    Is it the same biological mechanism? Different? Note: “He


    was depressed, he killed himself, for no reason, his life was
    great.” The presence of pathology is assumed because of the
    absence of causes; psychiatry abhors a vacuum.

    While it is clear that suicide is a risk in depression, the issue


    here is whether one can assume depression if they committed
    suicide?

    Three Problems Of “Psychological Autopsy”


    Hearsay:
    The evidentiary support for the presence of mental illness in
    those who commits suicide is mostly determined not by a past
    history of diagnosed psychopathology, but by a post-mortem
    psychological evaluation (“tell me what he was like?”) in
    which the deceased has drastically biased everyone around
    him by killing himself.
    A psychological evaluation is basically interviewing
    “informants” (e.g. family), over three hours, asking psychiatric
    screening questions to determine diagnoses. Think about this,
    seriously think about this. The guy is dead, and you’re asking
    the family if this guy ever exhibited signs of mental illness.

    The closest analogy is doing a post-mortem of a marriage by


    only asking the ex-wife. “The evidence strongly suggests 75%
    of divorced men are manipulative jerks.” Oh.

    Validity of Symptoms Descriptions:


    Example, from one of the sources of the above article:

    Where subjects suffered both physical illness and


    depressive symptoms before death it was often difficult to
    judge whether a depressive episode was present. To
    ensure a consistent approach to diagnosis, we took
    possible depressive symptoms at face value; thus, if a
    subject was reported to suffer tiredness, this was included
    as a depressive symptom regardless as to whether it may
    have been due to physical illness.

    Go figure: 77% of these people “had” a psychiatric diagnosis.

    Generalizability:
    So it’s legitimate to ask, what percent of suicides have ever
    been diagnosed before they died? What percent have been to a
    psychiatrist or primary care doc for psychopathology? The
    answer varies from 30-60%, which is another way of saying
    40-70% have never been. A full 75% had never attempted
    suicide in their lives— this was their first and last attempt. It’s
    important to keep this in mind because the point of the
    editorial is to offer the elderly “access through a care manager
    to algorithm-driven treatment”— yes, that’s what he wrote—
    then you’re going to help a maximum of 45% (the so far best
    response rate in psychiatry) of the 50% you actually ever meet.

    Part 2 here.
    Will The Suicide Rate
    Change As The Population
    Ages?
    September 24, 2009

    The correct question would be: what will they do?


    I.

    Part 1 here.

    The point of the editorial in AJP is that since everybody knows


    the elderly kill themselves at higher rates, we should go
    Orange Alert and mobilize America in preparation. Ok.
    There are a total of 30000 suicides a year. As you can see, the
    only group who commit suicide at higher rates as they age are
    white males. Granted, I don’t want white people to die any
    more than George Bush does, but this increase applies only to
    them.
    Now reread that quote in AJP:

    In most countries of the world, older adults kill


    themselves at higher rates than any other age group.
    Given that the leading edge of the large post-World War II
    “baby boom” cohort will reach the age of 65 in 2011,
    demographers predict a rapid rise in the number of
    seniors taking their own lives in subsequent decades. The
    need for effective approaches to late-life suicide
    prevention is pressing.

    There’s your sleight of hand. If the elderly kill themselves at a


    given rate, the fact that there are more of them coming
    shouldn’t change the rate, only the number. The trick is that
    “the suicide rate in the elderly is four times higher” is the only
    thing dramatic enough to get you NIH grants. If it was
    reported as an increase in the number of suicides— a number
    that in the most apocalyptic scenario would be in the hundreds
    — no one would care, and certainly no one would pay for it.

    II.
    Q: Why do the elderly kill themselves at higher rates?
    A: “Ummm…. because they are old and there is nothing left to
    live for?” That culture-bound moronity exemplifies my point.
    The old must be more depressed and pessimistic, after all
    they’re too old to enjoy life… or something… (God knows the
    young are enjoying it all so much.)
    And maybe many do feel that way, but maybe they aren’t any
    more intent on dying than the young (who have more non-
    lethal attempts) but are simply physically weaker and thus
    more susceptible to dying- even during what they hoped would
    be a non-lethal attempt?

    Q: Why do we expect an increase in the number of elderly


    people to suicide? Is it a stable suicide rate coupled with an
    increasing population?
    from andrewgbiggs.blogspot.com
    Well, the suicide rate has mostly fallen. Also note that the
    greatest change in rates occurred before the
    psychopharmacology era. The gazillions spent everywhere
    post 1960 have done nothing. But as anyone with experience
    using technical analysis will tell you, we don’t know what the
    hell direction those lines are going next. The above blog
    discussed the opinion that the rate declined with the creation
    of Social Security. Or was it the war? Or…
    It’s hard enough to understand what happened in the past. How
    is AJP so confident about the future?

    III.

    First, the suicide rates from different decades are not even
    comparable. An elderly person today will probably have little
    resemblance to an elderly person of 2030. Consider:
    will economic pressures push the elderly to live longer
    with their kids/extended families (or vise versa)

    or

    will family units continue their trajectories towards


    looser, smaller, and more disjointed (e.g. divorces)
    affiliations?

    will better physical health/sex/financial security lead to


    more satisfaction in later life

    or

    will promised better health/sex/financial security not


    materialize, leading to great pessimism?

    will narcissists cling to their lives/youth no matter what;


    Sex In The City VIII begins filming

    or

    will narcissists suffer the ultimate of narcissistic injuries?

    etc.

    IV.
    The chief reason that suicide rate predictions fail is that they
    are based, primarily, on absolutely nothing. Psychological
    autopsy is a biased interview occurring in a specific historical
    and cultural moment (e.g. the three generations before the
    current 40 year olds) not generalizable to the next one. Look at
    1930 vs. 1960.
    Psychiatric illness is a changing construct. What was MDD in
    1930 may in some ways be similar to 2009, but in others it is
    not. If it is madness to conclude a 2009 suicide must have been
    mentally ill, it is complete and utter madness to take this
    conclusion and apply it to 1930, let alone 2030.
    Instead of asking how the the hypothetical elderly might act in
    30 years, you’d be better to ask how we will act in 30 years.

    II.
    Q: Assuming that there is actually a suicide epidemic on the
    edge of the horizon, what can be done about it?
    A: Nothing. As with all complex behaviors, nothing works
    reliably across a given population. No drug (I’ll leave aside
    lithium for a moment) or therapy has been reliably shown to
    reduce the suicide rate across the population. “But I’ve saved
    so many of my patients…” You can only change the rates of a
    complex behavior such as suicide, violence, styles, opinions,
    at an individual level, or through society— the culture. If you
    want to lower the suicide rate, you can’t target “at risk”
    populations, you have to make suicide less of an option for all
    of society.
    Two examples:

    if you want to reduce terrorism, you cannot round up all


    terrorists and change their thinking. You must either a)
    kill individual terrorists; b) make terrorism less
    viable/interesting/acceptable/easy for all of society.
    if you want to reduce teen drinking, you can’t target the
    population of at risk teens and make them drink less. You
    must either target a) individual teens, one at a time; b)
    make teen drinking less viable/interesting/acceptable/easy
    for all of society.
    if you want to reduce the suicide rate, you can’t find the
    depressed people and create a population based treatment.
    You must either a) target each individual suicider; b)
    make suicide less viable/interesting/acceptable/easy for
    all of society.
    Simply: you will reduce the suicide rate much more if you take
    all guns off the earth than if you “improve access to
    healthcare.” (There may be other reasons why taking away all
    guns is not a good idea, that’s not the immediate point.)

    Q: Why is there so much focus on the coming suicide epidemic,


    if there isn’t any logical reason to assume one is coming?
    A: Please understand I am not dismissing suicide, I am fully
    aware of its devastation. But this is the creation of a hysteria
    that will generate a lot of activity (and money), and this— not
    the reduction of suicide per se— is the hysteria’s chief
    purpose. The mobilization of the mental health army will
    ultimately have no demonstrable effect on the suicide rate.
    The future revenue streams in psychiatry won’t be from billing
    for the treatment (Pharma) but from billing for the evaluation
    (insurance.)
    You would do better— and I mean this in complete
    earnestness; not that this should be done, but that it would be
    more effective— to take all the money devoted to this problem,
    and giving the money to the “at-risk” patients as a pension.

    –-
    http://twitter.com/thelastpsych
    Jay-Z Is A Genius
    September 28, 2009

    Q: What do the three red lines mean? A: Wrong.

    The three red lines mean “3,” as in “Blueprint 3.” Ok, so why
    aren’t they blue, like Blueprint? You should now start to
    suspect that what the lines mean isn’t the right question (the
    medium is the meaning.) The question is, why are they there?

    Look at the cover again. Making the rounds is this video, it is


    the making of the cover of Jay-Z’s new album, Blueprint 3.
    Read that sentence again and reflect before you watch the
    video.
    It shows the musical instruments being stacked, the sculpture
    being constructed. Then, at the end, the designers apply red
    color onto the sculpture itself.
    So while it looks the lines were digitally added, and it would
    have been much easier to digitally add them, they’re actually
    on the instruments. They’re actually real.
    II.
    Some have seen resemblances/sampling from such pictures as
    these:

    (From idolator)

    or this one:
    The “E” is the most relevant, as it was the “inspiration” for the
    cover. By inspiration, I mean it was created and shot by the
    same photographer, Dan Tobin Smith.
    But as you saw in the video, this cover is not a “sampled”
    version of those pictures, it’s not cut, paste, and recolor. It may
    look like, be inspired by, those others but— just like he
    doesn’t sample “hey hey hey, good bye” but actually sings it—
    everything you see and hear is strictly Jay-Z. Jay-Z is saying,
    I’m a real artist. I don’t take shortcuts. This is anti-Photoshop,
    death of the thumbnail. This image was entirely assembled, it
    took a long time, it took a lot of work. Even the red lines are
    real, not CGI.
    So now the point of releasing a “Making of The Cover” video
    becomes clear: it’s to show you how authentic he is.
    The red lines are there to lead you to discover that they are
    actually there.
    III.
    from Axel Peemoeller
    ettf.net

    Look closely/take my word for it, the colors are not


    painted/photoshopped onto the photograph, but are actually
    painted into the walls/ground/railings/etc. Cool, huh? It’s
    alright, you’re allowed to like it, you don’t have to be
    metafilter smug all the time.
    While this style of art has been around for centuries, today it
    carries a different implications: it is always conscious of the
    existence of CGI. Whatever else the art says or is, it is also
    saying, “it looks like CGI, but it isn’t.” Usually CGI is used to
    fake reality, but in this case the very point of the realism is to
    make you think it’s CGI, so that you can be awed by the fact
    that it isn’t. Its authenticity is reinforced by the work you have
    to do to discover it. “Holy crap, that’s real!”
    To repeat: this is something real that is designed to look fake.

    IV.
    What does it say, however, that this technique is regularly
    found in commercial art?
    It says the same as Jay-Z wants it to say: “if this packaging art
    is real, then for sure the product inside is completely real. And
    the artist is 110% authentic.”
    But this kind of authenticity is the most manipulative kind of
    fakery, because “the illusion” masking the reality only occurs
    if seen from one specific perspective, chosen by them.

    From any other perspectives decided by them, you don’t see


    the illusion.
    The illusion masking the authenticity— the red lines that look
    CG’d, the illusion you’re supposed to work through to
    appreciate the authenticity even more— never materializes.
    All you’re left with is the one level of real, and it is real
    boring.
    Here’s what is absolutely vital to understand: for the
    commercial part of the art to be effective, not everyone can be
    in on the trick. You need some people who say, “what’s the big
    deal? Some idiot painted some colors on the walls. I don’t get
    it.” You need them so that the people who see it from the right
    perspective are motivated to dig deeper. “Wait, are you
    serious?!” You’ve created us vs. them. You’ve branded it.
    Our postmodern society thinks it is clever for always looking
    deeper, for knowing there are always two levels. It “knows”
    appearances are lies, it knows the real truth is beneath the
    appearances. It tries to uncover.
    We’re not as smart as they are. Commercial art, Jay-Z, all of
    TV, all of the news, reverse the order of the levels. They hide
    the lie they want to tell you one level deeper, let you dig for it.
    And when you find it, after all the work, you accept that it
    must be the truth. “Backstage”, “behind the scenes”, “the
    making of”, “investigative reporter”, “obtained documents”,
    “leaked”— now we’re getting to the truth!
    You’re not.

    Commercial art of this kind works because it is able to control


    the perspective. You think you’re making your own judgment
    about what you see with your own eyes, but it has already
    been decided how you will see it, why you will see it, in what
    context… so that you “uncover” only what it wants you to
    uncover.
    V.
    If you can’t understand the emo kid with black lipstick, or the
    white kid in baggy jeans flashing gang signs, or Jay-Z
    pretending to be Italian, or any of a billion different obviously
    fake identities— and if you can’t understand why, despite the
    obviousness of the fakery, some girls who are not complete
    idiots fall for it— it’s because you’re not seeing his fake
    identity from the right perspective. He’s showing the fake
    symbols of something (toughness, intellect, etc) so that you try
    to look deeper, and whoever responds to what those symbols
    mean (toughness, intellect, etc) will do so.
    He’s dressing himself in red lines, tempting you to see if
    they’re real or not.
    If you are tempted to look more deeply (if you’re watching it,
    it’s for you)— like the smitten girl does— you’d see this
    appearance first, then through it: “if you got to know him,
    you’d see he’s really a…!” And then you’d pat yourself on the
    back for having intellectual courage to not judge by
    appearances! But you’ve been fooled by the commercial art
    illusion, thinking that because you saw through the illusion,
    therefore the deeper level must be authentic.
    Those who don’t come to it from exactly the right perspective
    are infuriated, “this guy is a douchebag!” You think you see
    something more real than she does, but you aren’t supposed to
    see more deeply— she is. You are supposed to be infuriated—
    that’s why she looks more deeply. She doesn’t like him, she
    likes what liking him says about her. She likes what your
    hating him says about her.
    “How the hell come she can’t see through this poser?” She
    does see through it, you don’t. She sees something fake, then
    something “real” underneath, and falls for him; you see
    something fake, stop there, and hate him.
    That’s exactly what he wanted, both times.
    That’s what Jay-Z wants, too.
    We are all commercial art.
    –—
    More on Jay-Z 1 2
    ––

    http://twitter.com/thelastpsych
    Is More Regulation Needed?
    September 29, 2009

    I know disagreeing with Daniel Carlat is like disagreeing with


    Obama— how can you?— but someone has to. The article is
    called, “Has the regulation of physician-industry relationships
    gone too far?”

    Dr. Daniel Carlat starts with a rhetorical trick, conceding


    ground at the outset thus establishing himself as a practical
    centrist and not an ideologue, and then stealing the ground
    back. Remind you of anyone?

    I disagreed with many of the presenters but was in


    absolute agreement on one point: interaction between
    industry and physicians is a good thing. It is crucial to
    scientific progress.

    It’s an election year trick. Carlat followers already know


    exactly where he is coming from; so conceding this much isn’t
    going to turn them off. “It’s politics. He has to say that.” Those
    who don’t know him can be soothed by what sounds like a
    reasonable voice.

    But suppose I want to find out whether Drug A is better


    than Drug B. Would I go to Company A for this find of
    advice? Of course not— this is the last place I would go.

    I realize this seems unassailable, but it’s not only theoretically


    wrong, it’s actually false.

    First, Company A can’t actually say it has a better drug than


    Company B. It’s illegal. They can’t even tell you about a
    published study, even one they didn’t do. (Don’t worry, I’m
    sure doctors will come across it on their own.)
    Second, if it was allowed, why wouldn’t you want Company
    A’s answer? It may be biased, but you already know the bias,
    and they’re not allowed to lie. Does Company A have nothing
    useful to say? Then you can ask Company B what they think.
    Isn’t that how people pick their President?

    But here’s why it’s actually false:

    Likewise, I would not go to a physician paid to promote


    Drug A for this advice. I would go to a source without
    that conflict.

    He means a unicorn. It does not exist.

    In fact, he does go to Company A for the info, he just blinds


    himself to it. The studies, academics, Departments, journals,
    reviewers— all are eye deep in Pharma money. “It’s not
    Company A money.” Oh. So when a Republican senator who
    does not get oil money votes for an oil project, you figure he
    conducted a dispassionate analysis of immediate energy needs
    vs. environmental/climate impact?

    II.

    … I know about human nature. When you have a


    financial incentive… you will respond to that incentive.

    I know something about human nature, too: more powerful


    than money is the desire to maintain identity. Narcissism.
    When a politician “gives the money back” in order to keep his
    job, he’s not doing it because the job will get him more money,
    he’s doing it because the job is more important than the money
    — it’s his identity.

    Your identity is so powerful that it actually biases other people


    more than money. Look back at my Republican/oil example. It
    fit perfectly, it made sense to you. But if I had made a
    Democrat/labor union analogy, it would have rubbed you the
    wrong way, even though they are equivalent. You’re biased,
    and for cheap.

    That’s why a man free of financial bias may be trustworthy,


    but he is not trustable. Where’s he coming from? Is he pushing
    Depakote because he “believes” it? Because his son, N=1,
    responded to it? Because he works at a university where
    antiepileptics are the cause du jour? Because his Depakote rep
    is hot?

    I don’t particularly want financial bias in my academics, but to


    single that out as the main source of trouble in our field is like
    singling out the elbow as the pivotal component of matricide.

    III.

    This is the same error people make about the need for
    government intervention, e.g. that the “free markets” have
    failed and more regulation is obviously needed. Even if one
    were to agree on principle that people can’t be trusted, the
    mistake is in forgetting that government is people. These
    people are subject to the same biases, cognitive errors and
    general prejudices as the guys at Goldman Sachs, albeit
    currently it in the opposite direction. We can argue that we
    prefer the government’s biases, but one cannot argue that the
    government is less biased, self serving, or corruptible.

    This may originally have been a country of laws, not men, but
    that’s not the country most modern people want; they want to
    be able to alter the laws to suit the times. Fine, it’s your
    country. But understand that if the laws are subordinate to
    men, then the enforcers of those laws will always have more
    power than you. Has anyone tried to get an anti-Depakote
    study published in J Clin Psych in the past decade?

    It’s excellent that Daniel Carlat thinks doctors like himself


    cannot be trusted to read and interpret their own studies, and
    that some other group of— doctors? lawyers? what?— with
    special bias-immunity rings need to be assembled to protect
    us. But those people are still people. This is why the NIH, with
    their incestuous grant reviewers, crazy politics and flavors of
    the decade philosophies is so dangerous— they’re just as
    biased as Pfizer except you think they are objective.

    In other words, before I agree to being regulated, I want the


    names of the people regulating me, so that I can at least laugh
    at the irony.

    I am asked all the time, “where can I go for unbiased


    information on medicine?” My God— if the physicists don’t
    have such a place, do you really think that medicine does?
    And why does no one ever ask where they can go for unbiased
    political information?

    People would do well to remember that at one point in our


    nation’s history, “government” was George Bush. When you
    argue that government needs to be more involved, you are
    arguing that George Bush needs to be more involved. I do not
    trivialize this discussion by offering Barack Obama as an
    equivalent example of the government you want so
    desperately to supervise your lives.

    –-
    also: The future of bias

    http://twitter.com/thelastpsych
    Why Can’t Kids Walk Alone
    To School? Part 1
    October 2, 2009

    136 comments on Metafilter about an article on the NYT, and


    none of them suggest that the problem is that adults are
    untrustworthy and dangerous.
    Via metafilter: a mom, Katie, decides to let her kid walk to
    school, a move so outrageous that the New York Times is
    compelled to write an article about it.

    ” ‘She’s just so pretty. She’s just so … blond.’ A friend


    said, ‘I heard that Jaycee Dugard story and I thought of
    your daughter.’ And they say, ‘I’d never do that with my
    kid: I wouldn’t trust my kid with the street,’ ” said Katie,
    a stay-at-home mother, who asked that her full identity be
    withheld to protect her children.

    Katie, too, is tormented by the abduction monsters


    embedded in modern parenting. Yet she wants to
    encourage her daughter’s independence. “Somehow,
    walking to school has become a political act when it’s
    this uncommon,” she said. “Somebody has to be first.”

    Any parent can sympathize: what if?

    But what if… what? Be specific, put some thought into this:
    are you worried your daughter will cross paths with a Bad
    Man, or are you worried that your daughter is walking into a
    world where everyone is an opportunist?

    II.
    One problem is that we aren’t trusting of ourselves as parents.
    Perhaps the older generations didn’t know or care about their
    shortcomings, but we do, for sure. Have we really done our
    jobs? Did we teach them enough about the complexities of
    human nature? It’s easy to say “don’t talk to strangers,” but
    how do you tell your kid to watch out for his otherwise good
    teacher? How do you tell them not to let a cop drive him
    home? (“Why would you ever tell him that?” A: Why would
    they ever drive him home?)

    It’s easier to hover. Not a judgment, just an observation.

    We probably all imagined that when we had kids of our own,


    we’d teach them how to beat down a bully. Well? I know we
    dreamed about how we’d teach our kids to escape from bad
    guys. Did you? Did you teach them how to manipulate their
    attacker? Or did you leave them to the Wii? “Well there are
    just too many other important things—” Oh, you taught him
    French? Started him on push-ups early? Game theory?

    Kids don’t ask to be chaperoned; they don’t ask to be


    forbidden from going “down the creek” and they sure as hell
    don’t ask for bike helmets. That’s all chosen by the parents. So
    the question really is, why do parents choose to do this?

    Don’t misunderstand me: I’m not saying we are failures as


    parents; I’m saying we are afraid we are. We are insecure that
    we have adequately prepared kids for life. This insecurity
    prevents us from letting them experience life. And thus they
    are actually unprepared, and thus we were right.

    III.

    “All this helicopter parenting is going to make kids grow up to


    be wusses.”

    Maybe, but it’s interesting that most people who say this don’t
    have any kids of their own. Parents might agree with the
    sentiment, but they’re still going to buy bike helmets. Geezers
    may like telling stories of how they had to walk five miles to
    school in the snow, but I don’t know any geezers who would
    let their grandkids do that today.

    Do you see that Katie, quoted above, is hiding her identity “to
    protect her children?” The world is much smaller. Just like it’s
    easy to imagine calling a guy across the country on a whim,
    it’s not so crazy to imagine a guy buying a $100 LAX to NYC
    plane ticket for the possibility of free 9 year olds.

    IV.

    Question: have we squandered the nanoseconds we do spend


    with our kids by using it to teach them not to judge people by
    how they look?

    Xanax yourself, Caps Lock. We adults do frequently judge


    people based on how they look, right or wrong. So on the one
    hand we think we can identify the Bad Men, on the other hand
    we are aware that we have not taught our kids to do it. So we
    have to do it for them.

    Have we crippled kids, in the name of equanimity? That we


    don’t believe anyway?

    Maybe such politically incorrect heuristics are precisely what


    we should be teaching them, precisely because they have
    nothing else to go by? I know that not every 50 year old white
    man with a mustache is a pedophile. You know what else I
    know? Run.

    Heuristics are short cuts that save you from overthinking.


    Sometimes you need handy, explicit rules so that thinking,
    education, logic, experience, and civilization don’t make you
    do the wrong thing. A joke by Dave Attell:

    If you walk outside and see a naked man running down


    the street, cock flapping in the wind, you run with that
    man. Because there’s some scary shit coming the other
    way.
    “But not all bad men look like bad men!” I know, but maybe at
    least steel the kid against some identifiable Bad Men? “But not
    everyone who looks bad is Bad!” So maybe the kid misses out
    on the gentle friendship of a mustached IT guy. Oh well. He
    can have a snow cone instead.

    V.

    Our insecurity is not unfounded. We barely spend real time


    with them at all, we get through the time until they go to bed
    or college, whichever comes first. And we’re certainly not
    anticipating the issues they’ll face in their future. What did
    you tell them about the ethics of killing robot hookers?

    Narcissism. We don’t see our kids as total human beings, they


    are still mostly extensions of ourselves. Since we’re not sure
    how well we’ve prepared them, AND we fail to see their
    unique strengths because they didn’t come from us, we just
    don’t know how they’d react.

    Will the kid really not be enticed by a guy with some


    candy/Playboys/pot? If he tries to grab a six year old and she
    runs, will she know how to get home?

    Or, and I can’t believe I’m writing this, if she’s 15, will she
    remember to run?

    We’re not confident in how we’ve trained our kids and so we


    don’t train them, reinforcing our insecurity. Meanwhile, we
    don’t see that they’re growing up anyway.

    Kids are the best, Apu. You can teach them to hate the
    things you hate. And they practically raise themselves,
    what with the Internet and all.

    Good point. We’d better monitor their internet use, then.


    Part 2 here.
    Part 2: Why Can’t Kids
    Walk Alone To School
    October 2, 2009

    From part 1, here.

    VI.

    Narcissists don’t feel guilt, only shame. Since we are a


    generation of narcissists, we can’t see other people’s
    perspectives, so we extrapolate: we assume that no one else
    feels guilt either. (And that’s probably accurate.)

    If guilt is gone, then there are no internal controls to a person’s


    behavior, only external ones. Follow along:
    You may have even been to a psychiatrist a few times—
    god knows millions of other people have— and you’re
    actually normal… imagine how messed up other people
    are!

    And be honest, look into your heart: you’re a pretty


    twisted person. You saw Halloween in the theatre on a
    weekday at 10pm. At points, the audience was laughing.
    You know they’re not all serial killers, but… isn’t that
    weird? Well, you laughed at one point, too, but you have
    control. How much can you trust them, in certain
    circumstances…?

    And I know you and your wife would never try to get
    your 16 yo cheerleader/babysitter drunk and seduce her,
    duh, obviously. But that concept is arousing, right?
    Nothing to feel guilty about, of course, you’re not
    actually doing it…

    Here’s the problem. Sometime around KROC Howard Stern,


    admitting such thoughts went from being acceptable (“as long
    as you don’t do it”) to commonplace. So there’s no associated
    guilt with the thought, at all. I’m not judging whether there
    should be guilt, only observing that there definitely isn’t any
    anymore. Include here masturbation, pornography, etc.

    So the issue isn’t whether there are pervs who might try to
    seduce your daughter on a babysitting gig after cheerleading
    practice; you already assume everyone is thinking it, because
    if you don’t feel any guilt, why would they? What you’re left
    wondering is to what degree external controls— shame— are a
    strong enough disincentive— word chosen very carefully—
    for the other guy. And the answer you’re going to come up
    with is: if there’s a way they can get away with it, not very
    strong.

    Societal narcissism has put us in a bit of a bind.


    We don’t believe that guilt will will control a person’s
    behavior, because we don’t feel any guilt in ourselves.
    We are very aware of the gigantic numbers of people that
    have easy access to us, but they are mostly supporting
    cast in our movie that we know nothing about because we
    do not really want to know anything about them, so we
    assume they’re like us— unable to feel guilt.
    if you consider yourself ethically/morally above average
    — despite the porn, cheating, self-serving lying, then it is
    entirely logical to assume most people you see in the
    street are cannibals.
    And the external controls you place on your kids and on
    strangers as protection end up being reminders that you
    haven’t done an adequate job of preparing your child for
    life.

    This is the result: you hover more, trust less, live with an
    unrelenting low level anxiety, and masturbate a lot.

    VII.

    And back in the day— sorry, back in a time you assume


    existed based on what little you know of it from watching Mad
    Men or Family Ties— you could at least trust that women were
    more moral and upstanding, they kept the men in check. So the
    fact that a guy was married was one point in his favor. But
    nine seconds of any modern TV drama— Private Practice,
    Brothers and Sisters, whatever— let you know that a perfectly
    normal, mannered, intelligent woman will sleep with a guy
    they don’t even like not just for lust or money or revenge—
    but for absolutely no reason at all. They’re not just immoral,
    which is fun; they’re amoral, which is terrifying.

    “Are you saying women are amoral?” – No, I’m saying the
    message men (and women) constantly get is that women are
    amoral. You did nod three sentences ago, right? Since you are
    too much of a narcissist to know what women think— I don’t
    mean you aren’t interested, I mean you are unable— how
    would you know if TV is wrong?
    What happens to society when the kids are taught not to feel
    safe with women? Guess we’ll find out.

    VII.

    “Are you talking about me?”— of course not you, you’re


    different.

    IX.

    This is a good time to point out that when we were kids, we


    were allowed to walk alone to school, to ride bikes without
    helmets, got spankings, took our chances down at the creek.
    Now we’re adults. Look around at the results. Perhaps walking
    to school alone wasn’t such a good idea after all.
    The Problem With Science Is
    Scientists
    October 6, 2009

    one of these is a false positive, the other is false


    I. In case you haven’t already heard the story:

    In a recent fMRI study, a salmon was shown a series of


    pictures of human faces showing various emotions: can a
    salmon distinguish them? and what brain regions are involved.
    15 pictures, ten seconds each.

    I won’t bore you with the anatomy. Because of the small size
    of the brain, exact brain structures could not be distinguished,
    but something in the brain did light up. A statistically
    significant number of voxels, comprising an area of 81mm3 in
    the midline of the brain, were active (p<.0001).

    So can fish interpret human emotions from a picture? I have


    no idea. I do know, however, that that fish can’t do it: it was
    dead.

    II.

    Others have discussed the hows/whys of such false positives


    and what can be done about them. But there are two other
    problems not discussed:

    These researchers chose a dead fish specifically so they could


    discuss the issue of false positives and why multiple
    comparisons correction in MRI studies is important. Thus, we
    know these results are false positives because we know that
    the fish is dead. Note carefully, however, that both of the
    things you know are told to you by the researcher; yet you are
    valuing one as “truth” and the other as “artifact” based on
    nothing but his word.

    The researchers might have been mistaken about the deadness


    of the fish— thus nullifying a potentially interesting finding.
    Or, they could have lied.

    There is no way to check. You’re rolling your eyes, “why


    would they lie about that?” or “how would they possibly make
    a mistake about it being dead?” and you’re right, about this
    they wouldn’t.

    But what about the old studies?

    If they do a study in which an anxious person shows weak


    activity in the amygdala— how do you know he was anxious?
    How wrong about the anxiety do you have to be to invalidate
    the weakness of the MRI findings? Not much.

    III.

    The danger of the “false positive” discussion is that it is


    forward looking: from now on, why should tighten our
    significance thresholds, change the confidence intervals,
    controls, etc. But what about all the prior data that finds only
    “moderate positive correlations” using more liberal
    significance thresholds, that may be infected by invalid
    behavioral assessments—

    —that because of the passage of time alone— not better data,


    but time— are now knowledge?
    IV.

    The biggest problem with MRI studies is that they’re hard for
    the layman to understand. Complexity in science protects
    prejudice.

    Understanding the Anxious Mind, in the NYT Magazine,


    discusses the science of temperament. Jerome Kagan studied
    babies, then followed them over the years. Predictably (i.e.
    what you’d expect the NYT to say), temperament as a baby
    predicted temperament as an adult, especially in the extreme
    cases.

    They explore the case of the highly anxious “Baby 19”


    (defined as being distressed by novelty) who, when she was
    15, was a plain looking teenager who liked writing, playing
    the violin, worrying and fidgeting. See? Genetics.

    …[Scientists] have put the assumptions about innate


    temperament on firmer footing, and they have also
    demonstrated that some of us, like Baby 19, are… born
    predisposed to be anxious…

    …[other scientists] all have reached similar conclusions:


    that babies differ according to inborn temperament…

    You’ll observe that those two quotes are about babies— babies
    are born a certain way. No argument from me. What they do
    not say is that the inborn temperament is the reason they are
    also anxious as adults, but that’s the conclusion they make
    every single time.

    “Temperament, it turned out, tended to be stable over those


    five years, at least in children who started out at the
    extremes.” Its stability is the evidence that the temperament is
    biological. If his haircuts are stable over the years, is that
    biological?
    But more importantly, the kids were raised by parents. Parents
    don’t parent in an ideal dispassionate manner, they parent in
    reaction to the kid in front of them. In other words, kids’
    temperaments alter the manner in which they are parented, and
    it’s a good bet that the parenting fosters that same
    temperament. Not a word on that; it’s as if it that couldn’t
    possibly be relevant.

    And why is testing a four month old’s behavior evidence of an


    innate quality? The first four months of parenting don’t count?
    “Kagan restricted his sample to children who were white,
    middle class and healthy.” Oh. So now all white people are the
    same?

    V.

    But that’s not real science, real science uses MRIs. If they
    studied it in an MRI, it must be true.

    Teenagers who were in the group at low risk for anxiety


    showed no increase in activity in the amygdala when they
    looked at the face, even if they had been told to focus on
    their own fear. …In the high-risk kids, even those who
    were apparently calm in most settings, their amygdalas
    lighted up more than the others’ did.

    “Overreactivity in the amygdala” = anxiety. But we don’t


    really know what the amygdala does, nor how it does it, all we
    know is where it is. Saying something occurred in the
    amygdala is like saying something occurred in Ohio. “Yes, but
    we have some sense of what the amygdala does.” And I have a
    sense of what Ohio does, too, it causes trouble in elections and
    gets its teens to kill themselves.

    But at least whether or anxiety is mediated by the amygdala is


    worth discussing. What you can’t do is take a structure that
    may be involved and therefore conclude that anxiety is an
    innate trait that is generally stable. Every time I punch
    someone my shoulder is overactive. Is my genetically
    mediated shoulder the cause of my alcoholic rages?

    And overactive as compared to what? What could possible


    serve as a control? Seriously, think about this. Point to a guy
    you believe could be a control in a study measuring what are
    here defined as subclinical levels of anxiety.

    Not every brain state sparks the same subjective


    experience; one person might describe a hyperaroused
    brain in a negative way, as feeling anxious or tense, while
    another might enjoy the sensation and instead uses a
    positive word like “alert.”

    None of those words mean anything. Brain state?


    Hyperaroused? Alert? How can anyone know that the “brain
    state” that two people are describing differently is the same?
    These words concepts are so vague that the researcher has to
    resort to Jungian terms in his descriptions:

    The persona can be controlled, but the anima often


    cannot… Nathan Fox of the University of Maryland says
    that when the anima erupts in high-risk children, it often
    takes the form of excessive vigilance and misdirected
    attention. In the first of his two longitudinal studies…

    If you don’t even have precise words to describe what you’re


    seeing, how in God’s name can you measure it, let alone blame
    it on the amygdala?

    VI.

    But research has to start somewhere, and my problem isn’t


    with the researchers or their study, nor do I doubt the
    relevance of genetics. My problem is that when theory is
    written up in the NYT, it becomes FACT, it becomes the
    default understanding. This understanding becomes part of our
    cultural filter. In the same way porn and Cougar Town has
    assured us that women over 40 can have satisfying extra
    marital sex with 20 year old bicycle messengers, we know that
    behavior is, in large part, genetically determined.

    This is how the article ends:

    The predictive power of an anxiety-prone temperament,


    such as it is, essentially works in just one direction: not
    by predicting what these children will become but by
    predicting what they will not. In the longitudinal studies
    of anxiety, all you can say with confidence is that the
    high-reactive infants will not grow up to be exuberant,
    outgoing, bubbly or bold.

    Think about this. Think about what the average person now
    understands to be true.

    Still, while a Sylvia Plath almost certainly won’t grow up


    to be a Bill Clinton, she can either grow up to be anxious
    and suicidal, or simply a poet.

    VII.

    Back to the salmon. The results were statistically significant,


    but the fish was dead. So we laugh. In 1620, that would have
    been evidence for the soul, and no one would have laughed.

    The problem is the same in both cases. They are questioning


    the nature of the data. They should be questioning the nature
    of the fish.

    part 2 here.
    More On Amygdala, Anxiety,
    and MRIs
    October 8, 2009

    After the last post, I thought, “perhaps I was too broad. Maybe
    too political, maybe I didn’t have enough concrete examples.”

    Then I opened my mail.


    What I found was the most recent issue of Primary Psychiatry,
    in which appears Imaging and Genetics: Future Applications
    in the Emergency Room.

    It reviews the literature on the neurobiology of aggression in


    precisely the way I was railing against in the earlier post:
    sufficiently vague that it makes people think this is alerady
    established, common knowledge.

    The amygdala, located in the temporal lobe, has been


    shown to be associated with aggression and violence.
    Studies(29) have found a high rate of atrophy, as much as
    20%, of the amygdala in aggressive and violent patients.

    Note: studies (plural) but one reference. Note: you can’t tell if
    20% is a high rate of atrophy, or if it means “high rate of
    people who have 20% atrophy.” And you’re not supposed to
    know, because the point is simply to make you feel secure that
    his overall thesis is well supported.

    But, according to reference 29, in a study of aggressive


    patients, only 20% of them had any amygdala atrophy (e.g. the
    other 80% didn’t.) The amount of atrophy was fairly small.

    Furthermore, that reference was a study of aggressive vs. non-


    aggressive epileptics. In addition to differences in aggression,
    the subjects also differed in IQ (lower IQ in aggressive group)
    and a history of encephalitis (associated with smaller
    amygdalas.) The study could well have been resubmitted: “A
    Couple Of People With Low IQs And A History Of
    Encephalitis Have Kind Of Smaller Amygdalas. We Think.”

    Here is the next sentence:

    Imaging studies9,10 have also shown abnormalities in


    amygdala functioning, including decreased activation of
    the amygdala during affective stimuli in psychopaths

    I’m sure whatever imaging studies they were doing 12 years


    ago were crackerjack, and based on two of these (which are
    the same data), the reviewer concludes psychopaths have
    decreased activation in the amygdala.

    Which isn’t what the studies found anyway.

    First, the study didn’t measure just psychopaths (e.g. antisocial


    PD), but psychopathic murderers who were incarcerated and
    legally insane. Note how the author extends these findings to
    psychopaths in general.

    Second, it didn’t find decreased activation in the amygdala, it


    found the opposite: higher activation on the right, and no
    difference on the left. Do you know the relevance of it being
    right vs. left? Of course not.

    So the studies say: “psychopathic murderers have increased


    activation on the right.” The reviewer summarizes:
    “psychopaths in general have decreased activation overall.”

    You would think that difference matters, but it doesn’t,


    because the point of the review article isn’t to teach you
    information, e.g. what happens to the amygdala, it is to
    convince you that aggression is biologically mediated. These
    articles succeed because it is established that no one will
    check whether it is actually increased or decreased (note that
    three reviewers did not check), because no one cares whether
    it is increased or decreased, because we all know those are just
    silly details.

    I may as well point out that the studies referenced here didn’t
    even measure the amygdala, they measured the subcortex
    (amygdala, hippocampus, midbrain, thalamus, together). Take
    that, precision instruments.

    II.

    In fairness to the psychiatry review author, the authors of the


    above references jumped to an even worse set of conclusions
    based on their own data

    Raine et al. speculate that excessive subcortical activity


    contributes to an aggressive temperament in both types of
    murderers, but that “while predatory violent offenders
    have sufficient left prefrontal functioning to modulate
    such aggressive behavior in a way to bully and
    manipulate others to achieve desired goals, affectively
    violent offenders lack this prefrontal modulatory control
    over their impulses, resulting in more unbridled,
    dysregulated, aggressive outbursts.” (bold mine,
    emphasis theirs)

    and then published this in a forensic journal. Do you see?

    The entire article is filler. All he wants to say is this single


    sentence:

    In effect, research is supporting the notion that repetitive


    acts of aggression are grounded in a neurobiologic
    susceptibility.

    This is simply not true. There may be aliens in the universe,


    but it is false to say, today, “in effect, evidence is supporting
    the notion that aliens can and do live in the universe.” All we
    know is that there are studies that show a relationship between
    specific behaviors and specific anatomical areas. However, we
    do not know the nature of that relationship.

    We cannot accurately quantify the behaviors and distinguish


    them from similar behaviors (is it aggression out of fear, anger,
    horniness, temporary insanity, or a combo?), and we can’t
    adequately control for billions of confounders (3 red wines/d
    vs. 3 beers/d, bad parents, too many horror movies, frequency
    of one night stands, etc). How then can we relate them to
    inadequately characterized anatomical regions using
    machinery with the precision of an icepick, and then conclude
    “predatory violent offenders have sufficient left prefrontal
    functioning to modulate such aggressive behavior in a way to
    bully and manipulate others?”

    We tend to focus only on one error, e.g. MRI false positive


    rate. But these studies don’t take into account all of the other
    errors. It is the problem of significant digits: 3.225 x 5.23441 x
    7 does not equal 118.16680575. It equals 100.

    III.

    You all think I’m exaggerating. That I am punching windmills.

    In keeping with this development, sometime in the future


    cord bloods will be taken routinely from birth and used to
    delineate the individual’s DNA so that genetic
    information will be readily available under emergency
    conditions to assure proper assessment of violent people.
    Hence, a patient presenting with an episode of violence
    and a history to support that will have their DNA
    contrasted with norms to determine if they have a
    predisposition to aggression and violence…

    I have enough rum to get through the rest of my life, but the
    rest of you would do well to heed my warning: if you do not
    rein in your social scientists, your civilization is doomed.
    In Honor Of Columbus Day:
    Christopher Columbus Was
    Wrong
    October 12, 2009

    Repost.
    Don Draper Voted “Most
    Influential Man”
    October 15, 2009

    The most important thing to understand is this: Don Draper


    does not exist.

    AskMen selects him “Most Influential Man”; for context, last


    year was Obama.

    On just about every level, the show’s protagonist is a jaw-


    dropping example of what so many men try — and often
    fail — to be.

    That would be a man, a real man; not a man-boy

    …[who are] are much more boy than they are man,
    obsessed as they are with fast food, video games and
    bodily functions. If the mainstream media is awash with
    representations of perpetually pubescent males, then Don
    Draper’s masterful manhood stands in stark contrast.
    II.

    One might think it ironic that this brand of retro-masculinity is


    being honored by a site that that itself caters specifically to
    “perpetually pubescent males.” It’s no accident, it’s website
    bait, like putting pictures of girls in bikinis. The type of person
    who wants to be Don Draper is squarely in AskMen’s target
    demo. If you’re watching it, it’s for you.

    I understand the appeal, why someone would want to be Don


    Draper. But I’m going to try and explain why you shouldn’t.
    This post isn’t for everyone: you know who you are.

    III.

    Don Draper is a narcissist. That’s not an assessment, it’s the


    premise of the show. The definition of a narcissist is one who
    creates an identity and prizes it above all other things, every
    moment of existence is spent perpetuating that identity, trying
    to get everyone to believe it. That’s Don Draper. The show
    gives him an interesting back story, but the key element is that
    the man at the ad agency called Don Draper is a constructed
    fake identity, one which he protects zealously. Nothing else
    carries that much importance.
    And like all narcissists, Draper isn’t pretending; he’s
    convinced himself that’s who he is. He often sabotages his job,
    health, and his relationships with only transient anxiety; but
    when his real/original identity is threatened to be exposed, he
    almost goes bananas.

    The ultimate goal of narcissism is not just to get everyone to


    accept the identity, but to get everyone to perpetuate it. He
    wants to be a brand. He wins when people confirm the brand
    even when he’s not around, like when someone on a train says
    to another, “Dell makes the clearest flat panel monitors
    around.” That guy’s reinforcing the Dell brand. Never mind
    they are all made by Samsung.

    Neither does narcissism care about being liked, only about


    being branded. You can hate the taste of Fiji water, as long as
    you concede that that horrible taste is the result of the water
    being too pure and from Fiji. The fact that you hate it is an
    advertisement itself; it supports the brand as something that
    the kind of person you are wouldn’t like.

    On the show, the office staff regularly discuss Draper’s


    exploits and characteristics, always in the same way. People
    may like or hate those characteristics, but no one disputes the
    characteristics. Campbell, indeed, hates him for these
    characteristics.

    IV.

    Don Draper (the character) wants everyone to believe his


    persona. Well, it worked; not only do the readers of AskMen
    believe it, they want to emulate it.

    You think it’s passive on his part; he’s hyper cool, and you
    want to be like him. Wrong. He’s trying to con you into
    thinking that. He’s voted Most Influential not because he has
    enduring qualities worth being influenced by, but because he is
    trying to influence you.

    “You’re getting way too abstract. I just like how cool he is,
    that’s all.” This is what I’m trying to tell you. He’s not cool,
    he’s pretending to be cool.

    V.

    “I don’t want to be Don Draper, just the old time masculinity


    he represents.” Don Draper doesn’t represent that, he’s faking
    it. Look at the show: how come in a show set in those “old
    times,” there aren’t any other “real men?”

    “Ok, fine, but he is masculine, strong, suave…” You’re saying


    something you don’t even believe. If you met Don Draper at
    the company picnic, would you think he was a real man?
    Would you want to emulate him? Would you want to take over
    his body and life?
    “Well, certain characteristics…” Now you’re almost there.
    You want to be an a la carte version of Don Draper. You want
    to pick and choose the good parts. When he’s voted Most
    Influential, they mean only the iceman, suave, sly, creative,
    “masculine” Don Draper. That’s not a person, that’s a brand
    image. If you hired an engineer from Dell because you like
    how they built the monitors, you hired the wrong guy.

    VI.

    “But I want to be a ladies man like Don Draper. Back then it


    was easier, because affairs were more acceptable.”

    No they weren’t. Leaving aside morality, cheating on your


    wife means that you haven’t fully connected to her, or have
    lost some of that connection. You don’t have to be Don Draper
    to pull that off. “Well, I want to be as suave as he is, I want to
    pick up girls like he can.” It’s the same disconnectedness. You
    could do it, too, then you’ll lose the ability to be deeply
    connected to someone. You can’t do both simultaneously.

    Consider a guy in 2009 who says he can’t meet women in


    bars. The biggest mistake guys make when trying to meet
    women is being overzealous, overinvested. They are unable to
    differentiate a one-night-stand from a full relationship. They
    approach both in the same way. When you’re trying to get laid,
    you can’t be trying to show her your soul, and you can’t be
    trying to see hers. It has to be light, fun. The “pick-up tricks”
    work because they delay the guy from doing what comes
    naturally, which is being stupid, dropping all 52 of his cards in
    her lap and saying, “see?! I’m worth it, I think!”

    This is why many men who actually get what they think they
    wanted are still unsatisfied. They meet a hot girl and it turns
    into a relationship, and they’re upset they can’t get one night
    stands. But if they got a one night stand, they’d be upset they
    couldn’t convert it to a relationship (and of course it would be
    her fault for being a slut, not knowing what she wants, etc.)
    You can’t have it both ways.
    Here’s how the logic disintegrates: if you’re at a bar and see a
    woman with a tattoo on her tailbone and big hoop earrings, we
    can all agree, given the right circumstances, she’d probably be
    up for a one night stand. “Yeah, but she only wants a guy who
    X–” Maybe, but she’d probably settle for you. “I don’t want
    her to settle for me, I want her to want me.” Then you don’t
    really want a one night stand, do you?

    She already knows all of this. Just as you think you can tell
    those are implants, she’s has you sized up from 100 paces.

    Here’s how you succeed: you have to have confidence in


    yourself, while simultaneously accepting that it could just as
    easily have been some other guy. If you’re not comfortable
    with that, get out of the bar.

    VII.

    “But it’s the whole idea of Don Draper— that kind of man,
    living in that kind of time, where men were men… it was more
    acceptable to have affairs, drink all day… The old days, men
    could act like men, even if they were flawed.”

    Draper can seduce women easily because he has both


    confidence and also lives, perpetually, in that state of
    emotional disconnectedness that let a girl know you’re not
    going to get all mushy on her. But that means he also doesn’t
    connect with his wife, nor she with him; that’s why the affairs
    “aren’t a big deal.” It has nothing to do with the year being
    1960. It’s just a bad marriage.

    You should note that his disconnectedness doesn’t make his


    wife less connected to him (though it doesn’t help.) His
    disconnectedness lead him to marry a woman who was not
    likely to be able to fully connect to him. Many times, you get
    only the relationship you’re ready for.

    This isn’t unique to Draper. Look at Campbell. He can cheat


    on his wife with almost no guilt because he’s disconnected
    from her; but of course she is just as disconnected from him.
    She doesn’t love him, she needs him as a supporting cast in
    her “perfect wife and mother” movie.

    The show doesn’t depict a “different time;” it depicts a


    (somewhat improbable) scenario where everyone in a 200 mile
    radius is a narcissist.

    VIII.

    Shakespeare created a lifelike, realistic character named


    Hamlet. Every actor who plays him, from Richard Burton to
    Mel Gibson, reinterprets Hamlet differently.

    What no one does is try to emulate Richard Burton playing


    Hamlet. You’re not playing a character, you’re pretending to
    be someone else.

    In the 2009 movie Star Trek, Captain Kirk was played by


    Chris Pine. But Pine wasn’t playing only Captain Kirk, he was
    playing William Shatner playing Captain Kirk, i.e. using
    Shatner’s same staccato delivery and other mannerisms. Any
    accolades Chris Pine gets— “he was great in Star Trek!” refer
    to his ability to imitate William Shatner, not be Captain Kirk.

    When you say you want to be like Draper what you are saying
    is you want to be the person Draper is pretending to be in a
    specific context. That’s not real. Given that Don Draper is a
    character acted by Jon Hamm, then you’re saying you want to
    be what an actor is pretending to be pretending to be. If you
    even try this for Halloween, they’re going to lock you up in a
    lunatic asylum.

    IX.

    What you want, really, isn’t to be Don Draper. What you want
    is to live in Draper’s world: where it is almost acceptable to
    have affairs; where you can drink all day and not get drunk;
    where you can say whatever is on your mind and not have it
    offend people; where creative men have some outlet for their
    ideas, and at least get paid really well instead. Where you can
    eat any kind of food you want and not get fat. Where you can
    act like you want to act, act like what you think a man acts
    like, and people will admire you.

    In other words, what you want is to be the main character in


    your own movie.

    part 2 soon

    ––––––

    http://twitter.com/thelastpsych
    The Neurobiology of Wisdom
    October 16, 2009

    It’s always in the last place you look. Dr. Henry Nasrallah asks
    Does psychiatric practice make us wise?

    We also integrate our complex observations and findings


    with the rich collage of each patient’s unique cultural,
    religious, and educational background. We strive to find
    hidden or higher meaning in patients’ symptoms… We
    assess their potential lethality toward themselves or
    others and examine the often tortuous course of their
    existence. And, unlike other physicians, we observe their
    transference toward us and simultaneously examine our
    own countertransference

    etc. What can be said? The article is self-aggrandizing wishful


    thinking, the kind of thing you expect from a bass player when
    he tries to convince a girl that he’s the soul of the band.

    The article could be ignored, if it didn’t take a tragic turn off a


    uranium mineshaft in the final third.

    The wonder of psychiatric practice is that we somehow


    navigate each patient’s unique jungle of thoughts,
    emotions, behaviors… By doing so, we develop different
    regions or circuits in our brains than surgeons,
    radiologists, or internists do. Meeks and Jeste’s wonderful
    article about the neurobiology of wisdom suggests that
    psychiatrists’ brains probably develop “wisdom circuitry”
    via advanced neuroplastic connectivity in the:

    prefrontal cortex (for emotional regulation, decision-


    making, and value relativism)
    lateral prefrontal cortex (to facilitate calculated
    reason-based decision-making)
    medial prefrontal cortex (for emotional valence and
    prosocial attitudes and behavior)

    I hope that readers of this blog can now see through this
    inanity. This is no longer just wishful thinking; it’s an outright
    lie. I don’t need to read Meeks and Jeste’s “wonderful” article
    to know that there is absolutely no way they could show that
    psychiatrists develop wisdom circuitry of any kind, let alone
    through the three made up pathways (aren’t they all just the
    prefrontal cortex?) he lists in bullet points (“I’ve summarized
    the points you need to know for the test with bullets.”)

    Nevertheless, there’s Nasrallah’s article. You don’t realize how


    significant it is: it becomes another article listed in the
    superscript of references no one looks up, supporting
    statements like “there is considerable evidence that…”

    II.

    It’s not all Nasrallah’s fault: he saw porn and couldn’t look
    away. The Meeks and Jeste article he references has a catchy
    title— The Neurobiology of Wisdom— and it’s in the Archives
    of General Psychiatry. But Meeks and Jeste’s article isn’t just
    bad, it is horrendous. It’s the research equivalent of a sarin gas
    attack. Everybody dies, nobody can tell why.

    It would be impossible to list all of the specific problems with


    the paper. As proxy, here’s the quote at the beginning of the
    article:

    Of all the pursuits open to men, the search for wisdom is


    most perfect, more sublime, more profitable, and more
    full of joy.—Thomas Aquinas
    That the six letters w,i,s,d,o, and m appear in that order is the
    only similarity between the “wisdom” sought by Aquinas and
    the one pursued in this article. While this might seem like an
    academic or minor quibble, it’s not: the purpose of the paper is
    to conflate “wisdom” with a set of characteristics that have
    nothing to do with wisdom at all, and claim a biological link.
    The article studies the color red and finds there “the essence of
    NASCAR.”

    The pursuit of wisdom for Aquinas was the pursuit of ultimate


    truth or cause; the article uses the term as a relativistic
    judgment on behavior. Here are the six components:

    (1) prosocial attitudes/behaviors,


    (2) social decision making/pragmatic knowledge of life
    (3) emotional homeostasis
    (4) reflection/self-understanding
    (5) value relativism/tolerance
    (6) acknowledgment of and dealing effectively with
    uncertainty/ambiguity.

    Don’t fall into the trap: though these may be positive


    attributes, only (4) has anything to do with wisdom as defined
    by Aquinas, or even as described by one of the references they
    use, e.g:

    reasoning ability
    sagacity
    learning from ideas/environment
    judgment
    good use of information
    insight

    Spend a moment and think about the difference between the


    two “wisdoms.” But don’t spend too long: the article takes the
    first group, finds a poor proxy for each, muddled by fashion
    and politics, and reviews the neurobiological data for those.
    III.

    Here’s the first one:

    One of the most consistent subcomponents of wisdom,


    from both ancient and modern literature, is the promotion
    of common good and rising above self-interests, ie,
    exhibiting prosocial attitudes and behaviors…

    “Common good rising above self-interests” would make Ayn


    Rand stab a harp seal; but regardless of what you think of
    Rand, it’s at least evident that this isn’t at all “consistent” in
    the definition of wisdom. Or are there no wise capitalists? But
    accept it and follow the logic to your doom:

    …such as empathy, social cooperation, and altruism.6


    Thus, sociopaths, who may exhibit exquisite social
    cognition and emotional regulation that actually facilitate
    their selfish motives, would not be considered wise.

    So selfish is not wise. Ok, I get it.

    Altruism: Altruism overlaps with cooperation, although


    altruism is notable for the potential harm or “decreased
    fitness” the altruistic person risks to help others.55
    Harbaugh and colleagues56 demonstrated that the idea of
    voluntarily giving money compared with that of paying
    taxes… caused increased activation in reward circuitry…
    Similarly, Moll et al57 reported that both receiving
    monetary rewards and deciding to donate money
    activated ventral and dorsal striatum. This somewhat
    paradoxically suggests that the neural substrate of
    altruism may be akin to that of more instinctual self-
    pleasures.

    I defy anyone to tell me how that paragraph describes altruism


    as putting the common good above self interest. If altruism
    makes you feel good, then it doesn’t rise above self-interest.
    I’m not saying altruism isn’t valuable, only that if it is
    valuable because it rises above “selfish motives” selfless, then
    the research suggests it isn’t valuable (modus tollens).

    IV.

    In order to illustrate what this paper did, I’ll explain it


    backwards: regions in the brain typically thought of as “reward
    centers” were seen activated in studies of donating money; the
    giving of money is thus labeled altruism, which, being a
    selfless activity, is “prosocial,” which, of course, is a
    component of wisdom.

    Hence, one can write the following sentence: “There is


    evidence showing a neurobiological basis of wisdom.”

    V.

    The entire article is like this. One more example:

    Value Relativism/Tolerance: Tolerance of other persons’


    or cultures’ value systems is often considered an
    important subcomponent of wisdom.

    Oh my God I need a nap. Is this really true? I’m not asking if


    desirable, I’m saying is Julius Ceasar not wise? Odysseus?
    Any of the Indian killing Founding Fathers? Or are they wise
    except for their wanting to take things over?

    Brain Localization via Neuroimaging. Neuroimaging


    studies of tolerance have frequently focused on prominent
    societal prejudices, especially those related to
    race/ethnicity. Some investigations have demonstrated
    that the regulation of “automatic” prejudicial responses
    follows a neurobiological pattern similar to that described
    for impulse control: dorsal ACC detects an undesirable
    attitude surfacing, prompting lateral PFC inhibition of
    undesirable attitudes, and leading to downstream
    amygdala deactivation.122-123

    First of all, the paragraph tells you these studies are about
    automatic race bias, e.g. does the picture of a black face make
    you think of the gun or the hammer? But what does that have
    to do with “tolerance of value systems?” Nothing, as they
    admit in the next paragraph:

    While sharing rudimentary neurobiology with impulse


    control, value relativism is conceptually more complex
    and its study would benefit from the development of
    novel measures/tasks.

    Here’s the point: since you admit that paragraph doesn’t


    support your argument, why do you even write it down?
    Because then you can say:

    Summary. Dorsal ACC and lateral PFC play important


    roles in tolerance of varied value systems by detecting
    and inhibiting, respectively, expressions of prejudicial
    responses.

    VI.

    One might now ask, “why was this paper even written, let
    alone accepted for publication?” Go back to the quote:

    Of all the pursuits open to men, the search for wisdom is


    most perfect, more sublime, more profitable, and more
    full of joy.—Thomas Aquinas

    Note that they dropped the “Saint.” Meanwhile, there’s no


    problem referring, a few sentences later, to Gandhi as
    “Mahatma.” That’s okay, because no educated person actually
    thinks Gandhi is a saint, but there are still plenty of
    numbskulls who need to be reminded that Aquinas isn’t.

    Cultural narcissism; the prevalence in science of “end of


    history” guys who think this time is different from all others,
    everyone who came before was stupid, naive, myopic, or less
    ethical. The authors may even be good Catholics, who knows,
    but they know philosophy was just marking time until the
    invention of the MRI. Summa Contra Gentiles becomes, well,
    a footnote.

    They don’t realize that their belief in the “neurobiology of


    wisdom” is nothing more than faith, structurally no different
    from Catholicism: a hierarchy of beliefs with no foundation in
    physical reality, and an endless stream of words.

    But Catholicism doesn’t call itself a science; and Aquinas at


    least had logic on his side.

    ––-

    update

    Previous post on the overreach of neuroradiology

    –––––––––-
    Summa contra gentiles, from where the quote was taken, was
    Aquinas’s discussing “wisdom” using arguments of reason,
    not religion:

    Some of the Gentiles, such as the Mohammedans and the


    pagans, do not agree with us on the authority of any
    Scripture by means of which they could be won over—in
    the way that we can argue with Jews by appealing to the
    Old Testament and with heretics by appealing to the New
    Testament. But they accept neither the Old nor the New
    Testament. Therefore, it is necessary to revert to natural
    reason, to which all are compelled to assent
    ––––—

    http://twitter.com/thelastpsych
    Wolf Blitzer Is Not An Idiot
    October 19, 2009

    It’s much worse than that.


    Balloon Boy: homemade weather balloon allegedly takes off
    with 6 year old boy in it, balloon comes down, no boy. The
    boy is later found hiding in the garage.

    Then it is learned that the family are “storm chasers,” they had
    previously been on a reality show called Wife Swap, the boy’s
    name is Falcon and the dad looks like he’s trying to look like
    another storm chaser:
    But the jig is up. In an interview with Wolf Blitzer, who asks
    the child why he didn’t come out of hiding when he knew
    people were looking for him, he looks at his mom and dad and
    says, hesitatingly, “you guys said… we were doing this for the
    show.”

    But Wolf doesn’t pick up on it. The father (“oh, man”)


    muddles through the interview— he’s waiting for Wolf to start
    yelling at him. But it never comes, 900 monitors in The
    Situation Room‘s and Wolf Blitzer misses the obvious. The
    interview finally ends.

    There was a flood of emails, apparently, and Wolf gets the


    family back for a follow up interview, “can you explain what
    the boy meant?” but by that point the father has had a chance
    to straighten the kid out.

    The conclusion is: The whole thing is a hoax, and Wolf is an


    idiot.
    II.

    The other conclusion, if it hasn’t already occurred to you it


    will before you finish reading this sentence, is that Wolf did
    pick up on it, but let it go anyway.

    Here’s an analogy, which may seem imperfect, but follow it


    through. The analogy is when a coworker walks in on two
    people who are calling him a jerk. Rather than confront the
    coworker, he pretends he didn’t hear it. So now everyone
    knows he heard it, but everyone is pretending it didn’t happen.
    It’s not fear of the other guy, it’s a fear of changing the delicate
    balance of the work environment. All he wants is to get
    through each day, he didn’t ask for drama, he didn’t ask to get
    involved in office politics. None of that stuff matters; the goal
    is to hold your breath, get paid, go home.

    So whenever they pass each other in the hall, they’re not just
    civil, they overcompensate. “What did you do this weekend,
    anything?” “Oh, I went down to the bay, my father in law’s got
    a boat.” “Yeah? Do you do any fishing?” etc.

    They both know it’s fake; they both know they hate each other.
    But if they want to keep working there, if they want the job to
    get done, then they’re both going to have to pretend the thing
    didn’t happen, to play their respective parts. The show must go
    on.

    III.

    While people are saying Wolf missed the obvious, in fact it is


    evident he did not. Here’s exactly what was said:

    Boy: You guys said that we did this for the show.
    Wolf: I- I- I heard what he said— but I’m not— it wasn’t
    really clear what was his reasoning why he… he heard
    you screaming Falcon, Falcon, and I’m sure he heard his
    mom screaming Falcon, Falcon, but why didn’t he come
    out of the garage at that point?

    What happened is that Wolf was in the middle of a story some


    people suspected was a hoax, but was still being reported as a
    “thank god he was hiding in the garage” drama. So he tried to
    protect the story. He tried to pretend he missed the comment
    so that everyone could go on with the story as it was being
    told.

    If you agree with this, then you have to also face the fact that
    Wolf didn’t consciously plan, “no matter what happens in this
    interview, I’m going to cover it up”— it was a reflex, an
    instinct. Get a drink, think about this: a reporter’s instinct
    wasn’t to go for the truth, but to go with the scripted story.

    You may think that I’m too much with the rum or too hard on
    Wolf— “he seems like such a nice man” but it’s not Wolf’s
    fault. He’s a cog in the Matrix. The next day Meredith Vieira
    interviews the family live on the Today show. While the father
    is denying to her it was a hoax, the boy suddenly says, “mom,
    I need a cup” and vomits. Vierra’s response to this is nothing.
    Forget about the implications of the boy’s vomiting, she does
    not even acknowledge that he vomited. Is she heartless? No.
    She’s flustered: her instinct is to preserve the show, like a
    stage actress, keep the scene going no matter what else
    happens.

    Now take your favorite political issue of the past, oh, I don’t
    know, 25 years, think about all you think you know about it,
    think about where you truly learned it— don’t lie to yourself,
    go ahead and google the phrases you use in your arguments
    and see where they came from— and despair.

    ––-

    http://twitter.com/thelastpsych
    How Am I Going To Get
    Paid If It Isn’t Autism?
    October 21, 2009

    But many children whose symptoms significantly differ


    from classic autism—who belong only on the milder end
    of the autism spectrum, if they belong anywhere on the
    spectrum at all—are inaccurately ending up with serious
    autism diagnoses.

    Wait: it isn’t what you think.


    In The Atlantic, Behind The Autism Statistics:

    So parents whose kids’ challenges are less severe are


    often urged to accept a full-fledged autism diagnosis, as
    otherwise they would lose access to state-funded
    treatment, and might, down the line, end up ineligible for
    support services in public school. The result is that the
    autism statistics grow and grow.

    In diagnoses without obvious physical pathology (i.e. anything


    in the DSM), doctors often give a diagnosis to a person with
    the express purpose of getting them benefits, e.g. Medicaid,
    school supports, etc.

    The Atlantic hints at one side effect of this: the national


    statistics for psychiatric diagnoses may be inflated. I’ll
    editorialize: not maybe, but absolutely are; we can’t get paid
    un;ess we bill a diagnosis. In the chart we may write, “rule out
    MDD” and in the note indicate they were normal, but
    epidemiological studies don’t read notes; they take billing
    diagnoses or look at the listed Axes.
    This is compounded by “awareness”— as more people hear
    about a diagnosis is, and they come in for an eval, their very
    presence contributes its prevalence even if they are told they
    don’t have it.

    II.

    The Atlantic spends the bulk of the space lamenting the


    inappropriateness of the diagnosis:

    [Dr.] Greenspan told me on the phone, (and later on


    camera), “Basically we have to misdiagnose these kids to
    get them help.” It’s the wrong help sometimes, but it’s the
    only way to get state funding.

    The concern isn’t the state funding, but the odd way the
    government, e.g. Medicaid, covers treatments. There are
    “approved treatments” for autism; any other treatments are out
    of pocket. However, if you’re not sure of the epidemiology,
    then you’re not sure of anything else like treatment or
    sequelae. If the autism stats are skewed by the presence of kids
    with something else other than autism, then how can anyone
    say with any usefulness that “studies have shown that
    treatment X is effective”? How can any government tell you
    what the best practices” are?

    The article talks about Sensory Processing Disorder— if the


    kid has it, he has to get an autism diagnosis to be eligible for
    services, except

    …while [the child] was making some progress, the


    therapy didn’t seem to be addressing his biggest
    problems, which involved motor challenges and sensory
    issues, rather than the kinds of social impairments typical
    of autism.
    I know very little about this diagnosis or its treatment.
    However, it’s logical and obvious that its inclusion in autism
    will make a) autism treatment seem less effective; b) SPD
    treatments untestable.

    III.

    The article, and the supporters of “autistic-like” disorders, take


    (IMHO) the wrong tack: they want “Sensory Processing
    Disorder” to be included in the DSM, “which would turn it
    into an official diagnosis that would come with much-needed
    help.”

    That’s the wrong approach, because it legitimizes the


    government’s use of the DSM, and so every new treatment
    will have to wait for their blessing. The better approach would
    be to provide coverage for treatments based on the
    recommendation of a treatment team, within the limit of a
    budget. Instead of saying, “we’ll cover this treatment at $120 a
    session but not this other”, simply provide $120/session for
    any kind of treatment suggested by the team.

    IV.

    Here’s the most important secret about Medicaid and


    Medicare: it isn’t about improving health, it is about paying
    people off.

    While the kid described above can only get the “approved”
    treatments for autism, he can get the approved treatments for
    every other condition as well: surgery, eye evals, antibiotics
    for infections. In other words, his “autism” got him full health
    insurance.

    Medicaid requires a “disability” and a very low income. The


    income of the child’s parents is irrelevant. All kids with a
    “disability” (e.g. ADHD, depression, etc) are eligible for
    Medicaid and its services. A child can get physical therapy,
    occupational therapy, speech therapy, not to mention a
    prescription plan, doctor visits, etc — all for free; never mind
    that the “child” goes to Eaton. Certainly the parents’ private
    insurance might cover these things but it might not. Maybe the
    Dad owns a restaurant and doesn’t want to pay for insurance.

    If you have a 25 year old unemployed actor for a son who lives
    rent-free in your house and spends your money on chest
    waxing and self-tanning cream, and he can get a doctor to
    believe this depresses him, he can get Medicaid.

    Because a disability has to be verified by a doctor and updated


    over time, the patient’s only way of maintaining the coverage
    is to use it. This happens all the time. Patients will come once
    a month for visits, fill the Zyprexa prescription and then throw
    them out— all to maintain their benefits.

    Before you get angry, understand that this isn’t a loophole, it is


    the point of Medicaid. For a myriad of reasons we do not have
    universal (not single payer, but universal) coverage, which
    would have the (seemingly) paradoxical result of reducing
    healthcare costs. But, surprisingly, we have a lot of poor
    people in the country. The government has found a way to
    transfer to them just enough money and services to keep them
    from rioting, without calling it a transfer, without calling it
    socialism. Simultaneously, it manages to pay doctors,
    hospitals, employers (through tax breaks), etc. Where is all the
    money coming from?

    Debt.

    ––––-

    A Boy With SPD?

    ––

    http://twitter/com/thelastpsych
    Shouting vs. Spanking
    October 23, 2009

    Fake, fake, everything you do is fake, fake, fake…

    From the NYT:

    “I’ve worked with thousands of parents and I can tell you,


    without question, that screaming is the new spanking…
    As parents understand that it’s not socially acceptable to
    spank children, they are at a loss for what they can do.
    They resort to reminding, nagging, timeout, counting 1-2-
    3 and quickly realize that those strategies don’t work…
    they feel frustrated and angry and raise their voice. They
    feel guilty afterward, and the whole cycle begins again.”

    The article describes parents who (of course) wouldn’t spank


    their kids, who thus end up yelling.

    Psychologists and psychiatrists generally say yelling


    should be avoided. It’s at best ineffective (the more you
    do it the more the child tunes it out) and at worse
    damaging to a child’s sense of well-being and self-
    esteem.

    This is absolutely TERRIBLE advice.

    II.

    The problem is neither the yelling nor the spanking, the


    problem is when. When these parents yell or spank, it isn’t in
    response to intrinsically bad behavior, it is in response to
    behavior that burdens the parent.

    Note what it is that causes them to yell:

    She can emulate one of those pitch-perfect calm maternal


    tones to warn, “You’re making bad choices” … That is 90
    percent of the time. Then there is the other 10 percent,
    when, she admits, “I have become totally frustrated and
    lost control of myself.”
    It can happen… at the end of a long day at home — just
    as adult peace is within her grasp — when the 7- or 9-
    year-old won’t go to sleep.

    or

    “I’d like to think that most of the time we have a good


    interaction based on reason,” Lena Merrill said of her 4-
    year-old daughter, whom she has never spanked. But then
    there are the times when “she’s done something like
    poured milk on the floor or ripped a page out of a book,”
    Ms. Merrill said. “I just lose it.”

    The yelling isn’t just disproportionate to the behavior, it has


    nothing to do with the behavior. She’s angry about other
    things, but she’s yelling about the milk.

    The kid has learned nothing about good and bad behavior. In
    fact, they’ve learned that “bad behaviors” merit only calm
    discussion, while things that annoy Mom or Dad are met with
    wrath.

    Watch your kid: are they more terrified of your reaction when
    they are caught in a lie, or when they accidentally knock over
    a glass?

    The natural thing to do would be to yell about bad behavior


    (“did you push that boy on the playground?!?!”) and be calmly
    annoyed when they spill milk. But.

    III.

    But that doesn’t happen, because the parent isn’t being honest.

    I recognize it’s done with good intentions, but pretending to be


    calm and reasonable “as much as possible” is neither honest to
    yourself, nor helpful to them: no one else on the planet is
    going to treat your kid that way.

    Two-thirds of respondents named yelling — not working


    or spanking or missing a school event — as their biggest
    guilt inducer.

    Read the article: the parents’ reactions are all of guilt. But it
    isn’t guilt, exactly—

    “Admitting I’m a mom that screams, shouts and loses it


    in front her kids feels like I’m revealing a dark family
    secret.”

    —it’s shame. Their yelling reveals them. Their carefully


    maintained identity (of sensible uber- parent) is revealed as a
    facade. And the facade isn’t in service of the kid

    …as parents understand that it’s not socially acceptable


    to spank children, they are at a loss for what they can do.
    but in service of their identity of “good parent.” But they get
    exposed, turns out they aren’t as rational as they thought—
    they yell over spilled milk.

    IV.

    Consider a mom and a kid in a toy store. The kids starts


    whining about buying something. He gets loud. The mom
    hisses through clenched teeth, “wait till I get you home.”

    I understand she’s frustrated. But why is she whispering it? At


    home she would have yelled, why not just yell now? She’s
    willing to carry the anger by car to another location— is the
    behavior that serious?

    She’s whispering because she’s embarrassed, not at the kid’s


    behavior but about what it says about her as a parent to
    onlookers. And she’s even more embarrassed by her reaction.
    She can’t let other people see her rage when it appears to other
    people that it is only about a kid wanting a toy.

    But if she catches the kid stealing, then she’ll let him have it,
    right there in public, because then there’s no shame in her
    yelling— it reflects well on her.

    The yelling isn’t the problem, the problem is that yelling is


    used for the wrong things.

    V.

    The single problem of modern parents, mothers and fathers


    alike, is that they are trying to be something— “good parents”
    (an identity construct) and not doing what is good for the kid
    only for the sake of the kid. (I look forward to your emails.)
    They may be doing good for the kid, but they are also trying to
    reflect themselves as good parents, they are also considering
    their shame. That cannot work, ever. The kid will sense this,
    and the lesson they will learn is that there is no absolute right
    and wrong, only pleasing the boss.
    I’m not judging you, untoggle the caps lock, I am trying to
    help you understand where it all goes wrong.

    If the parents had simply been real— angry when something


    angers them, more angry when it is worse and less angry when
    it is not as bad—they’d feel better, and their kids would learn
    much better life lessons. If they showed frustration when they
    were frustrated (and labeled it: “this is frustrating me!”) and
    disappointment other times and rage for the big things—
    instead of holding it in and then unloading— they’d be much
    less stressed and the kid could learn to mirror a range of
    emotions, instead of acting out. “He bites for no reason!”
    There’s a reason.

    But I have asked a generation of parents raised by amazingly


    bad parents in 30+ years of a preposterously self-absorbed
    media environment to forget everything life taught them and
    be real.

    –—

    http://twitter.com/thelastpsych
    The New York Yankees:
    Mission Accomplished
    October 26, 2009

    The House that George built.


    Sure, now that the Yankees are in the World Series I want
    them to succeed, I’m a New Yorker after all, and I certainly
    don’t want to see them lose, humiliated, or suffer injuries. But
    in all honesty, we have no right to be there. We have no
    business going to the Series— we got there on a series of false
    pretenses and bullying, facilitated by an impotent League that
    allowed us to get away with all kinds of manipulations and
    distortions. The reality is that Georgey has turned the Yankees
    into a rogue team. He’s squandered the respect and goodwill of
    the fans all in pursuit of his own agenda of dominance.

    I hate to say this, but we simply don’t deserve to win.

    The Yankees have made some serious mistakes in the League,


    and they’ve never taken any responsibility for them. Yankees
    fans ignore the mistakes, forgive the missteps, and turn a blind
    eye to everything, simply because it’s their team. They
    conveniently forget the 80s, the steroids, the domestic
    violence, the racism. They’re nothing but fans.

    The reporters are equally to blame, they have completely


    given up on objectivity. Ever since they were allowed to travel
    with the players and enter their lockerrooms, they’ve become
    extensions of the teams. They seem objective, but all they care
    about is maintaining their privileged access to the players, and
    if that means doing a fluff piece on A-Rod boning Kate
    Hudson instead of looking into Congressional perjury charges,
    well… It’s sickening, we should be ashamed, but we’re not.
    And they call Erin Andrews a reporter? She gives new
    meaning to the word embedded. They use her breasts to hide
    the fact that she’s just a cheerleader which I realize doesn’t
    make any sense, but that’s what’s stuck in my head. You
    know?

    No one seems at all concerned that the guys who call the
    games are all former players and coaches. No one calls them
    out on the obvious conflict of interests. You read about a game
    or listen to it on the radio, you think you’re getting objective
    information, but how do you know? “Strike 3!” Really?

    No one seems surprised that the national newspaper of record


    is called the New York Times. Hello? Is anybody getting this?
    I’m sure the Houston Chronicle has a different perspective, but
    we deliberately suppress other viewpoints. I challenge you to
    even find a copy of the Houston Chronicle anywhere in the
    city. Try and write a story about how power is being
    transferred from Steinbrenner to his sons, and see if you’re
    ever allowed in a ballpark again. So much for discourse. So
    much for dissent.

    Most Yankees fans are completely blind to the fact that the rest
    of the world hates us.

    If nothing else, the Yankees have been guilty of arrogance.


    What makes us so great? That we have more money to spend
    on their team? We may have a superior record, but that has to
    be looked at in the context of our ability to spend more money.
    The Yankees can just buy whatever talent they need. And
    Yankees aren’t smarter or more sophisticated than other
    players, they just have better equipment, better facilities. How
    the hell are the Mariners going to compete? It rains there
    constantly. The Yankees are just steroid fueled schoolyard
    bullies. The Yankees are the United States of baseball.

    Funny how while we’re busy destroying every other team, we


    ignore the fact that our players all come from those other
    teams. It’s not like we have any native talent, we’re a ballclub
    of immigrants. But you won’t hear that on ESPN.

    Let’s not forget a fundamental truth: yes, we’re New Yorkers


    and we love the Yankees, but that’s an accident of history. If
    we had been born elsewhere— if we were born in Houston,
    we’d be Astros fans, and every time a Yankee got pulled over
    for a DUI or got their head taken off by an errant fastball we’d
    ejaculate in our pants.

    If we want to be respected throughout the world, not just


    feared, we have to come together, come to understand that
    we’re not just Yankees, but baseball fans, and we have to
    respect that unity above all.

    Look, what happened in 2001 obviously was a tragedy. Of


    course I’m not saying I’m happy Arizona decimated us 4
    games to 3, I’m not saying I want it to happen again, I’m not
    saying we deserved it, but… I understand.

    ––
    http://twitter.com/thelastpsych
    You Want To Be Don
    Draper? You Already Are
    October 29, 2009

    One of these is Dorian Gray, the other is the picture


    Part 2 in a series, only for those for whom it is written. You
    know who you are.

    (Part 1 here.)

    I.

    Some say that the desire to be Don Draper is really the desire
    to live in a simpler time with established gender roles, a
    romanticizing the past. That’s a girl talking. When a guy
    fantasizes about living in the Middle Ages or a different planet
    of Don Draper’s America, they’re not wishing for a different
    environment, they’re wishing for a different movie. It’s not the
    setting, it’s the plot. No one wants to live in 500 AD; they
    want to be in King Arthur’s court, with a certain kind of
    adventure, or relationship, or… they want to be somewhere
    where most of the plot is already known: I want that to happen
    to me.
    Even when it’s a real historical time, even one as well detailed
    as the one in Mad Men, what you want isn’t to be alive then,
    but to be in that show. They want a movie in which the main
    character (you) already possesses a character that everyone
    accepts (you don’t have to be like Don Draper, you are Don
    Draper, and everyone knows you as that kind of person), act in
    any way you want; and though there will always be
    consequences and miseries and laughter and whatever, no
    matter what happens it always happens about you.

    II.

    A key plot point in Mad Men is that Draper’s coolness and


    masculinity is artificial, it is an act. That’s fine, everyone has
    an act of some kind, why not be cool? But when you choose
    your own act, be careful you do not choose to act like someone
    else who is themselves acting.

    This is why, whenever someone tries to affect the style and


    mannerisms of a character in a movie that other people have
    seen, it makes the other people cringe; it always looks
    horrifically fake. We already know what the original looks
    like. If you’re get on a bus to go to a sci-fi convention and are
    dressed like some kind of alien, you’re judged by the, well,
    coolness of your costume. But if you dressed like an existing
    alien— like a Dalek— people on the bus will think you’re an
    idiot. The better your costume, the more people will hate you.

    It’s even more difficult to emulate Don Draper, because Don


    Draper is already emulating something else (forget about Jon
    Hamm for the moment.) Draper (on the show) can get away
    with it because no one is familiar with what he’s pretending to
    be (some construct in his head) so they can believe it’s really
    him. You can’t be Draper because we already know Draper.

    Being someone else is very hard. Sometimes, even if you are


    actually who you say you are, it can still be fake. When an
    aging rocker tries to dress all cool and rock starry, it’s creepy,
    because even though he is authentically a rock star
    authentically himself, he is still faking it: he’s pretending to be
    who he was 30 years ago. We already know who he was 30
    years ago, and that’s not him now, so this impersonation is
    obviously, pathetically fake. Stop it.

    The only time we tolerate this is if we are at an aging rock


    star’s concert: because we’re all aged by that point, and we’d
    all like to pretend, if only for a little while.

    It goes both ways. Don Draper is 36. If you are 26, is there any
    way you could be Don Draper and make it legitimate? It only
    works if you’re in your late 30s, because the game he is
    playing is “I’ve seen it all.” You haven’t. You can’t fake it, any
    more than you can fake playing the guitar. It’s fake. She can
    tell. She may not tell you, but she can tell.

    III.

    “Can’t I just borrow some of his characteristics?”

    I know, it helps your social anxiety; I’m pretty sure no one


    wants to be Don Draper because they think it will help them
    pass a midterm. Ok, so what will being Don Draper get you?

    Suave? Cool? Sophisticated? Because I’ve written those three


    words, it appears that those are three things you could copy.
    But Draper doesn’t actually possess those three things, he is
    conveying those three things. He has branded himself as a guy
    with those three things; just as Nike has branded itself as a
    certain kind of shoe that isn’t made of inferior leather in a
    sweatshop. Draper the brand is a guy with a nice suit, but that
    suit is a brand, too (Hickey Freeman?)

    Note how uncanny it is to see him in bed in the morning,


    without a suit.

    If you want to emulate Don Draper, you will get the same
    exact outcome a) if copy his persona but wear your clothes,
    and b) if you wear his clothes while keeping your own
    persona. They’re all brands, they’re all equivalent, and no
    matter what you choose the girl will figure it out the moment
    she purchases you.

    “No, you’re wrong, you’ve misunderstood me, I feel like


    you’re almost giving me an answer, but you’re missing
    something, you’re not getting what I’m asking. He is cool and
    sophisticated. That’s why he can pick up girls so easily. I want
    to do that, I want that secret.”

    You can’t emulate Don Draper, and you think the problem is
    that I’ve misunderstood?

    I understand you very well, I’ve seen you in action. When I’m
    in a bar— and I have been in a great many bars— I watch the
    show. Life has become so much a copy of TV that I sometimes
    forget to pee because a commercial hasn’t come on. In one
    show I watched you were standing with a beer, staring but not
    staring, talking with your friends about things that interest you,
    but trying to figure out the right conversation to have with the
    girl across the way who probably would not be interested in
    those things. I saw you. I saw that there were the female
    equivalents of you in that bar, too, but you didn’t see them.

    In every case the problem is the same: you don’t want what
    you think you want. And the type of girl you think you want
    sensed this the moment she saw you. That’s why she was
    pretending she didn’t see you. Or did you think hot girls have
    no peripheral vision?

    IV.

    So you want to be Don Draper? You are. No, that’s not a


    motivational speaker’s empowerment mantra, it’s a sad,
    unfortunate truth. Or a warning, if you choose to listen.

    Look at your suave, sophiticated, masculine Don Draper. He


    married a beautiful woman; you will, too; and like him, when
    you get her you won’t be happy.

    But forget about marriage, who has this well hung lothario
    seduced? Has he had affairs with sexy secretaries, bedded
    underwear models?

    No, he’s had none of that; the three affairs he’s had in two
    seasons are a hippie artist with numerous other men in her life
    that she likes more than him; a beautiful owner of a
    department store— hardly one night stand material— who
    actually hopes it is going to turn into a marriage; and a woman
    as marginal as she looks. These are the conquests of the great
    Don Draper. Real women, to be sure, but none of them are
    who you’d want, right?

    And in every case, these women dump him the moment he


    reveals to them the black, infinite, starving neediness inside
    him. “I need you now!” he says to his mistress. She does not
    mace him because it had not yet been invented.

    Don Draper is that worst of all possible men. Cosmo warns its
    future starlets to beware the heartbreaker, but what girl doesn’t
    want her heart to get broken by a great guy? None of Draper’s
    conquests have their hearts broken; they have their spirits
    broken. He’s not a cocksman, he’s not a player, he’s not a
    ladies man. He is a serial monogamist, incapable of
    committing entirely to one person, but similarly incapable of
    at least committing to the playful lightness of physical
    intimacy and then just taking a nap. At least she’d know where
    you stand. They destroy the lives of everyone around them not
    limber enough to leap out of the moving car. Tuck and roll,
    that’s the secret Cosmo never tells you. Tuck and roll; but at
    least get out; he is driving you nowhere with a full tank of gas.

    These men stay with the girl— sometimes for years, without
    cheating— but their inner eye is always on something else. No
    matter how desperately they think they love, they also know,
    simultaneously and without contradiction, that they’re not
    really in love, and that this, too, will pass. They are immortal;
    there is always a future, because… because this can’t be it. But
    they fear the future, so instead of pursuing it, they wait for it,
    along with the girl they’ve handcuffed with inertia.
    These men are already Don Draper, they think because they
    lack his facility with gab they aren’t— but in every way that
    counts, at a genetic level, they are the same. If you want to see
    how it all turns out, watch the show.

    Now maybe you understand: when a guy with moussed hair


    and a seashell necklace starts staring at the girl’s chest and
    rubbing his own, it must feel to her like some kind of immense
    relief.
    50% of American Kids
    Receive Food Stamps
    November 3, 2009

    Marx was right. America is finished.


    I saw the news article late last night, then read the study in the
    Archives of Pediatric and Adolescent Medicine, and was
    blown away. The data were solid: simple enough, just ask
    people if they’d ever been on food stamps, and count them.

    30 years of household interviews, 1968-1997.

    By age 20, 50% of all kids will have used food stamps at one
    time.

    For black kids, the figure is 90%.

    40% of kids in married households will have touched food


    stamps; it’s 91% of kids in unmarried households.

    The good news is that only 19% will use them for more than 3
    consecutive years, which, of course, is also the bad news.

    I was all set to be terrified about America’s future, until I read


    the accompanying editorial, which reminded me of something
    someone said:

    The bottom line is that the current recession is likely to


    generate for children in the United States the greatest level
    of material deprivation that we will see in our professional
    lifetimes. The recession is harming children by both reducing
    the earning power of their parents and the capacity of the
    safety net to respond. However, it is also essential to
    recognize that children have been made extremely
    vulnerable to this recession by a decades-long deterioration
    in their social position.

    That something was: what does the author want to be true?

    II.

    In this case, while the results are technically accurate, they


    don’t mean what it looks like they mean, i.e. that we should
    dust off Oliver Twist for a glimpse into our future.

    Although the Food Stamp Program described in the paper is


    separate from the Women-Infant-Children (WIC) program, it
    appears that the study conflates the two. It’s not relevant to the
    outcome of the study, so I’ll simply focus on the WIC to show
    you why the headline is alarmist and misleading.

    First, in determining household income, only the legal family


    is counted. The income of unmarried couples, grandparents,
    etc is not counted. This is true, e.g., even if the boyfriend is the
    biological father and he lives there or gives money.

    Second, even though cutoffs for income are written as annual


    figures (e.g. $22,050 for a family of 4 or “185% of federal
    income guidelines”), they don’t look at the past year’s income,
    they look at how much the household is making right now, and
    then extrapolated.
    Don’t be fooled by “rate” of income. If you just lost your job,
    your rate is zero; you are eligible. And the next “mandatory”
    review is every 6 months. See you then.

    Third: No proof? No problem.

    Fourth: and more relevant to food stamps, a person can receive


    income from exempted sources (there are many);

    Fifth: unlike unemployment, in which you have to “show” you


    are looking for work, food stamps aren’t tied to need, only to
    nominal income. If you choose not to work (or choose to do
    volunteer work) and thus have no income, you’re eligible. I’m
    not accusing people of abusing the system, but it is evident
    that some people would make adjustments in their behavior if
    food stamps didn’t exist, rather than be committed to growth
    retardation and scurvy.

    III.

    There’s also a bit of crazy, crazy math in play.

    Nevertheless, only approximately 60% of those who are


    eligible for the program actually participate in and receive
    food stamp benefits. Consequently, it could be argued that
    the number of food stamp recipients represents an
    undercount of the total number of households in need of
    food assistance.

    So… 90% of America is in need of food stamps?

    IV.

    You will notice that I haven’t used this study to make any
    judgment on whether food stamps is a “good” or “bad”
    program, not because I don’t have a… nuanced… opinion, but
    because the study can’t be used that way. However, it will
    be/is used precisely in that way.

    It’s troubling that, as scientists, it never occurs to the authors


    to objectively speculate why these figures might be
    erroneously high; in fact, they assume that they are too small.

    Studies like this one are op-eds with numbers. They promote
    the particular bias of the doctors (read: social policy analysts)
    writing it. If 50% of kids get food stamps, then food stamps
    are necessary, end of story— that’s the point of the study. No
    politician in his right mind would dare question the
    implementation of such a program, let alone the need. In other
    words, it’s not the the actual data that compels social policy,
    but rather the ability to say, “doctors have determined that…”

    The press report interviews the author, the author of the


    editorial, and James Weill, “president of Food Research and
    Action Center, a Washington-based advocacy group.” Gee, I
    wonder what they’re all going to say.

    I’ve many times remarked that doctors spin data to subtly


    impart their particular bias. Sometimes, however, they just yell
    it at you. Here is the first sentence of the each paragraph of the
    editorial:
    Clinicians always inherit the results of bad social policy.
    Children are poor because their parents are poor, a fact that
    ties the well-being of children to the employment status of
    young adults.
    Children are particularly vulnerable to the current recession
    owing to the longer-term crisis in the American family’s
    ability to provide for its children.
    In meeting the basic needs of children, the only real
    alternative to the family is the state, an alternative that is
    increasingly incapable of meeting the growing need.

    And goes on like this, until the last paragraph:

    Children depend upon political proxies to advance their


    societal claims.

    Note that he sets up the government not outside a family


    helping it, but inside the family, as a proxy parent, able to pick
    up the slack. Since the government has money, it looks like
    this works, and it seems crazy to say you want them out (“are
    you saying you want the government to stop handing out food
    stamps?”

    But the populace is being trained to see themselves not as


    solely responsible for their children, but as part of a larger
    network of interested parties. That may sound comforting, but
    it radically alters behavior. It reinforces your connection to the
    state, as opposed to fostering your independence from it; and
    you become willing/obligated to sacrifice more and more in
    defense of the bureaucracy.
    Gossip Girl Is Going To
    Corrupt Someone
    November 5, 2009

    please let it be me, please let it be me

    The Parents Television Council does not like threesomes on


    TV. This is what they wrote in a letter to the network about the
    upcoming threesome episode of Gossip Girl:

    Will you now be complicit in establishing a precedent


    and expectation that teenagers should engage in behaviors
    heretofore associated primarily with adult films?
    Wow. Do you really think that this is the best choice of words
    to sway the makers of a show called Gossip Girl?

    II.

    I can understand worrying that menages are being


    mainstreamed— “Parents worst nightmare!” But there’s a bit
    of ignorance here: teens don’t watch Gossip Girl, they watch
    The Hills. The median age of the CW network is 34. Gossip
    Girl draws 2-3M viewers, 84% are women over 18-54,
    average age 27. Believe me, they already know about
    threesomes, and at least eleven have been in one (p<.00001)

    III.

    That said, the PTC does have a valid point, made terribly.
    Barely five percent of the TVs that are on at that time are
    tuned to the show; in other words, very few people watch it.
    Yet there isn’t anyone who doesn’t know about it, even if it’s
    imagined based on magazine covers. So the airing of a menage
    episode mainstreams it for people who don’t watch the show,
    and that’s actually more powerful a cultural influence. i.e. If
    you’re a fan of the show, the threesome is specific: those three
    people are doing it. For everyone else not watching, it
    becomes background noise: “oh, people are having threesomes
    now…”

    This is why it is true that even if you are not interested in pop
    culture, pop culture is interested in you.

    IV.

    Look back at the PTC’s quote at the top: the overly formal
    syntax is a set up, it’s an organizational chart. They’re the
    parents, reprimanding the adolescent network “who should
    know better” than to do that to their little sister audience.
    Obviously the CW isn’t going to buy it, so in order for this to
    have any power, it has to be made public.
    Hence, this comes from a press release.

    The PTC asks, I assume without intending any irony:

    Finally, you must ask yourself, how does airing this program
    serve your obligation to serve the public interest?

    If the PTC’s obligation is to try and get sex off TV, how does
    releasing a press release angry about “promiscuous and
    consequence-free sexual behavior”, days before the episode airs,
    serve the public interest? Doesn’t it just make you program
    your DVR? The press release got picked up by the news
    agencies and now it’s everywhere— the only reason I know
    there is a menage episode coming up is because of this letter.

    The network’s own promotions talk about the program as a


    ‘parent’s worst nightmare.’ How many 30-year olds care
    what their parents think? Zero. Only a teenager would be
    responsive to a parental ‘forbidden fruit’ marketing ploy like
    that, and CW knows it.”

    Do they not understand, or do they understand perfectly well,


    that their press release far more contributes to the
    mainstreaming of “risky behavior” than the show itself? It’s a
    question of branding: since the PTC is out of touch, anything
    they hate must be good. Once a brand is established, anyone
    can use it any way they want:
    The PTC needs to read its own mission statement. They’re
    upset not simply that there’s sex on TV, but that the TV makes
    that sex more acceptable to society. Ok, fine, but then they
    should not be in the business of censoring TV, but in
    influencing cultural norms to not want sex on TV.

    In other words, they should be doing it quietly, applying direct


    pressure on networks so that if they obtain the desired
    outcome, it appears that it came naturally. Otherwise, it looks
    like you are suppressing something— and people will look for
    it; or it appears self-aggrandizing.

    I have no personal beef with the PTC, but I am observing that


    the PTC, like so many other groups pressing for change,
    deliberately take approaches that fail (and have repeatedly
    failed—“mind blowingly inappropriate” is from 2007) and
    thus ensure their own existence. Worse, not only are they not
    effective, but their self-referential publicity makes it difficult
    for another group to gather members in order to legitimately
    try to effect change. If the PTC really cared about stopping sex
    on TV, then, oddly, the best way for them to do it is to disband.

    –
    http://twitter.com/thelastpsych
    Stanford Prison Experiment
    Redux
    November 11, 2009

    it appears I’d lay there too if I were you


    For those living in Antarctica, in 1974 Phil Zimbardo conducts
    a study, the point of which was to show

    the evil that good people can be readily induced into


    doing to other good people within the context of socially
    approved roles, rules, and norms, a legitimizing ideology,
    and institutional support.

    In other words, a person’s goodness or evilness can be


    dramatically influenced by situation.

    The first thing you should notice: my phrasing. “…the point of


    which was to show X.” Not to study X, not to determine if X
    was true.

    Subjects were randomly given a guard or prisoner role in a


    fake jail. It was supposed to last 2 weeks. He aborted it in 6
    days because “too many normal young men were behaving
    pathologically as powerless prisoners or as sadistic, all
    powerful guards.”

    Second thing to notice: his phrasing. “…normal… behaving


    pathologically… powerless… sadistic…”

    About his conclusions, they may imply that men are born
    innately good, but can be changed; or born innately bad, or
    born as blank slates— but how they’re born doesn’t seem to
    matter. They can be changed, and, apparently, without too
    much effort. No Milgram authority figure; simply the right
    circumstances, $15 and a uniform.

    You may want to ponder what this implies about the trivial
    characteristics we long to be genetic and fixed— extroversion,
    anxiety, the tendency towards spending sprees— when one’s
    entire moral compass can be spun full around in the course of
    a Hampshire Halloween.

    II.

    The essential conclusion to be drawn from this study— the


    one everyone draws all the time— is that this can happen to
    anyone. “Normal” people were incited towards evil. 75 people
    applied; Zimbardo chose the 24 for the study who were
    “judged to be the most stable (physically and mentally), most
    mature and least involved in antisocial behavior.” Also, they
    were Stanford students, right? Not from ASU. (zing.) Didn’t
    matter. It’s probably not necessary to point out how important
    this study is in psychology and the conventional wisdom. You
    can’t have discussion about a group atrocity without this study
    being invoked.

    There may be another explanation, and as soon as I start to


    write it you’ll guess the rest. Zimbardo recruited subjects
    through a newspaper ad that said

    male college students needed for a psychological study of


    prison life. $15/day for 1-2 weeks
    It’s a legitimate question: what kind of a nut signs up for that?

    There’s an answer. In a follow up experiment in 2007 designed


    specifically to answer that question, two ads were placed in
    newspapers, one recruiting “male college students needed for a
    psychological study. $70/day for 1-2 weeks” and the other,
    slightly different ad recruiting for “a psychological study of
    prison life. $70/day for 1-2 weeks.”

    The subjects weer screened with personality inventories, and,


    surprise, “prison study” recruits scored significantly higher on
    narcissism, social dominance, aggression, Machiavellianism
    and authoritarianism (but especially the first three.)

    When you do a study, you get what you pay for.

    III.

    Zimbardo thought he was showing how a “normal” person


    might be made evil. He could have asked what might make a
    “normal” person become a passive, beaten victim— it was the
    same experiment. Presumably the same forces are at work, but
    it is easier to believe that the distance between normal and
    victim is shorter than normal to evil.

    But if you accept, or at least seriously consider, that there was


    a selection bias in the recruitment of Zimbardo’s study, then
    there’s a new finding to ponder, and I don’t really know what
    it means.

    No surprise that a group of aggressive/narcissistic people who


    decide they want to be part of a prison experiment need little
    prompting to turn into viscous guards— but, apparently, these
    same aggressive/narcissistic people can just as easily be made
    into submissive prisoners. You might think they’d rebel more,
    fight back more, but apparently not.

    Maybe the the real conclusion isn’t how easily people with
    those characteristics can be pushed into an aggressor or victim
    status, but their tendency to identify with a group, whatever it
    may be.

    http://twitter.com/thelastpsych
    Is Obama Inspiring Black
    Adults To Step Up? The
    Nature Of Altruism, Part 1
    November 13, 2009

    no, I got this


    This isn’t about race. So take a breath, let’s go.

    CNN article, “Is Obama inspiring black men to step up?”— in


    this case, to become a Big Brother/Big Sister volunteer.

    [Obama] was giving a televised speech challenging men


    to get involved in their communities. The men [gathered
    in a barbershop] had heard the message before, but this
    time they could relate to the messenger. Obama had
    shared their struggles…but had never used his struggles
    as an excuse. Nor could they anymore, some of the men
    decided. Seven joined Big Brothers Big Sisters of
    America that morning,
    It took Obama to make this happen— no prior figures of
    inspiration? Is the resolve of someone who impulsively joins
    the Big Brothers because the President was making a speech
    worth betting on? etc. But, in fact:

    At the Atlanta chapter of Big Brothers Big Sisters, Rita


    Owens, the vice president of development, says she hasn’t
    seen any more black men volunteer since Obama was elected.
    “We can’t see any influx of black men volunteers,” she said.
    “We do not have enough black men stepping up. We have
    more Caucasian men stepping up.”

    Before you start talking race, my first thought reading this was
    about 9/11.
    I was working a hospital that day, and many people, especially
    nurses, wanted to go to NY to help out. But they wanted to
    take off work to go do it. In other words, they wanted to
    volunteer instead of doing their job. “But they need
    volunteers!” they’d argue to the refusing nurse manager. “We
    all need to make some sacrifices.” Of course, in doing so, they
    were volunteering the people left behind for double shifts.
    That’s the part they didn’t seem to get.
    So here, “seven joined Big Brothers Big Sisters of America
    that morning.” Great, they want to help a young boy in need of
    a role model. But do these men have kids of their own? It’s
    one thing if they’re living with their kids and want to give
    something extra to others. But if they’re living apart from their
    own kids, why not just spend extra time with them?
    Because doing “your job” isn’t as rewarding as “sacrificing.”

    Here’s what happened on 9/12 at my hospital, and what


    happens in so many cases of high-emotion altruism: they take
    the day off in order to go to NYC, but then don’t actually go
    (car wouldn’t start; heard on the radio they were blocking
    volunteers, etc). They win: they get the reward of the sacrifice,
    perform no actual sacrifice, and get the day off. Meanwhile,
    someone else had to sacrifice to cover their responsibilities.

    I think Rita Owens meant the statement “more Caucasian men


    stepping up” as a jab at blacks to get them movitated, but if it
    is factually accurate then these Caucasians are idiots. Really?
    Big Brothers? That’s the call you heard? Whites seem
    particularly prone to manic devotions to faddish volunteerism
    inspired by celebrity that are transparently self-aggrandizing.
    And temporary— they inevitably quit when the next fashion
    comes along. Keep in mind that the Caucasians she is talking
    about joined Big Brothers not because they just learned it
    existed, but because they were inspired by Obama. How long
    is that going to last?
    “How can you even question the integrity of someone who
    joins Big Brothers?” I’m not. I’m questioning the integrity of
    someone who is going to soon quit Big Brothers. I’m
    questioning what message that delivers to a) their real kid; b)
    the kid they will be soon abandoning.
    It’s going to take way more than Obama to generate any kind
    legitimate social consciousness in us. No, I don’t mean a
    Prius/vegan sort of consciousness, just the basic kind where
    we are aware that all of our actions have a blast radius, and
    other human beings are in it.

    II.

    What is not intuitively obvious is the psychological motivation


    of the people left behind: why do they do double duty and let
    these fakers get away with it? Why, when the man says he’s
    going to spend resources on someone else’s kid, does the
    biological mom of his kid not hit him with a sack of batteries?
    More importantly, why has this complementary behavior (guy
    volunteers, other guy forced to pick up the slack) been allowed
    to exist in human society? We don’t pee on each other
    anymore, so why do we allow this?

    There are two ways to look at it:

    By definition, altruism means sacrifice; if there’s an emotional


    “I want to help!” benefit, then it’s not purely altruistic (doesn’t
    make it bad, just not altruistic).

    Or you can take a strictly biological view of altruism: it results


    in a decrease in reproductive fitness, i.e. progeny. Biological
    altruism doesn’t care about intent; only that the action benefits
    others at reproductive cost to itself. Worker bees, who give up
    their ability to procreate, behave altruistically. The above
    volunteers, also under this definition, are not behaving
    altruistically.

    If you want to stick to evolutionary psychology, then the


    behavior of the above volunteers can be understood as the
    opposite of altruistic, it is self-promoting in the interest of
    reproduction. In other words, these temporary displays of
    volunteerism are chick magnets.

    But under almost any definition of altruism, the real altruists


    are the ones left behind. The worker bees who gave up sex for
    hex.
    Think, for a moment, why you think worker honeybees are
    worker honeybees. You probably figure it’s “genetic” i.e fixed,
    but honeybees are totipotent— the females, as larvae, can
    become either queen or worker. Furthermore, as adults, they
    can choose to change again, by activating or deactivating their
    ovaries. It’s up to the individual, not decided by God. Despite
    this, 99% of females decide to become sterile workers.
    The reason they do is twofold. First, the amount/kind of food
    given to larvae is restricted so that there isn’t enough to
    become a queen. Next, if a female chooses to have some
    babies, those babies are promptly killed by the other adults,
    with amazing efficiency. This process discourages the workers
    from laying any eggs in the first place. This isn’t some slow
    evolutionary process; they’re actually killing babies in there,
    on purpose. This is a guaranteed way of getting the civilization
    you want, and fast.

    When there is no queen in the hive, the killing of babies is


    reduced or stopped, until a new queen is made.

    The altruism of worker bees is socially coerced.

    Part 2 coming.
    –-

    http://twitter.com/thelastpsych
    The Fort Hood Shooter: A
    News Quiz
    November 15, 2009

    in which the better you score, the worse off you are

    “so it was the Zoloft?”

    I.

    New York Times


    MSNBC
    NPR
    Washington Times (NB: this is not the same as the Washington
    Post)
    Fox News

    Which news outlet published the following stories? (Hint:


    What do the titles say, and what don’t they say?)

    Nov 5: Army Doctor Held in Ft. Hood Rampage

    Nov 6: ‘Good doctor’ stressed out by deployment?

    Nov 6: Army: Suspect said “Allahu Akbar” before firing


    Nov. 6: Fellow Worshipers Describe Fort Hood Shooting
    Suspect as Devout Muslim, Troubled By Wars

    Nov 6: Obama: “Don’t Jump To Conclusions” on Fort Hood


    Shooting

    Nov 7 George W. Bush Visits Fort Hood, Wounded Soldiers

    Nov 7 George W. Bush Secretly Visits Fort Hood Victims

    (NB: these are two different articles.)

    Nov 7: Little Evidence of Terror Plot In Base Killings

    Nov 7: Suspect Was ‘Mortified’ About Deployment

    Nov. 7: Suspected Fort Hood Shooter Was “Calm” During


    Massacre, May Have Shouted “God Is Great!”

    Nov. 7: Uncle: Fort Hood Suspect Loved US

    Nov 8 A Doctor, And A Conflicted Soldier

    Nov 11: Walter Reed Officials Asked: Was Hasan Psychotic?

    Nov 12: EXCLUSIVE: Fort Hood Suspect contacted Muslim


    Extremists

    Nov. 14 Obama wants to delay Fort Hood probe

    II.

    Two observations. First, each title has an “angle.” At the same


    moment the NYT and others were pushing the
    doctor/deployment angle— and deliberately avoiding the
    Muslim angle, Fox and the Washington Times were featuring
    “Allahu Akbar” and minimizing any other factors. You will
    observe that reading only one “side” or the other would be
    worse than not reading any articles at all: you would have
    accepted a prejudice as “news” level truth. No outlet has a
    claim to the truth.

    The second is about the phrasing. On Nov 7, the NYT


    reported, George W. Bush Visits Fort Hood, Wounded
    Soldiers, but Fox News adds “Secretly.” Both articles are less
    than 5 sentences long, yet Fox uses “secretly” twice (in
    addition to the title) to convey the sense of a MacArthur
    coming to save the war. The NYT never uses “secretly,” nor
    does it explain that the Bushes specifically didn’t want any
    media to know they were there— a fact which itself could be
    newsworthy. All four Fox sentences are about Bush; only two
    of the five NYT are.

    Similarly, the “Obama wants to delay Fort Hood Probe” most


    certainly conveys a “do you see what this politically correct
    idiot is up to now?” Meanwhile, as the article explains, Obama
    really only wants to delay the Congressional probe until the
    FBI finishes its criminal investigation, which is not even a
    story worth reporting; Fox reports it only so they can attach
    that misleading title. They’re banking on you doing what you
    probably just did, which is read only the title. You are left
    either with consonance with Fox (“Obama is an idiot”) or
    dissonance (“I know Fox is an idiot, but I’m struggling with
    coming up with reasons why Obama might delay a probe. He
    must have a good reason, right?”) Either way, they have
    caused you to think a certain way.

    III.

    What’s very interesting— read: depressing— is how the news


    outlets protect themselves from the facts. For example, it’s
    probably no surprise that the major focus of the Fox News
    articles on Nov 5 concerned Hasan’s relationship to Islam. In
    contrast, on Nov 5, the two NYT articles do not once reference
    Islam. Indeed, one article almost goes out of its way to avoid
    it, quoting from some file: “no religious preference.” It then
    postulates “much about his background— and his motives—
    are unknown”.

    Yet the same NYT article that never mentions Islam does,
    incongruously, include a denouncement from the Muslim
    Public Affairs Council. It floats there, with no context within
    the article. This inclusion makes sense only if you already
    come in to the article with some knowledge that Hasan was
    Muslim. In this way, the NYT doesn’t have to take any
    responsibility in spreading the “gossip” of an Islam link, but
    can simultaneously take credit for showing both sides (or the
    other side) of an issue.

    In another, 770 word article of that same day, the word


    Muslim does appear— only once: “a U.S. born Muslim.” It’s a
    fact no one would question. But rather than simply reporting
    this fact, they attribute the information as coming from… Fox
    News. Think about this: is the NYT turning to Fox News for
    information? Of course not; they’re distancing themselves
    from the information.

    IV.

    From here:

    Viewership for the cable news channels surged on


    Thursday afternoon as news [of the shootings] shocked
    the country.

    What station had the most viewers? Average viewers from 3p-
    12a:

    Fox: 3.04M (usual 2M)


    CNN 1.58M (usual 0.9M)
    MSNBC 0.88M (usual 0.8M)

    “The O’Reilly Factor” had 5M.

    Discuss.

    –
    http://twitter.com/thelastpsych
    Fearless Kids Go On To
    Become Criminals
    November 19, 2009

    so he was wrong?

    In trying to understand, you have to follow that path of the


    reader, not the writer. Here is what they see.

    I.

    ‘Fearless’ 3-year olds might be tomorrow’s criminals

    Children who are fearless at 3 years of age might just be


    poised for a life of crime. According to a new study, poor
    fear conditioning at the tender age of 3 can predispose
    that person to break the law as an adult. Yet other factors,
    such as education… also play a role, the researchers
    concluded….

    Specifically, what Gao and his associates set out to


    determine is whether dysfunction of the amygdala, an
    almond-shaped mass… leads to an inherent intrepidness
    and disregard for the law.

    Every single one of these sentences is a lie.

    II.

    The study, Association of Poor Fear Conditioning and Adult


    Crime, is three pages long in which the word “amygdala”
    appears 17 times. However, the study has nothing at all to do
    with the amydgala. It measures something that is thought to
    originate in the amygdala. To say that “specifically” Gao was
    studying the amgydgala is like saying that when Fox News
    reports on Obama, they are “specifically” referring to Hawaii.
    Nor does the study have much to do with fearlessness as I’ll
    show.

    But the news article links permanently three unrelated words:


    “fearlessness” “crime” and “amygdala.”

    III.

    The study, started in 1970, tested 3 year olds for a “fear


    response” and then followed these kids over 20 years.

    Two decades later Gao and his team tracked down 137
    study participants who had committed serious crimes.
    These individuals had shown an absence of fear during
    testing at age 3, whereas 274 study participants who had
    grown to adulthood without a criminal record had
    displayed typical fear responses.

    Create your own narrative: “fearless” babies grow up


    undisturbed by consequence, punishment, or threats to their
    own safety, and live a life of immediacy and selfishness.

    But “fear” has nothing to do with it. Babies were hooked up to


    a sweat monitor, and subjected to Pavlovian classical
    conditioning: Every time they played a sound (say, “doorbell”)
    they followed it with the sound of a “car crash.” So the babies
    were conditioned to anticipate “car crash” whenever they
    heard “doorbell”— and so would sweat more.

    Sweating upon hearing the loud noise indicated a sense of


    fear, while no sweat meant the child lacked fear — that
    is, had poor fear conditioning.

    Not exactly. Sweating meant they had been conditioned. By


    example, all babies would exhibit “fear” when they heard only
    a car crash. What was going on here was that some babies had
    increased sweat when they heard the doorbell— i.e. they had
    been conditioned— and some didn’t.

    The false link is to couple “conditioning” with “fear” and then


    amygdala. But this paradigm isn’t really about fear; and while
    the amygdala is implicated in fear and conditioning of many
    different kinds that all fall under the umbrella of “fear
    conditioning” (e.g. taste aversion, etc), the role of the
    amydgala is drastically altered depending on what
    conditioning paradigm you use.(1)

    Apparently, those that didn’t respond to the conditioning went


    on to be criminals.

    IV.

    Well, that’s not exactly true either.

    Results
    No main effects of criminal offender group or stimulus
    type were found. A significant group-by-stimulus inter-
    action indicated that the criminal offender group failed to
    show fear conditioning at age 3 (F=4.554, df=1, 409,
    p=0.033) (see Figure 2). The comparison group (N=274)
    showed a greater response to the CS+ than to the CS-
    (t=2.852, df=273, p=0.005; d=0.345), whereas the
    offender group (N=137) failed to show this effect (t
    =-0.604, df=136, p=n.s.; d=-0.104).

    Those three sentences represent the entire body of information


    and discussion on the results of the study. The first half of the
    paper is introduction and methods; the last half is discussion
    about the amygdala and speculations on the neurobiology of
    crime that have nothing at all to do with the study they
    conducted. Go see if I’m lying.

    And, you will notice, the study failed on its primary outcome.
    Here’s the context: 1700 kids were studied. 20 years later, only
    137 had become criminals. Looking at the original conditioned
    response data, there was no way to predict which 137 were
    going to become criminals. Starting with the criminals and
    working backwards, they were only slightly less responsive to
    the conditioning than a selection of controls.

    V.

    So what do the results mean for individuals with fear


    conditioning deficits and their loved ones, and for society
    at large? It’s a wake-up call about potential problems,
    said Gao and other experts in the field. To enhance the
    proper working of the amygdala, which is believed to
    reduce criminal behavior in later life, enrichment
    programs are essential.

    I’ll admit, having lived through 20 years of the “decade of the


    brain” I didn’t fully appreciate the shift in direction modern
    psychiatry was taking. They have moved from a “fixed trait,”
    “everything is genetic” bias, to a “neurodevelopmental
    dysfunction” bias.

    The importance of this bias is entirely social, not scientific, as


    the science itself is the same, only the interpretation differs.
    This new interpretation allows early intervention programs to
    target the biological aspects, and not the social aspects. It
    justifies psychiatry to use its techniques for social change,
    which it had previously been doing without official sanction.

    You say: “Are you insane? We couldn’t do anything about


    criminality before; now maybe we can. Why is that so bad?”
    Because you can’t do anything about it at all. Because you
    can’t do anything about it at all. You had these same
    medications and techniques before but they didn’t work and
    you didn’t really expect that they’d work. Believing that they
    will work now won’t change anything.

    This is the reclassification of social ills as


    “neurodevelopmental disorders;” the offloading sociology to
    psychiatry.

    Addressing parental concerns, Benedek added: “Don’t be


    discouraged if your child has early brain dysfunction. It
    doesn’t mean that he or she is going to grow up and be a
    criminal. The brain can change and grow.”

    My God, my God.

    http://twitter.com/thelastpsych
    The Fraud Isn’t Baby
    Einstein
    November 23, 2009

    it will teach skills he’ll apply for decades to come

    Nothing more powerful, not lava or sunspots or the hem of a


    woman’s skirt, than self-righteous anger backed by the
    possibility you weren’t wrong.

    Parent alert: the Walt Disney Company is now offering


    refunds for all those “Baby Einstein” videos that did not
    make children into geniuses….the unusual refunds appear
    to be a tacit admission that they did not increase infant
    intellect.

    The key issue is their marketing as “educational,” a term


    which Disney dropped in 2006 after complaints by the FTC.

    “The Walt Disney Company’s entire Baby Einstein


    marketing regime is based on express and implied claims
    that their videos are educational and beneficial for early
    childhood development,” a letter from the lawyers said,

    What makes that claim false?

    calling those claims “false because research shows that


    television viewing is potentially harmful for very young
    children.”

    Hold on: are you telling me that the Federal Trade


    Commission ordered refunds based on that??

    Consider how hard it was for tobacco makers to be forced to


    do anything despite the science being everywhere. There isn’t
    anything conclusive about TV watching. I’m not saying TV is
    good, I’m saying wow, they can wreck a company over “some
    research suggests?”

    The FTC response was slightly different:

    Upon careful review of the matter, including non-public


    information submitted to the staff, we have determined
    not to recommend enforcement action at this time.

    We note that certain claims— such as that a product


    “introduces” or “resents” or “exposes” children to certain
    content— are unlikely, by themselves, to convey an
    educational benefit…

    And as for TV:

    To the extent the existing research does point in any


    direction, it suggests that television is an inferior means
    to teaching very young children compared to live
    demonstration…additional research is needed…

    In other words, Disney gave the refund because not because


    the FTC made them, but because there was a shakedown, in
    the form of a potential class action lawsuit, in progress. That’s
    America.

    II.

    In every article, there is a jab at the parents who bought them.


    “Did you really think it was going to make them smarter?
    Idiots!”

    It seeems that what was under attack wasn’t Baby Einstein, but
    the type of parent who would buy Baby Einstein— middle to
    upper middle class new parents, unsure of their skills, looking
    to give their kid any possible advantage since they’re not sure
    exactly what to do to raise a kid. Pre-school ballet, soccer,
    violin, Mandarin, Gymboree— throw everything at him.
    “Don’t these idiots know none of that works? That’s why I
    didn’t do it.”

    USA Today:

    The popularity of Baby Einstein also reflects a


    misunderstanding about the true nature of genius. Just a
    little life experience, even a few days in a regular U.S.
    school, demonstrates that geniuses are usually born with
    innate gifts that no DVD can impart.

    In other words: duh, and phew.

    But no one was shooting for genius— they were shooting for
    smarter, or at least not as damaging as TV. And if you think
    that “smart” isn’t affected by even haphazard early
    interventions, then you’re insane. How’s that for semantic
    blurring?

    III.

    There’s plenty of criticisms to level against overinvolved


    parents, but they are trivial in comparison to the main one:
    they check out when the kid is in 1st grade. Once the kid hits
    grade school, the whole ship is put on autopilot, and the two
    biggest forces in a kid’s life from 6 to 18 are school and “the
    media”— TV, internet, video games. I dare you: go and log, on
    paper, a kid’s typical day.

    This applies equally to lower income kids, for whom school


    often represents their only chance; to rich kids in private
    schools, whose parents figure if it costs $20k a year…

    Trusting a ridiculous public school system to prepare for an


    even more ridiculous college Ponzi scheme. “I got a B.S.!”
    Aces.

    Early interventions— both in education and in psychiatry are


    important in their own way. But the focus on early intervention
    is a way of avoiding the hard work: turning teens into adults.
    That’s where the money is. I mean isn’t.

    http://twitter.com/thelastpsych
    Man In Coma For 23 Years
    Not In Coma
    November 25, 2009

    Story: Man in “coma” for 23 years,

    Then a neurologist, Steven Laureys, who decided to take


    a radical look at the state of diagnosed coma patients,
    released him from his torture. Using a state-of-the-art
    scanning system, Laureys found to his amazement that
    his brain was functioning almost normally.

    My first instinct was to dismiss this. “Radical” and “state-of-


    the-art” are terms that describe technology that has been
    essentially unchanged for ten years. Either the old doctors
    missed it, or Laureys has better technology at his disposal.

    Belgian doctors used an internationally-accepted scale to


    monitor Houben’s state over the years. Known as the
    Glasgow Coma Scale, it requires assessment of the eyes,
    verbal and motor responses. But they failed to assess him
    correctly and missed signs that his brain was still
    functioning.

    So there’s one answer: they didn’t bother to scan him in the


    first place, or at least update the scans over time. They relied
    on a behavioral measure. It happens— complacency, routine…
    patient gets offloaded to a nursing home never to be heard
    from again. It happens.

    The moment it was discovered he was not in a vegetative


    state, said Houben, was like being born again. “I’ll never
    forget the day that they discovered me,” he said. “It was
    my second birth”.

    And there the science ends, and the politics begin.

    II.

    What do you want this story to be about?

    Many people thought this was a hoax, but not because of what
    I’ve described, but because of this:

    “I had dreamed myself away… I screamed, but there was


    nothing to hear,” he said, via hiskeyboard.

    Here’s a video, but the screen cap tells enough:


    That’s a therapist’s hand guiding his hand along the keyboard.
    “Facilitated communication” is controversial. Is it Ouija board
    stuff, or for real? The Amazing Randi and one quasi-famous
    bioethicist say FC is a fraud. Debate on TV and message
    boards all focus on FC.

    But that’s not what the actual news stories are really about.
    The articles don’t even mention Facilitated Communication.
    And Dr. Laureys doesn’t mention it in any of his scientific
    papers I’ve read. Even if FC is a hoax, even if this patient isn’t
    really communicating via FC, it doesn’t mean he’s not
    conscious. Isn’t that really the issue?

    That’s the hijack: Randi, and Caplan, and the public, can’t
    interpret MRI scans. So instead they’ll interpret and argue
    what they can— news videos. That’s politics.

    III.

    What does Dr. Laureys want to be true?

    I’d like to tell you I looked at the case write-up, but there isn’t
    one. That’s very suspicious, but also completely besides the
    point, because for Laureys, the point isn’t about Houben.
    That’s why he didn’t even write it up.

    What he wrote about, however, was better/newer applications


    of technology to detect consciousness. We can debate whether
    fMRIs are really novel or just appropriate practice, but what he
    is really doing is asking the European governments to pay for
    it. From Laurey’s perspective, he wants to change standard of
    care to regularly employ this technology.

    Following this, it’s no wonder the British press keyed in on it.

    IV.

    What about the Americans?

    “We have to re-evaluate cases like Terry Schiavo.” Actually,


    we don’t.

    For U.S. doctors the application of “high tech” scans is hardly


    novel, even getting Medicaid/Medicare to pay for it isn’t such
    a struggle. But the comparison to Schiavo’s case isn’t correct:
    Terry Schiavo was scanned with an MRI, people just disagreed
    with what it said. The Houben debate is whether we should be
    scanning in general.

    V.

    For my money, the case is suspicious but:

    The spectacle is so incredible that even Dr. Laureys had


    doubts about its authenticity. He decided to put it to the
    test.
    “I showed him objects when I was alone with him in the
    room and then, later, with his aide, he was able to give
    the right answers,” Professor Laureys said. “It is true.”

    Laureys would have to be insane to make up a lie of this


    giganticality, but anything is possible.
    The Coming Global Collapse,
    Sponsored By British
    Airways
    November 27, 2009

    if you can supply the prose I can supply the crystal ball
    If you’re even moderately interested in the financial news,
    you’ve probably seen this:
    Wow. What makes it scarier is that this is in the Telegraph,
    which, in June 2008 reported:

    I remember this story so well that when I needed today to find


    the link, I remembered the full title. Same newspaper, same
    author. I’m sure I’m not the only one who saw the similarity.
    And, of course, two months later the freefall started, and the
    S&P lost half its value.

    II.

    Maybe it’s my… perspective… but when I saw the story,


    something else caught my eye:

    The 2008 article had 293 comments. The average Telegraph


    story gets 20 comments.

    My first, cynical thought was: they wouldn’t make up a story


    to generate traffic and ad revenue (British Airways), just
    because they know it worked the last time, would they?

    I mean, “global collapse” is in quotes, right? Soc Gen had to


    have said it, right?

    III.

    A look at the actual report shows something a little different:


    Soc Gen outlines 3 possibilities— Bear, Central, and Bull
    scenarios, each detailed with unnecessarily complex graphics.

    They don’t think the “Worst Case Scenario,” will happen, they
    are just describing it. Their actual belief is stabilization in
    2009, and recovery in 2 or 3 years.

    IV.

    So why report it it this way? Why write a news story about


    something Soc Gen doesn’t believe is going to happen? Before
    you answer, consider that they only wrote about the “worst
    case scenario,” not the Central and Bull scenarios.

    It’s bad enough that the story is misleading, and that it


    provides no useful news. What makes it dangerous is that it is
    misleading precisely to draw readers; and by becoming
    popular it then causes things to happen.

    Newspapers are not objective informational resources, they are


    blogs. The sooner you internalize that comparison, the sooner
    you will be free.

    –-

    http://twitter.com/thelastpsych
    We Have Breaking News:
    You Don’t
    November 30, 2009

    a picture is worth a thousand words but a picture of a word is


    priceless
    Video:

    Michelle: Scott Wapner is our eye on the floor on the


    New York Stock Exchange. Scott.

    Scott: Thanks Michelle, well, you said it, it’s that 1042
    level that has me concerned…

    There he is, he’s not CGI, he’s not been digitally enhanced.
    He’s a real person, telling us real facts.
    Note the production. Michelle is in studio surrounded by
    monitors and newspeople and information. But she’s turning it
    over to someone who is on location. This is a deeper level of
    truth, he’ll have insights and information she/we won’t have
    because he’s there.
    Listen to the noise; he’s talking loudly over the bustle of the
    traders behind him. Raw info.
    But what’s he going to learn? 50-75% of trades are program
    trades. Does he speak Bachi? And it would be an easy thing to
    have him mic’d and filter out all the background noise. But the
    noise is necessary to the drama. It’s background music.
    Note how he keeps looking to his left, as if the S&P is over
    there having a sandwich. But the only thing over there is
    another monitor telling him the price. He has no more
    information than Michelle at the studio; which is to say, no
    more information than anyone else. In fact after 20 seconds,
    all he does is show pictures of charts, none of which are at, or
    are generated at, the NYSE.
    “Over at the Nasdaq Market Site” it’s even worse: the entire
    Nasdaq is electronic. The only guy making money at the
    Nasdaq market site is the reporter. His anchor could pull the
    quotes off Yahoo! Finance and it would be the same. In fact,
    those screens have less information than Yahoo! Finance. In
    the land of one eyed men, we’re listening to a blind guy.
    All of this isn’t to deliver better information, it is to convince
    us that they have better information.
    Scott Wapner doesn’t know why the market went down, but,
    importantly, the structure of CNBC makes it is impossible that
    he could ever know. The simple truth is that in the short term,
    the market went down because the Machines wanted it to go
    down. If you want to know why they wanted it to go down,
    you’ll have to ask them.

    II.

    This is the same setup one sees in ordinary news; an anchor


    leads a story, then hands it off to someone in a different
    location: closer to the truth. Sometimes, this on-location
    reporter will play a snippet of a prerecorded interview, e.g.
    I’m John Roberts, live at Capitol Hill, and earlier today I
    had the chance to talk to Senator Hutchinson…

    and then they play the interview. So what’s the point of


    standing on Capitol Hill if the information you have is neither
    live nor from Capitol Hill? Because you watched.
    Sometimes they’ll play a muffled audiotape, and because they
    are so helpful they will also write the transcript on the screen.
    This can always be recognized as a trick. The transcripted
    words draw your eye and concentration, so you see the words
    they want you to see, in their context, not in the original
    context. Imagine reading vs. hearing the voice message of a
    surfer dude charged with killing his girlfriend: “come on over,
    baby, this party is going to be killer…”
    This is especially true when the audiotape is transcribed and
    the transcription is read by a reporter. When you see that on
    TV, flee the area, your soul is in peril.

    IIIA.
    Medical journals are CNN.
    Everyone has access to published clinical trials. But nobody
    reads them, because there are review articles out there which
    summarize them. Note the direction of causality. Reviews
    don’t serve a need, they create a market— for themselves.
    That’s also what the press does. I see you furrow your brow,
    “wait, what—?” Read it again.
    Listen closely: since you at home have access to all the clinical
    trials, you could theoretically write a review article and
    publish it. But you can’t. Only academics can. You may have
    written an excellent review article, but in order to publish it,
    you have no alternative but to enlist the help of an academic.
    That’s the news, too. The only way to tell the world what you
    know and make it legitimate is it to tell Wolf Blitzer first.
    Those reviews will get published in the same journals as the
    clinical trials themselves, giving them credibility. When I
    reference a paper, no one asks if I’m referencing a primary
    source or a review article. The existence of the reference is its
    own proof of validity and objectivity.
    No one ever says, “The Telegraph says, ‘Societe Generale
    says, ‘prepare for a collapse.’ ‘ ” They say, “Societe Generale
    says prepare for a collapse.” Oh, I didn’t know you were tight.
    Can you have them call me?
    1.
    Aside: even Societe Generale does not correct the Telegraph.
    2.
    No, sorry, yet another typo— of course I didn’t mean “Aside:”
    I meant to type: “What could be the significance of Novartis
    not correcting the media’s description of the swine flu? But:”
    IIIB.

    Sometimes a review article will include a quote or a table from


    a primary source, just like a news team does.
    Bad enough: you don’t look up the quote or the table. Worse,
    the purpose of the quote or table isn’t to enhance your
    understanding of the material but to give credibility to the
    review. It makes you think that you are seeing a deeper truth;
    the review has layers to it, the review level and the primary
    source level. You have two levels of truth on those pages.
    Never mind you could simply read that reality yourself and
    skip the review level, which is, essentially, one nut’s opinion,
    unchecked by anyone, positioned as truth. But the presence of
    that table guarantees you will not do this ever again. “This
    review is comprehensive and extensively referenced.” That’s
    true.
    IV.
    Medical journals are rarely accused of ideological bias, they
    are accused of financial bias. The press are rarely accused of
    financial bias, they are accused of ideological bias. If you
    studiously spend one month looking for the opposite bias in
    both, what will happen is that you will become an alcoholic.
    V.
    “Let’s get down to our eye on the floor of the NYSE, where
    we have some breaking news.” But aren’t the barbarians in
    Greenwich?

    http://twitter.com/thelastpsych
    The Cognitive Kill Switch
    December 8, 2009

    this interview is about me, but it’s for you

    Convoluted story not worth exploring, Carrie Prejean, Miss


    USA contestant, was involved in some kind of litigation with
    the Miss USA pageant in which a masturbation tape she made
    years ago/yesterday figures prominently/not at all, resulting in
    some kind of settlement, and culminating with an appearance
    on Larry King to promote a book.

    King asked about the terms of the settlement; she said he was
    “being inappropriate.” He asked if she could say why she
    settled, and she said “Larry, you’re being inappropriate again.”
    She said “inappropriate” four or five times more before she
    pulled off her mic and left.

    A “nobody” shut down pro-interviewer Larry King. When a


    woman uses that word on a man, the conversation is over,
    whether he is right or wrong. The man is on the defensive, the
    whole conversation changes, it’s no longer about the thing that
    was inappropriate, it becomes about the character of the kind
    of man who would be inappropriate. He spends the rest of the
    time trying to defend himself, and, of course, she never has to
    answer the question.
    Cognitive kill switches change the focus from content to
    identity. Popularly, this mechanism is referred to as “short
    circuiting”, but “kill switch” is better because it implies it’s
    deliberate.

    II.

    One thought is that this works because of a power imbalance.


    If she was in a bar, where the power is mostly equal, she
    wouldn’t say “inappropriate,” she’d say, “die.” But with Larry
    King, or in an situation that does not have an escape (e.g.
    work, an airplane— a place where some relation must be
    maintained) she could reverse the power imbalance by calling
    him “inappropriate.” The only thing he can do is back off,
    which of course was the point.

    But there are too many exceptions for it to be just about power.
    It wouldn’t work on a psychoanalyst in therapy; he’d simply
    reply, “tell me more about that.” It wouldn’t work on a rock
    star. Larry King caved, but I can’t imagine Howard Stern
    caving.

    What those men on their side is an established reputation,


    identity: “you think that was inappropriate? Do you have any
    idea how inappropriate I can get?” Which translates as a
    willingness to confront the person about their use of
    manipulation. It’s a kill switch, too: she changes the focus
    from the content to his character, but then he changes the focus
    from his character to hers. He wins because his identity is
    already established.

    So “inappropriate” fails because the guy is known, and what


    was “inappropriate” actually wasn’t inappropriate coming
    from him. And, in the reverse: kill switches works when they
    are at least partially right.

    Prejean is correct: King was being inappropriate. He may have


    said “settlement” but Prejean understood he meant “sex tape.”
    She realized that King didn’t care about her, only about the sex
    tape. The only reason he asked that question is to get to the sex
    tape. She’s not a full person to him, she’s a news story. Now,
    you can say she’s an idiot for thinking there is any other
    reason to interview her, but regardless she thinks she’s much
    more interesting than just that. From her perspective, he is a
    man who only cares about her because she is currently hot and
    previously naked.

    When King asks about the settlement, it’s the most


    provocative question he, given his limited ability as
    provocateur, can ask. But if Howard Stern asks about the
    settlement, he’s actually asking about the settlement. When he
    wants to get inappropriate, we’ll know.

    III.

    Focusing on the specific case of a man saying something


    “inappropriate” about the woman he’s talking to (as opposed
    to a general comment, e.g. “I like hookers with a little mileage
    on ‘em”):

    If you accept that the kill switch changes the focus from
    content to character, then what she’s doing isn’t judging the
    words, she’s judging you. Some men don’t understand this
    mechanism, and it is both the cause of the conflict and the
    explanation for why the kill switch succeeds: the woman has a
    brain and a life experience, and she has you figured out. She
    knows you, probably better in this single respect (sex) than
    you know yourself.

    You don’t really get that she has this ability— any abilities;
    you assume she knows nothing about you other than what you
    tell her, you assume she is less intuitive than you, whether it be
    because you are older or perhaps “smarter.” The exact
    opposite is true. Because you don’t appreciate this, you think
    you are fooling her by masking your real interets with neutral
    phrasing. (“Oh, what kind of a bathing suit was it?”)

    The sum total problem you are having is this: you don’t see
    her as a person, you see her as…

    You think you are seeing her as a single, complete individual,


    but you are mistaking your undivided attention to her as
    perception of her.

    Consider the extremely awesome scenario in which your


    female coworker gets breast implants. What is a not-
    inappropriate way to comment on it? Answer: there isn’t any.
    You either can comment on it, or you can’t. And you know
    who you are. And she does, too.

    IV.

    So what can you do if you’re at the wrong end of an


    “inappropriate?”

    (Part 2 soon)
    I Am Tiger Woods, Part 1
    December 13, 2009

    my next endorsement will be from adidas

    Question: why would any of these women sleep with Tiger


    Woods?

    “Well, because he’s TigerWoods. Maybe they do it for the


    story, for their ego; maybe they do it because they think he
    might give them gifts or money; maybe they think he might
    marry them…”

    So it couldn’t possibly be because they like him? That had


    they not known about his fame and money, they still would
    have gone to bed with him?

    “Of course not. Not those girls.”

    I see. Do you think he doesn’t know that?

    II.

    Assume Tiger was not married. Describe the woman you think
    would love him “for him.” For whom Tiger’s fame and wealth
    plays no part at all, who would have loved him even if he was
    a shoe salesman. Which modeling agency would she have
    been with? Oh.

    Would Elin Nordegren have married him if he was just Tiger


    Woods, not TigerWoods?

    What do you think Tiger Woods thinks?

    III.

    Would these women have slept with him if he was half as rich
    and half as famous? How about 1/4? At what point would he
    have been insufficiently rich or famous for them?

    Yet it is entirely safe to assume these women have slept with


    other men who were neither famous nor rich. So why did Tiger
    have to be TigerWoods to get them?

    Do you think Tiger Woods doesn’t wonder this?

    Stop reading here. You should go get a glass of water. Take a


    nap, watch a music video, there’s a catchy one I quite like by
    Akon/David Guetta. Come back when you’ve thought this
    through.

    IV.

    It may, or may not, be true that these women are golddiggers,


    “whores”, or only interested in him because he is famous; but
    it is absolutely a fact that these women could be seduced by a
    man who isn’t famous or rich.

    The reason this is absolutely, incontrovertibly a fact is that


    these women are human beings. They have the same general
    needs— love, lust, attractions, loneliness, childhood dramas…
    Different things make them happy, in different ways.

    Tiger Woods does not seem to know this. He seems to think


    what every guy has at least once said: “she only wants a [adj]
    guy…”

    Taken to the inevitable conclusion, Tiger Woods needed one


    billion dollars in order to think a woman would want him. In
    order to get those women, he [thought] had to be TigerWoods,
    not Tiger Woods.

    This means that no matter who/how many women he sleeps


    with, he will never be satisfied, because he has tricked them.
    He wants them to like him, but he knows they only like
    TigerWoods. That would be okay if he was just after the sex,
    he’d have a one night stand and disappear; but instead, he tries
    to forge loose relationships that are based on him pretending to
    be his image. This always fails.

    The question isn’t how he could have cheated with ten


    women; the question is how he managed to keep it under 100.

    Va.

    “But if I say I’m a doctor, she’ll want to sleep with me.” No,
    that only works on patients.

    Vb.

    No, I’m not kidding. I’m not saying she has to be your
    patient…

    VI.

    “As a woman, what I want to know is why he would ruin what


    looks like a perfect marriage to a beautiful woman, he has two
    kids with her… why would he risk all that on cocktail
    waitresses, no matter how attractive they are?”

    Oddly, no man ever asks this question. It’s not because he


    knows the answer: he doesn’t. “Well, if I was TigerWoods, I’d
    probably do the same thing.” That’s interesting, you didn’t say
    you’d do the same, you said you’d do the same if you were
    TigerWoods. “No, I mean in the same situation as him.” You
    mean the one in which you’re a billionaire golfer married to a
    swimsuit model? Or do you mean if you were just a regular
    guy?

    “But it wouldn’t happen to me if I was a regular guy, it would


    only happen to someone like TigerWoods.”

    That is exactly what Tiger Woods thinks, too.

    (part 2 here)
    Tiger Woods, Part 2
    December 13, 2009

    I had hot sex with Tiger in 2002

    (part 1 here)

    VII.

    “I hate your cryptic, self-indulgent wanderings.”

    No one can be told what the Matrix is.

    VIII.

    A woman asks why a man risks his marriage because she’s


    seeing it from the other side: what else could this nut want?

    They think what he wants is something. What he wants is to be


    seen as something.

    This is what every man and a certain kind of woman asked in


    1998: “Bill Clinton was President, he could have had any
    woman he wanted, he chose Monica Lewinsky?” No, he had
    to become President to be able to get Monica. That’s the size
    of the power differential that was necessary for him to feel
    relaxed and confident that a woman liked him. If he had tried
    to get someone like, say, Cameron Diaz (who was also famous
    at that time for doing nearly nothing) he would be thinking,
    “oh my God, this woman can totally see I’m a dweeb.”

    At some point in the relationship of TigerWoods and


    ElinNordegren he felt himself become Tiger Woods to her. It is
    irrelevant whether or not this was true for her; in his eyes, she
    was seeing Tiger Woods. Why would a swimsuit model with a
    likely prior history of adequate penises get horny over a guy
    with a flabby belly?

    “Doesn’t he love her anymore?” Of course he does. She


    doesn’t love him, not like she used to. She doesn’t lust for
    him.

    “How do you know that?” I don’t need to know it, Tiger thinks
    it. If it took one billion dollars to get her interested in him,
    how much is it going to take to keep her interested in him, at
    the same intensity? It’s impossible.

    “That’s crazy. Who thinks like that?”

    Tiger Woods. Et al.

    That’s the problem with living in an era of narcissism. Even if


    you aren’t one, you’re not sure about anyone else.

    IX.

    “The best thing he can do is go on Oprah, admit his mistakes,


    maybe go into therapy to try to figure out what makes him
    cheat…”

    He was with several women multiple times over many years.


    He didn’t make a mistake, he didn’t stray, that’s who he is. You
    don’t get to say who you are, your behavior speaks for you.
    Trying to understand why he “cheated” or “strayed” or “made
    mistakes” is bad faith. Those behaviors aren’t deviations from
    his normal, those are his normal. You can’t isolate a behavior
    and unhook it from the overall self. “I’m not a bad person, but
    I do cheat sometimes.” No, you are a bad person. The behavior
    is your business, but you don’t get to commandeer the
    language.

    X.

    “So how can he stop doing it?” Are you talking about him, or
    you?

    You can’t try to understand why you cheat in order to stop,


    you have to stop first. And you can’t permanently alter a
    behavior without changing who you are.

    After much soul searching, I have decided to take an


    indefinite break from professional golf. I need to focus
    my attention on being a better husband, father and person.

    I know it’s a press release, but the words are technically


    accurate. Nowhere does it say “I have to stop cheating,”
    because if he simply stops cheating then he will forever be
    fighting against himself. He has to also change into the kind of
    person who does not cheat.

    There’s no turning back, there’s no half way. Once you stop


    you will be a different person. Many of your other interests
    will change, some of your friends will change, you will think
    differently.

    If this proves too difficult, try a different approach. Instead of


    being the kind of person who doesn’t do something, become
    the kind of person who does do something else that interferes
    with it. Become the kind of man who is proud of his fidelity.
    Or, at the very least, the kind of man who understands that he
    doesn’t have to be TigerWoods to get a girl, and if he does, he
    doesn’t want her. And she doesn’t want him, either.

    See also:

    How To Lose Weight

    Action Movie Fairy Tale

    –-

    http://twitter.com/thelastpsych
    Medical Bankruptcies,
    Redux
    December 14, 2009

    An old post has suddenly received a lot of traffic, and anger.


    So a clarification.
    Here is the original post.

    Here is my first comment by way of explanation.

    How we argue for something matters, especially when finite


    resources are at stake.

    1. Using bad data, or data misapplied, to support a case


    weakens the case, especially to those most able to effect
    change. I look up the study, I see it’s more about disability
    insurance than healthcare coverage. I think, “is this all the guy
    has? He had to play a little game to make his case?” If the
    Harvard guy can’t come up with real consequences, it makes
    me think it’s not a real problem.

    2. Didn’t he just detect a problem (lack of disability insurance)


    that he has decided to ignore in favor of pushing his agenda? If
    he was really interested in the truth, he would want to fix
    whatever the problem his data showed, in this case, disability
    insurance. By ignoring the facts of his study and using them to
    make a different case, it shows he is in support of an agenda—
    an agenda which is not likely to fix his reported problem.

    Which is fine, we all have agendas, and universal coverage is


    an admirable one; but it makes his opinion no more informed
    or useful than an NFL player’s. Neither can claim to have any
    superior insights; Himmelstein probably has superior insights
    about disability insurance, but he prefers to talk about a
    different issue.
    3. What if the government gave out universal disability
    insurance? Then these bankruptcies would fall dramatically.
    Now, by his data, there’s one less reason to have universal
    healthcare.

    A salesman doesn’t have infinite resources to convince his


    client to buy. A military doesn’t have unlimited resources to
    fight every battle in the world. Lawyers do not have unlimited
    resources to defend a client, and these are all public goods in
    the same general range of importance as healthcare. (NB: not
    all healthcare is life-saving.)

    –
    see also

    50% of Americans receive food stamps


    When Therapy Won’t Work,
    Try Cymbalta. When
    Cymbalta Doesn’t Work,
    You’re Dead Meat
    December 17, 2009

    this should work as well as placebo


    I.

    A patient describes being told by her psychiatrist that her


    depression was too severe for therapy or behavioral
    techniques. Only medication would work. The patient says
    that the doc was right:

    Her advice was grounded in neuroscience.


    One research study… used high-definition brain imaging
    to reveal a breakdown in the emotional processing that
    impairs the depressive’s ability to suppress negative
    emotions. In fact, the more effort that depressives put into
    reframing thoughts-the harder they tried to think positive-
    the more activation there was in the amygdala, regarded
    by neurobiologists as a person’s “fear center.” … Healthy
    individuals putting more cognitive effort into [reframing
    the content] decreas[e] activity in the brain’s emotional
    response centers. In the depressed individuals, you find
    the exact opposite.

    Well, that’s one interpretation. Another among the other fifty


    possible would be that depressive patients don’t have an
    opposite response to cognitive framing, but that they are
    unable at that time to do it— and so they end up using an
    emotional reframing, hence the amygdala effect. See? All
    depends what century you want to live in.

    It’s an easy criticism to make— and I’ve made it— that this
    kind of advice damages society, because it makes it
    acceptable, normalizes, that idea depression is primarily a
    biological illness that requires meds; and, in a more general
    way, that “health,” emotional and physical, is just as much
    other people’s problem as it is yours.

    The title of that article is: Note To the Severely Depressed:


    Don’t Try So Hard.

    II.

    “So you think that doctor sucks?”

    No, actually she’s a good doctor, and this is why robots will
    never be able to be (good) psychiatrists, though that they will
    become psychiatrists is inevitable. She (the doctor) looked at
    her, understood her, where she was in her life, and did what
    the Oracle did:

    Neo: But the Oracle told me—

    Morpheus: —she told you exactly what you needed to


    hear.

    She tailors the advice to the whole patient, their perspective,


    their life, their situation. That’s gold, that’s the only reason the
    psychiatrist is there. The psychiatrist did the cognitive
    reframing for her. The post doesn’t describe how awesome the
    Pristiq or Cymbalta was, it describes how awesome the advice
    was. Hearing the advice got her better, not taking the advice.
    Said another way: had she not internalized this advice, would
    the Cymbalta have worked?

    III.

    Before you ask me: no, I’m not advocating lying to patients.
    She wasn’t lying, she was saying what was true at that
    moment for her patient.

    “Until you feel stronger, I suggest you stay away from the
    type of self-help literature you have brought it because
    those texts can do further damage if read in a very
    depressed state.” [said the psychiatrist]

    The psychiatrist’s advice to this patient was perfect; this


    advice to anyone in general with depression would be
    disastrous— beyond it not even being accurate— for them and
    for society.

    Example: what if the medication doesn’t work? You’ve


    already told them that CBT and yoga are no good for severe
    depression, so if the meds fail, does a person have any hope
    left? One might reasonably argue that the type of person who
    fails medications should try CBT or yoga.

    Some people derive strength from knowing their symptoms


    aren’t their “fault” and out of their hands; others derive
    strength from believing that it’s entirely up to them, that they
    can overcome anything if they apply themselves. Each patient
    has to be evaluated separately, and their advice individualized.
    And, of course, all of this is in flux: in a month, they may have
    a different worldview. In psychiatry, if you burn a bridge,
    you’re trapping the both of you on one side.

    III.
    We can ask one last important question about the utility of
    advice in medical treatment. “Said another way: had she not
    internalized this advice, would the Cymbalta have worked?”

    Everyone knows that with every efficacious treatment, some


    proportion of it is related to a “placebo effect.” For example,
    being told you are being given a strong pain killer (but it is a
    placebo) reduces pain by some amount. Similarly, while
    antidepressants reduce symptoms by 30%, placebo does it by
    20%. So we atttribute some of the antidepressant’s efficacy to
    the “placebo effect.”

    This is based on the patient knowing they are getting a


    medication or a placebo.

    What happens when you are given a medication covertly? Not


    that they think it’s a placebo but it’s actually Valium, but rather
    that they are not aware they are injesting a chemical at all?
    Would taking valium but not knowing you are taking anything
    at all reduce the anxiety?

    Not very reliably.

    This doesn’t imply you feel nothing; it means that your


    symptoms remain unchanged. e.g. “I suddenly feel more tired,
    but still anxious.”
    We tend to downplay the effect of words. An antidepressant
    has a chemical effect that is real (even if it might not be
    efficacious) but words are thought to be incidental. That’s
    backwards. Someone can make you cry with words, someone
    can make you sad forever with words. How a doctor frames
    your chances for improvement matters. And how, by the pitch
    of his voice and the choice of words, he conceptualizes your
    problems also matters a great deal. Ask David Foster Wallace.

    (part 2, sort of)

    Also see: Is Prayer Worse Than Cymbalta?


    Intentionality In Treatment
    December 18, 2009

    the Abilify was supposed to improve your symptoms but you


    got better anyway
    As a follow up to advice in psychiatry.

    Intentionality in treatment matters, and it is conveyed in subtle


    ways.

    In an experiment, a subject could be put through a electric


    shock experiment, or a auditory tone experiment, as chosen by
    a second subject. However, sometimes this choice was
    reversed by a computer, and the resultant switch was revealed
    to the subject. In other words, he would see on the computer
    “Subject B chose to give you tones; however, you will receive
    shocks.”

    In this way, Subject A would think Subject B intentionally


    gave him shocks, or unintentionally.
    You can see that the subjects experienced the pain as more
    severe when they thought it was on purpose. However, look
    carefully, you see something else: when it’s by accident, they
    got used to the pain. When it was on purpose, they didn’t get
    used to it.

    II.

    Cognitive reframing can be used everywhere.

    There are plenty of examples related to pain, but it’s better if


    this can be applied more generally. When things are bad, is
    there a way to experience them as less bad? Instead of
    studying something as vague as “sadness” or “anxiety” let’s
    look at something concrete: losing money.

    When subjects were given $30 to gamble (max win $572, max
    loss $30) subjects were measured on how loss averse they
    were:
    Then these same subjects were given a cognitive reframing:
    “pretend you are a trader” “think like a pro” etc.

    This technique reduced loss aversion:

    not just subjectively, but even as measured by skin


    conductance, which measures arousal and sympathetic nervous
    system activity (similar to lie detector):
    Graph A shows that while people were more aroused (by skin
    conductance) to losses than to gains (“Attend” is simply
    gambling without using the reframing trick)— when given the
    cognitive reframing (the “Regulate”) this arousal disappeared.
    “Thinking like a trader” neutralized a physical response.

    When you tease out the people who are good at reframing
    (Graph B, the “Regulators”) the difference between using the
    reframing and not using it is even bigger.

    Clearly some people are naturally good at this, and others are
    not; but the technique can be universally tried. The more you
    practice, the better you’ll be.

    III.

    But the important part of this message is that a person’s


    experience of anything is very much influenced by context,
    presentation.

    Psychiatry has adopted a policy of pulling aside the curtain:


    letting the patient in on the language usually reserved for
    practitioners, which is fine, except that it is almost always
    misunderstood. “Dirty drug,” “bipolar“, “flip him into
    mania”— “augment with Abilify”— these terms convey
    information to the patient that is usually not intended— not to
    mention being factually empty. They are never corrected,
    because the psychiatrist has forgotten how to speak in ordinary
    but still descriptive language.

    Every university hospital has a “Treatment Resistant


    Depression” clinic. However, they are by referral only; a
    patient can’t just call and make an appointment. So why name
    it that? It’s a signal to doctors, “send them here.” But it’s not a
    secret signal— the patient knows what it’s called. What
    message does that send to the patient?
    –

    http://twitter.com/thelastpsych
    Merry Christmas
    December 25, 2009

    8,000 Americans dead in 9/11, Iraq and Afghanistan.

    Don’t email me with your “but what about” and “how can you
    equate—” It’s a fact, not a moral reckoning.

    Every one of them is missed by someone.

    Every one of them leaves behind a half-person, or perhaps


    twice a person, as they have to both eat pizza and open
    presents and smile at work while also carrying the burden of
    pointless emptiness.

    You hear his voice in a park, see him just rounding a corner.
    And every morning before you open your eyes you try to wake
    yourself up back—

    But time goes only in one direction. Better than spiraling


    inwards, towards nothing, as it does for parents who are left
    marking time after their child has moved on.

    There’s no shame in making him a memory and moving on,


    but there’s not much relief in it either.
    Hail and farewell.
    “She Said She Had Breast
    Cancer— But She Lied”
    December 28, 2009

    if it’s in here, it must be about breasts


    It’s worth reviewing an old story because wrong is forever.

    Suzy Bass, a math teacher at a private high school, had breast


    cancer:

    Because Bass had recently moved to Knoxville and was


    single, two Webb staffers—Julieanne Pope, 43, and Terri
    Ward, 51—became her part-time caregivers. “I left my
    cell phone on my nightstand every night in case she
    needed anything,” says Ward, the dean of faculty….
    When Bass was too sick to teach, they’d cover her
    classes. And they kept a steady stream of casseroles and
    smoothies going to her condo. “We’d visit and she’d be
    shaking, pale and so sick,” says Pope, Webb’s technology
    coordinator. At school Bass would cover her head—bald
    from chemotherapy—with a knit cap, and limp from the
    tumor in her foot.

    Except she didn’t: she made it all up.

    Listening to Bass detail the outrageous lengths she went


    to over the years to fake her symptoms is chilling…. Bass
    learned to draw convincing-looking radiation dots on her
    neck with a permanent marker… She would also roll up a
    bath towel, stretch it between her hands and rub it back
    and forth against her neck as fast as she could to give
    herself “radiation burns.” She shaved her own head with
    a razor and made herself throw up from chemotherapy
    “nausea” in school bathrooms.

    She did it for years, at multiple schools, with everyone,


    including her parents.

    Why? Not for the money— she didn’t ask for any disability
    pay/leave. So?

    II.

    I wish this was a joke: the article first suggests it’s bipolar
    disorder.

    Despite all that effort and time Bass spent learning how
    to appear sick, she claims that every time she feigned
    having cancer, she truly believed she was ill. “In my
    mind, I didn’t lie to anybody,” she says.

    Could someone honestly believe she is dying while


    actively lying about it? That’s part of the puzzle Bass’s
    counseling team is attempting to piece together. “It is
    certainly possible that given her diagnosis of bipolar
    disorder, Suzy could have truly believed she had cancer,”
    says Marvin Kalachman [who is treating her.]

    Note the construction of his explanation: the “known” quantity


    is “she has bipolar” and because of that, it is assumed she
    could believe her lies. But in reality, we don’t know she has
    bipolar and we certainly don’t know that she actually believes
    her lies. We only know that she lied. But he’s accepted her
    story and given her an alibi.

    This is the real danger of the overdiagnosis of mental illness: it


    prevents any further analysis of the symptoms. The debate
    from this point on will be about whether she has bipolar, not
    whether her symptoms— in this case believing her lies— are
    real.

    I don’t have to wait long for an example, here’s the next


    paragraph:

    “It’s possible for a bipolar patient to experience delusions


    lasting days or weeks during an episode, Dr. McInnis
    [professor of psychiatry at the University of Michigan
    and a leading expert on bipolar disorder] explains. In
    Bass’s case, however, she went to great lengths to fake
    symptoms—not a hallmark of bipolar delusions, he notes.

    He is correcting the diagnosis: bipolar delusions don’t look


    like this. “Delusions,” as in “she believes them.”

    III.

    Fortunately, the article abandons bipolar as an explanation


    (though not as her diagnosis), and instead turns to something
    that is even more wrong:

    Marc Feldman, M.D., a world-renowned psychiatrist, has


    treated more than 100 women who have faked serious
    illness… he believes he has her diagnosis: Munchausen
    syndrome, a psychological disorder in which someone
    feigns or self-induces illness to get attention and
    sympathy…these people know that they are lying, but
    typically don’t know why they’re compelled to do so.

    You’ll be tempted to disagree with me: “this sounds exactly


    like what she has.”

    And, he says, a diagnosis of bipolar disorder does not rule


    out Munchausen syndrome. Currently Bass’s counselors
    have not diagnosed her with Munchausen syndrome and
    say they are primarily focused on treating her bipolar
    disorder

    The problem with the article’s and the doctors’ assessments is


    that they are being fooled by the content of her lies and not the
    form. Because the focus of the article is cancer, because she’s
    faking a medical illness, the explanation must be some other
    medical (psychiatric) illness.

    What everyone does agree on is that this is a woman who


    will need help for a long, long time.

    “I feel sorry that she’s sick, but I don’t want her to do it to


    anyone else.”

    “I just wish we’d found the right doctor for her 15 years
    ago.”

    Bass is currently unemployed, a medical


    recommendation. “… I’m sick and I’m working on it
    every day,” she says.

    If she had lied for monetary gain, no one would assume it’s a
    psychiatric condition, but because the gain is non-financial,
    she must be ill. That’s because in America, only crazy people
    do things for no money.
    IV.

    The content of her lies suggests Munchausen’s; if this was


    accurate, you’d worry about this:

    But if Bass herself can’t promise that one of these days


    she won’t suddenly start faking breast cancer, melanoma
    or some other disease, how do I know she won’t? How
    does anyone?

    Because she “fakes medical illness for sympathy” the reflex is


    to focus on the words “medical illness,” but where you should
    focus is on “for sympathy.” Munchausen’s doesn’t predict
    what was in retrospect obvious to her students— she lied
    about everything.

    List of things said by Suzy Bass most of us believed…

    Had Breast Cancer…Lie


    Worked for NASA…Lie
    Played basketball for Florida State…Lie
    Got hit by a tornado…twice….Lie
    Good friends with Archie Manning…Lie
    Had dinner with Vince Young, Mike Vick, and T.O….Lie
    Wrote 3 textbooks….Lie
    Name is Suzy Bass…Possibly a lie

    Oddly, the Glamour article misses a lie that was right in front
    of them:

    In the fall of 2005, the school nominated Bass for the


    prestigious Disney Teacher of the Year Award. “[Bass]
    may be the finest teacher/inspiration I have ever been
    associated with in 32 years of education,” Jim Gottwald,
    the Paulding County principal told the Athens State
    University newsletter.
    The actual quote is “Dr. Bass.”

    Meanwhile, it lists some lies Bass herself revealed, but doesn’t


    recognize their importance:

    She once pretended she had a fiancé who died on 9/11,


    that she’d played basketball at Florida State University
    and that she’d starred in the North American tour of
    Mamma Mia! “What I did was wrong, and I’m willing to
    stand up and admit that,” Bass says, “but it doesn’t
    change that my intent was never to hurt anyone. Never.
    I’m not that kind of person.”

    The point here is that the faking of cancer is completely


    incidental to her life’s narrative, what is important is the
    faking. She faked cancer because, simply, it worked very well.
    If she could have gotten sympathy and esteem and identity
    from faking being a basketball pro, then the article would be
    called “She Said She Played For The Celtics— But She Lied!”
    and it would have appeared in Sports Illustrated.

    V.

    “So you think everyone is a narcissist?” No, but when you see
    elements of it, you can make some predictions.

    Before everyone goes bananas, I am not judging Suzy Bass—


    I’m not saying she is a good person or bad person.
    “Narcissist” isn’t synonymous with “jerk”— I’m using all of
    these terms to describe what I see, and make predictions about
    the future in order to help her and others like her.

    The worst thing that can happen to a narcissist is a narcissistic


    injury— in which their desired, constructed identity is
    revealed to be invented. In her case, it was literally fake, not
    just psychologically fake.

    What happens in narcissistic injuries? Rage and violence. But,


    as a woman with limited targets for rage, it gets turned
    inwards: depression, suicide.

    In 1995, when she was found not to have Hodgkin’s disease


    she went into a psych hospital for several weeks. And,
    eventually, she had to move— new location, new relationship,
    maybe even a new “identity”— but for sure you don’t stay put,
    exposed to everyone.

    At her second job in Dallas, GA, where she was found to be


    faking stage II ductal breast cancer, she was able to get away
    and find refuge at her parents house— where her parents still
    believed she had cancer. Identity intact.

    She eventually went to Knoxville, where she got the math


    teacher job and ultimately was exposed again, this time also to
    her parents. Now no solace anywhere.

    Once she left Knoxville, Bass admitted herself into an


    Alabama psychiatric ward and she told doctors she no
    longer wanted to live.

    The Munchausen is wrong, not because it’s formally wrong


    but because it is incomplete, in the same way as saying “it’s a
    thirst disorder” when it’s diabetes. If people are watching for
    “medical lies” as a clue to her condition they will inevitably
    miss the next set of non-medical lies and, importantly, the
    suicide attempt that is likely to result if those are exposed.

    The problem isn’t that this is a woman faking medical


    illnesses. The problem is that this is a ghost, and it’s faking an
    identity. There are a lot of Suzy Basses out there.

    –
    http://twitter.com/thelastpsych
    How To Create: Motivation
    for 2010
    December 31, 2009

    he didn’t finish it either


    This is what’s stopping you:

    1. The fantasy workspace.

    All artists— and probably all people— have in their minds the
    fantasy workspace. “If I could only work in…” Forget it. This
    is always going to fail. Always, every single time. They are
    distractions, they sap emotional and creative energy. You may
    be surprised to learn/assumed that this blog is written mostly
    in airports, hotel lobbies (wifi), and on my Blackberry.

    Here are some famous authors’ spaces. At first glance you


    might say, cool! but look closely, these are basically cluttered
    (or bare) offices and areas. They’re created out of ordinary
    necessity. They weren’t set up, they evolved over time.
    You may try to wave this photo at me:

    “Look, he’s writing in his fantasy studio.” Really? 20 books,


    with a fountain pen and oil lamps? I investigated:

    Real life at home follows a fairly consistent pattern. I get


    up between three and four in the morning and brew a pot
    of tea. In the cool months, I make a fire in the fireplace
    and sit down there to write. When it’s warmer, I go out on
    the back porch. We live on the edge of a few hundred
    acres of pine forest, and it’s pleasant to have the trees and
    birds and animals out there in the dark while I work.
    I do my first drafts in longhand, writing with a fountain
    pen into blank books. I like the freedom from machinery,
    and I seem to write more and faster that way than with a
    computer. It also gives me a definite first draft. Like most
    people, when I compose on a computer I keep jumping
    back and forth; by the time I print out a “first” draft, it’s
    actually been worked over a bit… There’s no electricity
    on the porch, so I write between two oil lamps — making
    up stories about the distant future, using medieval tools.

    Much of this set up is necessity, but in any case he doesn’t do


    it for very long:
    After I’ve finished about 500 words, I quit, and retire to
    the actual study, which is a book-crammed labyrinth of
    computer and office equipment.

    He has a real study, but writes elsewhere to get the juices


    flowing. Worth noting that he started writing this way only
    after he had already published several books.
    This is what you are thinking:

    “If only I had those kind of materials.”


    “If only I had better canvas.”
    “If I only had the Glengarry leads.”
    “If only I was rich.”

    Then you’d fail. Creative success is taking what’s available


    and rising above that. The “that” doesn’t matter, you’ll only be
    credited with success if you go beyond it. Maybe Picasso had
    good canvas but he had to transcend an entire way of painting,
    that’s what made him great, not the physical painting itself.
    Otherwise we wouldn’t be buying prints.
    Stephen King, On Writing:

    For years I dreamed of having the sort of massive oak


    slab that would dominate a room…. In 1981 I got the one
    I wanted and placed it in the middle of a spacious,
    skylighted study… For six years I sat behind that desk
    either drunk or wrecked out of my mind…. A year or two
    after I sobered up, I got rid of that monstrosity… got
    another desk — it’s handmade, beautiful, and half the size
    of the T. rex desk. I put it at the far west end of the office,
    in a corner….I’m sitting under it now, a fifty-three-year-
    old man with bad eyes, a gimp leg, and no hangover….It
    starts with this: put your desk in the corner, and every
    time you sit down there to write, remind yourself why it
    isn’t in the middle of the room. Life isn’t a support-
    system for art. It’s the other way around.
    2. Not starting.

    A common piece of advice is “just start!”/don’t procrastinate,


    etc.

    Let me explain, however, why this is a cognitive necessity.

    No matter how carefully you plan something in your mind—


    work through details, procure materials, etc— it can’t take into
    account everything that happens. Try imagining having sex
    with Paz de la Huerta; and then try actually having sex with
    her. The first is masturbation, the second is very tricky,
    although rewarding, business.

    Every creative idea is a dialogue between you and yourself


    (masturbation); every creative act is a dialogue between you
    and reality (sex.) You can’t account for that other half of the
    dialogue until you begin it.

    Reality takes many forms: the light of a computer screen, the


    need for the “great phrase” to be surrounded by words that are
    less inspired; hunger, the need to pee, fatigue, caffeine
    headaches, hangovers; relentless, crippling, blackening self-
    doubt. You can never account for these except through action.
    I don’t mean they are necessarily obstacles— they don’t
    necessarily hold you back— but the are real success of any
    creative act is that it transcended reality not by bypassing it,
    but by going through it.

    Or you can just go back to masturbating.

    3. “I need peace and quiet!” Not exactly.

    In airports and wifi hotspots, I am constantly distracted,


    usually by women, occasionally by lunatics. However, I get a
    lot done there because both women and lunatics are scared of
    me and so I am rarely interrupted. Peace and quiet is valuable,
    but if every 30 minutes the quiet is interrupted by a phone call
    or your spouse asks you if you bought the ham, you’ll get
    nothing done. Parents tell teens to turn off the FM radio so
    they can study better, but that act of telling them is far more
    distracting than two hours of commercial free Hot97.
    Sometimes, you interrupt yourself (check email).

    This is likely the biggest obstacle to practical creation.


    Creativity takes inspiration from everywhere, but working on
    the creation requires concentration, mental focus. Interruptions
    block this. Imagine again, you are having sex with Paz de la
    Huerta, and your spouse interrupts you to ask if you bought
    the ham. Seriously, how are you supposed to work like this?

    4. 90/10

    You can do 90% of something, but the last 10% takes years, or
    never gets done. How’s that novel coming? Almost done, I’ll
    bet.

    It’s the same process operational in dating. Long term


    relationships that never quite make the obvious and natural
    step of marriage; or furtive glances in a bar that never
    culminate in an audition: “hey baby, before you got here I
    thought I didn’t really want a blowjob. How ‘bout some
    Jaeger?!”

    All of those are the same thing: defenses. Abstractly, they are
    fears of finality. Not finishing means anything can still happen,
    your identity remains intact: “I’m a writer.”

    More concretely, they are a form of self doubt not about the
    success of executing the act which is in your control— the
    writing of the book, the asking the girl out— but of being able
    to manage the consequences which are not— the publishing of
    the novel, sustaining a relationship/finding a burn unit.

    5. Deciding to finish.

    It’s evident I am not a writer; but each post takes me hours to


    write, over days. I revise constantly, and still the result is—
    well, this. However, at some point I have to overcome my
    strong wish to revise again (and again and again) and hit
    submit. First, even though every revision takes the same
    amount of time, the improvement from subsequent revisions
    quickly plateaus. Second, unless I hit submit, none of the
    revisions do anyone any good at all.

    I have to decide that it’s finished. Read again: it isn’t actually


    finished, I have to decide it’s finished. Creative acts require a
    decision to terminate (e.g. sex with Paz) otherwise it can go on
    forever.

    Some creations, like a novel, are large enough that you don’t
    notice you’re avoiding termination. So break a big job into
    smaller pieces each with definite ends that exist reality.

    Example: don’t write the novel, blog the chapters. It worked


    for Dickens. The moment the first chapter goes out your
    relationship to the book will change. Not just due to feedback,
    but you’ll also find out how much of the novel you really had
    in you; if it’s really a novel or just an idea; if the novel is really
    a derivative of someone else’s. Etc.

    If you’re scared of the feedback, turn off the comments. The


    important thing is to do something in reality, not in theory. You
    can procrastinate a single termination point, but it is very hard
    to avoid multiple, regular, termination points.

    Even for losing weight: “I’m going to lose 10lbs by


    Valentine’s Day”— it’s easy to cheat on your goals and say,
    “well, I’ll just make it up next week.” Try, instead, taking a
    photo of yourself in a bathing suit each week and putting it on
    the fridge. Or mailing it to me. Or putting it on a blog. Force
    the idea— your goal of weight loss- to confront reality
    regularly, repeatedly, instead of once (at the end). You might
    say this is going to fail, but if this is going to fail, then you
    weren’t going to succeed anyway.

    Happy New Year. You’re running out of time.


    –

    http://twitter.com/thelastpsych
    Healthcare Reform Is About
    Protecting Monopolies
    January 4, 2010

    Andrew Lawrence predicted it would be completed at exactly


    the right time, whenever that was
    Brain teaser:

    A Medicare patient comes to a Los Angeles psychiatric clinic


    for a new psych eval. 45 minutes later, the doctor codes and
    bills it as “90801 Psychiatric Diagnostic Interview” for $169,
    fee set by the government.

    A month later, the patient returns for a 15 minute med check;


    the doc codes it as 90862 and bills for $61.

    Question: if this appears to be a consistent reimbursement rate


    of about $4/minute, why are there two codes? Why not just
    bill Medicare by the minute?

    II.

    Most people assume the codes are simply government


    bureaucracy, like penal codes or social security numbers, the
    numbers are for public use. They aren’t. They are a product,
    they are intellectual property. To use them, you have to license
    them. They are no different than a Jay-Z song: you have to pay
    Jay-Z for the right to use it.

    The trick is that doctors have no choice, Medicare requires


    them to use these codes— that they must first license or buy.

    Who owns them? You probably think it’s the government, but
    it isn’t: it’s the American Medical Association.

    In 2001 they made about $70M from those fees. Trent Lott
    attempted (read: pretended) to try to break this monopoly, but
    6 months later the Towers came down and no one needed to
    (pretend to) do anything after that.

    At that time (and now) politicians assumed that the AMA


    wanted the copyright protection to help doctors, because it
    prevented the consumer from comparing prices:

    The AMA has been able to impose on the entire nation


    the AMA’s obviously self-interested policy against
    consumers comparison shopping for medical care based
    on price by suing Web sites and others to prohibit them
    from posting comparisons of doctor and other medical
    fees on the Internet using the CPT code [said Trent Lott]

    And that sounds sufficiently populist to get support. But it’s


    about doctors. It’s about the business enterprise that is the
    AMA. It makes $70M from the CPT fees, but it makes only
    half of that from membership dues. In fact, most doctors don’t
    even belong to the AMA (I don’t, nor to the APA); it’s only
    about 15% of doctors.

    The AMA is in the healthcare business, but the business of


    healthcare is business.

    III.
    Lott was completely wrong, he was seeing the AMA as a
    proxy and protector of the greedy doctors it serves. Wrong.
    The AMA isn’t going to protect reimbursement rates from
    Congress, but you can be sure it will protect CPT codes. $70M
    might not seem like a lot, especially in comparison to the
    money at stake in healthcare reform; but $70M is a lot to the
    AMA.

    At some point in the growth of any organization, it spends


    increasing resources on its own existence. It’s not because it is
    evil or selfish, it is by necessity. Consider the hypothetical
    example that the AMA wants to serve doctors, but
    membership is declining, so to boost revenue in order to serve
    doctors it tightens its grip on CPT codes, journal fees, etc.
    However, doing these things puts it further at odds with
    doctors that they want to serve, resulting in further declining
    membership, which, by necessity, results in even tighter grips,
    etc.

    This is not an ethical judgment, it’s public choice theory, it’s


    survival. So far no problem. This is the important part:

    At some later point in the growth of an organization, as the


    members become more vocal in their disapproval, it begins to
    question the sanity of its own members; it doubts whether the
    people it serves even know what’s good for them. It assumes
    that the self-interest of the individual members is morally
    inferior to the self-interest of the organization.

    This point is an inflection point; it is the beginning of the end


    for one of them.

    –
    http://twitter.com/thelastpsych
    The Limits Of Control: The
    Movie
    January 7, 2010

    Hmm. Matches. Wow.


    People will describe The Limits of Control in different ways,
    but inevitably using the phrase “worse than getting raped in
    the penis.” That’s typed correctly. I did manage to find three
    reviews that did not include that phrase:

    “It’s an art movie with almost no dialogue, action, or


    story, about characters with no names who are doing
    either nothing or something that you never get to
    understand. And it’s long.”

    “Take an action movie, remove all of the action scenes


    and dialogue, and send straight to video.”

    “Biggest waste of time I have experienced since the


    Obama state of the union address.”

    Here’s the IMDb synopsis:


    The Limits of Control is the story of a mysterious loner, a
    stranger, whose activities remain meticulously outside the
    law. He is in the process of completing a job, yet he trusts
    no one, and his objectives are not initially divulged. His
    journey, paradoxically both intently focused and
    dreamlike, takes him not only across Spain but also
    through his own consciousness.

    Don’t ask me why, but this made me excited to think it would


    be a David Mamet redo of GI Joe: The Rise of Cobra. I was
    very mistaken. And I got retinoblastoma.

    The main character is an iceman, highly focused on the job he


    was hired to do (which we don’t understand.) He almost never
    displays emotion; he rarely talks. His face is made of concrete.
    Weird characters talk to him in cryptic sentences, pass him
    ciphers hidden in matchboxes which he reads, then eats. When
    he finds a naked billion (on a scale from one to ten, she’s a
    billion) on his bed asking to have sex with him, he says,
    “never when I’m working.” Control. He is frequently shown
    doing tai-chi, or staring at specific paintings in a museum: for
    focus. He always wears a suit when he is “working,” day,
    night,sleeping, city, or in a desert.

    That may sound like an excellent setup for a movie, except


    that there isn’t any movie to go with it. None. Nothing
    happens in this movie, ever.

    Here’s a pivotal scene from the movie:


    Now, it may be difficult to see from this photo what is actually
    happening, so I’ll tell you: nothing. At all. I don’t mean
    “nothing” as in “something, but it’s boring,” I mean nothing.
    For the whole scene. Let me emphasize again that this is a
    pivotal scene.

    Here’s a pivotal video clip:

    You may raise an eyebrow: “hey, what are you trying to pull
    here, that’s not a video clip, it’s a still photo.” Exactly. The
    Limits of Control isn’t a movie, it’s a series of photographs,
    each displayed for, oh, I don’t know, 25 minutes each? and set
    to music. Bring blotter acid.

    The movie seems to be offering you clues and hints about


    what’s happening. I paused the movie on one of the ciphers to
    see if I could crack it, but I couldn’t. I googled some of the
    phrases and images— nothing. I wanted to figure it out, but
    couldn’t.

    The entire movie is populated with surreal images which beg


    for explanation, or at least a link to the haiku that passes for a
    script. No.
    I have no idea what that building is, why he’s looking at it,
    why he has a picture of it, and why it appears later on as a
    small statuette.

    But, look, I don’t own a North Face jacket, it’s possible I’m
    just not hip enough to understand the symbolism. That turns
    out to be wishful thinking.

    Example: Destro asks the waiter to bring him “two espressos


    — in two separate cups.” Hmm, intriguing. He’s very
    emphatic about it, says it twice. But the waiter, who has to be
    deaf or retarded, instead brings him a double espresso. Destro
    yells at him, sends him back— it’s one of the only instances of
    emotion in the whole film. Hell, it’s the only instance of action
    in the entire movie.

    He does this, the ordering of two espressos, several times in


    the movie. This is framed and shot in such a way as to make
    its importance indisputable. So you say, ok, what gives? What
    is the relevance of two separate espressos? Is it a code, a
    signal? Is it an allusion to an Antonioni film, to Heidegger,
    what?

    Turns out you are wasting your time: this isn’t a symbol or
    clue, it was something that the actor actually did in real life,
    that the director, who was with him at the time, found funny.
    So he put it in the movie. “I found it amusing that he blew up
    at the guy.” That’s it. ‘Art imitates life.’

    Another example: the ending does have a sort of climax, but


    it’s not obvious, so if you made it this far in the film you are
    paying close attention to everything, looking for some sort of
    explanation like it’s the season finale of Lost. Why is does he
    change into that shirt? Why is he in an airport? Why is it
    green? etc.

    In the last scene, the movie picture appears to jolt suddenly;


    the only way I can describe it is that it’s as if the camera
    operator started putting the camera down before he turning it
    off. What’s the significance of that jolt? It’s in such contrast to
    the stillness of the rest of the movie. Does it mean it’s all a
    dream? He’s killed? What? No, believe it or not, that jolt
    happens because the camera operator actually did put the
    camera down before he turned it off. And the director liked the
    effect.

    I had to watch 27 Dresses with Katherine Heigl to detox from


    this atrocity, but then I ended up getting the bends. But that
    was the end of my involvement with this movie.

    Well, it was until this happened.


    (Part 2) The Limits of
    Control: The Dream
    January 9, 2010

    …wait a second, these aren’t matches, they’re MacGuffins…


    Part 1 here.

    Once in a while we gather at a friend’s house to watch a


    movie. We usually go to her house because it is the most
    inviting and comfortable, comforting; unlike mine, which is
    really only good for hiding POWs.. Her place, like her, is
    highly developed but but uncomplicated. Considerable taste
    but no knick knacks. No decorative soaps. When she’s not
    working (sports reporter) she doesn’t wear make up. She
    doesn’t need to. She doesn’t need clothes, either, but ignores
    this advice. Her (ex) boyfriend, whom I assume had a brain
    parasite, took 6 months terminally asphyxiate their
    relationship with a combination of weed, surfing, bartending
    and auditions.

    This time I picked a movie I had read about: I picked The


    Limits Of Control. She wasn’t in the mood for a movie, but I
    had thought she needed a diversion. (Remember, I thought this
    was going to be an artsy G.I. Joe.)
    Of course I was wrong. At about the first cafe scene I briefly
    fell asleep, then when I awoke a few minutes later I said,
    “what’d I miss?” and she said, “I filled your cup with
    strychnine.”

    Not only did she hate the movie, she couldn’t stop telling us
    how much she hated it. For days afterward. “I am actually
    angry at the director for robbing me of part of my soul with
    that stupid, pointless, go nowhere movie. Boring! It was like
    having to listen to someone tell you their dream.”

    And then she added, with restrained fury: “This is Chuck’s


    kind of movie.”

    II.

    Freud was clear on two things: dreams are wish fulfillments,


    and they can only be interpreted using free association. There
    is no dream dictionary where flying means sex and cougars
    mean cougars.

    Many elements of director Jim Jarmusch’s movie are dream


    like: they draw from waking life, have their meaning stripped
    away and are then endowed with some other significance,
    specific to the dreamer.

    For example, the title is derived from an essay with the same
    title by William Burroughs. But don’t bother reading it
    because (quoting Jarmusch):

    I don’t know why. I love the title. The film does not,
    obviously, relate specifically to the essay—and I love
    that.

    The two espressos, the shiny suits, “A Point Blank


    production”— all are references to real events (or movies or
    books, etc) which you are tempted to link back to. Resist.
    These aren’t allusions to something; they are symbols for
    something else. It’s not an episode of Lost. You can’t
    understand their meaning by looking up the references.

    The important thing is to say whatever comes to mind.

    III.

    Whenever a new “contact” approached the Lone Man, they


    would say, “you don’t speak Spanish?” as a secret passphrase.
    She thought this was stupid. “He’s an African man in Spain,
    and he doesn’t actually speak Spanish— wouldn’t you come
    up with a better code? It’s like using “do you want fries with
    that?” at a McDonalds.”

    In the Freudian logic of dreams, an inability to do something


    — being lost, stuck in traffic, something is missing—
    represents contradiction. And when that inability is
    accompanied by a feeling of inability— you’re stuck to the
    floor, it’s too heavy, you can’t run— it represents conflict of
    the will. So you just met a man and you’re not sure about him,
    and you dream you’re being chased by a powerful monster,
    but your feet are stuck to the ground and you can’t run. It
    would mean you’re conflicted about the monster
    (relationship.) But… but the dream as wish-fulfillment means
    you don’t want to escape.

    She lit up. “He’s passive aggressive. He chose to go to Spain,


    but he doesn’t know Spanish, so he has a convenient excuse
    not to have to listen to them. That’s a classic Chuck maneuver.
    There’s always a reason why he can’t be with you or give you
    his attention, but he yet he’s totally dependent on others to tell
    him his next move or what to do next, he can’t make major
    decisions on his own. So he waits for you to tell him, and then
    he picks and chooses what he hears.”

    “Was the ‘two espressos’ another kind of passphrase?” I ask.

    “No, I feel like that was just posturing, trying to make himself
    seem unique. It’s funny that he gets really mad at the waiter
    for not bringing him the right order, but he won’t sleep with
    the naked woman.”

    “How are those related?”

    “So, what, he has enough self control to resist sex, but not
    enough self control to be polite to the waiter? He’s a coward.
    What guy would not fuck a girl they found naked in their bed?
    What is he, 15? Is he a virgin? She’s not asking to get married,
    she just wants sex, just fuck her and get on with it. But he’s so
    nervous around women he has to pretend he’s a zen master?
    Maybe if he fucked her, he wouldn’t care so much about how
    he got his espressos.”

    No one else would have made this interpretation. I’m almost


    certain Jarmusch didn’t intend it either. But this was, after all,
    her dream.

    “Wow, that is so much like Chuck, always playing the part of


    “I’ll handle everything” but when it comes down to it… That’s
    why he balled out the waiter. He can control himself, but it
    makes him crazy that he can’t control other people or the
    world around him. So he creates all these rituals he has to do
    over and over to give himself the illusion of control.”

    I suggested Freud’s interpretation, that repetition with


    variations (for example, the nude woman, then in a raincoat,
    then as a painting; the white castle, then a picture, then a
    statuette) represents a working through of some issue or idea;
    and that multiple symbols can be seen as working through the
    same issue in different ways. It clicked.

    “That’s what all Chuck’s games are about, he wants everything


    exactly right, precise and perfect but that’s so nothing ever
    changes, he never moves forward, he never evolves.
    Everything has to be by his schedule. Do you know he once
    said “not while I’m working” to me one time? He’s a
    bartender, for Christ’s sake.”

    So I asked, “why would Chuck want to kill Bill Murray?” Bill


    Murray plays a Dick Cheney character. The Lone Man
    infiltrates his secret impenetrable bunker (not shown in the
    movie; “I used my imagination”) and kills him.

    “Bill Murray is his father, obviously. He’s spent all this time
    working through his ambivalence about me and his job and
    everything else, he’s finally mustered the courage to become
    his own man. Well, he wishes he did. He finally gets power
    over and he ultimately disposes of people that control him. I
    think a real father would want his son to stand up to him,
    because it means he’s finally a man. That’s why Bill Murray
    the father figure knows he’s going to be killed but isn’t scared,
    he doesn’t fight or run. And he says “you don’t know how the
    world works” with no fear at all, just contempt. Which is
    actually the kind of thing his dad would say. I could see that
    Chuck wishes he could get out from under his father and grow
    up.”

    “And fuck you?”

    “Too late for that,” she said.

    IV.

    I’ll repeat that I still thought the movie was boring. But now
    I’m not sure that matters. I think I am better for having seen it,
    my friend probably feels the same way. It has stayed with me
    and altered the way I look at other things. In the final analysis,
    what Jarmusch intended is probably irrelevant: the important
    thing is to say whatever comes to mind.

    http://twitter.com/thelastpsych
    Is Genetically Modified Food
    Safe?
    January 11, 2010

    uh oh
    A recent study on the safety of genetically modified food is
    important for two reasons:

    1. This is the first of its kind (!)


    2. This is the longest in vivo study (in animals) on the safety of
    this food: 90 days. (!!!)

    Rats were given one of three strains of genetically modified


    corn, or a non-GM corn feed, and studied for 90 days.

    The results were not encouraging,

    Our analysis clearly reveals for the 3 GMOs new side


    effects linked with GM maize consumption, which were
    sex- and often dose-dependent. Effects were mostly
    associated with the kidney and liver, the dietary
    detoxifying organs, although different between the 3
    GMOs.
    For example:

    While these are not gigantic results, keep in mind that these
    are rats are eating at most a 33% mixture of GM corn, and it’s
    only for 90 days. If you want to know if they cause cancer, just
    check with your kids in a few decades.

    II.

    It’s not obvious to me how eating something with modified


    DNA is harmful. When you eat DNA, you don’t incorporate
    bits of it into yours, any more than when you eat a pie you
    incorporate bits of pie.

    One corn (NK 603) was modified to be able to withstand the


    plant killer Roundup, and two others (MON 810 and 863)
    were modified to produce an insecticide. When you eat this
    corn, therefore, you are also eating some herbicide or
    pesticide. In other words, it may not be the GM corn itself that
    is toxic. If the corn is grown on a farm that is sprayed with
    Roundup, then you’re eating Roundup. It’s quite possible this
    study is measuring the toxicity of Roundup, not GM corn.

    Put another way: maybe they should find better ways of


    washing the corn?
    III.

    Does washing corn— or anything— help remove pesticides?

    A.

    In one study, water alone was tested vs. Fit Fruit And
    Vegetable Washing Kit.

    Three points:

    1. Study 1 fruit had been treated only with captan; Study 2


    fruit was treated with a mixture of captan and methomyl.

    2. Water and Fit both wash off captan well, but water isn’t as
    good for methomyl, probably because fruits are coated with
    wax after they have been treated with pesticides, locking in the
    deliciousness. Water doesn’t penetrate wax, but ethanol (in Fit)
    does— as does rubbing the fruit. Moral: scrub wash, then peel,
    then wash your fruit. Soaking them in rum is helpful and
    delicious but not recommended.

    3. This is what they mean by washing: soaking the fruit in 2L


    of water for 30 seconds, then rinsing it four times, 30 seconds
    each. Then rinsing again for 5 seconds with 2L fresh more
    water.
    B.

    An older study found that water was as good as Fit and even
    washing in 1% (!) Palmolive, significantly reducing 9/12
    pesticides studied. (It had no effect on 3 others, so there’s
    that.)

    C.

    What about meat?

    While many pesticides have been banned (e.g. DDT) they are
    still in the soil and get incorporated into the plant. In a similar
    manner, current pesticides are theoretically incorporated into
    the fat of the farm animals that eat the sprayed plants and feed.

    A study done in India found various meats (cow, goat,


    chicken) to be contaminated with several pesticides, including
    DDT. None of the animals appeared sick prior to their
    slaughter. However, and this is the point:

    Cooking means steam (in a pot.)

    I’d guess that cooking vegetables probably has the same


    effect.
    –
    http://twitter.com/thelastpsych
    Everyone Goes Crazy In A
    Different Way, As Long As
    That Way Is The Same
    January 14, 2010

    “yeah, everyone in America is so fake”

    The NYT writes The Americanization of Mental Illness:

    In some circles, it is easy to make friends with a rousing


    rant about the McDonald’s near Tiananmen Square, the
    Nike factory in Malaysia or the latest blowback from our
    political or military interventions abroad. For all our self-
    recrimination, however, we may have yet to face one of
    the most remarkable effects of American-led
    globalization. We have for many years been busily
    engaged in a grand project of Americanizing the world’s
    understanding of mental health and illness.

    The article cites the experiences of a Chinese psychiatrist in


    the 1990s who tried to explain the culture specific
    ramifications and meaning of anorexia in Chinese patient: not
    a fear of being fat, but a vague feeling of GI distress. This was
    some unconscious manifestation, a somatoform disorder.

    Then a woman passed out and died from anorexia on a


    subway:

    In trying to explain what happened to Charlene, local


    reporters often simply copied out of American diagnostic
    manuals. The mental-health experts quoted in the Hong
    Kong papers and magazines confidently reported that
    anorexia in Hong Kong was the same disorder that
    appeared in the United States and Europe.

    What happened next seemed to surprise the psychiatrist: not


    only did anorexia rates start to rise, but no longer was it due to
    the vague GI distress. These new anorexics specifically cited
    “fat phobia” as the core.

    Western ideas did not simply obscure the understanding


    of anorexia in Hong Kong; they also may have changed
    the expression of the illness itself.

    Dr. Lee surmised that because the language to describe


    anorexia came from America, then

    When there is a cultural atmosphere in which


    professionals, the media, schools, doctors, psychologists
    all recognize and endorse and talk about and publicize
    eating disorders, then people can be triggered to
    consciously or unconsciously pick eating-disorder
    pathology as a way to express that conflict.

    There are two points to ponder: first, what are we to do with


    the genetic basis if the incidence of a disorder jumps so
    suddenly?

    Second, and more importantly: if Chinese people are being


    nudged into developing western style diseases because they
    are being bombarded with western psychiatric descriptions,
    then what do you think happens to western people?

    That feeling you have is what Sartre called nausea. Seroquel


    won’t help.

    II.

    The article, through Dr. Lee, blames the usual suspects:

    Mental-health professionals in the West create official


    categories of mental diseases and promote them in a
    diagnostic manual that has become the worldwide
    standard. American researchers and institutions run most
    of the premier scholarly journals and host top
    conferences. Western drug companies dole out large sums
    for research and spend billions marketing medications for
    mental illnesses… Taken together this is a juggernaut that
    Lee sees little chance of stopping.

    In this case the problem isn’t psychiatry, it is the


    popularization of psychiatry: it is the press, it is the media.
    She didn’t read the DSM, she read the newspaper (and
    magazines and TV and…) They’re not simply popularizing
    western psychiatry, either— they’re popularizing western
    culture. It’s a safe bet that “local reporters” are going to be
    more westernized than “locals.” But reporters have a forum, so
    they get to determine the narrative. The “local reporters” in
    China basically did what the American press does: “here’s
    what we think happened. Hit Print. There, now it’s true.”

    When Google threatens to pull out of China, it isn’t because of


    human rights violations. It’s a battle for who will describe the
    universe. NB: Google will win.

    III.
    The article describes an experiment that could be called, “You
    rise to the level of your diminished expectations.”

    A subject tried to silently train a second person to press some


    buttons in a specific order. He is told that the second person
    had a psychiatric disorder either due to “life events” or to a
    “brain disease.” The only feedback they could give was to
    administer a very mild shock, or a very big shock, when the
    second person got the pattern wrong.

    When the subject was told that the second person had a
    psychiatric disorder due to life events, they got the mild shock.
    When it was due to a brain disease, they got the big shocks. If
    there is already something wrong with their brain, the subject
    figured he had to make things obvious.

    The point of this example was to illustrate that other cultures


    may end up stigmatizing the mentally ill if they begin to
    incorporate the Western idea that these are strictly brain
    diseases. Too late: incorporating the western idea was what
    gave them the disease in the first place. Seroquel won’t help
    that either.

    IV.

    “You have a background in genetics. How can you flippantly


    say that ideas are causing psychopathology?”

    The interaction of genes of risk with other genes that we have


    not yet identified— say, an insulin receptor or the size of your
    pancreas or your ability to fight a flu infection— that we
    wouldn’t even think is relevant, may be quite relevant. Most of
    our psychiatric genes of risk are risks only in certain
    environments. That may seem obvious, but consider that a
    person with schizophrenia, in which the mind has difficulty
    with reality, may be even more ill when their reality is actually
    less real: a Chinese teen in China saturated with western
    images. Perhaps if he never turned on the TV, he never would
    have developed the symptoms (or they would have been less.)
    The Japanese hikikomori phenomenon may be an example.
    Go back to the story of the Chinese anorexic woman who died.
    The article doesn’t point put the obvious: she had already been
    infected by the west. Her name was Charlene.

    Certainly I don’t hate the west; but when you dip your feet
    into someone else’s culture without the accompanying mental
    and social infrastructure that goes with it, well, you’re going to
    get anorexia. Or something.
    This Man Killed His Family
    And He Doesn’t Know Why
    January 17, 2010

    I guess I didn’t want any witnesses


    Christian Longo was a “successful businessman” who fell on
    bad times/spent too much money. Too ashamed to admit to his
    wife he was failing, he tried credit and then
    theft/forgery/counterfeiting to maintain the image. When he
    knew the cops were on to him, he did the obvious thing: he
    strangled his wife while she was on top of him during sex;
    then strangled his 2 year old daughter who was sleeping on the
    floor beside their bed; stuffed their bodies in suitcases; then
    put his other two sleeping kids into their car seats and drove
    them to a bridge, tied rocks to their feet, and threw them in the
    river. Then he went to Cancun.

    He had the kind of time in Cancun you’d expect: drinking


    beer, smoking pot, and pretending to be a New York Times
    reporter (he had always wanted to be one), and having sex
    with a girl who wanted to be a photojournalist who thought he
    needed one for his story. Within a month he was caught.

    Coincidentally, (or not, depending on your belief in


    synchronicity;) (or not, depending on whether you believe
    anything Christian Longo says;) the reporter he was
    impersonating was simultaneously being outed as having faked
    an article in the NYT.

    Longo was convicted and sentenced to sitting on death row for


    the rest of his life. But he never confessed. Longo decided he
    would only tell his story— the real story, of course— to
    Michael Finkel, the reporter he had impersonated.

    II.

    It’s not spoiling much to tell you that Longo is a classic


    narcissist, but it’s worthwhile to go through the examples:

    Longo was not a violent or mean person:

    In fact, I could not unearth a single violent incident in


    Longo’s life before the murders, apart from a minor
    scuffle his freshman year of high school. I looked
    everywhere; I spoke with everyone I could. I didn’t even
    find an occasion when he lost his temper, when he so
    much as raised his voice. He hardly swore; he never
    fought with his brother. A woman who attended his
    church said she used to tell her friends, “I wish my
    husband could be more like Chris Longo.”

    But past performance is not indicative of future results because


    he’s never been tested: he’s never had a narcissistic injury,
    wherein you are discovered to be not what you said you were.
    He thought of himself as— he wanted people to believe that—
    he was a successful, rich, businessman. But the business ran
    out of money, the debts piled up; so he counterfeited and
    forged, not to cover expenses but to keep up appearances.

    And you can’t admit that you’ve been deceiving your


    wife for years, that in reality she’s married a loser and a
    liar and a thief… You’re trapped.
    Trapped? If he cared about money he would have stolen more
    of it; maybe even killed a couple of people to get their money.
    No. If he cared about his freedom he could have abandoned
    his family and fled the country. No. If he felt guilty about what
    he had done he could have found Jesus or simply killed
    himself. No. The thing he cared about more than anything else
    was his identity, and the ones who reflected that identity back
    to him were his family. They had to go.

    Probably, you don’t understand how killing people you love


    so much protects your identity: aren’t you now going to be
    exposed as a murderer? But if you kill your family, then no
    matter what else happens to you it doesn’t matter, because
    they will never know. You did them a favor: they don’t have to
    live with the pain of knowing you are a fraud.

    III.

    Even a narcissist is going to feel some remorse when he kills


    his family, right? It’s not like he didn’t love them:

    When thinking back about times in life where my heart


    was squeezed in my throat, nothing hurt more than when
    Sadie fell off the swing that I was pushing her on. To see
    tears fall from your child’s face that you are the direct
    cause of was more painful than anything that I could
    remember. It’s still painful. How could I be so horrible &
    still have that sort of pain?

    Nope. Those are reflex emotions, the kind you feel watching a
    romantic comedy or a porn or Beaches.

    Also, he noted, as further refutation of his psychopathy,


    “I got choked up during E.T. & Titanic.”

    That’s right, he said choked.


    But his reaction to the photo [of his smiling kids]
    disturbed him. “I’m not really feeling what everyone else
    feel’s,” he wrote, tossing in, as he often does, an extra
    apostrophe. “What should be most difficult to stomach is
    what I’ve done [the murders], yet somehow that part is
    still palatable.”

    Narcissists don’t feel guilt. Only shame.

    IV.

    Guilt implies an internal sense of right and wrong. Whether it


    originates from your religion or your parents or the penal code
    or Star Wars isn’t relevant, only that external rules are then
    internalized, and you then build an identity around them. So
    that when you violate them and there is no way anyone
    noticed, it still gnaws at you because it conflicts with your ego,
    who you are. Id exists from birth, so superego has to precede
    ego.

    Shame comes not from the action but from the exposure. You
    wouldn’t say you were ashamed unless you have been
    observed, caught. Shame is a conflict with reality: I think I’m
    this kind of a person, but now this other guy has external
    evidence that I’m not.

    A narcissist can’t feel guilt because, while he admits to


    external rules (religion, ethics, etc) those rules are always
    secondary to his identity. As long as the identity is intact, you
    didn’t do anything really wrong. There’s no internal conflict
    with your sense of self because your identity has one
    superseding rule: self preservation. You will sacrifice
    anything, including your life, to preserve that identity. That’s
    why your boyfriend killed himself to get (back at) you.

    If Christian Longo had been arrested in Cancun for forging


    checks, he would have felt worse about that than about killing
    his family. And he will always feel worse about anything that
    exposes him than about killing his family.
    Longo’s facade in prison is the same as it was in the
    outside world: a successful businessman. On death row,
    people think he’s a stock-market whiz. And on the
    surface he seems to be. He subscribes to The Wall Street
    Journal and Barron’s and often keeps his TV tuned all
    day to CNBC. He supposedly calls his broker with picks
    and earns big profits. It’s actually an elaborate ruse. “All
    of that pretend stock market playing is believed to be
    real,” Longo writes. “I’ve never told anyone that it’s not.
    And I use the phone for sufficient amount’s of time to all
    for that thought to seem legit.”

    Maintaining the stock-market lie, Longo writes, is getting


    “exhausting.” But he can’t be honest, he explains,
    because of “extreme embarrassment.”

    This will never stop.

    V.

    There’s a passage in Finkel’s article that’s meant to be


    poignant: for the first time, Longo tells in graphic detail how
    he killed his kids. He describes putting them into their
    respective car seats and strapping them in, driving to the river,
    putting a rock in a pillowcase and tying it to one ankle,
    throwing the kid in the river and then going around to the
    other side of the van and repeating the process with the other
    child…

    “I can see the kids so clearly in my mind now,” he said.


    “You know when you catch a whiff of somebody’s scent
    and how vividly it brings back so many images? That’s
    how I feel about my kids now, I can feel them, smell
    them, touch them in my mind. I can hear their voices. See
    their faces. But I can’t remember who I killed first.”
    A tear escaped from his left eye. Just one. He wiped it
    away quickly.
    “I can’t remember who I killed first.”
    This is an vicious, absolute lie. He killed the child on the
    driver’s side first, and every parent knows which kid is on what
    side. This is a show, a pretense, designed to invoke sympathy
    for his suffering (note the single tear) and appear as though it
    wasn’t really him who was doing it— I’m not really the kind of
    person who would kill his kids. The problem is that he is
    exactly the kind of person who would kill his kids in this way
    for these reasons.

    In fact, nearly everything Christian Longo says is bullshit.


    Words, words, words, bullshit and more words:

    At first, Longo had blamed a drug-addled intruder for


    killing his family. Then he accused MaryJane of initiating
    the murders. Then he said he wasn’t really sure of the
    details. He testified for four days but never convincingly
    explained what happened that night…

    This isn’t a coherent defense, it’s pass interference, it’s


    reasonable doubt. It’s not important what did happen, it’s only
    important that it wasn’t him.

    …using charm and guile and a steady stoking of my


    journalist’s natural curiosity (he was innocent, he was
    framed, he had proof, he would show me), he soon
    became deeply enmeshed in my own life. In the first year,
    we exchanged more than a thousand pages of handwritten
    letters.

    And these endless words and the “enmeshing” into your life
    are a way of wearing you down into giving him the benefit of
    the doubt. Look, you know me, you know the kind of person I
    am, right? I can go on and on about this all day; just trust me.

    VI.

    What I’m about to write isn’t to further condemn him but to


    show you the psychology, the moves, so you can recognize
    them elsewhere.

    Rotting away on death row is not a narcissist’s idea of a good


    ending for his movie. Where’s the drama, the self-
    actualization, the people talking about you? No one cares
    about you, no one wants to hear your nonsense about who you
    think you are (hell, he’s spending time trying to convince
    convicts that he’s a daytrader).

    Longo found a way to make it worthwhile. Narcissists imagine


    themselves the main character in their own movie, and
    Christian Longo decided that movie was Seven Pounds.

    The movie stars Will Smith, who, after accidentally killing his
    family in a car wreck, seeks out worthy people who are in
    need of organ transplants. And then kills himself, with
    instructions to donate the organs to those people.

    I’ll let you imagine how Longo envisions this playing out. Of
    course, it doesn’t matter how it ends, only that in the interim

    And yes: so happy. He has a mission, a focus, a purpose.


    In a way, the project has transported him beyond the
    prison walls. He decided not to drop his appeals after all;
    rather he’s aggressively pursuing them full force, likely
    putting off his execution date by at least a decade. He
    needs the time, he says, to work on GAVE [changing the
    laws so that the executed are allowed to donate their
    organs.] He wants to live.

    Of course he does. This is a trick, you think the movie fits


    because of the organ donation angle, but the real association
    isn’t with organ donation but with Will Smith, the sleight of
    hand that it was an accidental killing of his family, yes, he did
    it but no, it wasn’t exactly him, he doesn’t even remember it.
    The organ donation is secondary. He wants that every time
    you think of Christian Longo you think of a man who
    ultimately performs a selfless act to make up for a tragic
    mistake.
    Will Smith’s character felt guilt despite no one else blaming
    him for the deaths. Longo is the opposite: everyone blames
    him, except himself.

    VII.

    The Esquire article is full of these examples and is worth


    reading. But I can hear you: ok, he’s a narcissist, I get it, but if
    there were no warning signs, how would anyone know?

    I don’t have an answer. I can say confidently that Zyprexa and


    Seroquel aren’t going to help.

    But there’s this: Longo killed before he was exposed. LA


    Fitness shooter Sodini killed because he felt the game was
    soon to be up. Etc. It seems that the truly dangerous time is
    right before, when the terror of the possibility of exposure
    grips them, and so all options are on the table. After exposure
    there is only defense and running and crying and anger, and
    rage and violence, too, but not the kill-anyone-who-knows
    kind you see the week before the pictures are to be released or
    the month before the girl goes off to spring break.

    I can’t tell you what to do about the guy you suspect is going
    down the wrong road, but I can tell the guy himself what to
    do: turn back. You know it’s complicated and exhausting to
    keep up the appearances, to keep pretending, even if it’s
    working, because eventually you will get fat, eventually you
    will get the bill, eventually she will leave you, eventually you
    will fail. It is inevitable.

    VIII.

    You want a simple answer: why did he do this?

    At no point in the Christian Longo timeline from birth to now


    was murder even a remote possibility. We look for reasons he
    did this: were there signs, a homicidal triad, bipolar, drugs,
    genetic history? We want reasons why it happened. There
    aren’t any.

    The important question is the one no one asks anymore: what


    was there that would have held him back?

    –-

    More on Longo in the NYT.


    Most Frustrating Technology
    of 2010 (so far): Google
    Android
    January 18, 2010

    if I see this thing in my house, I’m stabbing it


    I’m posting this here because I have no where else to turn,
    maybe someone can help me. Or, I can just publicly shame
    Yahoo and Google.

    The Motorola Android (Verizon) does not connect with


    Yahoo! Mail properly. There are two big glitches:

    1. Deleted messages reappear the next day, and read messages


    re-highlight as unread. There’s no predictability or periodicity
    to this. It can happen in an hour, or in two days.

    2. When you reply to an email on the Android, it saves


    thousands of copies in your Yahoo! sent mail box. Last night I
    deleted 46000 messages.

    This is what I’ve done so far. I’ve followed the Verizon and
    internet directions:

    1. Make sure Wi-Fi is turned off


    2. Press the E-Mail icon (the default Android E-Mail
    application)
    3. Enter your Yahoo E-Mail address and password
    4. Press “Manual Setup” in the lower left hand corner
    5. For “Incoming Server Settings” set the IMAP server to
    “imap.mail.yahoo.com” and the Port to 143
    6. For “Outgoing Server Settings” set the SMTP Server to
    “smtp.mobile.mail.yahoo.com” and the Port to 587
    7. Check “Require sign-in” and press Next
    8. Select how often your Droid will check for Email, and
    choose default options
    9. Give the account a name and set your display name for
    outgoing messages

    With these instructions the phone deals with email properly


    except for the two glitches noted above.

    I have tried variations:

    1. Removed the “mobile” in step 6 (so it is just


    smtp.mail.yahoo.com). No.
    2. I have turned off the “saved sent messages” in the Yahoo!
    Mail account options. It still saves.
    3. I have entered the username as both” XXX@yahoo”.com
    and just XXX. No.
    4. I have tried this with the free Yahoo! Mail as well as with
    the paid Yahoo! Mail Plus. No.
    5. I have tried driving over it. No.
    6. I have tried changing the outgoing settings to
    plus.smtp.mail.yahoo.com as well as
    plus.smtp.mobile.mail.yahoo.com

    I realize I can just switch to GMail, but if anyone knows how


    to resolve this, please let me know.

    Update:

    7. I tried changing the incoming mail server to


    imap.n.mail.yahoo.com. No.

    I determined that the copies are made each time the Android
    connects to Yahoo to check for emails, e.g. every 15 minutes,
    every time you send another email, or every time you hit
    refresh. It makes 2-3 copies each time (can’t figure out why)
    but over the course of a day…

    Update 1/24/10

    The problem appears to be hardware or carrier, not software.


    The Motorola Droid runs 2.0 and has the problem, while
    mytouch runs 1.8 and is free of this abomination.

    However, the Nexus One on Tmobile has the problem, too. He


    said he fixed the problem by removing himself from his
    Contacts. This did not work for me (I wasn’t in the contacts.)
    (Nope— this turned out not to work.)
    I’m Building A Rape Tunnel
    January 23, 2010

    i’m trying something new


    From Artlurker:

    …THE RAPE TUNNEL has come under fire from


    Columbus-based feminist groups not to mention local law
    enforcement officials. The artist plans to place himself in
    a room, the only entrance or exit being a 22 ft long
    plywood tunnel constructed by Whitehurst [the artist]
    himself. Then he says that for the duration of the gallery’s
    opening he will rape anyone who travels through the
    tunnel into that room.

    Why is he doing it? For effect:

    Why rape?
    Because as an artistic gesture, it’s one of the most
    impactful I can think of… It dawned on me that if the
    work [we local artists] created had never existed, the
    world would be no different than if it had. None of it
    mattered to anyone outside of our small and insignificant
    circle of peers. I wanted something that would have more
    impact.
    …I want to make it clear that I plan to make the
    experience as unpleasant as I possibly can to anyone who
    dares to crawl through the tunnel. I will try to the best of
    my ability to make them regret their decision.

    …I’ll try my very best to sexually assault him or her. The


    tunnel is constructed in such a way that it gets smaller the
    closer you get to the project room. The bigger you are,
    the more difficult it is to comfortably crawl out. And trust
    me, I have a lot of secrets up my sleeve to ensure that I
    can overpower anyone that comes through the tunnel.

    We can have a discussion on whether this guy is a narcissist, a


    douchebag, a genius, or an idiot.

    We can have a whole discussion on what should be the role of


    art; whether aesthetics exist independent of our consciousness
    or only because of its interaction with it; what constitutes art.
    We can discuss whether Warhol was an innovator by giving
    the artist the godlike power to decide what things are; since
    I’m an artist therefore this is art, and it can only be discussed
    as art— you would no sooner describe War And Peace as
    “savory with a hint of paprika—” and in this way, The Rape
    Tunnel must be judged and described only as art and not as a
    legal or ethical matter;

    or, whether Warhol was a hack who learned the wrong lessons
    from Marcel “is everyone here a moron?” Duchamp, in which
    case the Rape Tunnel, its artist, and anyone who goes to see it
    should be rounded up and sent to the spice mines.

    So you can have those discussions: here, here, here, or here.


    I’m, however, going to discuss something else.

    II. One Third Of Respondents Took It Personally


    I don’t remember where I read this statistic, but it seemed
    intuitively obvious: 9/10 participants find gang rape
    pleasurable.

    The Rape Tunnel is a hoax; the “art” isn’t the tunnel but the
    story about the (nonexistent) tunnel. The impact is in the
    (plentiful) discussion about it. Bravo. Score one for trolling.

    But if the purpose of the art is the reaction, then the reaction is,
    in one third of the comments, hate:

    Someone should turn this into the Self Defense Tunnel


    and shoot this asshole in the fucking face
    I suspect (hope) someone will go in there with a lead pipe
    and crack his head open as he makes his move.
    Someone please, for the sake of art and humanity, burn
    this down with him in it.
    You have concealed carry there, right? Mr. Whitehurst,
    meet my friend Mr. Glock. Problem solved.
    I’ll be sure to pack my gloc-9 before checking out this
    exhibit.

    People who did not have a weapon brought black men:

    Probably not real, but if it is we should get someone like


    Mike Tyson who is tough, mean and has an attitude to go
    down the tunnel. After Mike beats his ass and bites his
    ears off, he’ll BE art.
    I will be there and i’m big and black
    EYEM COMIN WII SEA WHO GOES MID evil You
    clownie Girl (by “Always Were Black”)

    References to raping him were not unexpected:

    It would be quite interesting if someone with HIV


    decided to take a small trip through the tunnel.
    Are there any large, strong, gay men willing to stop by
    and just pound this guy a new asshole in his little tunnel?
    Ya know, for the sake of ART? What a douche. Art fag.
    if Dick Whitehurst is looking for impact, why not send a
    large convicted male rapist with a long history of brutally
    abusing cellmates in there with him. i can’t imagine a
    more appropriate happy ending…
    I think that someone with AIDS should stroll down that
    tunnel and give that loser HIV baby! and then when he’s
    done raping you, say… “I have AIDS, and now you do
    too! Put that in your pipe and smoke it dirtbag!”
    I just hope someone with AIDS goes in with a bloody
    diseased anus, gets raped and then asks him how he loves
    his new AIDS

    though some creativity was displayed:

    he said he’d do anything that comes in— why don’t we


    send in like random attacking animals like cobras,
    badgers, porcupines
    two words: Chuck Norris

    I’m specifically interested in the third or so people who


    expressed these sentiments. Why so much hostility? First, you
    don’t have to go in. More importantly, why is this level of
    anger not directed at actual rapists? Years ago I lived near 180
    and Broadway in NYC. That’s a Rape Tunnel. If you go there
    there will be a guy waiting to rape you, sometimes they
    change shifts but there’s always someone on duty. And they’re
    hiring. Go there, get raped. EOM.

    But no one is taking the A train north to kill that guy. In fact,
    you’ve basically accepted his existence, you’ve ceded that
    entire neighborhood to him. You don’t like him, of course, but
    you don’t hate him, you just put him out of your mind, you put
    that entire area out of your mind. Meanwhile, this artist, an
    ordinary man, who is only raping volunteers, who has not
    actually raped anyone— that guy needs AIDS.
    “But this guy is a douchebag/evil/narcissistic/idiotic—” And
    the guy on Broadway isn’t? He’s raping because he doesn’t
    have healthcare?

    “But he’s trying to pretend rape is art!” So the crime of


    impersonating art is worse than actual rape?

    etc.

    All arguments about rape fail. You don’t hate him because he’s
    a rapist, you hate him because he isn’t a rapist, he doesn’t
    seem to know he isn’t a rapist, and is going to rape anyway.

    III. I Just Made You Hate 9 Gang Rapists

    Cyril Connolly said, “Hate is the consequence of fear; we fear


    something before we hate it.” He’s wrong.

    There are no special insights available about the nature of


    anger; but the nature of rage is well described. If you’re
    willing to agree that the above sentiments are rage— the
    irrational, out of proportion blinding hate that anyone else
    observing it thinks is pretty nutty— then there’s plenty to learn
    from it.

    First, the rage comes because this guy is weaker than us. When
    we feel safe, when we’re not afraid (of him), we’re free to
    explode in rage. (That’s why there’s road rage and not elevator
    rage.)

    In every horror movie I have ever watched, no one, neither


    characters nor audience, hated the killer. They’re too afraid to
    hate. In fact, sometimes they side with the killer— think of an
    audience of teen boys laughing at the funny/horrifying way the
    victim was butchered. (And, in reverse: only when they start to
    hate, when they feel the rage, do they become powerful
    enough to kill the killer.)
    Fear assumes limitless possibilities: the thing you fear has
    infinite power, infinite resources, infinite resolve, unknown
    identity. Hate comes when you know them. Cyril Connolly did
    not say, “if it bleeds, we can kill it.” But he should have.

    IV. All rage is the result of a narcissistic injury.

    I have no evidence, but I’ll wager that none of the quoted


    commentors own guns, are black, or have ever raped anyone.
    I’ll speculate but not wager they’ve never been in a tunnel
    before, either.

    All rage comes from a narcissistic injury. So the question,


    “why are these guys so angry?” should be reframed: “what is it
    about the artist/the scenario that is a threat to their identity?”
    They’re emphatically not afraid of being raped because they
    don’t have to go to the Tunnel. They are only responding to
    the artist’s words. That’s the threat.

    The reason you do not fear this artist and the reason you hate
    him is because you about him. You know how he talks, thinks,
    that he’s an artist, etc. You may make incorrect judgments
    based on this information (e.g all artists are wimps) but it is
    that you created a coherent picture of him that is relevant.

    The man on 180/Broadway whom you don’t know at all is “a


    rapist,” he has a right to that identity and you’re not messing
    with it.

    This artist isn’t a rapist, he has no right to self-identify. How is


    he allowed to give himself so much power? You can’t do it,
    you couldn’t grasp that kind of power, you couldn’t be “a
    rapist,” because you’re not that kind of person.

    But he wasn’t either.

    V. How To Rape Everyone At Once

    There’s a lesson here.


    If you’re running, say, a newspaper, and want the population to
    fear someone, you focus on identity and offer no other details
    not consistent with that identity; you fix the identity as
    primary. You don’t describe him, you declare him.

    To make people hate someone, start from fear but then attack
    the identity. Offer otherwise irrelevant information that puts
    them not in a negative light— too obvious— but in a
    contrasting light.

    To everyone else not intent on destroying our civilization to


    sell copies, there’s this advice:

    When you find yourself hating someone (who did not directly
    hurt you) with blinding rage, know for certain that it is not the
    person you hate at all, but rather something about them that
    threatens your identity. Find that thing. This single piece of
    advice can turn your life around, I guarantee it.
    The Massacre Of The
    Unicorns II
    January 26, 2010

    if it had a horn, I’m sure it would be a rhinoceros


    There’s a debate of sorts in psychiatry: to what extent should
    we rely on evidenced based medicine?

    It’s almost a trivial point— we’re going to rely on it anyway,


    why debate it? So the question should better be phrased, “to
    what extent should the future of psychiatry rely on evidence
    generated now?”

    In a series of articles Nassir Ghaemi tries to justify Evidence


    Based Medicine in psychiatry; specifically, the primacy of
    evidence over theories or models.

    Ghaemi’s says clinical realities are more important than


    theories, and EBM allows for the study of clinical realities.
    Any deficiencies in the evidence— confounding bias,
    diagnostic uncertainties, etc, are really a problem about the
    application of the studies, and not about the possibility of
    EBM in psychiatry. In other words, psychiatry is sound, but
    we need more and better data.

    Ghaemi is arguing for an empiricist’s approach, as opposed to


    a top-down theoretical approach— one that starts with a
    theory, with concepts, and either ignores evidence or bends the
    evidence to conform to an existing theory. (His eg:
    psychoanalysis.)

    II.

    He asserts that the foundation is clinical observation, which is


    then studied further using scientific methods. For example,
    hormone replacement therapy done on thousands, later
    determined to be ineffective if not harmful. See? More
    evidence, better practice.

    Hormone replacement therapy was the cure for many


    female illnesses. Decades of experience with millions of
    patients, huge observational studies with thousands of
    subjects, and the almost unanimous consensus of experts
    all came to naught when randomized studies proved the
    futility of the belief in that treatment (not to mention its
    carcinogenic harm).

    A moment’s reflection shows this argument to be illogical.


    Hormone replacement therapy did work. It had great risks, but
    to say that it was a failure is wrong. “It was the cure for many
    female illnesses, but…” So it was adequately tested in all of
    them, indicating its futility?

    Ghaemi would respond that we would need more studies to


    determine the efficacy and risks in each indication, in each
    population. That would be right, but that’s not what happened:
    doctors generalized the failure of a medication based on the
    outcomes in a restricted symptom set.

    “Not better than placebo” is another false start. If a medication


    and a placebo both show a 25% response rate, it doesn’t mean
    the drug is “no better than placebo”: what if two different
    25%s responded? Would the group that “responded” to the
    drug also have responded if crossed over to placebo?

    The same is true for symptoms: if placebo and drug both result
    in a 25% reduction in symptom severity, it neither means the
    drug is a failure, nor, indeed, that the placebo is a placebo.

    “Well, we’d need more and better studies.” Of course. I’ll wait
    at the bar.

    III. Pay No Attention To The….

    This story is apocryphal, so consider it a parable:

    Pierre Eymard and friends were studying novel antieplieptics,


    and used dipropylacetic acid (a solvent) as both an intravenous
    vehicle for the drug, and as placebo. They observed that the
    placebo worked, too, preventing seizures at the higher
    concentrations.

    If this had been a phenotype without visible effects, it would


    have been a perfectly ordinary conclusion that drug was not
    better than dipropylacetic acid— aka Depakote.

    “But placebos nowadays are inert.” Is the fluorescent lighting


    in the office a placebo— maybe it makes the anxious
    depressed patients more anxious? “Come on, those studies are
    from 1990.” I guess that means the question had been
    satisfactorily resolved, requiring no further investigation?

    “Well, more studies are needed…” Tell the bartender I take my


    rum straight.

    IV. Improvement In Depression

    Take the simple example of depression, as measured by the


    popular Hamilton Scale. The scale measures insomnia and
    weight loss, but not hypersomnia and weight gain. Using this
    scale, a patient who sleeps too much and eats too much is less
    depressed than someone who sleeps too little and has lost
    weight. And, any drug that fixes sleep and makes you gain
    weight has an advantage over drugs that don’t. In fact, a third
    to half of the improvement on the Hamilton could be
    accomplished by improved sleep and appetite alone. Go
    Zyprexa.

    Note that the results of drug trials are reported only as total
    scores; you have no idea what symptoms the drug is fixing, or
    not. “But it’s not powered to detect those effects.” Ok, but it
    isn’t designed to tell you if it’s an “antidepressant,” either;
    only if it lowers scores on the Hamilton in this single sample
    group.

    “We need more studies, more scales.” But in the meantime


    we’re left with “X is an effective antidepressant.”

    The standard academic line is that the evidence indicates all


    antidepressants are generally equally efficacious. Think about
    this. Have you ever met a single patient for whom that was
    true?

    For a hundred reasons, none of that data applies to the patient


    sitting in front of you, yet it is the best information you have to
    go on. You have nothing else. Ok, go. The problem is not in
    the application of evidence to your patients, the problem is in
    the application of the theory that the evidence is creating in
    you onto your patient.

    The Tohen data may show that Zyprexa is efficacious in


    depression, but when you prescribe it you are thinking,
    “antipsychotics in general are efficacious in depression in
    general, and I need a sedating one.” You are doomed.

    “But more studies are needed…” I look forward to reading


    them, or passing out, whichever comes first.

    V.

    That’s the issue. In order for this to be a science, there has to


    be a testable hypothesis. There isn’t any of that in psychiatry.

    Example: antidepressant induced mania is the kind of testable


    question amenable to scientific investigation. Do they cause it,
    or not? But it’s not easily answered, indeed, it cannot be
    answered. Which antidepressant? What’s an “antidepressant?”
    Cymbalta, Pamelor, or Seroquel? Or CBT? What about
    semen? Which symptom of depression is it treating or not
    treating that allows you to call it an “antidepressant”? You
    could do a billion studies on every drug ever made, in every
    description of “depression” imaginable and that would only
    allow you to say, “ah, I know the answer in a billion specific
    situations” but would still have no insights into the nature of
    the phenomenon.

    Why don’t all antidepressants cause it? “Well, there are


    exceptions to the rule.” You’ve been infected: the rule is
    meaningless.

    When you give someone Paxil, you are playing the odds: this
    worked in 25% of the guys we gave it to in 1997. There’s
    nothing wrong with doing this, that’s what you’re supposed to
    do; but it does not allow you to speculate on either the nature
    “antidepressants” or “depression.”

    Simply put, the problem with “Evidenced Based Medicine”


    isn’t the evidence, but the “based.” Existing evidence can
    guide practice, but cannot be used to create a general practice
    model. “Mood stabilizers are the cornerstone of treatment in
    bipolar disorder.” While I have no idea what you’re talking
    about, I’m certain to be punished if I don’t oblige.

    In physics, such empty theories don’t hurt anyone, and there’s


    value in the theory itself. String theory may turn out to be
    wrong, but you at least are going to be really good at math.
    Okay.

    But in psychiatry these empty questions and empty answers


    are still applied to social concepts as if they carried the weight
    of scientific validity. The question of “antidepressant induced
    mania” may be empty, but that doesn’t stop the legal system
    from using it. You can’t imagine the defense proposing that at
    the precise moment of the murder, the universe split into two
    equivalent eigenstates and the defendant, in this eigenstate,
    had been already determined to have had to have been
    committing the act of murder, which he already had even
    before he started; but that explanation carries considerably
    more scientific merit than the psychiatric one, by which I
    mean both have absolutely none at all. Wovon man nicht
    sprechen kann…

    VI. Here There Must Be Dragons

    “But you’re not really arguing against the primacy of


    empirical evidence, you’re arguing about the misapplication of
    that evidence. You’re arguing against incorrect
    generalizations, against lumping data sets together to invent a
    clinical model.”

    No, it’s much worse than that.

    The problem isn’t that the data is sound, but we shouldn’t


    hastily extrapolate or generalize from that evidence. The
    problem is it is impossible not to do this.

    The first reason is because of the use of words. “I met a


    blonde girl last night.” Oh really? he replied knowingly. The
    words “depression” or “bipolar” or “antidepressant” all existed
    before we started using them. “Bi” and “anti” and “relapse vs.
    recurrence” all have connotations that may have no relevance
    to the way they are used now, yet those connotations will
    inevitably surface. It seems as though “evidence based
    medicine” has discovered that the antipsychotic Seroquel is
    also good for depression, but that’s not science, it’s an accident
    of history: 15 years ago the molecule could have been tested
    for depression, only to now be approved for psychosis. The
    evidence, the science, may be neutral on the drug’s identity,
    but it will never be equivalent to an SSRI in your mind. In
    order for it to be successfully rebranded, everyone who
    learned it the other way has to die.

    Second, the explicit purpose of psychiatry is to apply the


    discoveries immediately. The hasty generalizations and
    applications aren’t a byproduct of the field, they’re the whole
    point. We don’t have time to wait for a physiological
    explanation for bipolar, we have to get people better now. But
    while extrapolating from “kindling theory” or one
    antiepileptic’s mania data to a theory of “mood stabilization”
    is a noble attempt, it’s still wrong.

    Third, our brains have no alternative but to assume causality.


    No matter how many times you say “X is associated with Y”
    we will think “X causes Y.” Academics like to point this
    mistake out when residents do it, but everyone is guilty of it,
    all the time. This isn’t a criticism of human laziness, this is
    how we’re designed. Our brains can’t help it, they do not
    allow for a vacuum, they force causality. The brain may not let
    it become conscious, but you’ll act like it, breathe like it. Even
    when you know it’s wrong. I know how a mobile phone
    works, yet I still yell louder when it starts breaking up. The
    only way to stop assuming one explanation is to be given
    another explanation.

    Fourth, while 1 + (-1) = 0, a positive study is never completely


    refuted by a negative one— and vise versa. Even if studies are
    of identical design in the exact same patients, the marketing of
    a study— who wrote it, where it was published, how many
    “thought leaders” got behind it, how many pages, tables— all
    of this supersedes the content. Even if you successfully
    appraise a single study on its merits, the rest of the vastness of
    psychiatric literature is available to you only by rumor. When
    the fashion turns away from SSRIs and North Face jackets,
    you’ll frown when they occasionally reappear.

    Fifth, simply asking the question often overwhelms the


    evidence. If you ask, “does Geodon cause QTc prolongation?”
    it immediately stops mattering whether the evidence shows
    conclusively that it doesn’t, or that it was a mistake; it even
    stops mattering whether you even understand what “QTc
    prolongation” means. The moment the question is asked, you
    are forever condemned to pause before prescribing Geodon.

    VII.

    I’ve avoided discussions about groupthink or specific biases in


    studies as they are incidental to the fundamental problem of
    psychiatry, which is a faith in the primacy of evidence in the
    absence of any interest in a theory of mind. Evidence can,
    should, and does inform practice, and none of its shortcomings
    should change the way we use it today. But faith in evidence
    hasn’t moved psychiatry forward at all in 50 years. More
    evidence will not fix this, because there’s nothing guiding the
    evidence.

    The unfortunate truth is that most of the evidence in


    “evidenced based medicine” is at best too limited for general
    application, at worst wrong. Many of you will reflexively
    recoil from this, retreating from the vertigo to the crowded
    safety of your peers, journals, and false idols, but this
    empiricism is only another kind of apostasy. Repent.
    4 Easy Steps Towards Weight
    Loss That Aren’t Drugs,
    Diets, Or Excersise
    February 1, 2010

    I can’t tell you not to eat it, but I can tell you how
    If you don’t like boring science, just skip to section III for the
    answer.

    I.

    Type II diabetics- and everyone else— have two problems


    with their diets. First, eating too many calories causes weight
    gain. Second, food (like carbs) that causes excessive or
    prolonged insulin secretion, while helpful in the immediate (it
    clears the sugar so you aren’t hyperglycemic) over time leads
    to insulin tolerance and resistance.

    Hence, low carb diets are favored for both weight loss and for
    keeping insulin levels low(er).

    However, while carbs are potent stimulators of insulin, protein


    and fat contribute as well. For example, consider two meals
    each of 2000kJ and 40g of carbohydrate:

    Meal 1: steak and potatoes

    Meal 2: bread, peanut butter, and milk


    Not only is the insulin secretion not the same, it isn’t even
    close: Meal 1 induces only half the insulin response of meal 2.

    An old study measured the insulin response to some foods,


    relative to white bread (=100.) It also measured glycemic
    score, (e.g. per 1000kJ of it, not per 100g of it.)

    You can see that the insulin response is not always related to
    the glycemic score. For example, brown rice is “as bad” as
    white bread (same glycemic score), yet causes considerably
    less insulin secretion. If you’re diabetic, you’d want to eat
    brown rice instead of white bread. Etc.

    In a more recent study, the weighted average of the insulin


    scores in a mixed meal was the best predictor of actual insulin
    levels— carbohydrate amounts and glycemic index were not.
    (Fat, however, was a predictor.)

    Summary: same calories, same amount of carbohydrate can


    result in different insulin responses.

    II. How much insulin do you really need?

    If I give you 100g of oral glucose vs. 100g IV glucose, will the
    insulin response be the same? No— the oral glucose causes 3
    times more insulin to be secreted. Think about this.

    The reason is that hormones GLP-1 and GIP are secreted by


    the intestine within 15 minutes of eating— specifically, after
    the absorption of fat and glucose there— and are responsible
    for (among other things) 50%-70% of the insulin response.
    The amount of insulin secreted is determined not just by the
    glycemic load, but the rate at which it reaches the intestine,
    because that’s where GLP-1 and GIP will be released— the
    main drivers of insulin response.
    (From Aug 2009)

    Notice that when the rate of infusion of is doubled (from 2 to


    4kcal/min) the insulin must explode upwards to result in the
    same level of blood glucose. You don’t want that: chronic high
    insulin leads to insulin tolerance and resistance.

    But now imagine taking a fixed amount of glucose, and either:

    closed symbols: big dump (3kcal/min for 15 min)


    followed by trickle (0.71kcal/min next 2 hours)
    open symbols: constant rate (of 1kcal/min x 2 hours)

    All that’s different is how you “eat” the glucose. Look at the
    graph. Circles are diabetics, squares are normals:
    Observe that the blood sugar is higher if you ate the sugar
    faster. For that meal, you were exposed to higher blood sugar.
    And insulin, more pronounced in the normals. For about 30
    minutes, the people with the quick appetite experienced almost
    twice the insulin.

    So slowing the rate at which glucose/food gets to the intestine


    would result in lower insulin levels and lower blood glucose,
    without necessarily changing the calories. If that sounds weird
    to you, learn it in the reverse: speeding up the glucose to the
    intestine will increase the GIP and GLP-1 and insulin
    response.

    Eating smaller meals and less sugar clearly will help. But I
    think you see where I’m going:

    III. Small Changes That May Help More Than A Little

    Obviously, changing what you eat and how much you eat is
    very important. But these suggestions are not about altering
    the content of your chosen meal.

    They’re going to seem obvious now, but you should do them


    anyway.
    1. Eating the same amount of food but much more slowly.

    Any association you make to the European meal is your own


    business. The science says cramming the food down your
    throat while driving to the prison camp is a very bad idea.

    2. Same amount of food, but change the order of the food you
    are eating.

    Eating the fat and protein portion of your meal before the
    carbohydrate will slow gastric emptying. (It may also make
    you feel full and you eat less.) Don’t eat extra fat and protein
    — just move the protein portion to the front.

    What you should not do is crack open a soda or iced tea or


    juice before you eat. If you must drink soda, which you
    mustn’t, do it at the end.

    If you are including a salad in your meal, definitely eat that


    first. (Soup would be an even better idea.)

    3. Get more sleep.

    Growth hormone is released during slow wave sleep,


    especially around 4-5am. Cortisol is inhibited. Sleep
    deprivation reverses this.

    Even if total sleep time is the same, suppressing SWS reduces


    glucose tolerance. So: no sleeping pills, and get the sleep
    apnea handled.

    Prolonged partial sleep deprivation increases ghrelin (appetite


    stimulating) and decreased leptin (appetite suppressing.)

    4. Put cinnamon on your meal.

    A bit of a cheat, but…


    3g of cinnamon added to rice pudding reduced insulin levels
    with no effect on blood glucose. How can the body get away
    with using less insulin to deal with the sugar? Apparently
    because a) it increased GIP (see above); b) it stimulated the
    insulin receptor, resulting in increased glucose uptake. It
    should be logical, therefore, that cinnamon could exert its
    effect even if given separately from the meal: a small study
    found that 5g of cinnamon even 12h before the meal helped
    reduce glucose responses.
    Check Out My New Acura—
    ads?
    February 1, 2010

    this is not an Acura ad

    I.

    I send my partner a note: “Check out my new Acura ads!”

    Acura is having a 24 hour promotion to coincide with the


    release of its new car, hence the ads you see today on my site.
    The ads mean money, of course, but I sent the note with some
    pride.

    The ads signify a form of success, that my blog is Acura-


    worthy for advertising. Never mind if that’s true— that word
    “signify” indicates something else going on: I’m judging the
    quality of the site by the ads on it.

    I’ve never judged a person by their actual car, because I’m


    hyperconscious of product branding and message, I am always
    alert to the deception. But here I am using the ad itself as a
    signifier.

    Subtle flash animations, good photography or design, and of


    course the product in the ad— all these things are signals to
    me about the site that has them. Of course, the ads mean
    different things to different people— Acura ads may
    symbolize a sell out, or out of touch— but the point is that the
    ads themselves, not the car, symbolize something. And what it
    symbolizes is: this company endorses you.

    Many sites like mine have google ads, which only “pay” if you
    click on them; hence, they pay very poorly. But they’re easy to
    install, so most sites have them. Consequently, it’s as much the
    ubiquity of Google ads that signifies “amateur” as the absence
    of the more branded display ads (e.g. Acura.)

    People often comment about what Google ads I have on my


    site, but I have no control over them, whether it’s advertising a
    camera or ginseng extract is up to them, not me. Frankly, I
    think Google uses it to punish bloggers. I wrote an only
    minimally critical piece about Google in 2007, and ever since
    then they’ve been serving Dianetics ads and destroying my
    email with the Android.

    But not that I am aware how I (previously unconsciously)


    made a judgment about websites based on the kind of ads it
    serves, the scientific question becomes: does the ad change the
    traffic?

    So I looked.

    II.

    It’s only a few hours into the Acura ad campaign, but I can tell
    you the trend: it hasn’t increased the number of hits to the site,
    but it has changed the click through rate. About 10% more
    people by this time have clicked through to read posts (in other
    words, fewer people landed on the homepage and left without
    clicking on a post.) I am amazed at this result, but there it is.
    The presence of an ad for Acura enticed people to stay awhile.

    Bigger websites out there should take note. If you run a stock
    advice site, make sure your ads are from the big brokerage
    houses and banks, simply because it looks like they endorsed
    you. And if you really want to look like a professional, dump
    the Etrade ads and get WSJ or Goldman Sachs to advertise
    with you.

    But if it turns out to be true that the type of ad alters reader


    behavior, then the next question to ask is: what would happen
    if you placed a fake Acura ad on your site? Copied one from
    some other site and slapped it up there?

    People already do this to themselves: luxury car logos as


    necklaces (old school, I know); college stickers on the rear
    windshield. This isn’t the same as having the product around
    to brand you; nor is it the same as the product itself
    prominently displaying the logo (e.g. Juicy on the butt). This is
    a conscious decision on a person’s part to take the brand (not
    the product) and use it to endorse themselves.

    Could you command a higher subscription rate if your ads


    were better? Could you get better advertisers because they see
    an Acura ad is already there? Could you manipulate the
    market by using fake ads?

    I’m not sure this has ever been studied, but the ramifications
    are huge: for one thing, it would mean the end of display
    advertising. Why would they pay you, when you maybe
    should be paying them?

    –-

    http://twitter.com/thelastpsych

    For those with ad block— do me a solid and turn it off when


    you visit this site. It’s better than a subscription…
    How Seroquel XR Works,
    Part 1
    February 4, 2010

    When evidence based medicine results in a government


    sanctioned lie.
    1. What is the clinical data on Seroquel’s efficacy as an
    antidepressant?

    In order to get an indication, the FDA requires at least 2


    randomized controlled trials. Both were identical in design,
    and nearly the same in outcome.

    Patients who were on an SSRI or SNRI, who were not


    improving after 6 weeks, were randomized to the addition of
    Seroquel XR 150mg/d, 300mg/d or placebo (along with the
    maintaining of their previous antidepressant at previous dose.)
    The results:
    On the basis of this, and the other similar study, the FDA
    approved Seroquel XR as an adjunct to other antidepressant in
    MDD.

    2. Is this a function of its antipsychotic properties?

    No. At 150mg/d there is very little D2 blockade; and not all


    antipsychotics have been able to show efficacy as an adjunct in
    MDD. Some other mechanism is likely.

    3. How is Astra Zeneca and the FDA explaining the


    efficacy?

    Not an easy question to answer. Any proposed mechanism


    must be accepted by the FDA; once a mechanism is proposed
    and placed in the package insert (and promotional materials),
    it cannot be changed without resubmitting to the FDA— even
    in the face of contradictory proof. For this reason, e.g. they are
    vague on the mechanism in schizophrenia:

    All of Seroquel XR’s promotional materials, the package


    insert, and the clinical trials describe the efficacy as the result
    of Seroquel’s effect on norepinephrine and the NET.

    4. What is the evidence for the proposition that Seroquel’s


    antidepressant effect is mediated by norepinephrine?

    Quetiapine is partially metabolized to norquetiapine. Any


    pharmacologic (i.e. receptor) description of the Seroquel’s
    effect must therefore include norquetiapine.

    Quetiapine does not bind to the NET; but norquetiapine, its


    chief metabolite, is a potent inhibitor if it. Tricyclics, Effexor,
    and Cymbalta all have considerable NET inhibition as well.
    It’s logical to conclude that when you eat a Seroquel, and it
    gets metabolized to norquetiapine, that it would then exert
    some action on the NET.

    5. At a clinically relevant dose of Seroquel, how much


    norquetiapine is there?

    Not much.

    The package insert states:

    The Cmax and AUC of norquetiapine are about 21-27%


    and 46-56% of that observed for quetiapine.

    Or, graphically (from Winter J Child Adol Psychopharm


    2008):
    Levels of norquetiapine did not differ IR vs. XR.

    6. What amount of NET inhibition occurs at 400ng/ml?


    Show your work.

    300ng/ml= 300ug/L

    300ug/L= 0.0003g/L

    MW norquetiapine = 295.4 g/mol

    0.0003g/L x 1 mol/295.4g = 1.02e-6M = 1015nM

    Norquetiapine’s Ki for the NET inhibition is between 12-35


    nM, depending on in vitro or in vivo.

    At clinically relevant doses, the NET is more than completely


    occupied.

    7. Wow, really?

    No, not really.


    It appears that, in contrast to the longstanding paradigm of
    post-Kohut modern psychiatry, there is more to the human
    body than serotonin and norepinephrine receptors. I’m as
    terrified as you are. I don’t know what to believe anymore.

    A study measured the NET occupancy to Seroquel and


    norquetiapine (administered independently) in monkeys after a
    single dose. Norquetiapine produced 80% occupancy of the
    NET at low concentrations.

    However, in the nine suckers induced to participate in this


    other study, 300mg Seroquel XR for 7 days generated 300nM
    concentrations of norquetiapine (as predicted above) and 35%
    NET occupancy in the thalamus. 150mg Seroquel XR— the
    dose at which it functions as an antidepressant— resulted in
    19% occupancy. That’s not very much.

    Consider that if Seroquel is metabolized to norquetiapine in


    monkeys as well, then a clinically relevant dose of Seroquel
    should produce clinically meaningful occupancy of NET (by
    the effect of its metabolite.) It didn’t.

    The actual occupancy of the NET after 300mg Seroquel XR is


    quite low, 150mg even lower.

    8. Can you compare this to the occupancy of something I


    know— like Effexor?

    NET PET studies aren’t as easy to do as DA studies, because


    many of the ligands used in the experiments bind
    nonspecifically and produce greater background binding.
    There’s also not an obvious negative to compare it to (e.g.
    there aren’t any DAT in the cerebellum, so that becomes your
    control in DAT experiments.) Radioligands specific for NET
    are only recently becoming used; Effexor doesn’t have
    available PET data because now that there are such ligands for
    use in a study, Wyeth doesn’t exist to pay for them. Take that,
    unbiased research.

    Understanding that the comparisons are not entirely fair, a


    blood assay in depressed humans found that after 8 weeks of
    Effexor 150mg, NET inhibition was 50%. At 375mg, it was
    60%. Paxil, an “SSRI”, blocked about 30% at 75mg. Note that
    Effexor is only 55% protein bound (Seroquel is 80%) and thus
    in a real patient, there is more free Effexor to exert activity on
    the NET, which may be why it has such a larger effect on the
    NET despite a theoretically weak Ki (2200nM).

    Despite this, the NET occupancy of a clinically efficacious


    dose of Seroquel XR (150mg) is likely too low to be the main
    cause of its antidepressant efficacy.

    Part 2 here.
    How Seroquel XR Works,
    Part 2
    February 22, 2010

    The ongoing story of a government cover-up


    Part 1 was here.

    Let’s assume it did bind to the NET, how much of the


    efficacy should we attribute to norepinephrine?

    In the pre/frontal cortex there are no pure dopamine


    transporters (DAT), and the NET is primarily responsible for
    dopamine’s reuptake. So the NET, which norquetiapine fully
    occupies/barely touches, transports about 50/50
    norepinephrine and dopamine.

    So even if the NET is inhibited, the ultimate effect in the


    frontal lobe may be related to dopamine.

    Are there any other better explanations for Seroquel’s


    antidepressant efficacy?

    It’s odd that while the FDA has chosen to be unsure about the
    mechanism of action in psychosis, it is confident in the MOA
    in depression. Here are some equally/more likely explanations
    for the antidepressant effect:

    H1 antagonism: sure, why not? 6 points on a Hamilton for


    sleep, another 2 for weight gain…

    Partial agonism at 5HT1a: Think Buspar.

    a2 antagonism: (inhibitory autoreceptors.) Blocking these


    would increase serotonin and norepinephrine release, etc.

    Unfortunately, a2 antagonism is a property only of quetiapine,


    not norquetiapine.

    Why is that unfortunate?

    Because if norquetiapine is marketed as a new drug…

    But if norquetiapine does actually inhibit the NET,


    wouldn’t that at least be a plausible mechanism for its
    efficacy? Since Effexor and Cymbalta work…

    I’ll grant that it is evident Effexor and Cymbalta work; but


    who are you asking to tell you why they work? Wyeth and
    Lilly? That’s like asking your future wife’s ex-boyfriends to
    write her a letter of recommendation. “She’s so awesome,
    she’ll make you really happy.” Oh, I guess I should go shave
    my back then.

    That’s a very disturbing visual, Backbeard.

    Let’s do an abbreviated analysis for Effexor. According to this


    non-porn site, the Ki for the SERT is 80nM and NET 3000nM
    (1000-6000). This means it “prefers” to go to the serotonin
    transporter (SERT).

    Consistent with this is PET data showing high SERT binding


    in striatum:

    This is a comforting graph, and shows the “fountain” approach


    to understanding a “dirty” drug’s effects. But note that the line
    isn’t flat, it still trends upwards. If the affinity for the SERT is
    200-600 times that for NET, then clinically meaningful effects
    on NET would have resulted in serotonin overload.

    But that’s speculation. You’ve already shown that the Ki’s


    are unreliable guides of in-vivo affinities and effects.

    Ok:

    What you want is a direct test of the operation of the NET in


    the human body.

    If you inject tyramine into your friend, it will be taken up into


    the presynaptic NE terminal by the NET, where it will cause
    the release of norepinphrine. The blood pressure then reliably
    goes up.

    If you block the NET, this effect will also be blocked, since
    tyramine can’t get in. Nortriptyline, a tricyclic and
    “norepinephrine reuptake inhibitor” blocks the tyramine effect
    almost completely.(1)

    What about Effexor? If Effexor is an NRI, it should also block


    the blood pressure elevation. Zoloft, not an NRI, should not
    block it— the BP should go up.

    This is ratio of post/pre blood pressures; >1 means tyramine


    caused BP to go up, <1 means tyramine couldn’t get BP to go
    up.

    What you see is that 75mg of Effexor was no more an NRI


    than Zoloft; and maprotiline (the NRI) turned Effexor 375mg
    into a cuckold.

    But surely Cymbalta has impressive clinically relevant NRI


    effects?

    What dose of tyramine is needed to make the BP go up


    30mmHg? That’s called the PD30. If a drug blocks the effect
    (like desipramine, an NRI, would) than it would take more a
    higher dose of tyramine:

    TYR PD30 (mg)


    Day 7 Day 8
    Placebo (n=12) 7 [4-14] 6 [5-9]
    Duloxetine 80 mg (n=5) 9 [5-8] 7 [4-7]
    TYR PD30 (mg)
    Day 7 Day 8
    Duloxetine 120 mg (n=6) 6 [5-9] 4 [4-7]
    Desipramine 100 mg (n=11) 30 [22-82] 18 [12-31]

    Well that’s unfortunate. (2)

    But then how can they claim Cymbalta is an NET?

    1. By ki, the SERT/NET ratio is about 10, versus Effexor’s


    200, so in that sense you get the norepinephrine “earlier” in
    the dosing cycle;

    2. If it blocks the NET, then it should also decrease the cycle


    of norepinephrine turnover (since it isn’t being taken back up
    and degraded.) So there should be less NE and its metabolites
    in the urine. And that’s certainly what this study finds
    (abstract:)

    Urinary and cardiovascular measurements suggest that


    duloxetine has an effect on NE synthesis and turnover,
    indicative of NE reuptake inhibition.

    “Suggest?”

    Compare the NRI desipramine (DMI) to placebo, note the


    decrease in urine NE and metabolites. You can see that while
    the levels of NE and its metabolites decreased in the urine,
    Cymbalta resulted in a decrease in only the metabolites, but
    not NE itself. Do you know why? No one else does either.

    On the basis of this study we can reasonably conclude only


    that duloxetine is spelled with an x.

    So you’re saying that they arbitrarily decided on the


    mechanism of action of Seroquel by its barely detectable
    similarity to Effexor and Cymbalta, which themselves
    don’t generate their efficacy the way they say they do and
    Seroquel hoped they did?

    At this point, someone in the room should probably say


    “oops.”

    –—

    Part 3. (You mean there’s a Part 3?)


    –-

    1. One interesting conclusion of this is that it would therefore


    be safe to mix an MAOI with Pamelor. THAT IS NOT A
    CLINICAL RECOMMENDATION.

    2. If you want to make a gazillion dollars, perform the TYR30


    test with Seroquel and norquetiapine. Residents: I just gave
    you a treasure map.
    Don’t Settle For The Man
    You Want
    February 8, 2010

    I stopped reading The Atlantic when I wanted to stop cutting

    Lori Gottlieb, in The Atlantic, writes Marry Him!, and


    describes a problem so pervasive and urgent it’s hard to
    imagine Obama hasn’t cleared his desk: what’s an
    “independent,” “feminist,” “heterosexual” 40-something
    “woman” with a sperm-donor child to do when she can’t find a
    man to marry her?

    My advice is this: Settle! That’s right. Don’t worry about


    passion or intense connection. Don’t nix a guy based on
    his annoying habit of yelling “Bravo!” in movie theaters.
    Overlook his halitosis or abysmal sense of aesthetics.
    Because if you want to have the infrastructure in place to
    have a family, settling is the way to go.

    Oh, that Lori Gottlieb, she’s a kidder. But she’s not kidding.
    There’s a few ways to go with this, but here’s a start: where is
    she finding all these idiots who yell bravo or have bad breath
    or poor aesthetics, or is this all the same idiot? If you’re 0/3 in
    a single paragraph, you need to consider the problem is you.

    To be fair, my conceptualization of what a good relationship is


    may be very different from hers. Here’s hers:

    In my formative years, romance was John Cusack and


    Ione Skye in Say Anything. But when I think about
    marriage nowadays, my role models are the television
    characters Will and Grace, who, though Will was gay and
    his relationship with Grace was platonic, were one of the
    most romantic couples I can think of.

    Nothing characterizes The Dumbest Generation Of Narcissists


    In The History Of the World better than using throw away
    cinema as a template for life. What kind of results did she
    expect?

    She thinks that Will being gay is an unfortunate coincidence,


    but it is actually the primary thing she wants. She wants a gay
    man not because she likes them gay, but because gay men
    aren’t real to her, they’re props. She wants someone who will
    see her the way she wants to be seen and fulfill various other
    roles she has planned for him, leaving herself free to “grow.”
    It’s hard to get that to happen when his Staff Of Unreasoning
    and Hyperbole is pressed up against her coccyx while she’s
    trying to go to sleep.

    II.

    That Will & Grace speaks to her is completely by design. The


    producers tweaked that show specifically for a certain demo,
    i.e. her.

    In its first miserable failure of an incarnation, it was called


    Ned & Stacey, and it paired Debra Messing with a good
    looking, heterosexual, womanizing rich guy. Everything else
    was the same. Here’s the opening theme:

    Ned: Why Stacey?


    Stacey: Why Ned?
    Ned: It was business.
    Stacey: Strictly business.
    Ned: Here’s the deal - to get a promotion, I needed a wife.
    Stacey: To get a life, I needed his apartment.
    Ned: So what the hell, we up and got married.
    Stacey: The only thing we have in common? We irritate each
    other.
    Ned: Right! Enjoy the show.

    The show lasted one season. No woman could relate to his, no


    woman would want this, only this. But make the main
    character gay, and you have a fantasy scenario: materialism
    and safety, but the emotional freedom to constantly reinvent
    and reaffirm yourself. The show should have been called, “The
    Non-Judgmental Dad I Never Had” or simply “Let’s Pretend.”
    But I’m not in TV.

    III.

    There are really two questions: the first is where Lori Gottlieb
    went so wrong, and the second is why The Atlantic thinks this
    is a legitimate posture.

    A short excursion through Lori Gottlieb’s prior life is


    illustrative.

    Her first book, in 2001, is about her experiences growing up to


    affluent but shallow parents (her description) in Beverly Hills
    in the 1970s. Pause for effect.

    This is what the Amazon blurb says:

    In the image-conscious world of 1970s Beverly Hills, 11-


    year-old Lori knows she’s different. Instead of trading
    clothes and dreaming of teen idols like most of her pre-
    adolescent friends, Lori prefers reading books, writing in
    her journal and making up her own creative homework
    assignments. Chronically disapproving of her parents’
    shallow lifestyle, she challenges their authority and
    chafes under their constant demands to curb her frank
    opinions and act more “ladylike.

    Many of you may sympathize. What’s a budding intellectual,


    not to mention future NPR contributor, to do in such a
    dystopia? Answer: she decides to become anorexic.

    Somehow this has been characterized as a struggle with


    anorexia but you’ll have to take my word for it: this is a
    struggle with anorexia the way Girl, Interrupted was a
    struggle with inadequate access to healthcare. It’s all blamed
    on her parents, and secondarily on her social group. This is
    from her website:

    “Of course they aren’t overweight,” Lori told her


    psychiatrist when asked if she thought the girls at school
    who diet are overweight. “Didn’t I already say they were
    popular?”

    Before you call Bill Cosby, consider that this kid is having a
    conversation with her psychiatrist. In the 1970s. Whatever you
    may think about the overpopularization of psychiatry today,
    there was a very specific demographic of kid that got to talk to
    a shrink in the 1970s, and that demographic is now in their
    40s, unmarried and writing articles for The Atlantic. If you
    think there’s no connection, then Amazon.com suggests you
    may also enjoy The New Yorker.

    IV.

    The mistake is to take the writing prowess Lori (now and at


    age 11) has and assume it mirrors the quality of the ideas. The
    writing is good (there, I said it) but the idea set is dangerously,
    catastrophically wrong.

    Her next book, Inside The Cult of Kibu, was about her
    experiences at a failed dot.com. This is the introduction:

    In the Spring of 2000, Lori Gottleib was lured away from


    Stanford Medical School to become the editor-in-chief of
    Kibu.com…. but after her comically unceremenious
    “unhiring” three months later…

    Work through the timeline. This book was published in 2002.


    Stick Figure was published in 2000, which means it was
    written before 2000, i.e. while at Stanford Med. Meanwhile,
    she’s hanging out at Whole Foods (not a joke) and joining
    Kibu. Then she’s fired. So she hastily put together another
    book.

    You can imagine this is how she dates. No direction, no sense


    of self, just jumping from one scheme to the next, trying on
    different identities. She actually laments how, while a med
    student, she was surrounded by more dot-commers than
    doctors. At parties they wouldn’t think her interesting enough
    as a med student; but when she signed with Kibu, she

    heard myself saying, “I’m on the cutting edge! I’m going


    to influence an entire generation!” Part of me even
    believed this.

    Your problem is you believed it. My problem is you were


    right.

    V.

    A reasonable question might be, what kind of a man is this


    woman looking for? I defy you to answer this question. She’s
    two books and at least three essays into the topic, and still I
    have no idea. What I do know, however, is what she’s not
    looking for. That’s where her laser focus is pointed.
    She titled one essay, “5 Traits In A Mate That Are Not Deal
    Breakers.” Take a moment to ponder the construction of that
    title. If I wrote an essay, “5 Things You Can Do That Won’t
    Make Me Stab You In The Teeth” how many condoms will I
    end up using? You might counter with history: she was having
    trouble with mates before she wrote that essay. True, but you
    know that the type of person who would think to write an
    essay like this one reveals herself in other ways as well.

    I’ve never believed that we should stop looking for Mr.


    Right (we shouldn’t!) - but I do think that by changing
    our rigid idea of who Mr. Right is, we’re more likely to
    find the right Mr. Right. You can’t just order up the
    perfect husband á la carte - I’ll take a little of this, a little
    of that, less of this and more of that. A guy is a package
    deal, as are we. Recognizing that isn’t settling. It’s
    maturity.

    I actually had to pull my car over to the side of the road when I
    read this. This woman is in her 40s. And she has a kid. What
    the hell did those halcyon hours at Stanford Med do to her?

    …having found myself still single at 40, I’d come to an


    eye-opening realization: Had I known when I was
    younger what would make me happy in a fulfilling
    marriage, I would have made very different choices in my
    dating life.

    This woman should have a scarlet “ME” on her shirt. What


    makes me happy? What do I want? You can’t run a
    relationship this way, you can’t run a life this way. But the
    longer she stays single, the more self-absorbed she becomes,
    the more she thinks about what she needs and wants.

    It’s almost unnecessary to list the 5 Things About A Man Lori


    Is Only Pretending Not To Care About, but here they are
    anyway: 1. His height. 2. His Match.com profile. 3. His
    occupation. 4. His age. 5. How he compares to “my type.”
    None of those are jokes.

    Indeed. I ended up falling hard for a 5′6″, balding, bow-


    tie-wearing guy I almost didn’t e-mail on Match.com. He
    wasn’t who I had in mind, but he was who I wanted to be
    with. And that, of course, is the thing that matters most.

    Indeed, indeed.

    VI.

    Back to the article. There’s absolutely no chance any woman


    will benefit from reading this article; I’d argue that it would
    even make her impossible to be in an elevator with.

    I referenced Will & Grace, above, but the real star of the
    article is Sex & The City. This article is written about, and for,
    Carrie Bradshaw.

    It’s equally questionable whether Sex and the City‘s


    Carrie Bradshaw, who cheated on her kindhearted and
    generous boyfriend, Aidan, only to end up with the more
    exciting but self-absorbed Mr. Big, will be better off in
    the framework of marriage and family. (Some time after
    the breakup, when Carrie ran into Aidan on the street, he
    was carrying his infant in a Baby Björn. Can anyone
    imagine Mr. Big walking around with a Björn?)

    She doesn’t get it, at all. Are you asking whether I could I
    imagine a big producer, like the one that Mr. Big is based on,
    carrying a baby? Sure, why not? Or do you mean a guy like
    Chris Noth, the actor who plays Mr. Big? He just had one, so
    yes. Or do you mean…?

    Meanwhile, the real Carrie Bradshaw (Candace Bushnell), the


    actress who plays her, and heck, even the character Carrie
    Bradshaw, are all in solid relationships exactly opposite to the
    ones she is looking for.

    Mr. Big wouldn’t carry a baby because that’s the character. If


    you’re looking to hook up with a two-dimensional character,
    you’ll get what you pay for.

    VII.

    Gottlieb figures that because she’s attractive and intelligent,


    the problem must be her standards are too high or men are
    threatened by her. Wrong. The problem is she is daring
    someone to like her. She has a Match.com profile— fine— but
    meanwhile, she publishes articles in major magazines that men
    are going to read, right? that say things like, “I’m at the age
    where I’ll likely need to settle for someone who is settling for
    me.” How do you like me now! “It’s not that I’ve become jaded
    to the point that I don’t believe in, or even crave, romantic
    connection. It’s that my understanding of it has changed.”
    Who’s up for role-play? You think I’m pretty? Bam! Now I
    have a kid! What do you think of that?

    All of this is what an adolescent girl might do, who puts her
    worst features front and center. She’s not sure her best features
    are going to be good enough, but if you can like her despite
    the bad ones, then you must be The One. (Never mind that
    immediate next thought will/should be, “what kind of a loser
    would like me?”)

    All of this is a game to elicit a specific response from the man:


    “oh, baby, those things don’t matter to me because I know
    that’s not who you are, I know the real you.”

    The guy is irrelevant. As long as he delivers his lines, on cue.

    VIII.

    You may wonder why I am focusing on The Atlantic article


    and not the book that just came out, Marry Him: The Case For
    Settling For Mr. Good Enough. First, I didn’t read the book.
    HA! Take that, required reading list.
    More importantly, a book contaminates only its readers, but an
    article in The Atlantic makes it ok for intelligent people in
    general to think like this. That makes her wrong ideas
    dangerous.

    You want something uplifting, so here you go: you can never
    have a good relationship with anyone when your focus is the
    relationship. There’s a human being there who existed well
    before you got to them, and they weren’t built for you or your
    needs or your parents or your future dreams as an actor. If you
    want to be happy with someone then your body and mind have
    to instinctively adapt to their happiness. If you’re not ready for
    this kind of sacrifice, then you’re simply not ready.

    Lori Gottlieb becomes a Therapist: The Cult Of Self-Esteem

    http://twitter.com/thelastpsych
    Family Annihilators Don’t
    Do It Because They Love You
    February 15, 2010

    phew?
    Newsweek runs a story, Inside the Minds of Family
    Annihilators. It describes the results of a ten year followup
    study which found that family murders spike when the
    economy is down.

    The study is not out yet, but the article hits most of the key
    words:

    control
    seek to create an idealized version
    humiliation
    shame
    rage

    The general thesis is that “when the economy is in decline,


    jobs are scarce, tensions are high, and the control these men
    seek becomes harder to maintain.”

    The article then describes two kinds of family annihilators.


    One type is:

    driven by rage: they are controlling and sometimes


    abusive figures who derive self-worth from the authority
    they exert at home. But that behavior typically plunges
    the marriage into crisis, often prompting the wife and
    children to try to leave. The resulting lack of control
    triggers feelings of humiliation, eventually leading the
    father to reassert his power in a final paroxysm of
    violence.

    Fair enough, easy to spot. But where the article (describing the
    study) goes wrong is the leeway it offers the other kind: the
    “altruistic” killer:

    The “civil reputable” killer, on the other hand, is motivated by


    a perverse form of altruism. “His entire identity is in his
    family”…Murdering his family members, then, becomes a
    way of rescuing them from the hardship and shame of
    bankruptcy and suicide.

    The idea here is that the guy doesn’t want his family to suffer,
    so he kills them. Wrong. He’s not sparing them the shame of
    bankruptcy, he is sparing himself the shame of having to face
    them every day, as a failure.

    This may seem like a trivial distinction, but it is very


    important.

    If, as the researchers would agree, these are murders motivated


    by narcissism, then doing something “altruistic” (including
    murdering them), doing something for the other, independent
    of how it would affect himself, would entirely be inconsistent
    with that mental process. In narcissism there is no action
    unless there is benefit to identity.

    For example, why not just kill himself only? Because it ends
    the movie as “he was a failure.” There’s no rebuttal, there’s no
    redemption. That’s your identity forever. That doesn’t work
    for him.

    However, he could himself so his family could get the life


    insurance. That would work, provided that the family knew he
    killed himself for the insurance money. Movie ends: tragic
    hero, sacrificed himself for others. That’s a fine ending.

    Except, in most cases, insurance doesn’t pay for suicide. So in


    order for it to work, the man would have to tell no one about
    his plan. It would have to look like an accident to everyone.
    No one could know. That selfless act— i.e. a total denial of
    himself, his identity, and his motivations, would be impossible
    for a man whose acting from a narcissistic perspective.

    This is going to seem obvious, but: for this reason, if he fails


    to kill his family, and then feels great remorse, you should not
    trust him. When he sits before you sobbing, how could I have
    done this, forgive me! in some bizarre way I thought I was
    protecting you! I’m so so sorry!— don’t believe it, that’s not
    remorse because there is no guilt. He’s revealed his true self,
    and it shames him: when the going gets tough, he will protect
    his identity before anything else.

    II.

    In an interview, the researcher, said:

    This seems to come out of nowhere. It’s shocking and


    you can’t predict it—there really aren’t any red flags.
    They don’t have a character or personality disorder.

    There is one predictor; but because familial murders are so


    uncommon the 50% or so that this one does predict isn’t going
    to get you any mileage. And, unfortunately it predicts
    precisely because, and only if, it is undetected: the man has a
    secret.

    The article describes how financial problems, loss of a job, etc,


    are precipitants, but what these murderers have in common is
    that the financial ruin reveals the Ponzi scheme of their life.
    He didn’t just lose his job; he lost his job and he had debts his
    wife didn’t know about. Or that he was really embezzling the
    money. Or he lost his job as a bartender so he can no longer
    pretend he’s a bar owner. That’s why these men don’t murder
    coworkers, whom they may blame or be jealous of; they
    murder the people they were trying to deceive.

    Hence, the prevention of family murders isn’t psychotherapy,


    it’s exposing the lie. They murder because they’re afraid they
    are about to be revealed. You can defuse this by getting past
    the terror of “about to be.” The lie closes you in; having it
    exposed is painful, but it allows for possibilities, hope.

    If you’re that guy— and you know who you are— own up
    now because the lies only get bigger. You have already shown
    yourself to be less than your lie; if it gets bigger, it will be out
    of your control. You don’t know where you’ll end up or what
    you’ll be capable of… in ten years.

    If you’re the wife, subtly make it easy for him to own up, or at
    least back out. He thinks his main value is in the keeping up of
    appearances. Repeatedly show him that that ,“the thing,” is
    unimportant to you; show him you love him for something
    else, hell, in extreme cases suggest to him you’ve always
    wanted to live the simple life in Nicaragua.

    Or run.

    But there are very few things in life that are certain. This is
    one: if your father or husband tries to kill you, he’s not doing it
    for you.

    http://twitter.com/thelastpsych
    The Other Ego Epidemic
    February 18, 2010

    so what’s behind the photographer?


    Some articles sent by readers:

    The Ego Epidemic: How more and more of us women have an


    inflated sense of our own fabulousness

    Author: Narcissism is an epidemic in our society.

    Newsweek: Generation Me

    etc.

    I.

    “Looks like you were right, even the popular press is catching
    on to the increase in narcissism—”

    Belay that. These magazines are your enemy. Do you think


    they exist to improve you?

    These articles aren’t saying narcissism is on the rise, they are


    saying grandiosity is on the rise. They are conflating the two.
    Even psychiatrists get this wrong, they are not the same.

    Leave aside for now what is the distinction. Look instead at


    the result: by focusing on the grandiosity, it leaves you, the
    reader, with an out. “Look at these grandiose idiots. That’s not
    me.” By virtue of the fact that you aren’t famous, important,
    grandiose, you must therefore not be a narcissist. It creates a
    self-satisfied sense of importance because you’re not like
    them. That’s narcissism. These articles actually reinforce your
    narcissism. They are the wrong kind of friend you’ve picked to
    assure you: “that stuck up bitch, what does she know, you’re
    too good for her anyway.”

    If you’re reading it, it’s for you.

    II.

    How can a man who thinks “my wife is way smarter than me!”

    or the guy who thinks, “I’m no ladies’ man, but I would never
    use a woman, even if I could!”

    or the woman who thinks, “I know I’m not a model, but I’m an
    attractive, intelligent, independent woman”

    — how can they all be narcissists?

    I. I. I. Me. I. Me. I. I. I. I. Me. Me. Me. Enough, we get it, we


    all know who you are.

    It’s why happiness always seems out of reach, why love seems
    elusive or complicated. And sometimes why other people get
    hurt.

    III.

    Grandiosity is only one possible manifestation of a psychic


    process that went awry. The essence, the defining
    characteristic of narcissism is the isolated worldview, the one
    in which everyone else is not fully real, only part a person, and
    only the part the impacts you.

    Narcissism is self-protective. It simultaneously allows for the


    reduction of the other to prop status, while reassuring you that
    this perspective is not wrong or dangerous because it’s not
    about superiority.

    You went to Haiti to help the refugees; great. You may have
    done it because you want to help; or you may have done it
    because it identifies you to yourself and others as a kind
    person, selfless, a helper. Which was it? The former comes
    from an external ethical structure that informs behavior. The
    latter is an internal identity that demands validation.

    NB: the Haitians don’t care either way, just show up.

    Narcissism is morally neutral. Only the results can be judged.


    But it usually predicts: if the boat starts sinking, identity first.

    IV.

    “I agree. Just do what’s right. Don’t worry if it makes you


    suffer now, God will reward you later.”

    Really? He can’t see through that? Which god did you pick
    out, that he can’t see you from the outside, the sum totality of
    your existence past, present and future?

    Of course: you picked the god that thinks like you.

    V.

    A little egomania isn’t a bad thing, especially if it spurs you to


    be better at whatever you’re supposed to be better at. Thinking
    your the best kid on the playground is not nearly as destructive
    as thinking you’re the only kid the playground. If you don’t
    believe me, try it.

    But you think you’re the best? Good. Get to work.


    VI.

    “Help me, please, I think I’m a narcissist. What do I do?”

    There are a hundred correct answers, yet all of them useless,


    all of them will fail precisely because you want to hear them.

    There’s only one that’s universally effective, I’ve said it before


    and no one liked it. This is step 1: fake it.

    You’ll say: but this isn’t a treatment, this doesn’t make a real
    change in me, this isn’t going to make me less of a narcissist if
    I’m faking!

    All of those answers are the narcissism talking. All of those


    answers miss the point: your treatment isn’t for you, it’s for
    everyone else.

    If you do not understand this, repeat step 1.


    The Rage Of The Average
    Joe
    February 19, 2010

    all of this has happened before and it will happen again

    “Obviously his methods were wrong, but you can see


    how a person can feel so excluded…”

    “Of course he shouldn’t have killed anyone, but you can


    understand the frustration of a guy who does the right
    thing, but still gets the shaft, meanwhile these other guys
    get everything handed to them…”

    “You know, he does have one legitimate point…”

    “All I’m saying is his explanation makes total sense…”

    “Look, I don’t condone what he did, but I can


    understand…”
    etc.

    II.

    Of course his explanation makes sense. What did you expect?


    Numerology? Bible codes? He’s not insane. The man could
    just as well have railed about blacks or illegal immigrants. It
    would still all make sense, it would all be internally consistent,
    and it would all be wrong.

    Look up there. See those quotes, those justifications? Those


    are what people said— after George Sodini shot up an aerobics
    studio. They’re the same hedges despite completely different
    events. That’s because the content is a red herring.

    If he had blamed the RAND Corporation and the reverse


    vampires, would you have listened? But since “IRS” seems
    plausible you overlook the paranoia.

    What people want is to take his possibly legitimate frustration,


    and extend it to his actions. “Since he was so frustrated, he
    eventually snapped.” The note tells you why he was frustrated,
    but it does not tell you why he killed anyone. If you want to
    use it for the former, go ahead. But the note is as informative
    as Mercury in Libra for the latter.

    III.

    “But the note says the IRS made him do it.”

    Funny: Sodini’s note said he did it because he was about to


    lose his job, but still it’s blamed on a lack of sex. You know
    why? Because no one cares why Sodini did it, they just want
    to talk about their own gripes. “Women are bitches.” “Men are
    misogynists.”

    In this case, people are going to use it as “see how the


    government drives people crazy?” and simultaneously by
    others to as “these anti-government nuts are crazy.”
    In other words, if you’re reading it, it’s for you.

    IV.

    “Was he a right wing nut? I heard he was a socialist nut?”

    It’s natural to look at this from your own perspective (“he has
    a point about the rich” etc) but this isn’t a manifesto, it’s a
    suicide note. The information of suicide notes are not reliable.

    And it’s a suicide note, not a homicide note, because it is about


    his life/death. Everyone else doesn’t matter.

    The reason why he’s so hard to pin down as right wing or left
    wing (or patsy) is that it’s not important to him, writing the
    note. The purpose of the note isn’t to convey information, it is
    to convey mood, and the seemingly random and contradictory
    positions he takes on issues is all in an attempt to win you, the
    reader, over to his side. He knows for sure he is angry, he
    knows for sure he feels wronged, but he can’t logically and
    realistically link the real world events to his level of anger. So
    he confuses you with words while blanketing you with mood.
    You have no idea what he’s talking about, but you definitely
    sympathize with the frustration. Boom— he got you.

    If you simply look at it as a “type”, then he’s a mass murderer,


    akin to a guy in a tower with a rifle. So the form of the note
    will be impotence, paranoia, displacement, a feeling of
    rejection/invalidation, and, of course, narcissism. I’ll make the
    simple observation that as obsessed with rules as he was, he
    didn’t think and didn’t like that they necessarily applied to
    him.

    The reason this is important— that you should focus on the


    form of the note and not the content— is that it speaks to
    “treatment” and prevention. If you had granted every single
    one of his wishes, he would still not have been satisfied, he
    would not have been happy. As bankrupt as he was, he still
    had a plane, a house to set on fire, a car… note also he didn’t
    seem to care about his family he left behind. The problem isn’t
    what happened to him in his life, it’s how he viewed his life
    and its expectations.

    I’m not saying he would inevitably found a reason to explode,


    or that rage against the IRS was not a factor. He may not have
    someday flown his plane into an old high school bully or a
    cheating wife— or maybe he would have— but it’s wrong to
    think of this as an ordinary man crushed under the weight of
    regulation.

    This was a keg of rum rolling around a smoldering ship.


    Maybe he blows up, maybe he doesn’t. Either way, abandon
    ship.

    V.

    Commonly heard after an event like this: “he was so nice, I


    can’t believe it he did this.”

    “We didn’t know that he had frustrations and troubles,”


    said Pam Parker, who had known Stack and his wife,
    Sheryl, for several years and last spoke to him a few
    weeks ago.
    “He always was very easygoing,” Parker told the Austin
    American-Statesman. “He was just a pleasant friendly
    guy.”

    You’re surprised because you think you knew him because of


    the duration of your exposure to his body and the sounds his
    mouth made; but they don’t put themselves into their
    relationships, they put themselves into appearances. The rest is
    just going through the motions.

    VI.

    Why hasn’t this happened before? Or: why isn’t this being
    called terrorism?
    Because the media says it’s okay to shoot women, but not
    okay to don suicide vest.

    We have already accepted— not acceptable, accepted—


    methods of American violence, and the media has a backstory
    for all of them, right or wrong: The 70s was serial killers—
    “caused” by childhood sexual abuse. In the 90s we had school
    shooters, “caused” by bullying. We have one for random
    violence against attractive women: loser loner, caused by
    (either) no sex or . So we can all be horrified, but not
    surprised.

    Now we have a template for a new kind of violence: anti-


    government Average Joe.

    Unfortunately, the creation of this template— the repeated


    discussion amongst pundits that “we don’t condone but…”
    and then a dramatization on CSI or in a movie, means that
    Average Joe mass murder is going to be inevitably part of our
    culture.

    But none of these templates are true, in the sense that there’s
    no causality. They are merely post hoc descriptive. And since
    dead men tell no tales, you can pretty much describe one any
    way you want, for your own purposes.

    If Joe Stack had reflected on that, he would never have hit the
    ignition.

    http://twitter.com/thelastpsych
    On Being White
    February 28, 2010

    Is there anyone who can speak frankly on matters of race? Yes:


    Louis CK.

    If you haven’t heard this before, pay close attention to your


    reaction to this clip; and then pay even closer attention to how
    it does/does not change at 1:30. Also think about how this
    would all be different if you were surrounded by whatever race
    you’re not.
    Wrong About Obama II
    March 3, 2010

    the sound you just heard is millions of teeth grinding at once


    In retrospect an easy call to make; at the time considered sour
    grapes: a year after the election of the Messiah, the country
    would instead be more angry and hateful than ever. Not the
    Change he planned, but you get what you pay for.

    The prediction was specific: not that Obama would ruin us,
    though he might; or that we were marching towards
    mercantilism, though we were.

    Instead, the prediction was really an observation about


    Messiahs: no one hates Christ or Mohammed, they hate
    Christians and Muslims.

    II.

    “No one is saying what Joe Stack did was right. But you have
    to understand the anger, the resentment, there’s a lot of people
    who feel like they’re just being pushed around. Joe Stack is a
    sort of a symbol…”

    Would anyone listen if I pointed out that these are the same
    words that we hated to hear about the 9-11 hijackers or
    Palestinian suicide bombers?
    But anyway, why do you need a symbol, why do you need him
    as your symbol? You’re angry that the government is creating
    a welfare state, with your tax money, that collars poor
    Americans into service and obedience. Jeffersonians were in
    opposition to Hamiltonians (and Lagrangians) not just on the
    principle of government authority— Hamilton wanting a
    strong central power to govern for the benefit of the people—
    but also on consequences: strong government meant big
    increases in public services and public debt, which in turn
    reinforces the reliance on an ever expanding government.
    Sound familiar? So what do you need Joe Stack for?

    Maybe because Joe Stack isn’t a symbol for the expansion of


    the welfare state at the expense of individual freedoms, or
    somehing; maybe he’s just a symbol of an angry man who’s
    not really sure why he’s angry, he just knows someone else is
    to blame. In which case he’s the perfect symbol.

    You don’t need a symbol to say, “taxes are way too high.” You
    need a symbol to say, “this is who I am.”

    III.

    James Surowiecki, the writer at The New Yorker without


    encephalitis, wote:

    Whereas the economic populism of the 1890s and the


    right wing cultural populism of recent years represented
    reasonably coherent ideologies, this new populism has
    stitched together incompatible concerns and goals into
    one “I’m mad as hell” quilt. The people may have
    spoken. It’s just not clear that they’re making any sense.

    Obama hasn’t closed Guantanamo— and he won’t. He hasn’t


    brought the troops home from Iraq; and he won’t. He’s
    increased those in Afghanistan, saying he’ll bring them back
    in 18 months. He won’t. He hasn’t reduced the opacity of the
    government, the Patriot Act just got an extension. But if you
    were for those things under Bush, why aren’t you relieved
    about those now? If you were against them under Bush, why
    aren’t you mad now?

    The primary thing isn’t what you are angry about, the primary
    thing is your anger.

    IV.

    This is an example. After the election— and anyone who


    didn’t vote for Obama will know exactly what I’m talking
    about— you didn’t dare say a negative thing about Obama in
    public. Certainly not a flippant slander, the kind that are
    common when discussing Presidents. If you were in a
    restaurant, before you said anything about Obama you took a
    serious look around to see who else was near you, and only if
    it was safe (read: white) could you quickly whisper some
    veiled comment. You weren’t even allowed to be pessimistic
    about Obama. That was the climate. Again, if you didn’t vote
    for Obama you will know what I mean, if you did you’ll think
    I’m exaggerating. I’m not. Talking negatively about Obama in
    public was like trying to tell a dirty joke down at Human
    Resources.

    Fast forward to last week. This is what I heard a guy announce


    in a crowded downtown restaurant, and I’m quoting:

    Fuck him. Fuck Obama, fuck him, and fuck his


    horsefaced wife. I’m sick of his shit.

    Agree/disagree if you want, but understand that that guy’s


    anger had nothing to do with Obama at all. That guy wasn’t
    voicing his opinion, he was looking for a fight. He was daring
    someone to say something. He wasn’t saying this loudly
    despite his better judgment, he was saying it on purpose. He
    was throwing the guantlet down, cognitive kill switch style.
    “Oh, I can’t criticize Obama? I can’t say anything because it
    means I’m a racist? Well fuck you too.” That guy did not have
    an airplane, but if he did I am certain he would have flown it
    into his sandwich.

    This is the point: that man doesn’t hate Obama, he hates


    Obama supporters.

    V.

    This is what the Angry Joe thinks people thought in Nov 2008:

    Red: “I guess McCain. What other choice do I have?”

    Blue: “Go Obama! Ha! Who’s laughing now, bitches! Take


    that! I hope he raises taxes to 500%, I hope he rapes your
    daughters. Time to redistribute the income, all to me! Payback
    time! You mother–”

    Unfortunately, his crazy paranoic delusion is validated by ten


    seconds of any episode of the Rachel Maddow show.

    VI.

    In case you have had a short life or memory, Obama isn’t the
    most hated modern President. In terms of depth of hatred,
    Reagan beats them all, even Nixon. Openly considered a
    monster, evil, he was going to bring us to nuclear war on
    purpose just to kill minorities and then he’d forget all about it
    because he had taken a nap. The band Genesis made a video
    with him doing pretty much that, and it won awards. Imagine
    if a pop band did that with Obama.

    However, the hatred was confined to Reagan, not to everyone


    who liked Reagan. No one got cut off in traffic and thought,
    “look at this jerk, I’ll bet he voted for Reagan.” But now…

    This is probably because of the way we’re now trained to


    discuss politics: me vs. you. We are encouraged to make the
    focus be the argument, not the content. Setting yourself in
    opposition to someone who appears to have a definable
    character is a shortcut to your own branding, which is why
    you’re having the argument.

    VII.

    The problem with getting the President you want, only to find
    that he not only doesn’t deliver on his campaign promises, but
    he’s quite uninterested in delivering many of them, is that you
    don’t blame him, you blame the government.

    We’ve become what we dread most: France. A strong central


    government that everyone throughout the spectrum hates. Now
    what? Can’t punch a government, but you can kill an entirely
    uninvolved IRS agent with an airplane. Score one for freedom.

    “The country is ungovernable, we need a reform of


    government!” Why is it more ungovernable now? The
    government is the same one we’ve had for 2 generations.
    Nancy Pelosi, Harry Reid, Mitch McConnell, Dick Durbin—
    all your major players from both sides— have been there for
    over 20 years. Ideas and ideology haven’t changed since
    Vietnam. Obama was the Change guy— but there aren’t any
    new ideas there. Hell, he’s even copying Bush.

    The deep, strong cry of all civilized nations, — a cry


    which, every one now sees, must and will be answered,
    is: Give us a reform of Government! A good structure of
    legislation, a proper check upon the executive, a wise
    arrangement of the judiciary, is all that is wanting for
    human happiness…

    If only!

    Were the laws, the government, in good order, all were


    well with us; the rest would care for itself! Dissentients
    from this opinion, expressed or implied, are now rarely to
    be met with; widely and angrily as men differ in its
    application, the principle is admitted by all.
    Just like then, it’s nigh impossible to find anyone who doesn’t
    think this is true. A complete turnover of Congress would be
    awesome, I’ll admit, but don’t think for a second that anything
    can change just because you change your representatives. The
    problem isn’t the government, the problem is you. It is always
    you.

    VIII.

    You can’t imagine how you, one guy, can be the problem—
    the government is much bigger than you, isn’t it? But there are
    millions of people exactly like you. One byproduct of modern
    narcissism’s reliance on finite media is that countless other
    people are modeling their lives on the same template you are.
    You think you are unique in your thoughts and identity, turns
    out you are a clone. You think you’re the only guy for whom
    X was transformative? The only guy with an iphone?

    Most of you are huddled around the same directors feeding


    you the same lines which you regurgitate with sufficient
    passion you think you came up with it. I’ll bet you’re sure that
    “tax and spend Democrats like Nancy Pelosi and Harry Reid
    are running this country,” or that we need “renewable sources
    of energy that will also help create new jobs”— all of which
    might even be true except that the exact same contentless
    words are being thought by millions of other people who are
    all sure they know it. That doesn’t make you pause?

    It would be awesome, awesome, if these sound bites were


    being fed to you with an intent to deceive- as part of a
    Hearstian conspiracy to make the cattle think one thing so the
    Elites could do another; in short, awesome if, after all, there
    was some organized effort leading to a clear goal, no matter
    how nefarious. But there isn’t. It’s a battle royal, every man
    and company and politician fighting to eat and not be eaten.
    Even families operate at cross purposes, kids trying to leave,
    parents holding on to nothing, everyone looking for a
    “moment to myself.” This isn’t a war of ideals, it’s
    cannibalism.
    IX.

    Are you teaching your kids that certain people— the


    government— oppose your values? Why would you teach
    them that? By all means teach them your values, but don’t
    communicate it as a battle against other people. You’re turning
    your kids into you.

    X.

    You get the politicians you deserve. Arguing over “cutting


    spending” polarizes Americans because that soundbite is
    contentless, but elicits a strong emotional response not to a
    plan but about an imagined recipient (welfare abusers, etc.)
    This kind of a debate is an addictive drug.

    Politicians will give you what you want. If you say you’re for
    “cutting spending” then they’ll be for “cutting spending.”
    That’s all. If you want them to actually cut spending, you have
    to tell them what spending you actually want cut. They’re
    representatives, not leaders, right?

    Senator Bunning didn’t understand this. He thought


    Americans actually wanted spending cut, so he actually
    blocked the extension of unemployment benefits. Man, what a
    square. Well, he’s only been around for a term and a half.
    Chalk it up to inexperience.

    XI.

    Required reading for anyone unclear about the stakes is


    Ferguson’s Complexity and Collapse subtitled in the print
    edition, When The American Empire Goes, It Is Likely To Go
    Quickly. But for those who are used to getting their political
    theory from aviation experts or the people who discuss them,
    here’s the most important line:
    Neither interest rates at zero nor fiscal stimulus can
    achieve a sustainable recovery if people in the United
    States and abroad collectively decide, overnight, that such
    measures will lead to much higher inflation rates or
    outright default… such decisions are self fulfilling.
    (italics mine, emphasis ours.)

    You can’t change the government because you don’t even


    know what you want from it. You have to reconfigure your
    own mind. Your current expectations of life aren’t just
    unrealistic, they’re not even what you want. Another
    byproduct of narcissism is when you model yourself on a
    template, you’ll pursue the goals of the template. You’re
    chasing someone else’s happiness.

    I don’t think we’re on the verge of collapse, but I can predict


    that unless we turn away from empty political discourse, we
    are in for more airplanes.

    http://twitter.com/thelastpsych
    Illusionist
    March 12, 2010

    “i agree”

    I.

    The brain assumes that any two lines which meet must form a
    plane; specifically, that they do not overlap but separated
    along a third access by empty space.

    But what makes the object an illusion isn’t that the lines don’t
    meet— they do; but that the surfaces— middle “prong”
    (starting from the tip and moving back towards the base)—
    don’t meet. In fact, the surface disappears. The illusion,
    therefore, is one of constancy: in a static 2D drawing, an
    object cannot disappear into nothingness.

    The parts of the object are perfectly ordinary— consider the


    tips vs. the base— but their union presents a paradox because
    a static depiction demands change. It asks you to see the prong
    as both prong and empty space— that it changes before your
    eyes. A surface becomes a boundary, and a boundary becomes
    a surface. It is as if the fork exists in two simultaneous states,
    an idea which is incompatible with our reality.

    II.
    “It’s an illusion. It’s an impossible object.”

    How is it an illusion? How is it impossible? It’s completely


    possible, I’ll draw it myself:

    So real is this object that I could teach a blind man to draw it.
    How can you say it doesn’t exist?

    The illusion isn’t that this 3D object doesn’t exist. The illusion
    is that this object represents a 3D object at all, and that that 3D
    object doesn’t exist. But the 2D drawing certainly exists, and
    the 2D object is not telling you to see it as a 3D object, the
    object isn’t talking to you. The question you should be asking
    yourself is why you need to see this as 3D. No sane person
    looks at this 2D drawing and says it is impossible:
    The fork isn’t an optical illusion at all; the eye sees perfectly
    clearly what is before it. This is a cognitive illusion; and,
    indeed, it isn’t even an illusion— your cognition parses every
    detail, analytically, interprets the discontinuities as part of a
    continuum. In short, the cognition knows fully well that what
    it sees is easily drawn in 2D and impossible to construct in 3D,
    and knows precisely where the error lies— and yet it wants
    wants to see this object— not any 2D objects, not a scribble
    ball, but this specific object— in 3D, despite its better
    judgment. This isn’t involuntary; you can stop any time you
    want. You want to see this a certain way, and so you choose to
    do so.

    You are being lied to, by yourself.


    Swallow This: How Seroquel
    XR Works, Part 3
    March 14, 2010

    if you could only see the truth

    Part 1
    Part 2

    Now let’s stop asking how, and ask what: what does this drug
    actually do?

    FDA:
    Major Depressive Disorder sNDA Submission
    The FDA approval of SEROQUEL XR for MDD was
    based on a supplemental new drug application (sNDA)
    comprising findings from two Phase III, placebo-
    controlled studies that assessed the efficacy and safety of
    once-daily treatment with SEROQUEL XR as adjunctive
    treatment in patients with MDD.

    Note the word adjunctive. Two trials showed its efficacy as an


    adjunct. Like Abilify, Seroquel is only indicated for use as a
    supplement to a failed/failing antidepressant. Maybe it’s a
    necessary combination of a serotonergic effect plus (a non-
    existent) noradrenergic effect, or some other synergistic
    mechanism; but it’s an add-on, so get adding.

    An adjunct— to what?

    There’s your data, it’s one of the two trials the FDA used to
    grant the indication. The other trial’s data was nearly identical.
    (1)

    Seroquel was tested as an add-on to SSRIs, and also Effexor


    and Cymbalta. (The top line is placebo + SSRI/SNRI.) If we
    believe that at the doses used Effexor and Cymbalta are
    blocking the NET, and Seroquel at 150mg is doing the same,
    then why would we expect the addition of Seroquel to be of
    any use? They’re both fighting for the same site, only one can
    bind, so? You wouldn’t mix Paxil and Zoloft, would you?

    So either the NET isn’t relevant here; or, if it is, then those
    patients on Effexor/Cymbalta + Seroquel will not show greater
    improvement (e.g. as compared to Celexa + Seroquel). And
    the pooled data you see above will appear less impressive
    because the Effexor and Cymbalta patients dragged the overall
    average down.

    Or, more simply: if they did the study only with SSRIs, maybe
    the augmentation results would have been even better!

    So either the FDA is wrong you shouldn’t mix it with


    Effexor/Cymbalta, or you should because the FDA is wrong
    about the mechanism. Good luck, have a drink. Your next
    patient is the dumpster guy from Mulholland Drive.

    You’re frightening me with your talk of dumpsters and


    intimations of rum.

    Drink up.

    This is from the promotional slide deck that Astra Zeneca uses
    to detail doctors, showing the results of the two trials.
    Take a good look at this slide, and compare it to the one above,
    from which it came. Do you see anything weird? Take minute.

    Stop looking at the data curves. Stop looking at the p values.


    What do you expect to see there? You already know it’s going
    to beat placebo or else they wouldn’t have made a slide. Do
    you really think you’re going to discover something there?

    This slide is an illusion like the impossible fork, you want to


    see this as a representation of something else instead of seeing
    it for what it is.

    I’ll give you a hint:


    What happened to studies 1-5?

    Undoubtedly, your first thought will be that AZ hid the data. I


    wish that was true.

    This is a promotional slide. The purpose of it is to push


    Seroquel. That means that nothing on it is not either compelled
    by the FDA or on purpose to get you to believe. They are
    accurately labeled studies 6 and 7 so that there so doctors ask
    about the other 5 studies. Why do they need doctors to ask?
    Because the FDA forbids them from mentioning them. So strict
    is this ban that the AZ reps are not even told by the company
    there are 5 other studies, so that they don’t accidentally
    mention them. I am not exaggerating. The reps don’t know.

    You know what makes me happiest? When the government


    considers certain information so disruptive that it not only
    doesn’t it tell the citizens, it doesn’t even tell other members of
    the government. So that the only people who know are the
    heads of the government, and the heads of a for-profit
    corporation.

    There’s a word for that kind of thing. But anyway.

    So what were studies 1-5?


    Studies 1-5 were all monotherapy studies— specifically, 4
    acute trials and one 6 month maintenance study. And all but
    one acute study worked.(2)

    More importantly, two of the trials that worked used 50mg.

    In fact, AZ also submitted 5 other studies— all positive— to


    the FDA showing efficacy in GAD at doses starting at 50mg.

    So this drug is efficacious as monotherapy in depression


    and anxiety?

    Apparently so, and apparently at doses less than 150. Of


    course, since the adjunct trials were only done using 150 and
    300, those are the doses that get approved. Safety, to the FDA,
    means they’d rather you get 3x to 6x the necessary dose—
    along with a probably irrelevant drug— than reveal that it
    worked as monotherapy.

    Wait a second— if there’s very little NET inhibition at


    150mg, doesn’t that probably mean there isn’t any at all at
    50mg?

    Oops.

    Why would Astra Zeneca want to convince us that the


    mechanism of antidepressant effect was NET inhibition,
    when there is so much evidence (that presumably they are
    aware of) that it isn’t?

    Astra Zeneca doesn’t want to convince us of that: the FDA


    does.

    –-

    Coming soon: Part 4

    1. Note that 300mg was not better than 150mg. And why
    would it be? The higher the dose, the more dopamine blockade
    your getting, which isn’t relevant to depression otherwise we’d
    be augmenting with Haldol, which we aren’t. (NB: which is
    why Abilify augmentation stays below 15mg.)

    2. Seroquel 150 vs. Celexa 20 vs. placebo: no difference.

    –
    http://twitter.com/thelastpsych
    “[You, not I, are] killing
    people on a grand scale”
    March 18, 2010

    A much lauded/quoted report, the World Health Organization’s


    report on social justice
    The report detects the subtle causes of social injustice in the
    world, adeptly avoids simple left/right political tropes and
    outlines several concrete steps to reduce inequality in an
    urgent and immediate way. That was the plan, anyway.
    Instead, it concludes the introduction: “Social injustice is
    killing people on a grand scale.”
    The report is here, but I’ve chosen to link the Slovakian
    version of the 7.8MB pdf because if you read the English
    version The Ring will get you, it gets everyone. From now on,
    you’ll want to sleep with a gun and a crucifix under your
    pillow. Works for me.
    That the report is so politically biased as to be useless is not
    here the point, that’s for Glen and Rachel to argue. The point,
    rather is to show what the purpose of such a document is, why
    it exists in a medical journal, and how social policy reform is
    now executed by a few, covertly.
    First, simply to show that the report’s recommendations are
    not just vague or impossible, they are not even
    comprehensible. Here are some specific recommendations,
    chosen entirely at random:

    Set up an interagency mechanism to ensure policy


    coherence for early child development such that, across
    agencies, a comprehensive approach to early child
    development is acted on.

    Fie upon it. Here’s another, this one was in bold:

    Adopt a social determinants framework across the


    policy and programmatic functions of the ministry of
    health and strengthen its stewardship role in
    supporting a social determinants approach across
    government.

    A short one, I assume written in Fortran:

    Institutionalize and strengthen technical capacities in


    health equity impact assessment of all international and
    national economic agreements.

    And you’ll say, “oh, come on, that’s not random, you’re just
    selecting them out of context.” Enjoy your context:
    Don’t ask me how I know this, but I am 100% certain this
    report was typed on a Mac.

    The ones you can understand make you a bit uneasy, even if
    you’re for them:

    Strengthen gender mainstreaming by creating and


    financing a gender equity unit within the central
    administration of governments and international
    institutions.

    •Create a dedicated budget for generation and global


    sharing of evidence on social determinants of health and
    health equity.

    •Build national capacity for progressive taxation and


    assess potential for new national and global public
    finance mechanisms.

    A working definition of social justice is you get what you


    deserve and you deserve what you get. The report is free and
    in the British Medical Journal, so in that sense it is supremely
    just.
    II.

    Now, to why the report exists, what is anyone supposed to do


    with it?

    None of these recommendations can or will be implemented,


    and, indeed, this report does not exist for that purpose. The
    report is pure Borges. It exists not to be read— it wouldn’t
    even matter that it was actually written, so long as people
    believed it had been written; it exists in order to be referenced,
    to be able to say “the WHO says that social injustice is killing
    people on a grand scale” (4500 hits); to validate individual’s
    opinions as if they were grounded in science. The idea is to
    create a scientific basis for an ideology, in the absence of
    science. In psychiatry we call those “thought leaders,” and the
    rest of you laymen call them “experts.”

    For example, the report allowed this professor of clinical


    epidemiology to say:

    Pointing to the harmful health consequences of the


    “market oriented economic policies” pursued since the
    1980s that have led to a “significant reduction in the role
    of the state and levels of public spending and
    investment,” the report provides evidence that equity
    oriented growth can produce the health gains of
    development without the adverse effects of growth that
    favours the “interests of a rich and powerful minority
    over the interests of a disempowered majority.”

    Fortunately, he knows that the data to which he refers is— his


    words— “not value free.” Unfortunately, he thinks that’s a
    good thing.

    Don’t get sucked into arguing about this on the basis of


    politics. Argue on the merits of the data. Otherwise, these
    politically motivated interpretations of reality will lead to
    stunningly idiotic policy decisions, such as the one quoted by
    this person who I assume has meningitis:

    “If we could do something about prevention, we could


    empty the hospital wards.”

    Really? Can the editor of the British Medical Journal be


    simultaneously politically indignant and naive to think that
    hospitals fill because people are sick?

    III.

    So if that’s what the report is for— to serve as a superscript to


    someone’s personal proclivities— what is the basis of that
    report? Not what does it say, but what is the underlying thesis?

    Gas up your airplanes.

    Part 2 soon.
    The Source Of Society’s Ills
    March 19, 2010

    hint: it’s the guy on the right


    (Part 1 here)

    Richard Wilkinson, epidemiologist, looked at data to


    determine if numerous social ills— from crime to teen
    pregnancy to mental illness— are caused by any one single
    factor.

    In fairness, he knew in advance what he wanted the answer to


    be, so when he found it it wasn’t so much a surprise as a
    potential 350 page book available at Amazon. But data is data.

    One might accuse me of misrepresenting people’s ideas, so I’ll


    give Wilkinson the first word:

    [Aside: did this make you angry? Realize your anger is


    directed at the people, not specifically the ideas even though
    you disagree; you hate the kind of people you imagine this
    video represents. Empty political discourse reinforces a
    division among people, not ideas. Not only did Wilkinson fail
    at winning you over, he’s made it impossible for you to even
    consider listening.]

    The single cause that he found isn’t poverty or a lack of


    economic growth. What Wilkinson did not find— and what
    too many other intelligent people think that he found— is that
    income inequality is the cause of society’s ills. The problem is
    not that your country has too many poor people:

    The single cause is relative inequality. Those 25% Americans


    who live 50% below the average income still have a lot
    compared to Slovakians; but they’re sicker/unhappier than
    most Slovakians because they are poorer than other
    Americans.
    Wilkinson makes explicit that the relationship of relative
    inequality to social ills is
    nation specific (Americans compare themselves to other
    Americans, not Slovakians)
    in one direction: crime/obesity/unhappiness is caused by
    income inequality, not the other way around

    and implicitly that the issue is not necessarily an inability to


    access services (e.g. health care) but a relative inability to
    participate in that society. By analogy that is not at all a joke:
    the problem isn’t that you don’t have a million dollars, the
    problem is that the other guy does, and now he doesn’t want to
    hang out with you.
    Wilkinson has numerous solutions, previously discussed at
    Starbucks, of varying levels of efficacy or insanity, depending:

    progressive income and property taxes


    good labour law, protection of union rights
    more generous pensions
    higher minimum wages
    ceiling/maximum wage

    etc.
    It’s important to point out three things:

    1. Why he titled his book, “The Spirit Level:” Not a


    reference to living free of materialism, but rather a
    carpenter’s tool to check and see if things are level.
    There’s no “invisible hand” at work here.
    2. Wilkinson is not just another academic social policy
    theorist who references Marx; he is also the editor of the
    2003 version of the WHO report on social justice.
    3. Despite Wilkinson’s explicit reference to inequality being
    judged within a specific country, the WHO report extends
    it to cover all countries— so it doesn’t just call for
    income redistribution within your nation, it calls for it
    across the world.

    So we’re back to the beginning: what does income


    redistribution have to do with medicine? Since it is apparently
    the cause of numerous social ills including crime and war, why
    is it the role of one of them (health) to start the process, and
    not, say, the Department of Corrections or the military??

    What, you think doctors are just better humanitarians?

    Part 3 here
    Relative Income Inequality
    March 23, 2010

    did i make things worse?


    Part 1
    Part 2

    Reiterated: Wilkinson finds that one judges equality against


    people in their own nation; and absolute income is not nearly
    as important as relative income inequality.

    we looked at life expectancy, mental illness, teen


    birthrates, violence, the percent of populations in prison,
    and drug use. They were all not just a little bit worse, but
    much worse, in more unequal countries.

    …what matters aren’t the incomes themselves but how


    unequal they are. If you’re a more unequal state, the same
    level of income produces a higher death rate.

    It’s such a simple argument that it is easy to think he’s saying


    something else. He’s not talking about an inability to access
    basic services or buy food and shelter— not “haves” and
    “have nots” but the “psychosocial” (his word) effects of
    inequality.
    There are problems that we think of as problems of
    poverty because they’re in the poorest areas of society,
    but a country like the U.S. can be twice as rich… and the
    problems are no better even though Americans are able to
    buy twice as much of everything as the poorer developed
    societies.

    The income inequality matters because we are a social species


    and relate not to absolutes but to each other in our own nation.

    So, is he right?

    Of course he’s right. You don’t need any of his data to know
    resentment is always relative to the other, frustration is
    synonymous with a impeded will, and that both of these exact
    a biological and psychological toll. I don’t need anyone to tell
    me that massive executive pay drives people bananas. And as
    I’ve hopefully made obvious by this point, most people’s
    anger about policies, politics, and problems are really about
    our relation to some other group of people.

    But slow down. The mistake everyone is making is conflating


    the problem— income inequality— with the proposed solution
    — income redistribution.

    II.

    First, while the hard data point to “income inequality” because


    it’s the only measurable statistic for the real issue of income
    justice, i.e., getting what you deserve and deserving what you
    get. When people talk about the social effects of income
    inequality in America, they always bring up CEOs but never,
    not once, ever, bring up Warren Buffet. Or baseball players. Or
    the Kennedys. Or Sandra Bullock. As much as Sandra Bullock
    drives me insane I have never set fire to a trash can or
    impregnated a teenager because she made what is obviously
    way too much money for agreeing to be in the worst movies
    ever scripted by spider monkeys.

    However, we have some (obviously warped) sense that these


    people deserved their incomes. So what we’re really wanting
    isn’t income redistribution but a sense of distributive justice.

    Well, good luck on that one: who is going to be trusted to


    redistribute? “The government” isn’t a spirit, it’s a bunch of
    people that seem to be selected for infidelity. And people
    Americans are rightly suspicious of the criminal justice
    system; why would the distributive justice system be perceived
    to be any more fair? It doesn’t matter a lick whether it is
    actually fair or not because it will be filtered through a lifetime
    of prejudices and cognitive biases. As one rambling fool put it,
    it’s the Stroop test applied to public policy.

    I’ve not seen anyone bring up a point that will be obvious the
    moment I say it: rich people can get angry, too. If people get
    angry because they don’t have what they think they deserve,
    imagine the anger that will manifest when people have things
    taken away from them. Don’t yell at me: it matters not at all
    whether “the rich” are entitled to their anger or justified in
    their purchase of a Cessna, only that it is a fact that they will
    be angry.

    You can’t pretend social unrest only comes from the bottom
    up; when a group of feel unfairly branded as “the problem” by
    the likes of people whom they believe have never actually
    produced anything (i.e. congressmen), and what they feel
    they’ve earned taken from them, well, they won’t be breaking
    store windows and flipping cars over, but your society will be
    transformed all the same.

    Again, I am not justifying their anger, I am warning against


    what you think is so obvious a solution. I am describing
    reality: rich people can buy guns, too. And Congressmen. This
    is a fight that you cannot win, not here and not for at least two
    more generations.

    If you attempt income redistribution, not only will you fail, the
    country will bury you for 25 years. It happened to Jimmy
    Carter. It will happen again.
    III.

    The second reason income redistribution will fail is that you


    change its value by redistributing it.

    If you run Wilkinson’s book through Babel Fish, you see that
    when he writes “income inequality” he actually means
    “relative inability to participate in society.” In other words, the
    disparity isn’t income, it’s consumption.

    Income inequality seems to explain why America has more


    social ills than, say, Costa Rica but it’s because income means
    something completely different to Americans than it does to
    Costa Ricans.

    To any nominally poor nation— take your pick, from African


    subcontinent to nearly integrated industrialized Romania—
    income is only a supplement to an existence. In America, it
    represents expectations, potential, identity, everything. Even
    the least materialistic American makes judgments about other
    people based on this income, even if the judgments are inverse
    ones (“the rich are bad” etc) or about himself (“I’m not like
    other Americans, I don’t need an income.”)

    Income represents the potential for consumption, and this


    potential is the measure of social equality.

    Wilkinson strolls right up to this point, has his face bitten off
    by it, and walks away oblivious:

    Status competition causes problems all the way up; we’re


    all very sensitive to how we’re judged. Think about
    Robert Frank’s books Luxury Fever or Falling Behind, or
    the great French sociologist Bourdieu—they show how
    much of consumption is about status competition. People
    spend thousands of pounds on a handbag with the right
    labels to make statements about themselves. In more
    unequal countries, people are more likely to get into
    debt. They save less of their income and spend more.
    That’s what his data actually shows, but he falls back on
    income inequality. Status competition, personal branding,
    attempts at self identification. Even nearly perfect
    redistribution of income will not affect these social ills because
    people will find something else to set themselves apart from
    the rest. High school students manage to create a viciously
    unequal society that drives some kids to suicide and others to
    Columbine and others to group sex and it has nothing to do
    with income at all. Or are we still blaming genetics for all
    that?

    IV.

    When I tell you that narcissism is the biggest epidemic this


    generation faces, I’m not looking to get on Oprah, I mean it.
    Any tentative political solution— redistribution of income,
    modification of entitlements (either more or less), focusing on
    education, whatever— while these are all noble approaches
    that likely will have some immediate impact— long term all of
    them will fail. All of them. The problem is deeper than
    incomes, it is expectations, and you can’t redistribute
    expectations.

    You could hand every American $10M in gold bullion right


    now, free and clear— you could take it right out of a CEOs
    pocket and call it social justice— and nothing will change
    except that they will drink more.

    I’m not constructing a conservative argument against a liberal


    policy, I’m not choosing an economic ideology; I am taking a
    strictly realist’s perspective that income redistribution will fail.
    And it will fail also in China and in Brazil and yes, even
    Scandinavia. Everywhere, it is inevitable.

    There’s a very specific reason for this, Wilkinson hits it but


    refuses to pursue it to its conclusion; instead, he falls back on
    income inequality:
    If you grow up in an unequal society, your actual
    experience of human relationships is different. Your idea
    of human nature changes. If you grow up in a
    consumerist society, you think of human beings as self-
    interested. In fact, consumerism is so powerful because
    we’re so highly social. It’s not that we actually have an
    overwhelming desire to accumulate property, it’s that
    we’re concerned with how we’re seen all the time. So
    actually, we’re misunderstanding consumerism. It’s not
    material self-interest, it’s that we’re so sensitive. We
    experience ourselves through each other’s eyes—and
    that’s the reason for the labels and the clothes and the
    cars.

    (Part 4 soon.)
    Will You Ever Be Happy?
    March 26, 2010

    no
    “Participating in society”: The Bebe Problem

    I once dated a girl who worked at Bebe. Is being hot a


    prerequisite for the job? Not officially, anyway. But is dressing
    well required? Of course. And she was definitely dressed well.
    Didn’t have to be Bebe, but it had to be this season and
    designer. She liked DKNY.

    But she was only making, what, $25k/yr? She couldn’t


    possibly afford to dress the way she was expected to dress for
    that job, not without credit card debt or money from parents or
    boyfriends. Forget about saving, right? And no, no health
    insurance.
    But there she was. It probably never occurred to her that going
    into debt in order to keep a job is preposterous, because that’s
    the way it’s been done there— and for receptionists and
    hostesses and etc, forever.

    That’s not The Bebe Problem: The Bebe Problem is: she
    thinks she is choosing to do it.

    II.

    No one told her she needed to dress like that, exactly. But
    somehow the job selects for a woman who will. Somehow she
    received the message that to work in a job like that she needs
    to dress up equivalently to the VP or partner or owner. And
    they’re great clothes, so she likes it, it helps rationalize the
    purchases. That helps hide the obligation of it.

    It’s one thing to dress yourself up as a personal brand. It’s


    another thing when you are being dressed up by someone else
    as extensions of their brand. And yet another thing when you
    don’t even realize it’s happening to you, when you think
    you’re making the choice yourself.

    I lied about the Bebe Problem. The real Bebe Problem is that
    this is happening not just to sales girls, but to everyone.

    III.

    They saved Pamela Anderson and Kate Gosselin for the end of
    first episode of Dancing With The Stars. The host, Brooke
    Burke, said, “and coming up next: she’s the most downloaded
    woman in the world, and she’s America’s most famous mom!”

    I had a moment of nausea, so I put down the rum. Don’t both


    of those descriptions more accurately apply to Pamela
    Anderson? How is Kate “the mom?”

    The whole show is full of moms. Brooke Burke has three kids,
    and unless she is eating them she is incontrovertibly a better
    mom than Kate. On the DWTS website, contestant Niecy Nash
    (2 movies and 3 TV shows) lists “motherhood” as her greatest
    success in life. But she’s not the mom either, because she’s
    black. She’s the “oh no he di’nt” girl. TV is all about equality
    as long as everyone stays in character.

    Pam is the sex object, even though she is no longer a sex


    object, nor does she need to be.

    And Kate, who is more accurately described as The Woman


    Whose Haircut Cures Priapism, represents “the mom.” Why?
    Pam and she both have hair extensions, they’ve both had
    plastic surgery, they’re both hyperconscious of their
    appearance and image, so? Truth be told, I’d let my kids live
    with Pamela Anderson way before I even let them visit the set
    of Saw IV that is the Gosselin house. So?

    Why is Kate “the mom?” Because she plays a mom on TV.

    IV.

    DWTS is a reality show, of sorts. What (theoretically) makes


    the show interesting, apart from the dancing, is you get to see
    people be themselves not their characters. Pam Anderson is
    thus an awesome choice, because it’s a rare chance to see the
    real woman behind the icon. Unfortunately, on the first
    episode she was very nervous, and to mask it she overacted,
    she pouted and wiggled and bit her lip and went over the top
    sexy, the way an embarrassed child becomes spastic. She hid
    behind her character, and in that setting it will make people
    find her annoying. There are plenty of places other than DWTS
    or my basement to see her naked, that’s not what we’re here
    for. She’d be infinitely more interesting if she was just real,
    because that’s what we want to see.

    That’s not the case for Kate. You already know what she’s like
    in real life, or meta-real life anyway. If you like Kate and are
    watching, it’s because you want to see a “normal” person get
    the chance to be famous on TV. The trick is fooling you into
    thinking she isn’t that already.
    Pam Anderson already had plastic surgery; Kate got it for the
    show. That’s why People adores her: she’s a mom becoming
    something else. If you find yourself rooting for Kate, because,
    like People, you think it’s great that a regular mom is getting
    to have fun, then it’s a fairly safe bet that you’re miserable.

    V.

    I hope it’s obvious that Kate “the mom” is just as


    manufactured as Pam “the sex bomb.” But I’m staring at the
    TV, I am not drunk or insane or an imbecile, and I am trying
    my hardest, but even knowing everything I know I cannot stop
    seeing Kate as The Mom and Pam as The Sex Bomb, it is
    impossible for me to stop these unconscious, reflexive
    associations from happening.

    If I was a woman of, say, 30, overwhelmed by hidden


    ambivalence, making next to nothing while spending next to
    everything, simultaneously unfulfilled by my excellent
    material possessions while protected from facing my actual
    social position; if I had to choose a direction in life but
    realizing that my choice probably didn’t matter because the
    outcome had already been decided by the audience, yeah, I’d
    be on Abilify, too.

    VI.

    Someone ask Richard Wilkinson where he would place my ex-


    girlfriend, or Kate Gosselin, on his continuum of social
    inequality.

    http://twitter.com/thelastpsych
    This Is Baywatch
    April 1, 2010

    Three of the women in this picture don’t exist


    (An article from 1995. I edited it and added some pictures.)

    I.

    “Baywatch supports impossible standards that women are


    pressured to follow.”

    Everyone knows these women were selected because they are


    hot, that’s the point. They represent ideals of a certain kind.
    How badly will “regular” women’s self-esteem be mangled if
    they can’t be ideals? I think they’ll be fine.

    Will more women want to dye their hair blonde? Get


    implants? Probably. Will this end up destroying America?
    Probably not. Will it set impossible standards for women, turn
    men impotent when confronted by A cups? No. Why would
    Baywatch do it if pornography can’t?

    Pamela Anderson isn’t the problem. CJ is the problem. She


    doesn’t exist.
    It’s conceivable that with the right supplies, you could look
    like Pamela Anderson. This won’t destroy society. What
    women can’t do is look and live like CJ on a lifeguard’s
    income.

    But Baywatch convinces people that there is a certain level of


    ordinary materialism that everyone can have. “This is what it
    $20,000 a year looks like.”

    That’s what’s going to destroy America.

    II.

    How much does it cost to be CJ? Not Pamela Anderson— CJ.


    So, not how much are implants, a nose job and a personal
    trainer; but how much are CJ’s nail appointments, and hair?
    How much does her (or any of the characters’) makeup cost?
    The car lease? Her CD player and apartment in Malibu? The
    sofas? CJ and the gals never wear the same clothes in two
    shows. Never the same shoes. How much does that cost? They
    don’t shop at Sears, right?

    Baywatch, along with Beverly Hills 90210 and Melrose Place,


    is changing America in ways you don’t notice— precisely
    because you don’t notice. In prior TV and movies any
    incongruous displays of wealth had an explanation, however
    cliched. Magnum PI lived off the kindness of Higgins. Rachel
    on Friends has rich parents. But with rare exceptions, the
    characters in the new crop of 20 something TV have access to
    material goods way outside their pay range, but they are made
    so ordinary you never think to question it. We know very well
    how Pamela Anderson affords it. But it’s made axiomatic that
    CJ can.
    You are so busy wrestling with the sexuality of the show that
    you don’t realize that a certain material lifestyle is being made
    normal.

    III.

    Pretend one of the shows was about interracial dating. Say,


    Guido gets upset that CJ could be with a Black Man whom he
    assumes is a thug because he listens to rap. Following a
    standard script, Guido gets into trouble and is saved by The
    Black Man, and so learns that “it’s the person inside that
    counts” and thus there is nothing wrong with interracial
    dating. Ok— let’s say you disagree. Let’s say you’re willing to
    accept that not all black people are criminals, but you still
    have some serious reservations about letting your daughter
    date white guys (see?) “Oh,” you think, “they’re pushing a
    liberal agenda.” You assume that Hollywood is liberal.

    Maybe— but what’s more important is that you just learned


    that the default is that there is nothing wrong with interracial
    dating. The show said: this is how most of the world thinks. If
    you disagree with this position, it’s up to you to explain why—
    not up to them to defend it.
    Well, that’s what the show does to leather sofas. It makes
    having a big TV or new shoes the obvious and default. You
    can protect yourself from the emotional damage of not looking
    like Pamela Anderson because you know she’s “impossible.”
    But you have no defense against new shoes because they’re
    ordinary. You’ve incorporated a certain level of materialism
    into your identity and you can’t ever shake it.

    Baywatch will end up selling more clothes than breast


    implants.

    IV.

    Let’s close our eyes and imagine, as I do frequently, peeling


    off CJ’s red lycra one-piece. I like to stand behind her when I
    do it. What do you see that’s impossible? Oh, the lack of tan
    lines.

    It seems like a trivial point, but it’s not. No matter what


    enhancements you do to your body, after days and days on the
    beach tan lines are inevitable. So either she goes to a tanning
    studio as well, or her existence is impossible.

    Pamela Anderson with no tan lines makes sense, and so you


    being different is explainable. But when CJ doesn’t have them,
    then you’re not going to have them either.

    It’s wrong to look at the Baywatch women as pornography,


    especially during a time when actual pornography is becoming
    so easy to acquire. The real pornography is the surrounding
    materialism, the casual display of impossible lifestyles and
    unattainable goods as if they are ordinary commodities. After
    ten hours of porn, a breast flash doesn’t seem like a big deal.
    After ten hours of Baywatch, leasing a car doesn’t, either.

    In twenty years, Pamela Anderson probably won’t look like


    she does now, but she’ll still have her money. But what’s going
    to happen to the 20 somethings who expect a certain basic
    level of luxury? Baywatch is popular all over the world, so this
    won’t be limited to Americans. What’s coming is a worldwide
    generation of future 40 year olds who will not be able to afford
    what they are now being conditioned to expect.

    Right now the solution is easy— debt. Because that’s what


    everyone does to afford what they assume is basic standard of
    living— e.g. cable TV. Besides, the 20 somethings always
    have the future— the promise of a better job, more money. I
    wouldn’t be surprised if in ten years it will be completely
    normal to be two or three annual salaries in debt.

    The debts will come due, and they will come due the moment
    the 40 somethings realize that this is the most they will ever
    make; that they can’t take on more debt; they can’t live the
    lifestyle that they thought was ordinary.

    I’m prepared to deal with the awesome social consequences of


    a generation of women with breast implants. But how can I, or
    anyone, live in a world where it is expected that you live well
    outside your means?

    –-

    http://twitter.com/thelastpsych
    I’m Not The One You Should
    Be Worried About
    April 5, 2010

    the poor girl in this Acura commercial never stood a chance


    I.

    I’m thankful to those who defend me, and I’m not surprised by
    those who hate me, but either way you are missing the point. I
    don’t matter. It’s debatable whether my ideas matter, but for
    sure they matter much more than I do.

    I am “Alone.” What does that mean? It means that no other


    characteristic should matter to you, the reader, except that
    there’s only me, whatever that is.

    I don’t write anonymously because I want to protect my career


    — most of my work is forensic and it’s unlikely the guy whose
    been in jail for a year awaiting trial for drug possession is
    going to care about my thoughts on DWTS; he’s got way
    bigger problems, like how the city criminal justice system isn’t
    merely unfair but quite likely completely unconstitutional.
    And I’ll say, on my behalf, at least he has someone like me on
    his side.
    I write anonymously so that you aren’t distracted by my age or
    lack of manners or political sympathies. They don’t matter. If
    you want to say that narcissism didn’t play the crucial part in
    this maniac’s murder of his daughter just because she liked the
    wrong kind of guy, then we can have a good rumble. But if
    you want to say that narcissism didn’t play the crucial role
    because— I’m white, or single, or drunk; then you’re trapped
    in the generational circuit of illogicity that is the very point of
    this blog.

    II.

    I don’t blame you for wanting to attack or defend me; that’s


    how we’re trained to think about complicated issues. We’re
    alive in a time where the President’s attackers and defenders
    both assume he is lying, saying “what he has to say.” We don’t
    believe words, we believe identity. If Obama did it, then it’s
    either definitely good or bad, depending on what you think of
    him. Never mind that if you look at what he’s done, it looks
    almost the same as what Bush did. Wild. Should’ve swallowed
    the red pill.

    The Matrix is a great movie but a poor expression of


    Baudrillard’s philosophy. The Matrix is quite straightforward,
    there’s no confusion, no paradox: you’re either in the Matrix,
    or you’re in the real world. You may not know you’re in the
    Matrix, but that doesn’t change the fact that you are or are not
    in it.

    A true Baudrillard Matrix would be a single world that became


    so fake that you no longer needed the original. The whole
    world becomes a fake; there is no recourse to the real world.
    You’ll know it happened when you look at a copy of
    something, the original of which you have had no actual
    knowledge, and say, “oh, that’s so authentic.” If you are under
    47 and think Mad Men is much more accurate about 1963 than
    Oliver Stone’s JFK— or vise versa— then you’re in the
    Matrix. GET OUT.
    “Inability to participate in society,” lamented Secretary of
    Socialism Wilkinson, eyeballs deep in the Matrix. That’s what
    he thinks drives people crazy. He’s right; but the solution isn’t
    a redistribution of income, it’s reducing the desire to
    participate in the Matrix. Somewhere in the past 50 years or so
    the media accidentally constructed an artificial reality that was
    hidden by the on-purpose entertainment reality of TV shows.
    You look at any of the CSI shows and think, “well, of course
    this isn’t a real representation of actual crime scene
    investigators.” But it never occurs to you to think as they’re
    arresting a suspect, “since when did it become ordinary for
    professional cops in their 40s to have no kids, tons of
    disposable income, and regularly go out on dates that end in
    sex? And what the hell happened to body fat?”

    No wonder people think— feel, experience— that they lose


    part of themselves when they have kids. Or grow old.

    Commercials are even worse. That attractive, well dressed


    woman who looks longingly at a passing two door Acura ZDX
    is a synthesis that you resist— you know that they’re selling
    Acuras, and you’re not falling for it. You’re so clever, seeing
    through it— you know owning an Acura doesn’t make you an
    attractive well dressed woman, nor will it attract such a
    woman. But what you don’t realize you’re learning is that this
    is what attractive well dressed women look like. Acura is
    selling Macy’s. And Macy’s is having a sale; for the right price
    you can be 25 forever.

    That advertising agency probably just wanted to sell some cars


    today; not change the society you will want to participate in
    tomorrow.

    I guess that’s why they say: May the best of your todays be the
    worst of your tomorrows.

    But you ain’t thinking that far ahead.

    Know what I mean?


    –

    http://twitter.com/thelastpsych
    Everything’s Amazing and
    Nobody’s Happy
    April 6, 2010

    worth repeating
    A not very happy
    observation about +/- being a
    woman
    April 10, 2010

    one of us has a question

    I’m writing a long post about psychiatry (I write several posts


    at once, and finish them randomly.) As with many other posts,
    I often email academics, journalists or other primary sources
    to ask them a question.

    Sometimes I ask because I don’t know, but often it’s a “stupid”


    question to test someone’s bias/perspective/actual knowledge.

    As a recent example: I asked two different academics


    (paraphrased) “how does seroquel work as an antidepressant?
    Is it the NET, and how much binding is there?”

    Key point here: these are “famous” or busy or important


    individuals, used to getting a lot of emails; and my questions
    are very basic, very easy to answer, and an ordinary person
    should have been able to look up the answer themselves.

    I construct the email to appear as if I am a college-aged


    person.
    My observation having done this several dozen times:

    If I use a (fake) male email address, e.g. “petermiller@”


    no one ever responds.
    If I use a (fake) female email address, e.g.
    “melissamiller@” I get answers almost every single time.

    I’ll add that the majority of the people I email are male; the
    few women I’ve emailed haven’t been any different. I’ve
    confirmed this by waiting a long time (month) and re-emailing
    a different (but still simple) version as a woman.

    The conclusion I went to first was that there is some


    unconscious sexual element; not that the academics thought
    they were going to seduce me, of course, but that they derived
    some greater pleasure in answering the women than the men.

    But perhaps there’s a different explanation: there may be an


    assumption that if a guy asks such a basic/stupid question, then
    he’s an idiot and not worth bothering with; but if a girl asks it,
    well, a college girl isn’t held to the same standard/ expected to
    know as much.

    I’d be interested in knowing other people’s reactions and


    experiences with similar scenarios. I’m quite willing to accept
    alternative explanations.

    http://twitter.com/thelastpsych
    Why Is There So Much
    Pollen?
    April 15, 2010

    I’m bored and horny, which are the same thing

    Female trees are not sought after by landscapers (especially in


    the city) because what makes them pretty— flowers and fruit
    — also makes them considerably high maintenance. Someone
    has to clean up after them.

    So urban landscapers favor male trees— no flowers. But


    plenty of pollen.

    There are things which complicate allergies in the city.

    First is the urban environment: it’s concrete and limited.


    There’s nowhere to go, nothing to do, except blow around
    aimlessly.

    Second, because of the cars, etc, there’s plenty of carbon


    dioxide— essentially fast food for trees— which makes the
    trees pollinate even more.

    Third— and if you don’t live near a city all you need to do is
    watch any TV show set in a city— Grey’s Anatomy or CSI NY
    — there aren’t that many different kinds of trees. The same
    types are used over and over. People forget that there are
    millions of kinds of trees, they expect to see the same 5 or so.

    Unlike delicious rum, exposure to the same kinds of pollen


    over and over makes you more sensitive to it, not less.
    Certainly if there were more species of tree out there, you
    wouldn’t react as negatively to a repeated presentation of the
    same kind. But, as said, female trees are deliberately avoided
    by landscapers. Since you’re not used to seeing different kinds
    of trees, it never quite hits you that this state of affairs is not
    only unnecessary, it’s deliberately manufactured.

    But most importantly to the problem of pollination is simply


    that there aren’t any female trees. This makes the male trees
    pollinate more. Ordinarily, a paucity of female trees would
    result in a shift in equilibrium, to form more females/less
    males.

    But the landscape isn’t natural, it’s artificial— no female trees.


    So the male trees, instinctively, keep upping their game;
    they’re not aware they’re doing it, of course. Nor are they
    aware that it doesn’t make a difference what they do— because
    the environment is being manipulated from the outside.

    II.

    Imagine what kind of upkeep would be necessary if, for some


    reason, we didn’t have any male trees. How much would it
    cost the city to both remove the male trees while maintaining
    the female trees, the seeds, etc? Putting aside environmental
    concerns, trying to keep up this kind of disequilibrium
    wouldn’t make any economic sense. We’d quite quickly figure
    out a way to plant some male trees.

    III.

    Or, this.
    Why Is It So Hard To Find A
    Good Black Man To Marry?
    April 15, 2010

    uh oh
    Prologue here.

    I.

    From The Economist:

    Imagine that the world consists of 20 men and 20 women.


    Since the numbers are even, everyone can find a partner.
    But what happens if you take away one man? You might
    not think this would make much difference. You would
    be wrong… With 20 women pursuing 19 men, one
    woman faces the prospect of spinsterhood. So she ups her
    game. Perhaps she dresses more seductively. Perhaps she
    makes an extra effort to be obliging. Somehow or other,
    she “steals” a man from one of her fellow women. That
    newly single woman then ups her game, too, to steal a
    man from someone else. A chain reaction ensues…
    1 in 9 black men in their 20s is in jail. And only a third of
    black women 30-44 are married. The study, Male
    Incarceration, The Marriage Market, and Female Outcomes,
    from which the above hypothetical is drawn estimates that for
    every percent of incarcerated men, there’s a 2.4% drop in
    marriage rates.

    You might say that the educated black women are not likely to
    marry the kind of men who are being incarcerated. Maybe, but
    besides the point: the key statistic is that 96% of black women
    marry black men, and if 10% are in jail, well, what is she
    supposed to do?

    II.

    Actually, it’s not besides the point, it is the point. Other studies
    have tried to correlate the quality of eligible men to the overall
    marriage rate— i.e. where are all the “good” black men?
    (Un)Surprisingly, they have mostly found little overall effect,
    with no explanation. In a normally functioning economy with
    a dwindling supply, women would be predicted to… settle.
    But the marriage rate would be high.

    This paper is unique, however, because it correlates the actual


    number of men— indeed, men precisely not high on the list of
    choice mates. Their absence has an effect not on the women,
    but on the men. There’s less incentive to try harder. Or try at
    all.

    Here’s the missing sentence from The Economist quote:

    A chain reaction ensues.Before long, every woman has to


    try harder, and every man can relax a little.

    III.

    Do I need to bring up the fact that a lot of (black) people spend


    months, sometimes years, in jail— pre trial? Only to have a
    bench trial with a public defender who does not know their
    name, and who urges them to take the plea with time served?

    IV.

    Here’s an illustrative example: 70% of black babies are born


    out of wedlock. They’re obviously not all sired by inmates, so
    how does this happen? According to the study, the decreased
    pool of men- any men— means the ones left become more
    valuable independent of their actual “quality” (as defined by
    behavior eligibility, etc.)

    “I thought I was a catch,” sighs an attractive black female


    doctor at a hospital in Washington, DC. Black men with
    good jobs know they are “a hot commodity”, she
    observes. When there are six women chasing one man,
    “It’s like, what are you going to do extra, to get his
    attention?” Some women offer sex on the first date, she
    says, which makes life harder for those who prefer to
    combine romance with commitment.

    V.

    There’s also the problem of contagion. A black baby may be


    born into a loving set of educated parents, but what is the
    effect of simply knowing that a close relative— say an uncle—
    has been in the joint? Or, more commonly, that there are
    female relatives who have no choice but to raise a child on
    their own; and there are male relatives who don’t have to live
    with their kids?

    When a parent does something, it makes that action a


    potentiality in the world of the child. A parent who publishes a
    book— even one that no one ever reads— has, at least, placed
    writing a book into the range of possibilities. It works both
    ways.
    A.

    Behavioral economics is so much fun because by reducing the


    human condition to the impulses of inanimate objects, or at
    best rhesus monkeys, you get to ignore all that confusing stuff,
    like pornography, and its obviously non-existent effect on
    human desires. “They were maximizing a utility function!”
    And how.

    Anyone else a little nervous about reducing black men to a


    commodity with binary utility? No? Just me? Sweet.

    B.

    If you didn’t like that thought, you’re going to hate this one:
    why does the black female doctor quoted above think she’s “a
    catch?” Don’t yell at me, all Glocks down— what makes her a
    catch?

    Because she’s a doctor? But I don’t know (m)any white


    women who think being a doctor increases their chances of
    finding a husband, makes them more appealing. Go over to the
    med school and ask the women what they think they’re doing
    to their marrigeability. “A lot of men don’t want a woman
    who’s away all the time.” “They’re threatened.” Or, my
    personal favorite: “oh my god, all they want are the nurses.”

    The answer is that since black women have been able to take
    on the very qualities they want in a man, they assume that the
    men would value these things in the same way. You may need
    to revisit that assumption.

    C.

    You may not be interested in TV, but TV is certainly interested


    in you. If black men of a certain type are taking their cues
    from media images, it’s safe to assume the same for women.
    Right?
    So what do we have? The unique, mandatory role for all black
    female personalities— from Oprah to Wanda Sykes— is to say
    “oh no you didn’t” and move her neck back and forth
    sideways. Each woman may do it to varying degrees, and they
    are certainly allowed to do other things, but it is mandatory
    that they “keep it real” at least once per broadcast.

    For fiction— always more powerful— we have: the spectrum


    of hoes in music videos; there’s the strong, quietly suffering,
    approaching middle age and beyond, and, of course, solitary
    black woman; and the educated and attractive black woman—
    wherein “educated” is a descriptive proxy for “controlling” or
    “insane bitch.” Something on the order of Why Did I Get
    Married Too?- let’s-break-some-shit-because-he-lied bananas.

    Let’s say that media portrayals of “educated black women that


    can’t get a man to commit”— that’s a brand— storming over
    to his job and smashing things because of alleged infidelity
    does NOT make real women more likely to do this themselves.
    Fine. What I am certain it does do, however, is make that
    behavior less terrifying to black men. “Oh well, that’s just
    what they do. She’ll get over it.”

    The First Lady isn’t any of these stereotypes, but suffers from
    the problem of being an actual person and not on CSI or a
    reality show, and thus can’t be a role model. Sorry, I don’t
    make the rules. So young girls can choose between Anita Van
    Buren or Omarosa. I’ll say what you’re all thinking: yikes.
    …they’re just like us?…

    But aren’t the black women in prime time strong and noble,
    even if there are only four types? On every medical drama on
    TV— ER, Private Practice, Grey’s, etc— the only attractive,
    well educated females who aren’t serially bedding/flooring
    men with Wicked rapidity are the black women. Every week,
    the black women struggle with/over the same man; and those
    men are always the best at what they do, the chiefs, the
    leaders. At some point, the men inevitably fall for a white
    woman. Not permanently, of course; nothing is permanently
    on TV.

    Unfortunately for black women, these shows are scripted by


    white women. If black girls are watching TV, then they’re
    getting their options from white women. The message is: our
    lot is to have a series of chaotic relationships in the search of a
    non-existent ideal; yours is to suffer over one.

    IV.
    The cycle— for blacks and whites— only ever gets broken in
    one of two ways. One is that this generation grows old and
    dies, and the next one gets its shot.

    The second is that generation 1 stops raising generation 2 by


    proxy. Accept that what you do is more important than who
    you tell them you are. “I’m taking you to church right after I
    finish yelling at your mother.” Ok, Dad. I’ll be in the car.

    V.

    If a paucity of black men cause women to “up their game,”


    settle, and be alone; and men to assume a cavalier, non-
    committal posture, one might ask what happens to a society
    with too many men.

    Apparently, not the opposite. Why hasn’t it become true that


    Chinese women are protected, elevated, catered to? That
    Chinese men have to “up their game” or settle?

    It’s an interesting question, one that will likely require a


    Chinese academic researcher to perform a similar study in her
    own country on her own people.

    http://twitter.com/thelastpsych
    The Dumbest Economic
    Collapse In History
    April 17, 2010

    If nothing was ever going to be the same again, how come GS


    is back to where it started?

    Anyone who sucks at poker knows: if you lose 50% on a bet,


    you have to go up 100% just to break even. Jamie Dimon is
    therefore the greatest poker player ever.

    Of course I know Bear Stearns went under, I was watching TV


    when it happened. But we were all repeatedly told that it was
    never again going to be so easy for financial companies to
    make such huge money. The CEOs didn’t deserve their big
    payoffs because they had lost so much of “the public’s”
    money. That was the point, right? “We want clawbacks!” Claw
    what back?

    Everywhere I look, I see that unless you lost your job, nothing
    has changed. Look closely at your life. Other than body fat,
    what’s changed?

    II.

    Let’s go corporate. Astra Zeneca is a good case study. What


    has been the longer term impact of the Crash?

    Pretty much nothing. Except for the 15% cut in its workforce.
    A skeptical person might suggest that it was only able to
    improve its earnings not by selling more products but by
    cutting expenses. A finite and unsustainable maneuver. So sell
    AZ?

    A more cynical person, though, might think that AZ simply


    used the “recession” as an excuse to lay people off, and get
    fewer workers to do more.

    And a paranoid would think this: there’s a popular idea that in


    a recession, the government should create jobs
    programs/public works projects. But what if it’s the other way?
    What if the government had some projects it needed done?

    And the business sector that it serves needs a reason to reduce


    their labor costs without people going 12 Monkeys on them.

    There’s a word for this, but I always get it wrong.

    (IIb.

    There’s an analogy for the credit crisis that I am convinced is


    awesome: chemotherapy. Spread the poison liberally around
    the world. When you’re done, you’re weaker, but anything that
    had a high growth rate is dead. You’ve solved your Putin
    problem. Remember “we want a new reserve currency!” at
    $140 oil? U.S. to Putin: bite me.

    “A rising tide lifts all boats.” said JFK. But we’re the only one
    with a boat, rickety as it may be. So let’s Noah’s Ark this
    bitch, and drown the lot of them. If they want aid later, we can
    pay them in Euros like they wanted.

    That’s how you solve a labor problem.

    /sarcasm)

    III.

    Back to reality.

    Remember how the crash was going to make people spend


    less, especially on frivolous things? Remember how the one
    single positive effect of the Great Crash was that the culture of
    the next generation would be less materialistic than their
    elders, the Dumbest Generation of Narcissists In The History
    Of The World?

    If there was any company that under that hypothesis should


    have gone bankrupt, it is Duke University coed fraternity
    Aeropostale:

    Explain to me how Aeropostale not only survives the crash,


    but actually grows? Don’t say “pent up demand,” I’ll gut you.
    Look at the chart. Pent up for what, 3 months? Everyone
    suddenly needs last year’s winter tops?
    Is this pent up caffeine withdrawal? “$4.50 for a grande
    battery acid with skim? Let me have a blueberry dessicant as
    well. (I don’t know why, but I’m like, so hungry today!)”

    IV.

    “Listen you insensitive jerk, people have lost their jobs, their
    homes, they can’t feed their families—”

    I’m insensitive, I don’t have retinal cancer. I see what’s


    happened to them, do you see what’s happened to everyone
    else?

    “Is the era of easy credit over?” recommended the AP two


    years ago.

    “I think we’re undergoing a fundamental shift from


    living on borrowed money to one where living within
    your means, saving and investing for the future, comes
    back into vogue,” said Greg McBride, senior analyst at
    Bankrate.com. “This entire credit crunch is a wakeup call
    to anybody who was attempting to borrow their way to
    prosperity.”

    and

    “We’re going to see some fundamental changes in


    consumer behavior,” said Frank Badillo of TNS Retail
    Forward, a consulting and market research firm

    This is what “fundamental” looks like:

    I’m pretty sure incomes aren’t up since 2007. So either we


    have the same amount of money we had in 2007 and are
    spending the same, or we have less than 2007 and are spending
    more. Either way: really?

    Get it? Double the unemployment, same sales. While some


    people aren’t “participating in society” the rest of you have
    made up for it, and then some.
    m=1? “Sorry about the delay, next stop 80”?

    Housing prices have fallen, but they have also stopped falling.
    Maybe they’re not going up, but if you still have your house…
    you’re home free?
    If you took two Ambiens in 2007 and just climbed out of your
    bathtub now, here’s what you’d feel required a remark: “oh,
    they’re ending Lost.”

    V.

    You’ll say I’m selective in my charts. “Put up Citigroup!” Fair


    enough; but my point here is that we were supposedly in for a
    systemic, historic, and permanently altered economic
    landscape, and we’re right back where we were started.

    That’s Moral Hazard, and I capitalize it because you should,


    too. What have we learned? Nothing. What’s changed?
    Nothing. What are we going to do now? Buy a car. “With what
    money?” Zark off, man, you’re harshing my buzz.

    (Economist:) The recession came at the end of a period


    marked by record levels of inequality. Many Americans,
    lacking true upward mobility, bought its trappings, such
    as a bigger house or better car. Disaster duly followed.
    Is there any reason to think this scenario isn’t worse now, more
    likely to be repeated? While some people worry about
    inflation, and others about a double dip recession, what’s
    actually happened is that we’re back in the same boom/bust
    cycle.

    Of course I understand that the various government actions


    have helped. That’s the point. There is nothing that will
    prevent this from happening again. I don’t want the Crash to
    have been worse, but I don’t want it to have happened in the
    first place. It did. Now it’s going to happen again. It is
    inevitable. Maybe not in my lifetime, but definitely in my
    kids’. Isn’t that worse?

    Of course I understand that CEOs are corrupt and Bush lied


    and [random Huffington Post link here]. Enough, I get it.

    But have you changed? Doing anything differently? Instead of


    buying yet another identity signal, have you saved the money
    for the kid you don’t even have yet? Blame the CEOs if you
    want, they don’t shop at Aeropostale and if they do they can
    afford it. So?

    The problem and solution is you. It has to start with you. It is


    always you.

    –
    http://twitter.com/thelastpsych
    China Needs More TVs
    April 22, 2010

    we’re mad as hell

    Sumner Redstone is the Chairman of the Board of CBS, UPN,


    Viacom, MTV, BET, half of the CW, and Showtime, and he is
    86 years old and close to the end of his time. And woe is us.
    We’re in a lot of trouble.
    So, a rich little man with white hair may die. What’s that got to
    do with the price of rice, right? And why is that woe to us?
    Because you people and 162 million other Americans watch
    TV. Because less than 3 percent of you people read books.
    Because less than 15 percent of you read newspapers.
    Because the only truth you know is what you get over this
    tube. Right now, there is a whole, entire generation that never
    knew anything that didn’t come out of this tube. This tube is
    the gospel, the ultimate revelation. This tube can make or
    break presidents, popes, prime ministers. This tube is the most
    awesome goddamn force in the whole godless world. And woe
    is us if it ever falls into the hands of the wrong people.

    II.
    And that’s why woe is us that Sumner Redstone may die.
    Because this company could be in the hands of— anyone.
    There will be a new Chairman of the Board sitting in Mr.
    Redstone’s office on the 20th floor. And when the 12th largest
    company in the world controls the most awesome goddamn
    propaganda force in the whole godless world, who knows
    what shit will be peddled for truth on this network.
    So, you listen to me. Listen to me. Television is not the truth.
    Television’s a goddamn amusement park. Television is a
    circus, a carnival, a traveling troupe of acrobats, storytellers,
    dancers, singers, jugglers, sideshow freaks, lion tamers, and
    football players. We’re in the boredom-killing business.
    So if you want the Truth, go to God. Go to your gurus. Go to
    yourselves! Because that’s the only place you’re ever going to
    find any real truth. But, man, you’re never going to get any
    truth from us. We’ll tell you anything you want to hear. We lie
    like hell. We’ll tell you that Grissom always gets the killer and
    that nobody ever gets cancer at the Baywatch house.

    And no matter how much trouble the hero is in, don’t worry.
    Just look at your watch. At the end of the hour, he’s gonna
    win. We’ll tell you any shit you want to hear.

    We deal in illusions. None of it is true. But you people sit


    there, day after day, night after night — all ages, colors,
    creeds. We’re all you know.

    III.

    You’re beginning to believe the illusions we’re spinning here.


    You’re beginning to think that the tube is reality and that your
    own lives are unreal. You do whatever the tube tells you —
    You dress like the tube. You eat like the tube. You raise your
    children like the tube. You even think like the tube.
    This is mass madness, you maniacs.
    Where Parents Go Wrong
    April 23, 2010

    it’s not genetics, it’s repetition compulsion

    This is the story told to me.

    A 38 year old woman, Anne, married with three kids, has a 17


    year old brother, Tim, who still lives at home with his (and
    Anne’s) parents. Tim got his teenaged girlfriend pregnant.
    Oops. Should he have an abortion?

    While he felt he could tell this to his big sister, he definitely


    did not want to tell his parents. They were crazy— a fact
    corroborated by Anne. They weren’t just strict, they were
    almost delusional. Denial, avoidance, displacement were the
    main coping styles; do nothing was core policy. Bill too big?
    Procrastinate. Coughing up blood? Humidifier. There was
    plenty of affect there, especially anger, but it was always
    focused on arguing about the problem, never solving the
    problem. “All those stupid doctors will do is charge my
    insurance thousands of dollars and then say they don’t know
    anything. Crooks, crooks I tell you!”
    The first panicked phone call Anne received was the day Tim
    learned his girlfriend was pregnant. “I don’t understand this! I
    used a condom every single time! I’ll bet she was cheating on
    me!”
    A few days later he became a political philosopher. “You
    know, these Glen Beck freaks want to control what a woman
    does with her body!” And it became cleverly self-serving:
    “Men don’t have the right to tell a woman what to do. It’s
    ultimately a woman’s decision, right?”

    For two weeks, the teens were individually and collectively on


    the phone with Anne and her husband trying to make sense of
    their own conflicted emotions.

    Of course, Anne and her husband were highly conflicted as


    well. Wrestling with the reality of an abortion, or not, and that
    they had been sworn to secrecy. They couldn’t tell the parents.
    Everyone was in full agreement that the irrationality of the
    parents would make any decision at all nearly impossible. The
    teens would eventually have the child not because they chose
    to, but because of paralysis.

    II.

    Not a spoiler: Anne has to get on the phone right now and call
    her brother and say the following words: “if you don’t tell
    mom and dad in the next hour, I will.” And hang up.

    Why in the next hour? Because idle time leads to catastrophes,


    like suicide. He should not be given any time to “realize” that
    “there’s no way out of this.”

    Anne’s job is not to protect Tim from their insane father. If


    Anne wants to be supportive, she can say, “I’ll come with you
    to tell them, and I’ll help calm the Unabomber down.”

    By not telling, Anne sets herself up to be hated by both the


    parents and her brother. The parents will, of course, say, “how
    could you not tell us? He’s our son, he’s a minor! How would
    you feel if this was your kid!?”

    In ten years, her brother will get to say, “you know, that was
    the hardest decision I ever made, and I wasn’t really mature
    enough to make it, and by not telling, you let me make it
    alone. Basically, if it hadn’t been for you, I would never have
    gotten an abortion.”

    III.

    Tim understandably didn’t want to tell his parents. But instead


    of owning his decision and not telling anyone, he brought his
    sister and husband into it. Why?

    The therapy answer is, “he wanted some support.” But really,
    he wanted to unload a heavy secret, discharge the energy. He
    wanted to get to the “I feel better just talking about it” stage.
    The shame part had been overcome. Now he was free to
    decide what he wanted to do.

    This is why he chose to tell his adult sister. It wasn’t because


    he valued her advice and wisdom. He told her because she was
    an adult, a parent of three kids. That’s the next best thing to
    telling your own parents. And so if Anne was ok with not
    telling her parents, then for sure he could be okay with it.
    Adult decisions, made by an adult.

    Of course, by unloading, he had loaded her up. He didn’t care


    about that. Instead of him being up all night thinking, “oh God,
    what have I done?” he was sleeping. Free of morality and
    ethics and shame and guilt, he could focus on logistics. She
    was the one up all night, “oh God, how did this happen? What
    should he do? What should I do?”

    In short, Tim had chosen the worst possible posture: passive-


    aggressive. He didn’t take his burden on his own shoulders,
    like a man, and not drag anyone down with him; nor did he
    assert himself, again like a man, and tell everyone what had
    happened and what he had decided, and take the
    consequences. No. He boldly asserted his autonomy on
    someone with no power over him and hid from the people who
    had a lot.
    V.

    “But what about Tim’s girlfriend? Why doesn’t she boldly


    assert her autonomy somewhere where it counts?”

    Of course she should. Obviously, everything said here applies


    to her. But How To Be An Assertive (Not Aggressive) Woman
    was written in 1976. Women’s trouble now isn’t how to assert
    themselves, but picking from the overwhelming availability of
    choices.

    But more importantly, it is a real problem for men (and


    consequently for women.) They aren’t assertive, they only
    pretend to be assertive. That’s why they think they look for
    manliness in fictitious characters that no 70 year old man
    would ever think was a real man. Don Draper, Tony Soprano,
    and pretty much any rapper are to men today what Mary Tyler
    Moore was to women in the Pleiocene epoch. Note carefully
    the relationships of all of the above.

    Even if passive-aggressiveness is stereotypically ascribed to


    women, it is always considered in contrast to directness of
    men. The two offset each other. If you follow this logic, then
    passive-aggressiveness in men is a disaster.

    VI.

    I’ll grant you that this thinking is not abnormal or pathological


    in a 17 year old. But this is a pivotal moment. How he deals
    with this— one of the hardest decisions he will ever make—
    will set the stage for how he deals with all future lesser
    calamities. If passive-aggressive works for a pregnancy, it’s
    for sure going to be the default for tardiness and infidelity.
    His parents are probably going to say, “we didn’t raise him
    right! How did he not learn that abortion is wrong?! Why
    didn’t he listen to us all these years?!”

    In fact, they raised him with total precision. They made


    another one of themselves in every way. He learned how to
    deal with problems from them. He learned what’s right and
    wrong from them— and what he learned was that the reason
    abortion is wrong isn’t because it is wrong, but because they
    say it’s wrong; that what’s right and wrong is determined not
    by an external ideal, but by whoever in the room has the most
    power. I hope you all know by now how this all turns out.

    –-

    http://twitter.com/thelastpsych
    The Conspiracy Theorist’s
    Guide The Financial Crisis
    April 28, 2010

    Now, with boldface and exclamation marks! And only most of


    it is a joke!

    Question: How do you create the impression of a classless


    society so the proletariat doesn’t rise up and beat you with
    their ipads?

    Answer: you make sure everyone can afford everyone’s


    products.

    So what becomes the marker of class, if not possessions?

    Services. A nice car is less of a status symbol than having a


    housekeeper, or cook, gardener, vacations, plastic surgery,
    restaurants. Only a chump says, “I own a Lexus.” A real
    player has lunch at Morton’s. Or better, breakfast at the
    Watergate.

    But aren’t those prohibitively expensive for all but the


    super rich?

    Not if we use illegal immigrants. Saved!

    But…

    The only reason you can afford to go to Morton’s and brag


    about it is that at several points in the chain, from agriculture
    to dishwasher, cheap labor was used. Otherwise that steak you
    ate would cost nineteen thousand dollars. Yeah. Google it.

    And if it was nineteen thousand dollars, Morton’s would go


    out of business, laying off however many actual citizens still
    work there. See? Thank your “inept” border police for your
    steak and your job.

    So it’s all about labor costs? All of this? The boom, the
    bust, taxes, healthcare reform— it’s all about labor?

    Four questions about the Civil War:

    1. How many southern whites owned the 4 million slaves?


    2. Why did poor southerners who did not own slaves still
    support slavery?
    3. 1857: a book, a state, a panic.
    4. What did the railroad tycoons give the Confederates for
    Christmas in 1868?

    So it’s all about trains?

    As throughout history, from slavery to outsourcing to the


    underground economy, it’s all about cheap labor. And you
    know what? As long as you can afford your MacBook Pro,
    you’re not going to do anything about it. Oh, you’ll complain
    that Bush lied, for sure, but a ten hour battery means you’ve
    got plenty of porn time. Enjoy your right click button, be-atch!

    But didn’t Arizona just make illegal immigrants… illegal?


    What are they going to do for cheap labor?

    Hmm.

    “Some [Phoenix] farms use inmates for relief from labor


    shortages.” Phew. Thought we were going to have to deport
    them.

    Yeah, but what about non-manual labor jobs?

    Like prison call centers? Or graphic design? Dell used to use


    prison labor, but stopped in 2003 because it found cheaper
    labor elsewhere…

    How much to they pay?

    Oh, like, 50 cents an hour. Prison labor has been on the rise
    since Carter, kicked into gear in the 1990s, and is due to for a
    rediscovery.

    Extra extra credit: when and why did America achieve moral
    clarity and outlaw the use of cheap prison labor?

    Irony or design? How is it that Americans have some of the


    worst high school scores in the world, but on the other hand
    see college as an entitlement?

    “…and Columbus thought the earth was flat and Jamestown


    invented the massacre…”

    Can you summarize all this in one short quip?

    All of this has happened before and it will happen again.

    II.

    I DIDN’T LIKE THAT BOLDFACE GUY’S LINE OF


    QUESTIONING. EXPLAIN YOUR LIES.

    A boom/bust cycle has been in place for millennia. That’s


    right, well before the Bushes colonized Saudi Arabia. The
    modern incarnation has been supported by the Global Elites
    (Rockefellers, Trilateral Commission, The Bilderberg Group,
    RAND corporation, reverse vampires) behind the backs of
    sucker politicians, e.g. whatever Treasury Secretary happens to
    be in office.

    BUT WOULDN’T FORMER TREASURY SECRETARIES


    COMPLAIN?

    how can they speak if they have no breath?

    Secretary of the Treasury/CEO of Alcoa/Chairman of the


    RAND Corporation Paul O’Neill, in 2001, wrote that there
    was a financial contagion coming, and as investors saw it
    spread among emerging markets, they would pull out their
    money, worsening the contagion. “Hey, hey, who asked you?”
    Fired 2003.

    Replaced by John Snow, former CEO of CSX. As everyone/no


    one knows, right before he was appointed Sec. of the Treasury
    in 2003, he sold CSX to the Carlyle Group, the secret “private
    equity” cabal controlled by the Bush family. It also owns
    Dunkin Donuts!

    In 2004, an “investigation” discovered he had “accidentally”


    bought $10M of Fannie Mae debt back in 2002; to “avoid”
    conflict of interest, he quickly unloaded that debt in 2004, and
    was cleared of ethics charges. What luck!

    He left in 2006 in order to “die” of “cancer.” He was replaced


    by the current Secretary, Hank “go fuck yourself” Paulson.

    What about the other Secretaries?


    Carter’s Treasury Secretary G. William Miller, inventor
    of Stagflation and the Chrylser Bailout: dead 3/2006.
    Clinton’s Secretary Lloyd Bentsen: “Bentsen was
    awarded the Presidential Medal of Freedom, the nation’s
    highest civilian honor, in 1999 by Clinton. “Under his
    leadership in 1993, when some of the rest of us had our
    doubts, we passed the economic plan that paved the way
    for what is now the longest peacetime expansion in our
    history.” Nope! Dead 5/2006.
    Donald Regan: “After Wall Street and government, I
    decided that there had to be more to life than the stock
    market, golf and drinking.” The hell you say! Erased
    2003.
    Carter’s first Secretary, Michael Blumenthal: fled to
    Berlin, supports Obama.

    If you’re counting: three dead in 2006, two fired/dead 2003,


    and one still at large.

    WHAT ABOUT FORMER SECRETARY PAUL VOLKER?


    HE’S NOT DEAD, IS HE?

    Oh, you mean founder of the Trilateral Commission, along


    with Alan Greenspan? And member of the Bilderberg Group
    along with Donald Rumsfeld and Paul Wolfowitz? No, he’s
    fine. They’re all fine!

    BUT THE PICTURE BOX SAID IT WAS ALAN


    GREENSPAN’S FAULT FOR KEEPING RATES SO LOW
    FOR SO LONG.

    Exactly. It was also Toll Brother’s fault for making houses as


    impossible to resist as they were to afford. And Aeropostale
    for making great looking Ts that are just the right side of too
    small.

    BUT…

    You look a little pale. Here, have a bottle of water. It’s by


    Coca-Cola!

    BUT IF THEY PURPOSELY LET THE MARKET CRASH,


    THEY’RE SINKING 401(K)S— THAT MEANS THEY
    WILL INEVITABLY HAVE TO INCREASE SOCIAL
    SECURITY. ISN’T THAT THE OPPOSITE OF WHAT
    THEY WANT?

    That’s the scam, yo. Like the drug dealer on the first
    encounter, once you’re hooked, once you’re reliant on the
    government for healthcare, and social security, and everything,
    you’ll never dare revolt. They own you forever. Sure, you’ll
    post idiotic rants on blogs, but do you think they care about
    that?
    Deconstructing a
    Promotional Slide Deck:
    Geodon
    April 28, 2010

    You can complain that all data is biased and all promotional
    programs propaganda, but until someone comes up with a
    better system of medical education and figures out how to pay
    for it, this is all we have.

    My intention is not to do a Carlat “all medicines suck” style


    hit piece. I want to show how to do a powerful analysis of a
    PROMOTIONAL slide presentation, and also how to detect
    some of the typical tricks/misdirections. These are frequently
    used by academics as well.

    These slides are for Geodon’s new indication, Geodon as an


    adjunct to Lithium or Depakote for Maintenance of
    Bipolar Disorder. It is what doctors (will) see at promotional
    programs (e.g. dinners) and versions of these will become rep
    detail pieces (what they’ll show doctors.)

    I don’t have the slides, but I did get a peek at them, so I’ve
    redrawn them from memory. Yes, memory.
    Slide 1:

    Indications (“antipsychotic”) etc, are descriptors, not


    identifiers. 15 years ago Geodon was tested for schizophrenia,
    and found to be effective. Today, it is tested for maintenance
    bipolar; so we say “this antipsychotic is also effective for
    bipolar maintenance.” Wrong. That’s an accident of history. 15
    years ago they could have first tested it for bipolar, and today
    done schizophrenia trials, and then we’d say, “this is a mood
    stabilizer that also treats psychosis.” Both of those statements
    are empty. It is a chemical, it has utility, not identity.

    Side 2:
    What does the author want to be true?

    This is the main slide, disguised as a throwaway. As the


    “introduction” it clarifies for you what is established already—
    according to the presenter— even though it may not actually
    be established. “As has already been established, Windows is a
    superior operating system.”

    Pfizer has decided to market Geodon for mild states, and


    emphasize it’s better weight profile.

    Their message is: “hey, even though you think Geodon is weak,
    nothing works as monotherapy. And we at least have an
    indication for maintenance.”

    It seems there’s no way to manipulate this: two simple quotes.


    The second quote seems to follow from the first, i.e. because
    the rate of success of monotherapy is so low, therefore you
    need a combination. But, in fact, reference two doesn’t
    attribute the prevalence of combination therapy to a lack of
    efficacy. The sentence preceding quote 2 is:

    In recent years, the therapeutic armamentarium for


    bipolar disorder has expanded in terms of options. Hence,
    the clinical management of bipolar disorder now usually
    involves a combination…

    There’s combination out of necessity, and combination out of


    availability.

    Slide 3:
    Their message: “We took some manic/mixed bipolar patients,
    and randomized them to mood stabilizer alone vs. mood
    stabilizer + Geodon, for 6 months, to see which kept them
    stable (time to intervention) longer.”

    Let’s work from the middle “Stabilization/Randomization”


    square. What were they stabilized with? Li or VPA, + Geodon.
    What were they randomized to? Either a continuation of that,
    or the Geodon was taken away. So the study doesn’t measure
    maintenance efficacy, it measures the speed of relapse if you
    take one of the two medicines that got you stable away.

    Go back one step to the first circle. What happened to some of


    the 580 people who couldn’t get stabilized, after 16 weeks, on
    Li/VPA + Geodon? They didn’t stay in the study. Same with
    those who had some adverse event. 50%, gone. So by the
    middle square, the study had effectively selected for those
    patients who could tolerate and respond to Geodon.

    Continuing backwards, it appears that the study begins at the


    big green vertical line, but it doesn’t. Reformatting the slide
    gives a more clear explanation of the events:

    You now can see that there was one extra initial step. Real
    outpatients on any kind of medications were screened. If they
    were manic (MRS>14 or 18) then they were TAKEN OFF
    THEIR MEDS and given Li or VPA, at therapeutic level, for 2
    weeks. Those patients who DID NOT IMPROVE on the
    monotherapy were then given Geodon as well, for 3-4 months,
    until stabilized.

    This effectively screens out patients who respond to


    monotherapy. Consider: you already know that by the end of
    the study, the monotherapy patients will relapse faster, because
    monotherapy didn’t work in the first place.

    Aside: this may be a question of severity, but how is it possible


    to let more than 600 people stay manic for two weeks on one
    single medication, and not intervene?

    Slide 4:
    Their message: “Geodon + Li or VPA was superior to Li/VPA
    alone for preventing relapse.”

    More full message: “Geodon + Li or VPA significantly


    increased the probability of being relapse free.”

    Of the 240 patents who started the maintenance phase, only


    138 finished. Kaplan-Meier analysis is a way of analyzing the
    probability of an event (in this case, being relapse free) even
    when there are dropouts for other reasons. It’s probably more
    useful to simply say this:

    [during the 6 months] intervention for a mood episode


    was required by 19.7% (25/127) of subjects receiving
    ziprasidone, compared with 32.4% (36/111) of subjects
    receiving placebo.

    …median time to intervention for a mood episode for


    ziprasidone and placebo, respectively,was 43 days (7-
    165) and 26.5 days (2-140), among patients who required
    an intervention (n=61).

    You might be tempted to say the following: “hey, Depakote or


    lithium alone wasn’t that bad— 70% probability of being
    relapse free. So?”

    What would be awesome was to have a straight placebo arm


    (i.e. Li/VPA + Geodon vs. Li/VPA + placebo vs. no meds at
    all), to compare.

    Though one shouldn’t compare across studies, etc, etc,


    compare the above survival curves to those found in the
    famous year long Depakote maintenance study (Depakote vs.
    lithium vs. placebo monotherapy trial for prevention of mood
    episodes— (done by the same guy, hey. would you look at
    that))

    In that study, the same maintenance power of depakote and


    lithium wasn’t better than placebo.

    Slide 5: Dosing
    This slide does not tell you the doses used to keep people
    stable for 6 months; it tells you the doses used to stabilize the
    patient, i.e. the acute mania dosing.

    It is true that they were then kept on these doses, but you don’t
    know if doubling the dose— or halving the dose— would have
    changed the outcome of the maintenance phase.

    It is already established in the acute trials that it takes 120-


    160mg of Geodon ALONE to treat acute mania; perhaps the
    50% that only needed 80mg here had some effect of the
    VPA/Li; or there was better attention to giving with food here;
    or the permitted use of Ambien and Ativan (<2mg) also
    helped. In any case, it seems reasonable to say that one should
    not expect any acute efficacy at all under 80mg.

    Slide 6: Nonadherence
    Looks like a throwaway; but it’s the whole marketing
    message. Weight gain= Zyprexa/Seroquel; Sedation =
    Seroquel; Akathisia = Abilify as defined in the secret Big
    Pharma Marketing Playbook. They all use the same copy.
    (Geodon would be QTc.) The slide lets you know that this is
    why patients stop their meds, so be proactive…

    First, the actual Guidelines reviewed studies that find that


    denial of illness and lack of efficacy as the main culprits. In
    fact, they write “there is not a robust association between
    medication side effects and adherence… a survey of 3000
    patients found that side effects ranked 7th on a list of
    concerns…”

    But those studies aren’t the point: the Expert Consensus


    Guidelines aren’t a review of studies, they are a 40 question
    survey given to 40 experts in bipolar. “What do you think is
    the standard of care? What’s your favorite Dr. Who episode?”
    Also note that these experts don’t routinely treat patients.

    The Experts rated side effects as the main adherence issue.

    The experts’ ratings agreed with the findings in the


    literature about the importance of poor insight and lack of
    illness awareness, belief that medications are no longer
    needed, and lack of treatment efficacy as key factors that
    can contribute to adherence problems. It is interesting
    that the experts gave more prominence to side effects as a
    contributor to adherence problems than has been
    reported in surveys of patients and other studies in the
    literature.

    Yeah, that is interesting.

    Even more interesting is which side effects these Experts rated


    as most important, in decreasing order:

    Weight gain (women)


    Sedation
    Sexual dysfunction (men)
    Cognitive side effects
    Weight gain (men)
    Sexual dysfunction (women)
    Akathisia

    You can see that akathisia got a promotion on the slide.

    Final point:the studies found that patients were most troubled


    by weight gain and cognitive side effects:

    It is interesting, although not surprising, that the experts


    considered excessive sedation a more important
    contributor to adherence problems for patients with
    bipolar disorder than schizophrenia, reflecting clinical
    experience that patients with bipolar disorder strongly
    dislike being sedated.

    It may very well be that Experts/academics see a population


    that doesn’t like sedation, whereas an inner city psychiatrist
    might believe the only thing patients crave is sedation.
    Slide 6: Weight Gain

    It looks like Geodon had no effect on weight; alternatively, it


    looks like Li or VPA will cause 5% of patients to gain >7% of
    their body weight (e.g. 10-15lbs.)

    But this tracks weight changes starting from the double blind
    phase. Remember, patients were loaded with VA or Li for two
    weeks, then Geodon was added for 10-16 weeks. Not to
    mention they were already on meds in their past. Could they
    all have gained 100 lbs in the first four months, only to level
    off in the maintenance phase? Of course. Did that happen?
    Who knows?

    All that you can say is that after being on Geodon for 4
    months, the proportion of people who go on to have even more
    weight gain in the next 6 months is 5%.

    Slides 7 and 8: Sedation and Movement Disorders


    Same deal: these are the side effects only in the last 6 months
    of a 10 month study. Could sedation have been massive but
    transient in the first four months? Could tolerance to the
    effects have developed? We know 50% of patients dropped out
    by the randomization phase— half of those due to adverse
    events. Did the people who experienced sedation or movement
    disorders quit?

    The study had effectively screened for patients who could


    tolerate these kind of side effects, so you’d expect them to be
    low in the last half of a study.

    Slides 9 and 10: Discontinuation/Tolerability


    Same deal, again.

    Please take a moment and look at the slides as if it was your


    first time. Despite the clear labeling “At 6 Month Phase”, you
    can’t help but think “rates of adverse events were low.”

    If you’re astute, you might even think, “weird, people on two


    medications actually had fewer side effects, lower
    discontinuation rates.” And your mind would start speculating:
    well, the Geodon is actually a little activating, so it
    counteracted the sedation that was caused by the Depakote.”

    No. The Geodon doesn’t counteract the sedation; nor are there
    really “low rates” of discontinuation. Remember, 50% of the
    people stopped the combo even before randomization, and
    50% of those stopped specifically because of an adverse event.
    So Slides 9 and 10 are showing you the rates of AEs in people
    who had already tolerated 4 months of both medications.

    This is important and must be understood. Content— whether


    it be a Pharma slide or a newspaper article or anything else—
    is almost never factually inaccurate. But the story, the style,
    the presentation is intended to get you to lie to yourself. This
    slide very obviously says, “in the 6 Month Phase.” There’s no
    misinterpreting that— and yet you did.

    Don’t blame yourself entirely, it is a trick. If the slides were


    presented with the intention of imparting information (instead
    of a story) then it would never have shown you only the Phase
    II data, it would have offered you something like this:
    which comes from the study itself.

    But don’t get excited, the studies are almost never more honest
    than the Pharma slides. The above Subject Disposition tree is a
    very recent phenomenon in articles, forced on it by an
    exhausted readership, and many articles still don’t use it. Not
    that it would make any difference: no one reads the articles
    anyway.

    Slide 11: Geodon Must Be Taken With Food


    The FDA recommends test meals for medication studies, but
    specifically two: high fat (50% of calories from fat) and high
    calorie (1000 calories.)

    It isn’t clear from this slide what constituent of food is


    necessary to the absorption. Some foods need specific
    conditions for absorption (e.g Vitamin C needs an acidic
    environment and absorption is reduced by fat.)

    Geodon is highly lipophilic, so it would make sense that fat is


    key to absorption. Nope:
    Low, medium and high calorie diets are 250, 500, or 1000,
    respectively.

    Fat appears to have little to do with it. Calories matter, thought


    the benefit appears to maximize at 500 calories— doubling to
    1000 calories is only marginally better.

    What isn’t known is whether the effect is due to pH, transit


    time, or some other factor.

    The simple problem is that to get Geodon to work you need


    120mg or so, and it has to be taken with food. Any claims
    about lack of efficacy before these two conditions are met are
    just plain silly. They should have made a slide with that, but
    they didn’t.

    Slide 12: Dosage Adjustments Are Not Necessary With


    Geodon

    (I found this slide on the internet and saved myself an hour


    with MS Paint.)

    This slide is often presented with another showing specific


    drug inhibitors/inducers (ciprofloxacin, phenytoin, etc.)

    While theoretically legitimate, it mostly doesn’t have enough


    of an effect with antipsychotics to matter. So there’s little point
    to learning it, though the idea that Geodon is metabolized
    differently and has little effect on/from liver metabolism is
    good to know. (But there is a cardiac effect with other QTc
    prolongers.)

    A better way to use this information:

    Smoking cigarettes can dramatically reduce some


    antipsychotic levels. It can cut Haldol in half, and reduce
    Zyprexa by 40%. But in ordinary practice, that doesn’t matter
    — you’d have instinctively given the patient more mg because
    he’s not better. You may not realize that you did this because
    the drug level is lower (not that he is sicker), but ultimately it
    doesn’t matter.

    Where it does matter is a hospital, where patients aren’t


    allowed to smoke: psychotic patients is stabilized on 10mg
    Zyprexa, he gets discharged and goes back to smoking a pack
    a day. See?

    So what really matters is changes from the usual. It’s


    important to know that a guy takes HCTZ and smokes 2pp/d,
    but it’s just as important to know if that status changes.

    In my opinion, every opportunity should be taken to lower


    dosages or stop medications. If a guy quits smoking for real, I
    try to cut his Zyprexa in half. “Really?” Yes, really. The liver
    tells me to. If a patient “shows frequent noncompliance” with
    a medication but otherwise seems stable, I don’t encourage
    them to comply. I reduce it or, if it’s an SSRI, stop it entirely.

    Slide 13: FDA Warning

    WARNING: INCREASED MORTALITY IN ELDERLY


    PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS

    Elderly patients with dementia-related psychosis treated


    with antipsychotic drugs are at an increased risk of death.
    Analyses of seventeen placebo-controlled trials (modal
    duration of 10 weeks), largely in patients taking atypical
    antipsychotic drugs, revealed a risk of death in drug-
    treated patients of between 1.6 to 1.7 times the risk of
    death in placebo-treated patients. Over the course of a
    typical 10-week controlled trial, the rate of death in drug-
    treated patients was about 4.5%, compared to a rate of
    about 2.6% in the placebo group. Although the causes of
    death were varied, most of the deaths appeared to be either
    cardiovascular (e.g., heart failure, sudden death) or
    infectious (e.g., pneumonia) in nature. Observational
    studies suggest that, similar to atypical antipsychotic
    drugs, treatment with conventional antipsychotic drugs
    may increase mortality. The extent to which the findings of
    increased mortality in observational studies may be
    attributed to the antipsychotic drug as opposed to some
    characteristic(s) of the patients is not clear. GEODON
    (ziprasidone) is not approved for the treatment of patients
    with dementia-related psychosis [see Warnings and
    Precautions].

    First, this is a warning about dementia related psychosis, not


    about being elderly. An 80 year old man with bipolar disorder
    does not have this risk; a 55 year old with dementia related
    psychosis does. (More accurately, no studies have found a
    similar mortality in elderly patients without dementia related
    psychosis.)

    Nor is it even clear what the risk is: as many of these patients
    died of cardiac events and infections, it can’t be blamed on a
    direct brain effect.

    The warning was based on deaths reported in the 17 trials


    (5000 patients, aver age 81) using the six atypicals.
    Importantly, these were short term studies: the increased risk
    of death happened in 6-12 weeks.

    Two observational studies found conventionals had the same


    risk.

    There are numerous questions to ask, I’ll ask two you might
    not have thought of:

    1. The 17 trials were in 2002-5. Assuming Geodon was


    shown to have the same risk, how did it cause the risk if it
    was (probably) dosed low and without adequate meals? Is
    it therefore dose independent? Or is the mortality due to
    something else? Similarly, 5mg of Haldol is “more”
    antipsychotic than 5mg of Zyprexa, but less
    anticholinergic (etc.) If both of those carry the same risk
    (studies were not powered for this) then it suggests
    something else is the cause.
    2. I know these studies were mostly done in nursing homes.
    Were they mostly done by psychiatrists? Imagine an
    agitated patient gets a pill— placebo or antipsychotic.
    Does the calming effect of the atypical delay a cardiology
    or infectious disease consult by a day or more… while
    the placebo patient appears sicker, so gets an EKG or CT
    faster? Remember, the average age is 81. How much time
    to you need to go from bad to dead? In other words, is it a
    function not of the medication, but of what I’m calling
    intervention bias: “we did this, let’s see how it works
    before we do something else.”

    –––—

    If you liked this (and enough people link to it or click to it),


    then I may do one for all slide decks/promotional materials,
    and put it into an email newsletter.

    http://twitter.com/thelastpsych
    Study Finds Chocolate
    Causes Depression. In Other
    News, These Kinds Of
    Studies Cause Insanity
    April 30, 2010

    all three of us are crying inside

    From the Abstract:

    Results Those screening positive for possible depression


    (CES-D score >16) had higher chocolate consumption (8.4
    servings per month) than those not screening positive (5.4
    servings per month) (P = .004)
    Oh god, please, I need a drink.

    The authors are very careful to assure everyone that they don’t
    mean to imply that chocolate causes depression, this is just an
    association. Let’s not jump to conclusions.

    II.

    Chocolate lovers ‘are more depressive,’ say experts- BBC

    The More Chocolate You Eat, the Higher Your Risk of


    Depression, Study Hints— ABC News

    Chocolate And Depression Go Hand In Hand- CNN. First


    sentence:

    When Dina Khiry is feeling a bit down, she reaches for


    chocolate. “I like Reese’s peanut butter cups, Hershey’s
    bars, and chocolate cake batter,” says the 24-year-old
    public relations associate. “I feel better in the moment —
    and then worse later on, when I realize that I just
    consumed thousands of calories.”

    Does anyone understand that there is barely any chocolate in


    any of those chocolates? Even the Hershey’s Bar, which has
    the highest of all of them, has 10% chocolate liquor (smashed
    cacao beans.) And if the box doesn’t say “milk chocolate,”
    then all bets are off. White chocolate has plenty of cocoa
    butter, but no chocolate solids. And no caffeine, theobromine,
    or flavinoids. Still counts, though, right?

    And see the phrase “cocoa processed with alkali” in the


    ingredients of “chocolate cake batter“? Alkalinization (makes
    it easier to mix) drains the cocoa of the flavinoids. Is it going
    to “work” the same? That’s like saying “rum processed with
    fire” will have the same mood stabilizing effects. IT
    DOESN’T. I’VE TRIED IT.

    simulacra

    The study, as best as I can tell, did not ask them what kind of
    chocolate they were eating, it only measured “ounces of
    chocolate candy.” Is an ounce of chocolate covered cocoa
    beans the same as an ounce of Hershey’s Krackel, which has
    no cocoa butter (all vegetable oil)? (1) The only thing they
    have in common is a disdain for fair trade.

    Can you imagine if someone did a study about mood and


    alcohol consumption, and measured it as “ounces of an
    alcoholic beverage” but didn’t specify beer, wine, spirits, or
    rubbing?

    III.
    On the one hand we have no idea how much chocolate was in
    a serving, if there was any at all.

    On the other hand we have “depression.” What’s a CES-D?

    It’s a 20 question 0-3 survey that people answer about their


    mood over the past week. Think about this.

    The scale doesn’t diagnose depression at all; you could have


    had 30 suicide attempts in the past year and happen to have
    had some sex this week and come out fine on the inventory;
    or, you could have been the merriest gal in the whole wide
    world until your stupid boyfriend dragged you to see Avatar
    and now you’re calling a hotline. So?

    Can you really link a chronic behavior (e.g. eating chocolate)


    with a static observation of mood over one single week? I
    mean, I know you can, but shouldn’t there be some kind of
    law?

    IIb.

    Each of the 20 questions are scored:

    0 points Rarely or none of the time (< 1 day)


    1 point Some or a little of the time (1-2 days)
    2 points Occasionally or a moderate amount of the time
    (3-4 days)
    3 points Most or all of the time (5-7 days)

    How depressed are you if you answer 1 for each, total=20?


    Not very?

    Then why, in order to show increased chocolate is associated


    with increased depression, do they use the binary standard of
    >16 and <16?

    Worse:
    The mean CES-D score was 7.7, with a median of 6.0. The
    CES-D scores ranged from 0 to 45 (maximum possible score,
    60).

    So let me rewrite the abstract: “in a study of people who were


    not depressed, people who were more not depressed last
    Thursday than others have been eating a little bit less of
    something they thought may have smelled like chocolate.”

    III.

    You’re probably asking why I would bother to pick apart a


    relatively unimportant study. That’s the reason. Why is it in
    one of the most important medical journals? Does it answer
    any questions? No. Does it direct future experiments? No.
    Does it completely confuse an already confused public, who
    only yesterday were told that just the right amount of mercury
    in your diet is awesome, only to have scienticians later correct
    that to silver?

    Let’s review:

    uncontrolled use of the word “chocolate” +

    unclear metric for assessing consumption of what little


    chocolate is in the Peanut Butter Cup+

    vague definition of depression offered to a public that already


    thinks “depression” means something else+

    illogical link between chronic behavior and time x +

    three reviewers +

    one editor +

    article in Archives of Internal Medicine, and all the free press


    you could ever want.

    But wasn’t there anything encouraging about this study?

    Of course there was! Thank GOD, thanks be to GOD— this


    study was free of the corrupting poison of Big Pharma. In your
    face, Pfizer! Science can dress up in its sexiest minidress and
    strut confidently down the dark alley of ignorance and
    prejudice, unafraid and unmolested because it is protected by
    the enveloping goodness of the NIH. You go, girl!

    this is going to turn out great

    –—

    (1) Hershey’s, et al, petitioned the FDA and EU to allow them


    to change the definition of “milk chocolate” to allow for the
    substitution of vegetable oil for cocoa butter. The FDA said
    no, but the EU thought it would be awesome idea.

    To emphasize: not simply change the ingredients, but to


    change the definition of the word.

    –
    http://twitter.com/thelastpsych
    The Copenhagen
    Interpretation of Lost
    May 4, 2010

    If you follow Lost, you know that there are two parallel
    universes, one in which Jack et al are on the Island conflicting
    with Locke/Black Smoke Monster; where Charlie drowned
    and Faraday is a physicist who is killed by his future mom;
    and the other universe in which Jack is a practicing doctor,
    Desmond a rich playboy, Charlie’s alive, and Faraday wants to
    be a musician. &c.

    All are free to speculate about what it means. But it’s valuable
    for other reasons to offer two understandings of the concept of
    parallel universes.

    In the popular understanding of parallel universes, every


    decision or possibility splits the universe into simultaneously
    existing, equally “real” and autonomous universes, e.g the cat
    is alive in one universe, and dead in another:
    So when you choose A over B, your universe proceeds
    accordingly, but another is split off next to it.

    But you see that the possible universes trail behind you. You
    make a choice, there’s a split, and you leave exhaust and a
    universe behind. What’s particularly interesting about this idea
    is that while it purports to be a solution to the difficulties of
    quantum mechanics, it actually doesn’t require quantum
    mechanics at all. It’s a purely semiotic interpretation: the
    universe splits. No math, no confusion. You can’t
    communicate with that universe in any way, so is it “real?”

    The Copenhagen Interpretation has it the other way. In this


    case, all possibilities exist before you (to varying
    probabilities), but once a selection has been made, all other
    choices are obliterated. Reality becomes a series of successive
    obliterations of potential realities. Just like middle age!

    It’s immediately arguable that since these are all statistical


    functions, they do not necessarily apply to an individual case
    (i.e. to your choice of A or B) but instead describe the system
    of such events. In the same way, an equation might describe
    how oxygen molecules (O2) are dispersed in a room, but it
    doesn’t predict in reality where each molecule is.

    The point, for Lost, is that by having Desmond, Charlie, Jack,


    et al become aware of this other universe (e.g. Desmond’s
    flash of Charlie drowning in the car) they are not jumping to
    the other universe, but in fact obliterating the one they are in,
    in favor of the other (Copenhagen interpretation.) This makes
    Locke/Smoke Monster’s desire to leave the island, and the
    feared consequences (“everything will cease to be”) more
    accurate. Locke isn’t just changing universes, he is causing
    that one to obliterate.
    TV Creates Its Own Enemies
    May 6, 2010

    the bomb came from A, the attack on America came from B

    Contessa Brewer on MSNBC, about the Times Square


    Bomber:

    “…there was part of me that was hoping this was not


    going to be anybody with ties to any kind of Islamic
    country because there are a lot of people who want to use
    this terrorist intent to justify writing off people who
    believe in a certain way or come from certain countries or
    whose skin color is a certain way. I mean they use it as
    justification for really outdated bigotry.”

    Contessa is an awesome name. Oh well.

    It’s safe to assume who she was hoping the bomber was going
    to be was a white guy from Nebraska. And the easy criticism
    here is that she is a leftist nut, so I’ll leave it to others who
    make their living that way.

    But the missed criticism is the second part of her quote. “…


    there are a lot of people who want to use this terrorist intent to
    justify writing off people who believe in a certain way…”
    That’s all her. I understand she meant airplane pilots flying
    with only the right wing, but that’s the whole point: she is not
    aware that form of her criticism applies equally to herself.

    Which brings me to the second point: how many airplane


    pilots does she really think are going to use this incident as an
    excuse to hate Muslims? Those that hate Muslims don’t need
    an excuse; those that don’t hate Muslims are unlikely to be
    suddenly converted to Islamophobia.

    “Those certain people” are other TV pundits. That’s her whole


    world. That’s why it seems to her like “a lot of people” will
    manipulate this story. The 30 or so pundits on either side that
    constitute her entire social and intellectual universe will most
    certainly use this incident to mouth off for the next trimester,
    but the average American barely cares at all. (Not a good thing
    either, and had it gone off a different story altogether. But.)

    When you watch TV, especially the news, understand that they
    are merely arguing with themselves. This isn’t “lose Cronkite,
    lose middle America.” These people do not represent America,
    they are not in touch with America at all.

    But, sadly, scarily, and certainly, they provide the language


    and framework that you will adopt wholesale. The intellectual
    problem isn’t that some Pakistani nut tried to car bomb the
    Lion King, the problem is that our understanding of it will
    come from a gated community of idiots.
    The 1000 Point Drop and
    What Is Happening Now
    May 7, 2010

    not even close, but that’s what the data shows


    I. This is What Happened Yesterday:

    II. This Is What’s Happening Now:

    (Jim Cramer) …Remember, we were down a lot. You


    cannot have that kind of drop, even if it was exasperated
    by some sort of computer trading glitch, unless something
    is really, really wrong in the world, dead wrong in the
    world. So what is the problem? I have got a theory, it
    goes like this: governments of the world are uniting in
    hurting their economies…

    No government is ever worried about the stock market.


    Not in their country, not in our country— that would be
    unseemly, beneath their dignity…

    Governments worry about three things: paying the bills,


    keeping people in work, and keeping inflation in check.
    The issue right now is that these are conflicting goals all
    over the world. The areas that generate jobs for other
    places, especially China and Brazil, they are slamming on
    the brakes. The areas that are desperate to pay the bills
    are doing so at the expense of jobs, that is Europe. And
    the US, we don’t know what we’re doing— other than
    worrying about punishing the rich people who work at
    banks. That seems to be a major theme that has captivated
    Washington.

    III. This Is What Happened A While Ago:

    Why was Galileo persecuted by the Church for saying what


    the Church had previously paid Copernicus to say?

    Copernicus was afraid to publish On The Revolution of


    Celestial Orbs not because he thought the Church would stone
    him, but because he was afraid other academics would laugh at
    him. What was threatened was the Aristotelian paradigm.

    A hundred years later, the paradigm was much more…


    flexible. It could accommodate new data supporting an old
    theory.

    Oddly, Galileo’s own data technically showed that the Earth


    didn’t move— the Sun revolved around it— but that the rest of
    the planets revolved around the Sun. But Galileo was seeing
    his data through another (Copernican) paradigm, so he…
    interpreted things differently.

    Galileo had an epic scientific debate right under his nose that
    would have kept everyone occupied for hours. The Church
    would never have been involved. But Galileo wasn’t satisfied
    with science; he wasn’t satisfied with showing that Ptolemy
    was wrong, nor was he worried that he might be showing
    Copernicus was wrong— he wanted his data to be evidence
    that Catholicism was wrong, e.g that Scriptures had to be
    interpreted figuratively.

    Galileo broke the Cardinal Rule: wovon man nicht sprechen


    kann, daruber muss man schweigen.

    IV. Repeated, for emphasis:

    …Remember, we were down a lot. You cannot have that


    kind of drop, even if it was exasperated by some sort of
    computer trading glitch, unless something is really, really
    wrong in the world, dead wrong in the world.
    Geodon slide deck post
    finished
    May 8, 2010

    and can be found here. If people like it and there’s interest, I’ll
    do a similar thing for other slide decks and promotional
    materials, and maybe put out a monthly email newsletter.
    Depends on how much interest/clicks/links it generates.
    China Needs Fewer TVs, Or
    A Billion Of Them
    May 8, 2010

    I’m just as surprised as you, but at least I’m drunk

    I.

    Reread Part 1. What’s happened since?

    II.

    Studies have apparently shown that soap operas shown in


    developing countries introduce/reinforce progressive values
    like female empowerment, education, equality, with very real
    effects on the society (e.g. birth rates are lower, girls stay in
    school longer, etc.)

    From a news article entitled, “How soap operas could save the
    world“:

    “The evidence we have from these academic studies is


    that quite often [soap opera viewers in developing
    countries] take away different attitudes toward things like
    how many children they want, what is acceptable
    behavior for a husband toward his wife, what is the
    breakdown in a household of responsibilities over things
    like finances, should we be sending girls to school,” says
    Charles Kenny, an economist at the World Bank.

    Soaps are particularly powerful because they attract so many


    devoted viewers. But other shows have similar effects. Charles
    Kenny wrote more extensively about this in Foreign Policy:

    When a woman reached the final five [of Afghan Idol]


    this year, the director suggested “it would do more for
    women’s rights than all the millions of dollars we have
    spent on public service announcements for women’s
    rights on TV.”

    Ok. But what did it change in women, exactly?

    III.

    1. How fast does the culture change due to TV? Probably only
    by a half-generation. Tick tock.

    2a. If this effect is real, is it conscious and deliberate on the


    part of TV execs? Are interested parties creating shows to
    influence the culture (as opposed to simply selling product?)

    2b. If this effect is real, why don’t special interests (the


    government, the Christian Coalition, GLAAD, whatever) just
    give money to established Hollywood producers and say, “can
    you make cannibalism ok?” or “Please rewrite history or me.”
    Works for Spielberg. So?
    Certainly everyone loves to complain that TV is destroying
    society, why not get together and use TV to push the agenda
    you want?

    Maybe they don’t themselves know how real this effect is? Or
    maybe they don’t want to. Maybe Spielberg doesn’t want to
    change the world, just be thought of as the guy who wanted to.

    IV.

    You’ll observe that the article’s title isn’t “How soap operas
    alter the world” it’s “How soap operas could save the
    world”— so it’s a good thing, then? I know the result here was
    that women wanted empowerment, but it could just as easily
    have gone the other way. Why would a soap promote only the
    positive values of empowerment but not promote the
    negatively sexy ones such as showering with your boss and
    recording it?

    This is from the Museum of Broadcast Communications


    article on soaps, specifically 1960s medical soaps:

    The therapeutic orientation of medical soaps also


    provided an excellent rationale for introducing a host of
    contemporary, sometimes controversial social issues
    Yay progress. But here’s the sentence immediately preceding
    it:

    Their popularity also spawned the sub-genre of the


    medical soap, in which the hospital replaces the home as
    the locus of action… the biological family is replaced or
    paralleled by the professional family as the structuring
    basis for the show’s community of characters.

    Not to mention our own personal community of characters.


    Eventually even those get replaced with TV families. Why
    else would there be an all new episode of Brothers and Sisters
    this Mother’s Day?

    V.

    If you’re still trying to figure out whether the studies show that
    TV violence causes real violence or TV progressivism causes
    real progressivism, you’re approaching the question the wrong
    way. Those are accidental outcomes influenced not by the
    content of the shows, but the way TV makes you look at
    things.

    And that way of looking a things is— get ready— narcissism.


    TV makes you look at things not starting from the thing, but
    starting from yourself. No third world village woman looks at
    a soap and thinks, “I wish women had the right to freely
    choose their own husbands.” They look at it and say, “I wish I
    could choose my husband freely.” It looks like a positive
    value, but that part’s an accident. If you look closely, TV has
    only made her ask what she would like for herself. It promotes
    of the right to self-identify. You can argue whether that’s good
    or bad, but the argument has to be about that.

    VI.

    Soap operas were stylistically different from other shows


    because they were open ended, unlike the neatly wrapped
    episodic dramas and sitcoms. They are also shot in quasi-real
    time. If a character says something dramatic and the show cuts
    away to another scene/subplot, when they return they will pick
    up exactly at the moment of the character’s last words. You are
    hand-held through every step of the emotional processing. It’s
    impossible to apply the full force your prejudices to a social
    problem, e.g. abortion, when the show never gives you a
    moment to do so. You are carried through the entirety of the
    process through the character’s life.

    Soaps are also directed as a theater (opera) production,


    conscious of the audience’s placement relative to the stage.
    Characters never turn their back on the camera; they’ll turn
    their back on the other character (e.g. both facing outwards,
    towards the audience) and argue in a way no one ever does.

    It’s a stage effect: it pulls the viewer into their lives. You’re in
    there, day after day, part of the action, part of the drama—
    which they guide you through. No closed ended show can be
    as powerful.

    It’s hard to appreciate how unusual that was, because


    nowadays most TV dramas are run like soap operas: Sex &
    The City, Grey’s Anatomy, Brothers and Sisters etc. That’s
    what makes these shows so much more culturally influential
    than porn. Or church. If I was going to L. Ron Hubbard a
    religion, I would take Sunday services, and serialize them.
    Tune in next week.

    VII.

    TV doesn’t just influence those who watch it, it’s enough


    simply to be aware of TV:

    Barely five percent of the TVs that are on at that time are
    tuned to Gossip Girl; in other words, very few people
    watch it. Yet there isn’t anyone who doesn’t know about
    it, even if it’s imagined based on magazine covers or ads.
    So the existence of a menage a trois episode mainstreams
    it for people who don’t watch the show, and that’s
    actually more powerful a cultural influence. i.e. If you’re
    a fan of the show, the threesome is specific: thosethree
    people are doing it. For everyone else not watching, it
    becomes background noise: “oh, people are having
    threesomes nowadays…”

    This is why it is true that even if you are not interested in


    pop culture, pop culture is interested in you.

    VIII.

    Let’s say I forbid my daughter or son to ever watch TV. What


    happens? Is she at a disadvantage because she is slightly less
    familiar with the rhythm of her social group? Will he be
    mystified by the seemingly contradictory desires in his female
    classmates? Will they both be frustrated and anxious at how
    everyone interprets social and political events using the exact
    same phrases, none of which they know?

    IX.

    Those of you expecting the rise of the Chinese Dragon and the
    collapse of the American Eagle are all going to die, along with
    your grandkids, way before that ever happens. Plan
    accordingly.

    When Charles Kenny says TV is promoting values, what he


    means is western values. Right? As long as America controls
    the horizontal and the vertical, western values— or whatever
    CBS decides those are— will be exported and fetishized.
    Accompanying those will be a interpretive framework built on
    narcissism. It is inevitable. You’ll see Chinese women
    disdainfully rolling their eyes about American frivolity and
    arrogance even as they dab dry their Cosmopolitan splashed
    Hermes clutches and wonder why they are single in a nation
    infested with Y chromosomes. “The last guy I dated didn’t
    even want to want to sex me anymore, let alone get a real job.
    Do I need to move to fucking Australia?”
    Take a breath, Wildman, have a drink, the caps lock is on the
    left and I’m not going anywhere. Let me ask you more
    immediate question: not everyone in China has a TV. What do
    you call it when part of a population becomes exponentially
    and suddenly more western while another part doesn’t at all?

    I’ll save you the Google search: the answer is Iran.

    Tell Sally Fields a happy mother’s day from me when you see
    her tomorrow. I’m glad to hear she’s doing good.

    http://twitter.com/thelastpsych
    Frosty The Snowman
    May 13, 2010

    there are worse things than being alone but it often takes
    decades…

    It was 1979 and the boy was 7 and playing a Mattel electronic
    soccer, and Karen was 3 and resting her head on her mother’s
    thigh, but the other part of it was that they were in the hospital
    and her mother was dying.

    The accident put the mother into a coma immediately, but left
    her that way for another ten hours, nine of which were
    dreadful waiting. Waiting for something to happen, waiting for
    it to be too late to stay any longer, waiting for a doctor to come
    and tell them what the test that they had waited for was going
    to show.

    The father was there, just coming up to sober. He had given


    the kids the soccer game to distract them so he could process
    his grief.

    There was a nurse there as well, she tried to offer the girls
    some juice, but Karen didn’t want any juice. The boy scored a
    goal so no one offered him anything.

    The mother let out a gasp, then there was some sort of rushing
    and organized chaos as the medical staff moved parts of her
    body around and family asked frenzied questions, within a few
    seconds more doctors were there, more nurses, and both kids
    were pushed to a corner where they both stared at futility.

    Eventually it was over. It had actually been over well before


    that. But.

    There is a moment, it comes immediately after the doctors stop


    working and immediately before you understand that the
    person is forever dead, where time pauses. Everything stops.
    That stillness is inviolable, it is at that moment when you
    witness quantum physics choosing between potentialities, you
    are watching it decide that this not that will be, this is what
    will be what has happened.

    It was in that sacred moment that Karen chose to sing. “Frost-


    y the snowman! Was a very happy soul—”

    She never actually got to “soul,” because by “Frost-” the back


    of her father’s hand slapped her in the face with such impulse
    that she fell over.

    It was a reflexive slap, the song was such an affront to the


    family and to quantum mechanics that his hand got to her face
    even before his eyes did. Everyone winced. No one said
    anything. The staff looked away, down, up, at machines and
    papers. The original nurse put a smile on and lead the kids by
    the hand outside. Maybe there was some ice cream there, let’s
    leave the grown ups to talk.

    “But I want to sing Frosty!” said Karen. ” Just one time?!”

    II.

    The problem with guilt, unlike shame, is that it is with you


    even when you are Alone.

    Karen grew up and carried the guilt of that accident with her,
    the guilt of that single instant: she had distracted her father in
    the car. Too loud. Dropped the Oreos. The father had turned to
    look at her, yell at her. The only part that wasn’t really her
    fault was that no one wore seat belts in 1979.

    Thirty years later she didn’t even have solid memory of her
    mother, but the accident and the hospital were in hi def. Her
    brother’s descent into drugs, her father’s decline into nothing,
    all had happened because she hadn’t been able to save her
    mother. Not directly, but inevitably. No matter how you
    worked backwards from the splitting of 30 years of
    potentialities, they all started with the dropping of the Oreos.

    And she had run through in her mind, in those 30 years, every
    other alternative potentiality: if she had simply sat quietly;
    listened to her father; died in a fire; died in utero… so many
    other possibilities and if any of them, therefore her mother
    would still be alive.

    But those were unsatisfying fantasies, because they didn’t


    change the source of her guilt which was, she knew, the
    dropping of the Oreos. That’s what had to change, the
    opportunity missed. Then her mother would be alive, then she
    would have succeeded, then the guilt would be gone.

    She parented differently now that she had a 3 year old


    daughter of her own, it was all four point harnesses and Chevy
    Suburbans and no snacks in the car.

    But you can protect your kids from the world, you can’t
    protect them from you.

    When the family goldfish died Karen decided to use it as a


    teaching experience for her young daughter. They’d take the
    fish outside and bury it, and say a prayer, and in this way
    would learn about death and God and about the enormity and
    ceaselessness of the universe, that life is finite though
    memories are not.

    But what do we know about the universe that we think we can


    teach? We humans fret about personality and behavior and the
    relative contributions of nature vs. nurture, but if someone
    asked God if they should study Francis Crick or Carl Jung, He
    would spit in their food. Get thee behind me, Satan.

    When Karen sat Catherine in front of the bowl, in that instant


    of silence when Catherine should have been watching
    quantum decoherence, she instead did this:

    “Frost-y the Snowman! Was a jolly happy soul! With a corn


    cob pipe—”

    And the mother snapped. “CATHERINE!”

    Catherine’s head jerked back. Her eyes darted to the dead fish.

    “Why are you singing THAT?!”

    Eyes darted back to the mom, back to the fish, back to the
    mom. “—and a button nose—”

    “Stop! Why are you singing that?!”

    A sob came up first, back and forth went the eyes. “…I have
    to.”

    “Why?!”

    “So he’ll wake up…”

    Nothing in that room moved, except a flow of tears and


    Catherine’s eyes, watching quantum mechanics take away her
    beautiful fish.

    “… but now it’s too late…”

    –—

    http://twitter.com/thelastpsych
    What iPads Will Do To Your
    Family
    May 14, 2010

    awesome… masturbation just got a little easier

    Chuck Hollis, a VP at EMC Corporation, writes about what


    buying the iPad did to his family. It’s short, go ahead and read
    it.

    And then I brought home the iPad.


    …The members of my family immediately gravitated to
    the new shiny thing — no prompting, no encouragement,
    no migration, etc. They are drawn to it like a moth to
    flame.
    I now have this strange love/hate relationship with Apple.
    And I think it won’t be long before I’m forced to make
    another trip back to the Apple store.

    I’m not trying to ignite an iPad war, nor am I saying that the
    iPad is not an inventive piece of technology. The iPad has a
    market, but that market is plagued with a number of troubling
    appetites. But he’ll never buy a desktop again? BS. Let’s say
    you take video or a photo with a camera. There is currently no
    way to get that to an ipad except through a traditional
    computer.

    The problem isn’t the iPad itself, but what he plans to do with
    it. What he describes in this article is totally unproductive
    activity. Sending photos, facebook, and smiling, always
    smiling.

    My wife asserted her rightful place in the hierarchy later


    that evening, and took it upstairs to the bedroom to relax
    while watching TV. Tap, tap, tap. Occasionally, she
    showed me something interesting she found online. And
    smiling.

    Let me guess, she was watching HGTV and browsing


    GOOP.com, right? Consume, consume, consume.

    He’s describing a consumption device, not a production


    device. These aren’t devices you use to create anything. They
    are media consumption devices. Can you write anything of
    substance on an ipad? Do actual work on an ipad? I understand
    that it is certainly fun to use, and that it’s neat. Does that
    justify $500 + $20/month?

    And that’s fine if that’s what they are. They’ll be successful


    for the same reason all kinds of things are successful. It makes
    people smile. Great. So do Vente Moccachinos, which I
    assume comes in red as well as standard black. People buy
    gourmet cookware to scramble eggs. They buy high
    performance cars to sit in traffic. Just because I think it’s
    stupid doesn’t mean I don’t also think it won’t be hugely
    profitable, nor does it mean I don’t understand the product. I
    understand it perfectly. These devices are for people who
    approach computers and the web the same way they approach
    TV.

    Can I rip 1080p blu-ray discs to it? Can I edit HD video? Can I
    write a document on it longer than 100 words? Can I prepare a
    presentation, work on a spreadsheet, etc.? Will it run MAME?
    Will it do all these things at the same time?

    And to his main point: “I don’t think I’ll be buying desktops


    anymore.” Yes you will, because judging from the article you
    buy every stupid piece of crap that any of these tech
    companies ever make. “As I think about it now, we’ve got a
    fleet of 6 PC desktops of various vintages and three Windows
    laptops — two of them that actually work well. On the Apple
    side, we’ve got an iMac and two MacBook Airs of different
    vintages. We just updated the family NAS server to the most
    recent Iomega device.” So yeah, there are a few more desktops
    in your future.

    The criticism here isn’t about the tech. I just bought a


    MacBook with edges so sharp I can slit my wrists on it while
    I’m looking for the right click button. But it’s a slick ride, and
    boots up fast enough for me not to punch the CPU. Is it
    “better” than a PC? Sure, I’ll grant that.

    My criticism is about the mindset. Not everyone— settle down


    — but many look at Apple from the “if I only had the right
    equipment, I could—” perspective. It’s a false idol. None of
    these products will improve the quality of your production if
    you are not already producing. And there’s a very good chance
    that it will suck the time and energy out of your life, exactly
    like porn.

    Forget the All-Clads and the Whole Foods. Go buy some


    Acme non-organic eggs and mass produced waxy tomatoes,
    and figure it all out.

    Stock tip: the fact that I finally bought an Apple can be taken
    as some sort of top.

    –-
    http://twitter.com/thelastpsych
    The French Obey Authority
    Figures
    May 17, 2010

    do the right thing


    I.

    A French documentarian creates a fake game show (a la


    Milgram obedience experiment): he tells the subjects that in
    this game show, they are to shock the “contestant” if he
    answers the questions wrong. (Of course, there was no real
    shock, everything was faked.)

    Just like with the Milgram experiments, most (64/80) of the


    subjects shocked all the way to the top, despite the anguished
    screams of the contestant.

    Milgram would (and did) say something like:

    But the psychological conclusion, at once both facile and


    unimaginable, is that they were simply following orders:
    they hated making Jean-Paul suffer and expressed their
    desire to stop the game — but, apart from 16 of the
    participants, never managed to resist orders from an
    authority figure to carry on.
    II.

    Here are two important questions I have yet to see asked:

    1. are there really people in France— in France!— who


    have not heard about the Milgram experiments?
    2. are there really people in France who would think that
    there could be a TV show where you actually torture
    other people for real? I realize the EU is crumbling, but
    let’s postulate that France is not in Japan.

    It’s possible that these people are not so much obedient as


    idiots, condemned to repeat history because…

    III.

    But there’s another, more likely explanation: these people live


    in France.

    They’re brought up in a normal, liberal society that doesn’t


    usually torture its citizens. It’s a TV show, so it’s presumably
    voluntary. Why would they stop? Imagine you’re the contestant
    to receive the shocks, you’ve withstood shocks all the way up
    to 400 volts, and now the nimrod on the other end decides he’s
    not going to shock you because he finds it morally
    objectionable— the same guy who’s never heard of the
    Milgram experiments yet has made a thorough investigation of
    the relevant balance of ethics. Now the game is ruined, and
    you go home with your depression treated, for nothing.

    There’s a difference between blind obedience to an authority


    figure, and knowing where you are.

    IV.

    A lot is made of whether the individual has the moral fortitude


    to resist an authority figure. What of it? No one cares about
    your particular moral stance, except you, which puts that
    squarely in the narcissism bin. You can refuse to participate,
    but you know they’ll simply get someone else, right? So what
    have you accomplished?

    The important question isn’t whether you would refuse to


    participate, but whether you’d be willing to smash a
    fluorescent light bulb and wave it around like a light saber and
    bust that guy the hell out of there. Or something. No one
    expects you to be a Jedi, but don’t walk out of there with your
    head held Facebook high because you chose to think of
    yourself first.

    Zimbardo and the Stanford Prison Experiment

    Why I Refused To Participate In Milgram’s Experiment: I’m a


    Communist

    –-

    http://twitter.com/thelastpsych
    What US v. Comstock Means
    To You
    May 20, 2010

    phew… won’t be needing this anymore

    Let’s dispense with CNN-soundbite analyses of the case.

    Washington (CNN) — The U.S. Supreme Court ruled


    Monday the federal government has the power to keep
    some sex offenders behind bars indefinitely after they
    have served their sentences if officials determine those
    inmates may prove “sexually dangerous” in the future.

    …At issue was the constitutionality of federal “civil


    commitment” for sex offenders who are nearing the end
    of their confinement…

    Not even close. This isn’t about sex offenders. This is the
    Supreme Court, not your local public defender/bench trial
    farce pretending to be justice. And it isn’t “by extension”
    about the indefinite detention of terror suspects.
    It isn’t about whether it is ok to civilly commit criminals after
    they’ve served their time. This is something I am against, can
    argue it classically, drunkenly, or violently, your choice, but
    regardless, isn’t really the point.

    The question here was whether the federal government is


    allowed to engage in civil commitments for anything other
    than the enforcement of (federal) criminal law. More generally,
    is the federal government allowed powers it thinks important,
    not explicitly granted by the constitution, but not specifically
    prohibited either?

    And, is the Supreme Court going to let them?

    The answer is, yeah, pretty much.

    II.

    Thomas, first two sentences of his dissent:

    The Court holds today that Congress has power under the
    Necessary and Proper Clause to enact a law authorizing
    the Federal Government to civilly commit “sexually
    dangerous person[s]” beyond the date it lawfully could
    hold them on a charge or conviction for a federal crime.
    18 U. S. C. §4248(a). I disagree. The Necessary and
    Proper Clause empowers Congress to enact only those
    laws that “carr[y] into Execution” one or more of the
    federal powers enumerated in the Constitution. Because
    §4248 “Execut[es]” no enumerated power, I must
    respectfully dissent.

    All extra power that may be needed by the government is


    explicitly granted to the states. That’s the whole Federalist set
    up. “The powers not delegated to the United States by the
    Constitution, nor prohibited by it to the states, are reserved to
    the states.” That’s the whole point.
    The government already does lots of things outside its
    enumerated powers. It builds prisons. It can declare a
    quarantine. It gets away with these because they are closely
    related to actually enumerated powers.

    The test is whether the desired power/law— is “necessary and


    proper” and also “legitimate,” as defined as “within the scope
    of the Constitution.” But the two parts of the the test must be
    equally considered.

    (Thomas) Unless the end itself is “legitimate,” the fit


    between means and end is irrelevant. In other words, no
    matter how “necessary” or “proper” an Act of Congress
    may be to its objective, Congress lacks authority to
    legislate if the objective is anything other than “carrying
    into Execution” one or more of the Federal Government’s
    enumerated powers.

    You can be for Big Government or you can be against it.


    Whatever, it matters not a lick. It matters GIGANTICALLY
    that the supposedly conservative, strict constructionist Chief
    Justice, a man who had previously been in a tennis club
    actually called The Federalist— has come down decidedly on
    the side of, “well, I guess in some cases it’s ok…”

    Say what you want about Scalia and Thomas, but undeniably,
    they are old. They will die. If they were the only two willing to
    put pen to paper against a government looking to expand its
    powers, look out.

    III.

    “The court’s holding today is a victory on behalf of the


    American people,” said Sen. Patrick Leahy, D-Vermont,
    chairman of the Senate Judiciary Committee.
    “The process to enact this law to protect our children
    from those who would do them harm was difficult. I am
    heartened to see an overwhelming majority of the
    Supreme Court uphold this important child protection
    law.”

    Listen, dummy, you have it backwards.

    All constitutional questions aside, the practical outcome of this


    is that it puts a criminal matter into the hands of the
    psychiatrists. Is that what you want? Worse: it places the
    prediction of a future crime in the hands of the psychiatrists.
    Worse still: it places the prediction of a future crime on the
    basis of not having actually committed any crimes yet in the
    hands of the psychiatrists. Note that one of the defendants
    didn’t actually molest anyone, he only had child porn. Is
    hentai child porn? Well, it is now.

    Is raping a child a mental illness? Not is it evil, not is it


    curable, I’m asking if it represents a discrete pathology? How
    is a psychiatrist to intelligently predict dangerousness there?
    What if he gets it wrong— in either direction?

    In an ordinary psychiatric commitment, I have to predict


    whether this guy’s mental illness may cause him to be
    dangerous. Note carefully: not predict if he is dangerous, but
    whether that dangerousness is the direct result of a mental
    illness. If I think a guy is going to shoot a rival gang member,
    locking him in a hospital isn’t allowed. So? He raped a child
    last week. He exhibited no signs of that behavior previously,
    and he doesn’t have any now. So?

    IV.

    I’ve nearly had it with this country, with this generation.

    Forget about being responsible for yourself, people are not


    even willing to be responsible for choosing someone else to
    bear the responsibility. Don’t bother me. So long as I can
    Facebook all night and not have to have sex with my spouse.

    The government, not just Obama, Bush too— is the


    manifestation of this narcissism and laziness. On the one hand,
    the government wants all the power in the world to do what it
    thinks is right, the other half of the country be damned. And
    we say, sure! just drop me off at Nordstroms, it’s on the way.
    On the other hand, anything it finds politically toxic it offloads
    to the group with no scientific rigor and no ethical framework
    beyond expediency. Got poverty? You can apply for welfare
    and disability down at the community mental health clinic.
    Got criminality? They have a branch office in the jails, too.

    Whenever you hear about Chinese schoolkids getting slashed


    or Japanese teenage hikikomori masturbating to bootlegs of
    The Ring, it seems only logical to wonder, hey, what’s up with
    that crazy culture?

    So I put it to you: you got an epidemic of pedophiles- or you


    have a media created fantasy of an epidemic of pedophiles; for
    which the government response in either case is a) more
    powers for us; b) more psychiatry for you.

    What’s up with that crazy culture?

    http://twitter.com/thelastpsych
    The Other Technical
    Analysis
    May 21, 2010

    the American male may be dead, but the consumer is not

    I. The Machines Are In Charge Until At Least 2012

    If you accept the proposition that the government is doing


    whatever it can to prevent further deflation, then you can also
    say that the fundamentals of the market are at least temporarily
    being overruled.

    If fundamentals are less important, then technicals are more


    important. The Machines are running the short term show.
    Whatever caused the “flash crash” may or may not happen
    again, but it was inevitable that we would return to that low.
    Similarly, it was inevitable that the machines will read the red
    200dma as a support (next day), the blue 50dma (and arrow)
    as a resistance, and, currently, that they would see the low
    back in February (yellow) as a support. It must bounce off that
    point— not because the fundamentals warrant it, but because
    the machines have that locked in as a key point.

    It doesn’t mean it can’t bounce and then go much lower again


    — but bounce it must.

    II. My Precious

    A while ago I noted the unusual finding that gold and platinum
    were selling at the same price. That’s not a world I want to live
    in. So platinum has raced ahead, now at $1500/oz while gold
    is at $1100.

    The ratio is now fixing itself:


    We’re still in a deflationary world. Maybe someday we get
    inflation. But in both cases, gold goes higher (gold goes down
    during times of slowing inflation.) I thus conclude that in order
    for the ratio to be acceptable in a universe that does not permit
    more than one season of Miami Medical, platinum must go
    even higher. I am aware that the supply of platinum has
    increased and more is coming, but again, fundamentals matter
    less in the short term. Plan according to your beliefs.

    III.

    I’ll make three longer term, fundamental points.

    1. Stocks
    What’s a fair P/E for another year’s worth of economic
    nonsense? Assume a PE of 13-15, and S&P earnings of $70,
    you get 950 level for the S&P. That can be considered a fair
    value for the S&P.

    However, to the extent possible, the U.S. government wants it


    to be the bottom, and will do whatever is necessary to make it
    so.

    2. Consumer Sentiment
    You can measure the economic growth and consumer
    sentiment through a million abstruse metrics, but for me, as go
    Aeropostale and Apple, so goes the country.

    3. Oil

    When the BP oil well blew up in celebration of Hitler’s


    birthday and started leaking 50k barrels/d of precious,
    delicious oil all over the place, because that’s what he would
    have wanted, you would be forgiven for thinking that it would
    drive oil prices spectacularly higher.

    Nope.

    It’s all about the value of the dollar and, more importantly,
    growth prospects here and abroad. In Europe, those prospects
    aren’t good (for now.) That blip upwards on May 10 was when
    the EU announced a $900B bailout.

    You may want to take this as a sign that the supply of oil isn’t
    fundamentally the problem, but rather the demand.
    4. When Humanity Gets Together And Decides To Do
    Something With One Voice, Are They Always Wrong?

    This Shiller Imaginarium product surveys the confidence of


    investors that there will NOT be a market crash in the next 6
    months. Draw your own conclusions.

    5. Is This The End Of The World?

    (previously):
    –

    http://twitter.com/thelastpsych
    The Perfect Game: What
    Would You Do?
    May 22, 2010

    If the pitcher has so far pitched a perfect game, and you are the
    batter in the bottom of the 9th, do you purposely strike out to
    give it to him?
    What The Miss USA Pageant
    Says About Us
    May 25, 2010

    i am completely disgusted that she would do this for free

    I.

    And that’s why it is ridiculously obvious that when the


    Miss USA Organization, co-owned by Trump and NBC
    television, released a racy video lingerie photo shoot of
    this year’s contestants… the sole purpose was to pump up
    the ratings for this Sunday night’s telecast of the 2010
    pageant on NBC.

    No.
    This past pageant got 6.6M, which is the same as last year.

    You may be tempted to think that these scandals are blown up


    in the media in order to boost ratings for the pageant. Yet
    while everyone knows about the controversies, you can’t find
    one person (other than me) who actually watched the pageant.
    The marketing has all failed, from Vanessa Williams to Carrie
    Prejean. Why would they think seeing half naked women in
    lingerie would entice me to want to watch them fully clothed?
    Whoops?

    IIa.

    The photos seemed designed to generate controversy and


    buzz about the pageant, TODAY’s Matt Lauer suggested
    to pageant president Paula Shugart. “Yes, to some degree
    it’s marketing,” Shugart admitted

    Wrongolongoria. The controversy isn’t to get viewers to watch


    the Pageant, the controversy is to get viewers to watch the
    Today Show.
    Shows don’t operate on their own, they’re soldiers in a
    standing army. Miss USA is run by the Miss Universe
    Organization, owned by Donald Trump and NBC Universal,
    which is co-owned by GE and Vivendi. That means the Miss
    USA pageant can be enjoyed as a loss leader for MSNBC,
    NBC, USA Network, Bravo, A&E, Hulu, Activision/Blizzard,
    and Universal Studios.

    And rival media is free to capitalize on it if they want. Oh, is


    she Muslim? Then off to Fox News and Glen Beck and etc.
    You think CBS is talking about it because they want to boost
    NBC’s ratings?

    Whenever someone talks about a television’s show’s ratings as


    if they have valuable information, punch them in the mouth.

    IIb.

    Small aside: if the game is eyeballs, then it becomes less


    relevant that they get the facts straight once you are watching;
    only that you watch.
    Is this what the Miss USA represents? It used to be all -
    American girls, the leaders of the future. These are the
    leaders of the future?

    If you’re watching this Fahrenheit 500 deliver the business


    news from a bar, you’re probably not worried about accuracy.
    Why do I suddenly want a drink and a plane ticket?

    III.

    CBS News, unaffiliated with the pageant but hey, it’s news,
    right? gets to ask, “Are Rima Fakih’s Sexy Shots [of her in the
    stripping contest] Any Worse Than The Lingerie Photos?”

    The answer, obviously, is yes, they are worse, they are much
    worse, and by worse I mean much better. If I have only one
    click left, I wanna see the stripper pole. Lingerie? What is this,
    the set of Falcon Crest? Bring on the pole.

    “Americans are a puritanical lot that can’t handle sexuality.”


    Oh, no, they handle it just fine, otherwise it wouldn’t be
    everywhere. They just can’t handle it when they’re with other
    people.

    When you’re by yourself and the sex scene in a rated R movie


    comes on, do you change the channel? “It seems wrong to
    watch the expression on her face change as she mounts him. I
    choose to turn away.”

    But with every passing year of marriage those scenes frustrate,


    you try to avoid them. Not when you’re Alone, of course, but
    when you’re watching with your spouse: you worry it is
    reminding them how inadequate you have become.

    It happens also when you’re with people you’re not intimate


    with. Are they watching how you are watching it? If you’re
    too interested, will they think you’re a pervert, and if you
    appear bored, will they think you’re a prude? So there’s dead
    silence as everyone in the room pretends they’re not
    pretending.

    The word for all of this is shame.

    It’s perfectly normal to feel this way. But you chose this world,
    this is the one you wanted. What kind of a world is it where
    we want sexuality in everything, have normalized sexuality in
    everything, but are ashamed to be caught looking at it?

    A world that prefers to be alone, of course.

    IV.

    A quick word on the homosexualization of public sexuality, or,


    what’s up with all the naked guys in ads and movies
    nowadays? Is everyone gay? No. Otherwise it wouldn’t work.
    When a guy gets caught watching a naked girl in a movie, he’s
    got some pretending or explaining to do. When a guy gets
    caught looking at a naked guy in a movie, he still gets the
    signifier of sexuality to use any way he wants, but without the
    shame. That the ladies might like it is an added plus.

    Son of a bitch… Posh Spice is smoking hot

    V.

    There’s a simple reason why the stripping pics are “worse”


    than the lingerie pics: she was told to pose in lingerie; she
    chose to strip on her own.

    If there is one thing that makes Americans— or at least the


    media, which both reflects and creates American tastes—
    nervous, it isn’t sex, but sex that it can’t control.

    Maybe it’s a uniquely American thing, maybe not: as long as


    sex/iness comes with a price tag, we’re ok with it. Controlled,
    manufactured, artificial— safe. Lingerie shoot? “She had to do
    that for the pageant.” Oh, so that’s the answer. It’s not real.

    But if she’s caught stripping for fun, then… what does that say
    about me?

    The feminist argument is it sets a standard for women that they


    are forced to at least wonder about. “How can I compete?” But
    it’s worse for men. Playboy is fine. Girls Gone Wild drives us
    bananas. “They do it… for nothing? They’re willing to get
    naked on camera for nothing… yet every time I try to be nice
    and buy one of them a drink, they won’t even look at me… I
    don’t get it, I don’t get it…”

    Wanton displays of sexuality leave no room for


    rationalizations. “That kind of girl only wants a rich guy.” But
    she did it for free. So?

    America tends to be deferential to prostitutes and porn stars,


    because it understands them. It’s powerless against sluts.

    Which is why we call them sluts in the first place.

    http://twitter.com/thelastpsych
    NY v Junco: Sex, Civil,
    Hygiene, and Mental, All In
    One Post
    May 27, 2010

    when you lay down with dogs, you come up with fleas

    Forensic psychiatrist James Knoll writes The Political


    Diagnosis: Psychiatry in the service of the law. You should
    read it (short) now, I’ll wait.

    If you have the great misfortune to live in NY, as I once did,


    for three years in a miserable art deco apartment building near
    180 and Broadway, sandwiched between Hellfire and
    Damnation, fighting thugs to get into an apartment you had to
    fight roaches to get out of— but I digress.

    In any event, the state of New York is pleased to offer civil


    commitment of sex offenders. How do you determine who is
    “a sex offender requiring civil management?”

    According to the Mental Hygiene Law (yes, it’s called that)


    ” ‘[s]exual offender requiring civil management’ means a
    detained sex offender who suffers from a mental
    abnormality. A sex offender requiring civil management
    can, as determined by procedures set forth in this article,
    be either (1) a dangerous sex offender requiring
    confinement or (2) a sex offender requiring strict and
    intensive supervision.”

    The second sentence is indecipherable. I think it says, “a


    person requiring commitment is a) a dangerous person
    requiring commitment or b) a person requiring commitment.”

    Leaving us with the first sentence: “… is a sex offender who


    suffers from a mental abnormality.”

    Mental abnormality is: a condition that “predisposes him to the


    commission of conduct constituting a sex offense and that
    results in his having a serious difficulty in controlling such
    conduct.”

    Which makes sentence 1: “a sex offender requiring


    commitment is a sex offender who suffers from a condition
    that makes him a sex offender.” Which, of course, means
    anything you want it to.

    II.

    Douglas Junco was sentenced to 15 years for attempting to


    rape a woman because she gave him a ride home from a bar.
    After serving out his sentence, the state tried to civilly commit
    him further, but the jury refused to play along, so Junco went
    to Georgia and raped a 48 year old relative.

    You’ll probably want to say that he should have been civilly


    committed after all.

    So what psychiatric testimony was presented to get him


    committed? The psychiatrist diagnosed him with:
    Axis I: Impulse Control Disorder NOS.
    Axis II: Antisocial Personality Disorder.

    I will post a naked picture of myself punching a dolphin if


    anyone can tell me what the difference between those two
    diagnoses is in this case. Which one of these constitutes the
    mental abnormality? Explain your answer using evidence. It’s
    a trial, right?

    The judge:

    …the court expresses its concern that although the


    respondent had been subjected to numerous psychiatric
    evaluations while in custody over a prolonged period of
    time (since 1992), he never was diagnosed with impulse
    control disorder NOS until the evaluation by Dr.
    Gonzalez on March 15, 2007. The court is further
    concerned that Dr. Gonzalez was generally not aware of
    the circumstances surrounding the numerous “tickets”
    issued to the respondent while in custody; that the doctor
    apparently gave some consideration to a criminal charge
    against the respondent in 1991 which was in effect
    immediately dismissed; that a determination had been
    made in a separate proceeding that as to the instant
    offense there was a lack of sexual contact; and, finally,
    that the doctor apparently was not provided with, nor did
    he therefore consider, any favorable reports submitted as
    to the respondent while he was in custody.

    If you are thinking the psychiatrist didn’t do a good enough


    job of presenting evidence to commit, you’re missing the
    point. The psychiatrist did everything exactly the way every
    other psychiatrist does things, i.e. half-assed and
    disinterestedly. But that same evidence could easily have
    gotten a man committed forever. The reason he wasn’t
    diagnosed with Impulse Control Disorder while in prison is
    because there was no external reason for the diagnosis. There
    were no services to provide or deny him on the basis of a
    diagnosis. And the reason Gonzalez did diagnose him with
    that is because that’s what he needed for a commitment, in the
    absence of good stuff like psychosis. Expediency. It’s that
    simple.

    In addition to reviewing numerous documents and reports


    concerning the respondent, Dr. Gonzalez conducted a
    telepsychiatry interview of Mr. Junco which lasted
    approximately one hour. Incredibly, the doctor did not
    take any notes during the interview.

    Incredibly? Your Honor, what was incredible is that it lasted


    an hour, and by incredible I mean completely and utterly
    impossible.

    Again, to clarify: we’re upset he didn’t do a good enough job


    to commit, but a judge could easily have just taken the
    psychiatric testimony at face value and locked him and his
    mom and his fish and his car for a century. The hoax is that
    there is any evidence to present at all. What evidence? What
    does a shrink know about future behavior, of human nature?
    I’m not saying intelligent things aren’t known; I’m saying they
    are not more known by shrinks. Hell, why wouldn’t you just
    ask other sex offenders for their testimony?

    The reason this guy was able to get out and rape again is the
    same reason why other people who won’t ever hurt anyone
    will be held indefinitely with no recourse: political expediency
    masquerading as science.

    III.

    Just a piece of advice. If you are ever arrested, make sure to


    ask for a jury. As for two juries. If your lawyer says the words
    “bench” and “trial” at any point in the same paragraph, flee to
    Argentina. Those 12 idiots, imperfect as they are, are one of
    the only things protecting you from a top down, hierarchical,
    classist, flow chart wielding government clusterfuck that has
    no time, interest, or money to deal with people as individuals,
    so it deals with them as groups, types, diagnoses and organ
    banks.
    Sex In The City 2
    June 3, 2010

    dum dum dum-dum, dum dum da-dum

    Sex And The City 2 is not the worst movie ever made, because
    it is not actually a movie, it is a 2.5 hour Bin Laden tape
    entitled, “Why We Hate You.” Fifteen minutes into this
    recruitment video I hit up twitter:

    thelastpsych @alqaeda whats ur paypal? I want in I also have


    drug pens and wicked sneaks

    thelastpsych d alqaeda can u pick me up at the airport? or can


    meet you at Tony’s

    thelastpsych d alqaeda on 2nd thought dont bother, in a


    generation we’ll be extinct

    alqaeda @thelastpsych @abiliquel @speidi @bananasplits


    @axlrose @bjclinton @chrisnoth IF THIS IS IN RESPONSE
    TO THE MOVIE, THANK YOU FOR YOUR INTEREST.
    WE ARE CURRENTLY EXPERIENCING HIGH CALL
    VOLUMES. PLEASE TRY AGAIN TOMORROW.

    thelastpsych @alqaeda noobs get on teamspeak i’ll be on


    after work

    This movie was prohibitively terrible, even though I paid for


    my ticket, I still had to sneak into the theatre. Think about that.
    “I’m really here for the A-Team,” I told the usher. “I bought
    the wrong ticket for my hot girlfriend, who’s at the bar
    ordering Grasshoppers that are not for me at all.”

    He took a deep breath and puffed his cheeks out, exhausted.


    “Keep your hands where we can see ‘em, wildman, this is a
    family joint. And leave the London Fog in the car.”

    II.

    You may be aware that the gals, courtesy of Samantha’s


    recession-proof job as something vague go on an all expenses
    paid trip to Abu Dhabi, which is also recession proof, even
    though, of course, it’s not. There’s no evidence of a recession
    anywhere in the movie because BORING.

    Here’s what’s weird: the government of Abu Dhabi wouldn’t


    let them film the movie there, so they instead filmed it in
    Morocco. But they left it as Abu Dhabi in the story. I’m pretty
    sure the average SATC viewer does not know the difference
    between Morocco and Abu Ghraib, let alone Abu Dhabi, so
    why the pretense? I’m not trying to be funny, I’m sure they
    can see that the letters spell different words, but if I asked
    anyone in that theatre if Abu Ghraib was the capital of
    Morocco, you don’t think they’d have to call Facebook if it
    wasn’t the other way around?

    Samantha: Doesn’t Abu mean “penis” in Middle Eastern?


    Carrie: I thought it meant “something gay.”
    Charlotte: I think I may be gay in real life.
    Miranda: No, that’s me, you’re confusing your characters.
    You’re the girl that all straight guys say they’d do if Al Qaeda
    forced them to choose. The dark haired innocent and naive
    one.
    Bin Laden: You’ve also aged the best out of all of them.
    There’s probably a moral there, but it got lost in all the crotch
    shots.

    III.

    I’m pretty sure Matthew Broderick is not gay, because no


    woman married to a gay man would appear in a movie where
    gays are forced to play 8 year old school girls. The movie
    features a gay wedding that is completely incomprehensible on
    any level. Right off the bat: the two “brooms” (yeah) have
    always hated each other, but can still get married because they
    don’t have complicated emotions like 40 year old white
    women.

    Carrie: My life has become much less gay since I got married.
    Brooms: If we overlook a decade of animosity and get
    married, would you come to the wedding to be the center of
    attention?
    Carrie: It would be my pleasure.

    And why is Liza Minnelli in the wedding? Why is she singing


    Beyonce’s “All The Single Ladies?” IT’S A GAY WEDDING
    BETWEEN TWO GAY MEN. Why is Carrie in a man’s tux?
    That doesn’t make any sense, they’re gay, not transvestites.
    But for an audience that concedes, “Abu Dhabi/Morocco,
    what’s the diff?” such questions are clearly beyond the point,
    the point being that the gals lead fun, exciting lives, reality be
    damned. Walk into any 20 something bar in America and the
    semi-drunk girls in the corner have at some point played “If
    we were in Sex and The City, I’d be______” and it never
    occurs to any of them that that game is the very reason they’re
    on Cymbalta.

    The movie isn’t just an affront to homosexuals, it’s an affront


    to stereotypes of homosexuals. If you’re looking to see a
    movie where two gay men with infinite leisure time lounge
    fully dressed on someone else’s bed and ooh and ahh while an
    ex-Chud tries on different unflattering outfits, then I suggest
    inpatient.

    But the wedding isn’t for the couple, of course, its sole
    purpose is to give Carrie the opportunity to reflect on her own
    married life. She relates every second the wedding to what’s
    going on in her head. Not obtrusively or egotistically, but
    quietly, with a smile, so you get the false impression she’s
    happy for the couple. Is it impossible for Giappetto’s first
    attempt to engage the world without making it completely
    about herself?

    Maybe the gay wedding was the director’s little attempt at


    progressivism, “we at SATC2 support the right of gays to get
    married!” but does no one think it a little weird that they
    support the right to do what Carrie et al obviously think is a
    bad idea for themselves?

    Charlotte: My gay friend is marrying your gay friend!


    Carrie: Just when you thought everyone you knew was too
    old to get married, here come the gays!

    That’s a real quote. What does that even mean?

    IV.

    Still, you have to give them credit for taking the movie out of
    New York. Got to find fresh meat, I guess. I understand that
    part of the allure of travel is the opportunity to sleep with
    exotic people native to that land, believe me, I get it. Have you
    ever slept with a Hungarian in Budapest? A Botswanian in
    Gaborone? An Egyptian in Alexandria? A Russian in Brighton
    Beach? A Texan in Houston? I’ve done all those things and
    more, and my evaluation of intercontinental travel is HELL
    YEAH.

    But these four don’t even notice the Moroccans around them,
    unless they are waiters. Not because three are married, of
    course, HA! dummy, that just means you’re not allowed to
    wear a condom. No, they don’t notice the natives because for
    these idiots, the Middle East is nothing but a backdrop, a set, it
    may as well just be a green screen. What men do catch their
    eye? An American ex-boyfriend, the Australian Rugby Team,
    and a Portugese explorer named Rikhart who for the purposes
    of the movie had to be from Scandinavia/The
    Netherlands/what’s the diff?

    V.

    There is a positive lesson in Sex And The City 2, and it is this:


    spending thousands on shoes, beautiful designer clothes and
    accessories doesn’t make you look better, sometimes it merely
    highlights your comparative ugliness. The juxtaposition is too
    jarring for an unsuspecting and unmedicated person to handle.
    Say you’re looking at the ground of a busy sidewalk, and you
    say, “oh, look, those are a pair of really beautiful Christian
    Louboutin shoes and HOLY JESUS IT’S MR TUMNUS!”

    For comparison, take a look at this man:


    His tie, shirt, and haircut are each individually of better quality
    than my eyes, and cost more. But you wouldn’t have thought
    him any more attractive than if he was standing in a bathrobe
    on top of a toll booth peeing on convertibles as they passed
    below. Here he is dressed for a battle of wits:

    No difference. Save your money.

    “But I’m not dressing this way for men, I’m doing it for
    myself.” Yes. That’s the whole problem right there.

    VI.

    What I was going to do is talk about how SATC appeals to the


    heteronormative standards applied to American women in
    much the same way as the the A-Team movie appeals to men.
    SATC reinforces the role of women as spendthrift, gossipy,
    superficial, entitled, playful, and non serious. A-Team
    reinforces the notion that men should be capable, charming,
    rough and tough, funny, effective, etc.

    But then I thought about how the plots of SATC and the A-
    Team actually converge into the same movie. See, what
    happens is that the girls go to Abu Dhabi where their wacky
    vaginas get them into yet another jam with the religious police,
    so it falls to the A-Team to weld a hat on a duck and bust them
    out. Murdoch disguised in a burqa hacks a/the computer and
    they crash their van into the Dome of the Rock to launch their
    surprise attack. Faceman then sweet talks all the gay arab
    clerics, B.A. shoots evil mastermind Manolo Blahnik in the
    foot, the duck recovers the vaginas, and cars flip over and
    explode but the drivers crawl out. Finally, at the culmination
    of a daring helicopter dogfight, Hannibal releases the girls
    from their prison cell in the Nordstrom Rack high atop the
    Burj Dubai. “I love it when a plan comes together,” says
    Hannibal, and kicks Samatha off the roof. Fin.

    http://twitter.com/thelastpsych
    Most Prescribed Drugs 2009:
    Post 1, JFK to SFO
    June 4, 2010

    I’m sure we have a pill for that


    (The Air Tran challenge: they offer Wifi on my flight, so how
    well can I use it? Post 1.)

    In 2006 I offered you the Top 25 psychiatric prescriptions.

    Want to see what’s changed in 2009?

    The decade long WMD that was Depakote? Does anyone want
    to apologize for that? Hello?

    II.

    You have to dig a little bit. Look at Wellbutrin XL, at 2M,


    down by 73% from 11M. But bupropion (generic Wellbutrin)
    is up, at 8M. Add the two together, and you’re back to 11M.
    This doesn’t even account for generic bupropion SR +
    Wellbutrin SR. So in this case, the company isn’t marketing
    the branded drug, but doctors still want to use the chemical.

    This makes it hard to argue that it’s Pharma that is pushing the
    “overprescription” of Wellbutrin (in contrast to Prozac, which
    has fallen.)

    Meanwhile, Risperdal is up— but it’s generic now. So why


    up? Because many insurance plans ask for it first. Same with
    Celexa, which is the “generic” of Lexapro (I know, I know).
    Add the two together, not much change.

    But what is evident here are three trends:

    SSRI/SNRIs are on the way out, except for Cymbalta.


    antipsychotics are up, probably taking over for
    antidepressants
    antiepileptics appear to have been a terrible, embarrassing
    fad.
    either more people are on medications than in the past, or
    the same number of people are getting more medications.

    III.

    In 2008, drugs sales rose only 1.8%. in 2009, by 5%. Those


    are both low. Very low.

    Yet:

    number of generics exploded to 75% of prescriptions in


    2009, up from 57% in 2004
    number of branded drugs fell by 8%
    total drug sales climbed to $300B (more spending on
    drugs).
    But generics only accounted for $75B.

    In other words, even though we are using way more generics,


    we are either: using more medications than ever before (as
    above); or the few branded ones we are using are even more
    expensive than ever.
    That turns out to be the case: specialty drugs (e.g. Avastin) for
    chronic illnesses jumped to 21% of the sales.

    If you couple post-Obama American medicine’s (and I’m not


    blaming him) focus on preventative medicine and long term
    maintenance— where Big Clinics and Big Insurance will be
    the winners; with Big Pharma’s move away from expensive
    acute treatments to really expensive long term treatments, you
    almost have to wonder if that’s more than a coincidence?

    III.

    Here’s the punchline: there’s a little over $100B in waste (pdf)


    due to outright noncompliance, according to Express Scripts.
    This number is undoubtedly high, because it is based on
    monthly refills— for example, if it takes you 40 days to use up
    a 30 tablet supply, then you’ll use only 9 scripts a year. Based
    on this, they estimate a compliance with antidepressants of
    83% (i.e. 10 scripts a year). However, psychiatrists (unlike
    most other specialties) ask you to come back every month or
    two months at which point you’ll get a new script- regardless
    of how many you actually have left. No one says to their
    psychiatrist, “you know, I still have a lot of Cymbalta left over
    from the last script.” So the actual noncompliance is likely
    much higher.

    In other words, while prescriptions may cost a lot, the real


    budget killer is waste, thrown in garbage cans or flushed down
    toilets.

    IV.

    And I’ll say what no one dares say: how many times does a
    patient agree to “take” Zyprexa and Effexor just to get the
    Klonopin? Or Lipitor and glucophage, just to get Percocet?
    True story: there’s a pharmacy I walk by on the way to the
    sketchy city movie theatre, and every time I pass it I see guys
    tossing full pill bottles into the outside trash can.

    V.
    The solution: have Pharma pay for the first 30 days of any
    treatment (e.g. vouchers.) Only after a patient has been on it
    for at least a month should the insurance cover the rest; this
    cuts out the wasted one or two or three first attempts at
    medications (“I didn’t like the Cymbalta, so I stopped it.”)

    Copays, hated by all, are a necessity: free medications are not


    valued by patients/humans; nor should the copay be subsidized
    by medicaid or other plans. Five dollars is enough.

    And, finally, the most hated of all (choose a or b):

    a) all prescriptions should require a prior authorization by the


    doctor, and a supplemental one every six months. The easier it
    is for docs to prescribe, the more they will prescribe. Now
    you’ll think twice before you add on the Buspar.

    b) you make all medications full access, and priced however


    Pharma wants, but you give each doctor a pharmacy budget,
    e.g. $20/patient per month.

    Another reality no one wants to hear: doctors will have to


    accept managed care at the treatment level (e.g. formularies)
    or they will have to accept managed care at their
    reimbursement level. Or both.

    http://twitter.com/thelastpsych
    Love Means Not Letting The
    Other Person Be Himself
    June 7, 2010

    The anvil is the better choice: D6 to XO4


    You get married in your twenties, but 20 years and three great
    kids later, not to mention the idyllic farm in Big Sky country,
    you seem to have made it. The rest is coasting.

    From the NYT:

    Sure, you have your marital issues, but on the whole you
    feel so self-satisfied about how things have worked out
    that you would never, in your wildest nightmares, think
    you would hear these words from your husband one fine
    summer day: “I don’t love you anymore. I’m not sure I
    ever did. I’m moving out. The kids will understand.”

    Wouldn’t be the first middle aged man who suddenly realized


    he belonged not with his family but in a pre-furnished uptown
    apartment living on take-out. They say that the older kids get
    over it, but that sounds like something a psychiatrist would
    say, i.e. completely made up.
    Her parry:

    His words came at me like a speeding fist, like a sucker


    punch, yet somehow in that moment I was able to duck.
    And once I recovered and composed myself, I managed
    to say, “I don’t buy it.” Because I didn’t.

    She figured that this was a mid-life crisis; not another woman,
    or a failing on her part, but the discovery that his “personal
    trajectory is no longer arcing reliably upward as it once did.”
    So, she treated it like “a child’s temper tantrum”: she ignored
    it. For four months.

    Not ignored him: she included him in all family activities,


    talked to him, set a place for him. But she refused to engage in
    discussions about separation.

    So he turned mean. “I don’t like what you’ve become.”


    Gut-wrenching pause. How could he say such a thing?
    That’s when I really wanted to fight. To rage. To cry. But
    I didn’t.
    Instead, a shroud of calm enveloped me, and I repeated
    those words: “I don’t buy it.”

    He was… surprised. He tried different ways to get through to


    her, but she kept “not buying it.”

    “Go trekking in Nepal. Build a yurt in the back meadow.


    Turn the garage studio into a man-cave. Get that drum set
    you’ve always wanted. Anything but hurting the children
    and me with a reckless move like the one you’re talking
    about… What can we do to give you the distance you
    need, without hurting the family?”

    II.
    My first reaction was: this woman is insane. e.g.:

    (To her husband) It’s not age-appropriate to expect


    children to be concerned with their parents’ happiness.
    Not unless you want to create co-dependents who’ll
    spend their lives in bad relationships and therapy. There
    are times in every relationship when the parties involved
    need a break. What can we do to give you the distance
    you need, without hurting the family?

    I don’t know what that means, but I’m pretty sure I don’t like
    it.

    And this clear example of needing to go on/off pills:

    You see, I’d recently committed to a non-negotiable


    understanding with myself. I’d committed to “The End of
    Suffering.” I’d finally managed to exile the voices in my
    head that told me my personal happiness was only as
    good as my outward success, rooted in things that were
    often outside my control.

    What put me off was her unwillingness to see him on his


    terms. Identity may be arbitrary and malleable, but the one
    with the body has a bigger claim to it, right? She wanted him a
    certain way, he didn’t want to be that way, and she didn’t care.
    She wanted to be the one who chose his identity.

    Also, she was a writer which made me suspect the whole


    thing. Why does this stuff always happen to writers and not
    longshoremen?

    III.

    But as I mulled it over for two months, I had to defer, this


    woman had it right. She didn’t overthink it. The obvious thing
    to do would be to take it personally (“he’s not in love with me
    because I’m old and fat”); the easy thing to do would be to use
    it to air out old angers with him (“you always took your
    mother’s side!”); and the tempting thing to do would be to do
    therapy on him (“don’t you think you feel this way because
    you’re old and fat?”)

    But instead she let it evolve naturally. She got out of the way
    and let him do exactly what it was he wanted to do, which
    was, specifically, choose his own identity. What she hoped, of
    course, was that he’d choose the one he already had for the
    past twenty years. But it was a gamble, because he could have
    chosen to become a middle aged man who prowls airport bars
    looking for stewardesses. (I’ll preempt your joke: when I did it
    I was a very young.)

    The analogy is to adolescence, where the more you badger


    them about their ____, the more they’re going to believe they
    really want ____; because they aren’t identifying with ____,
    they are identifying with not-you. That’s what teens do, that’s
    what anyone who feels their identity is being decided by
    others.

    He, representative of too many men, wanted not to be


    something new, he just didn’t want to be anything decided by
    someone else, even if he actually likes that thing. I came to
    understand this when I reread his quote, with the additional
    last sentence:

    …you would never, in your wildest nightmares, think you


    would hear these words from your husband one fine
    summer day: “I don’t love you anymore. I’m not sure I
    ever did. I’m moving out. The kids will understand.
    They’ll want me to be happy.

    Why would this nut think that they would want him to be
    happy? On some level they might, but why would they choose
    his happiness over theirs, or their mom’s? “They’ll want me to
    be happy” are the words of someone who has no idea what he
    wants, and so picks the meaningless word “happy.”
    IV.

    I had to concede that she does know him better than he knows
    himself, after twenty years; not because she has seen into his
    soul but because she hasn’t: she’s seen what he’s done,
    repeatedly, for twenty years. That’s who he is, regardless of
    who he says he is.

    Not great example, but: he says “I love japanese culture, I love


    japanese food” but she knows to find him at the burger joint
    and not the sushi place. Who he is is “a guy who just says he
    likes sushi, but does like burgers.”

    Also, hopefully, she has a sense of what are his values—


    again, not what he says they are, but what he does. So she
    might find it legitimately out of character that he wants to
    move out since, for example, he could tolerate her infidelity
    just to stay near his kids.

    So if we grant her a particularly unique perspective on her


    husband, then she may be in a position to know what’s a phase
    and what’s not.

    And hence what she did- potentially humiliating and even


    futile— was the right gambit.

    V.

    Here’s the depressing part: if she had let him go, via arguing or
    clinging or whatever— then he probably would not ever regret
    his decision to leave. Living at the Residence Inn, he would
    sincerely think he had made the right choice, that he had to
    move on.

    But he wouldn’t be any happier. Different life, sure, but not


    better. This is what Laura intuited. He may as well have
    moved from Cleveland to Indianapolis and swapped Lacoste
    for Polo. “Wow, this is so much better.” Meanwhile, he’s left
    behind a perfectly good life.
    Everyone will tell me their situation is different and it may be,
    so I’ll say it like this: if outside, impartial people who know
    you both perceive it to be a mid-life crisis and not a
    fundamental problem in the relationship, then bank on it. The
    problem isn’t the relationship, the problem is you.
    VI.
    One thing I almost forgot: Laura’s husband is a dying breed.
    The trend now— generation <40— is for the woman to have
    the mid-life crisis. Before you jump on men, it’s a combination
    of factors.
    On the male side, the drive for novelty and nueva vida loca is
    turned inwards, so that rather than chase new experiences they
    close off from the outside world and dream them. They don’t
    end relationships, they stay caulked to the inside of one,
    unmoving, ungrowing, apathetic; while their minds and DVRs
    are an imaginarium. The few things they do choose to jump
    recklesslsy into are obvious go-nowheres: one night stands
    (for the married man); making a movie; daytrading. They’re
    easy to attempt, and easy to blame on externalities when they
    inevitably fail.
    They don’t break up with the girl, they ignore her until she
    breaks up with them.
    On the female side: well, reverse 50 years of history and it’s
    what men went through. Promised the world as described by
    Coca Cola and whatever TV show was popular at the time. All
    opportunities are open to anyone who wants to work, a new
    car, a big house, a career. But no one told the men that those
    things were for their families, not for them, that none of this
    would make them happy, and, indeed, would make them
    realize how little their lives are really worth— unless they
    understood that their lives had value only if it was of value to
    someone else. So for a while they chased sex, affairs, or took
    up an out of the house hobby (e.g.golf). Something to give
    them the temporary illusion that they were free, and that the
    world had possibilties, not pot roast and pot bellies.
    That’s where women are, encouraged like the men had been by
    media images that say, “of course you can! (if you have the
    right bag).” You can’t. It didn’t make men happy, and it sure
    won’t make you happy. If you think it looks stupid when a 40
    year old man buys a convertible or has to go find himself or
    chases a 20 year old intern, think how stupid it looks when the
    woman does it.
    Women since 1980 have been sold a big fat lie, the same one
    the men were sold since 1945. It didn’t turn out well for them.
    It did make men drink more, so you can look forward to that.

    –—

    http://twitter.com/thelastpsych
    There Is No Link Between
    ADHD And
    Organophosphate Pesticides
    June 10, 2010

    come on you guys: what do the authors want to be true?

    Pediatrics has a now famous study in which it was found that


    kids exposed to certain pesticides had significantly increased
    risk for ADHD.

    There is universal praise for this piece of garbage, bow to the


    only true god: Evidence!

    Michael L. Goldstein, MD, who was not involved in the


    study, said the study results are “very interesting findings
    from a very well-done study from a good database.” The
    report, he said, “certainly got my attention when I read it; I
    was really impressed by it. I think it is a groundbreaking
    study…”

    There are no dissenters, the worst that is said is “well,


    correlation isn’t causation.”
    Sorry, there is one dissenter— a pesticide rep:

    Garry Hamlin of Dow AgroSciences, which manufactures


    an organophosphate known as chlorpyrifos, said he had
    not had time to read the report closely. But, he added, “the
    results reported in the paper don’t establish any association
    specific to our product chlorpyrifos.”

    Ha! And the fact that he objects must mean it’s true. (Never
    mind chlorpyrifos was specifically not associated with an
    increased risk in this study.)

    But the problem isn’t the data— in psychiatry, the problem is


    almost never the data.

    The study purports to show some relationship between


    pesticides and ADHD. But this is silly; a priori, pesticides at
    high enough doses disrupt cognitive function. Duh? So what’s
    the point of the study? Have they found that kids are getting
    exposed to much higher levels to pesticides than we ever
    thought? Or that the pesticides are even more toxic than
    previously known? No. So?

    The purpose isn’t to show that pesticides can cause ADHD; the
    purpose is to solidify in your mind that ADHD is real.
    While you’re busy teasing apart statistical or methodological
    issues, such as whether a single static urine sample is sufficient
    to infer pesticide exposure in general, or the lack of control for
    diet, or how did they calculate the odds ratio? you are not
    questioning whether ADHD is a real disorder, and that what
    they say it is here is what others say it is elsewhere.

    But it’s a trick. You cannot use a correlation between two


    variables to prove the validity of one of the variables.

    You cannot use a statistical correlation between pesticides and


    ADHD to reinforce the validity of ADHD, but that is what they
    did. And everyone fell for it.

    II.

    Note that the rate of ADHD in this study (12%) is double the
    national average. You don’t have to agree with me on this, but:
    that national average is likely inflated, i.e. kids were diagnosed
    ADHD that should have been bipolar, or anxious, or normal. So
    whatever happened in this diagnostic sniper attack (telephone
    interviews of parents, and did not exclude symptoms that
    could/did occur in another disorder) is suspect.

    Regardless, it is indisputable that under the best circumstances


    — a two hour interview with PET scan and genetic testing—
    the diagnosis “ADHD” is not biologically homogeneous.
    Whatever Billy has, even if it appears identical to what Jamal
    has, may be biochemically completely distinct. Early HIV and
    the flu both appear identical in the beginning, but I’m not
    having sex with either.

    This doesn’t mean that “it doesn’t exist”— the behaviors are
    real. Nor does it mean the same medicine (e.g. Adderall) can’t
    help it/them.

    So now to the study, which finds a correlation between


    pesticides and an increased risk for a report of a cluster of
    behaviors. No argument from me at all. But the rigorous
    explanation of this study is that pesticides increase the risk for
    these behaviors, not “ADHD.”

    III.

    If I’ve lost you, think of it like this: if this study found not just
    correlation but causation— if the study proved that pesticides
    actually caused all of the symptoms that are detected by the
    ADHD inventory, then that isn’t ADHD, any more than
    psychosis caused by cocaine is the same as schizophrenia. This
    would be pesticide poisoning. And if you’re treating it with
    Adderall, you’re an idiot.

    IV.

    Stated explicitly: the purpose of these studies is not to establish


    a link between variables, but to gain popular support from the
    public for one of the variables so that it becomes insanity to ask
    whether it’s real.

    Here’s an example. If the study determined a link between


    pesticide exposure and IQ, you’d say, “oh, I guess that makes
    sense that pesticides would lower intelligence.” If you do
    enough of these studies, say, 10,000 of them, you wouldn’t have
    learned anything more about pesticides and intelligence—
    because what else would there be to say? but you would have
    drowned in the passive assertions that IQ measures intelligence.
    So it would become insane to question whether IQ is a good
    measure of intelligence (“oh come on, you’re not asking
    rigorous questions, we’ve been doing it this way for decades”).
    At best— another trick— the debate may turn towards whether
    the Wechsler test is a valid measure of IQ.

    Maybe it is, maybe it isn’t; but there are other kinds of studies
    that would tell us that. You can’t use these correlation studies to
    reinforce the validity of IQ. But that’s what would
    happen,10,000 garbage studies later. “Oh, yeah, IQ. Everyone
    knows about that.”

    V.

    “You’re just silly. You haven’t discussed construct validity…”


    If you had this thought, then you’re the problem. I have
    discussed construct validity, without saying the words
    “construct validity,” because the words distract from the
    discussion. Same with “statistical significance.” But that’s the
    move, drown the public in jargon and they’ll cling tightly to
    whatever they do understand, which in this case is the title:
    “Pesticides linked to ADHD.”

    Every second you spend talking about construct validity is a


    second you aren’t talking about the fact that the kid in front of
    you has something far more serious than ADHD.

    If you are a talking to a scientician and they say “construct


    validity” or sling around a chi-squared, grab their tie and slam
    their face into the desk, and then run, run, run, you are being
    lied to.

    VI.

    “Why didn’t you publish this post earlier, when the story first
    came out????”

    You mean because the further away we get from the hot news
    cycle, the less you’re interested in the truth? And so apathy
    allows it to stand as true, because it all seems plausible (face
    validity, bitches.) That’s social science for you.

    But the answer to your question is simple: I don’t get paid to


    criticize studies. I have a job and a life and an alcohol problem
    that doesn’t leave much room for blog posts.

    If you don’t like something going on in politics, there are ways


    to voice that. But looking deep into a “scientific” concept
    requires a level of sophistication which, if you possess it, means
    you’re probably busy with a day job. So you have neither the
    time nor energy to dissect articles in Pediatrics— and, anyway,
    no forum. I, at least have a semi-popular blog; but even so I’m
    subject to the same time and monetary constraints. If I need
    money for rum, do I spend an extra hour at work, or write a
    post?
    Had it not been for the little money I do get from this blog,
    maybe I would not have written this post at all, because… why
    bother? And so all you are left with is their dogma. Search the
    internet, the Letters To The Editor. Anyone else saying what I
    just said in this post? You may not agree with my post, but you
    are nevertheless better for having read and considered it.

    I’m not saying I’m the only one who thought it; I’m saying that
    those who thought it, or could have thought it, are busy with
    other things, and the people who should have thought of it
    physically can’t.

    What do you think would happen if the NIMH paid


    astrophysicists to look into psychiatry? Ain’t never gonna find
    out, they have their own problems. Specialization doesn’t mean
    I’m the best, it means stay off my lawn.

    Since I/us/astrophysicists don’t have the resources to publish at


    all/as fast as Pediatrics or CNN, they get to decide what’s true.

    The people who get paid to look at ADHD are all unanimously
    on the same side, that’s what conveys the illusion of objectivity.
    Pretending to be divided pro- or anti-Pharma, or “dopamine
    hypothesis” vs. “noradrenergic hypothesis” makes it look like
    there’s a lot of vigorous debate, but debating what color is a ki-
    ran just means ki-rans are real.

    Please don’t misunderstand me, I am not blogging for money.


    I’m showing you that so much of what you think you know,
    what you think is fact, is established not by the force of
    evidence but by the absence of resources for the opposition.
    The ones with the money are all unanimously in agreement.

    So yes, I would have liked to have posted day one; but I would
    have liked it better if someone else on the inside said, “umm,
    wait a minute? Really? We’re going to CNN with this?”

    ––-
    http://twitter.com/thelastpsych
    –

    More on pesticides here.

    Note: I added another section to the earlier Love Means Not


    Letting The Other Person Be Himself.
    Pesticides And Fruit
    June 15, 2010

    everything tastes better with Coke

    I.

    This is how it works.

    They write a study about a link between pesticides and


    ADHD. I observe that the link isn’t the point; the point is to
    provide another half inch to the stack of “studies about
    ADHD” so you never question the diagnosis itself.

    But there’s an unfortunate result of that debate: because I’ve


    gone “the extra step”— gone meta, if you prefer— you don’t
    think there are any other steps to go.

    So you don’t think about the pesticides. Because the focus is


    now on ADHD— whether the link is real, or whether it’s a
    different syndrome— you are lulled into false security if your
    kid doesn’t have ADHD. “Phew, I guess the pesticides don’t
    affect him.”

    II.

    In the comments someone had asked: What about a gene that


    mediates a link between organophosphates and ADHD? A
    gene that makes you more sensitive to pesticides? That would
    explain the heritability of ADHD too, wouldn’t it?

    The NTE gene exists in two copies. If you’re lacking both


    copies of the NTE gene, you’re dead. If you lack one copy,
    you get a 40% reduction in the NTE enzyme (made by the
    gene). According to this study, deficiencies of this enzyme
    make mice more sensitive to organophosphates— it makes
    them hyper and distractible.

    But it matters what you call things. If this were true, then it is
    only saying that some people (who have deficiency of the
    enzyme) are more sensitive to organophosphate toxicity. You
    could even go so far as to say that those symptoms look
    exactly like ADHD— but they’re not ADHD, they are still
    pesticide poisoning. You would actually have to go back and
    say that some kids were misdiagnosed as having ADHD, but
    they really had pesticide poisoning.

    As a techincal issue, lacking this gene/enzyme wouldn’t cause


    an increase in pesticide metabolites in the urine, i.e. lacking
    the gene wouldn’t cause a greater exposure to pesticides,
    which is what the Pediatrics study detected.

    III.

    What should we do? Wash our fruits?

    This is a meta-analysis of studies of various produce


    preparation techniques on levels of pesticides. The R* is the
    percentage of pesticide left on the fruit, e.g. frying removed
    90% of the residue.
    Baking made the concentration of pesticides go up because of
    water loss; but much of the pesticides themselves could also
    have been burned off. So feel free to bake.

    Peeling is the best method. The skins of many fruits contain


    high concentrations of nutrients, but they’re simply not worth
    pesticide exposure.

    Washing does not help. Even though it looks like washing


    helps, most people don’t wash their genitals as well as they
    washed these fruits: soaking in a bucket of water for 5-20min;
    using acetic acid or ethanol washes; multiple washes with a lot
    of water; combinations of all of those. And that still didn’t do
    much. If thunderstorms don’t wash away pesticides, why
    would five seconds under the tap? (one, two, three, four, five.)

    IV.

    The study followed 23 kids over a year, letting them live their
    crazy lives. But for two non-consecutive weeks, they
    substituted organic produce:
    There are a million other pesticide studies I could have used to
    show the difference between organic and ordinary produce,
    but I chose this one to make a different point: you have been
    lied to so many times, now you are being lied to by yourself.

    There is a nearly 100% likelihood that you are looking at this


    chart the wrong way. You are probably saying, “hmm, I
    wonder what it was on days 95-100 that reduced their
    pesticide exposure?” What you should be asking— and it is
    not the same thing at all— is “hmm, I wonder what was going
    on in days 1-5, 9-93, 180-278 that exposed these kids to such
    high levels of pesticides?” Normal is NO pesticides. But
    you’ve allowed “common” to be replaced with “acceptable.”

    So let’s look at the results here:

    1. on the days they got organics, they had minimal exposure to


    pesticides— this means that everything else in their life
    (outside, inside) did not really contribute to their exposure, it
    was almost all due to produce.

    2. better illustrated by a reworking of the above graph:


    there was a seasonal effect— Winter and Spring had higher
    OP exposure than fall (and summer.) What’s different in the
    winter and spring? We don’t have American produce to eat,
    what with their EPA controlled pesticide levels. The
    supermarkets stock the South American produce where,
    apparently, they have super bugs that can only be killed by
    plutonium mist.

    V.

    There is no easy way to present this data, but trust me: it’s
    worth it.

    This study looked at pesticide concentrations in fruit based


    soft drinks, e.g. made by Coca Cola, across the world. The
    same product, in different countries, has different pesticide
    levels. Here’s one:
    Likelihood Of Winning The World Cup

    O= Orange drink, L= lemon drink.

    1. Depending on which country you’re in, you get more or less


    pesticide. Take that, you Limey bastards.

    2. U.S. not shown? Because there are no fruit juices in our


    fruit juice soft drinks: all artificial flavoring. Yay chemicals!

    3. This is only one pesticide. Toxicity to multiple pesticides is


    not just additive, but synergistic.

    4. The max EU standard is 0.1 ppb. That’s zero point one.


    Take that you Fanta drinking scurvy preventing Limey
    bastards. Should’ve stuck to rum.

    Vb.

    Thus, we can make a graph:

    This Is Where You Don’t Want To Live


    See those small purple bars? They represent the EU max,
    0.5ug/L. NB: again, U.S. is low not because we care, but
    because we don’t care.

    How do you get that much pesticide into a drink with only 5%
    juice? See II and III above: they get their lemons and oranges
    from countries with lax pesticide standards, and they don’t peel
    them.

    Vc. How can they get away with that? Answer: using words!

    The EU max standards, above, are for drinking water. The max
    standards for fruit are much, much higher, which means this is
    ok by fruit standards.

    You may not think that a 5% fruit soda by Coca Cola is a fruit,
    but it is.
    someone tell me how to peel this bitch

    Vd.

    I looked for Coca Cola fruit sodas that were tested in the U.S.,
    and found 3— each had 3% fruit juice. None of them had any
    detected farm pesticides— likely due to the use of American
    lemons and oranges (thanks, farm subsidies.)

    However, they did all have 0.4, 0.5, and 0.7 ug/L of
    carbendazim, a post-harvest antifungal. Which, as near as I
    can tell, is banned.

    I think it’s excitingly excellent that though these drinks contain


    almost no actual fruit, they contain plenty of the pesticides of
    actual fruit.

    http://twitter.com/thelastpsych

    another possible explanation for the rise of “ADHD”

    more on pesticides and food


    –
    A Diagnosis Of
    Schizophrenia
    June 17, 2010

    should be accurate to 10 dolichoi

    When I read psychiatric articles, I wonder if the authors think


    that because the stars in the sky are small, a microscope would
    be the best tool.

    Nassir Ghaemi and Frederick Goodwin make the case that


    diagnostic divisions (between bipolar, schizoaffective, and
    schizophrenia, in this case) are still very important.

    They write,

    [The] overly broad use of the term schizoaffective was


    illustrated in a patient referred to one of us as
    schizoaffective. However, his manic and depressive
    episodes, both of which included periods of florid
    psychosis, responded prohylactically to a combination of
    lithium and valproate… When the lithium dose fell below
    75 mg/day, psychotic symptoms recurred; when lithium
    was reestablished at only 75 mg, the psychotic symptoms
    disappeared. Clearly, this patient is not schizoaffective
    but rather has severe psychotic symptoms integral to
    bipolar illness.

    Slow down.

    II.

    A 22 year old Omani male with no prior psych history, but


    with a family history of psychosis, presents with change in
    personality. He says that he hears “spirits” that tell him other
    people because they have done bad things. He says his food
    has been poisoned by spirits. His father has been possessed by
    the devil. He is not interested in doing anything, and does not
    want to do anything but sit in his room.

    However,

    within traditional Omani society, abrupt personality


    changes or altered states of consciousness are commonly
    attributed to spirit possession. The belief in possession is
    embedded in social- cultural teaching, in which invisible
    spirits are deemed to inhabit the earth and influence
    humans by appearing in the form of an anthropomorphic
    being.

    Father confirms this is part of their belief system.

    He is given Lamictal 100/d and Risperdal 2/d, and is cured.

    III.

    If you’re confident he doesn’t have a demon, applaud yourself


    for your advanced scientific insights.

    One of the main tenets of a biologically based system of


    psychiatry is that an Omani man with schizophrenia may have
    different cultural manifestations of the disease, but it’s
    schizophrenia nonetheless. This looks like schizophrenia, not
    bipolar disorder. The Lamictal was probably useless.

    However, the neurologists found that even though he had no


    seizure activity on EEG, on SPECT scan he had low perfusion
    in the left temporal lobe while psychotic, and an improvement
    in perfusion when he recovered.

    From a biomedical perspective, the condition of the


    current patient would suggest symptoms of chronic
    schizophrenia, a diagnosis that is supported by a family
    history of psychosis. In the parlance of modern
    psychiatry, the patient met criteria for schizophrenia and
    responded to risperidone, a known treatment for
    psychosis. [However] the possibility remains that
    lamotrigine may have ameliorated the patient’s psychotic
    symptoms by controlling ‘non-convulsive seizures’.

    If you think he was merely misdiagnosed, you have missed the


    point. There is nothing short of a SPECT scan that would have
    made this diagnosis. Prior to these tests, he had schizophrenia
    — not appeared, but had it— formally, according to
    phenomenology, course of symptoms, family history, and
    degree of impairment.

    No amount of evidenced based medicine will protect you from


    this. A thorough SCID, family history, and full panel of labs
    would diagnose him with schizophrenia. Under that diagnosis
    — which he reliably has (several people using the same
    diagnostic techniques diagnose him the same) there would be
    no “evidence” for the use of Lamictal.

    Worse, under Ghaemi’s plan, improvement on Lamictal would


    be suggestive of bipolar disorder. Which he didn’t have at all,
    i.e. not based on either biology or phenomenology.
    III.

    An example. You don’t need to know anything about the


    internal anatomy or biochemistry of a rhinoceros to know one
    when he gouges you in the face. Purely on phenomenology
    alone, you get it right 100% of the time. This is important:
    100% of the time. It could be bigger, smaller, whiter, blacker—
    none of this will confuse you. Ever. In the same way, there’s
    no theoretical reason we would need to know the biology of
    schizophrenia to diagnose it accurately.

    However, the simple reason we get the rhino right is because


    we’ve all seen a picture of a real rhino. No one tries to identify
    a rhino based on compiling a list of shared characteristics of
    rhino-ness. We do it with a split second comparison to an
    already agreed upon sign.

    i don’t like it when people try to impose labels on me

    Even the word “rhinoceros” is a sign. You don’t phonics out


    the letters “r-h-i-n-o-c-e-r-o-s” in order to know what it says.
    The word is actually an image.

    Schizophrenia isn’t like that at all. There’s no “ideal”


    schizophrenic to match it to. Even when you think you’re sure,
    it could turn out to be… non-convulsive seizures. Or bipolar.
    Importantly, this isn’t a case of “schizophrenia is wrong; he
    actually has non-convulsive seizures.” By the most rigid
    definitions, he has both disorders, in the same way a kid with
    pesticide toxicity also has ADHD. Which, of course, is
    nonsense.
    So how would you know? You wouldn’t, so what Ghaemi
    proposes is to take medication response as informative. That’s
    even less reliable.

    If a depressed guy responded to Seroquel in 1999, did he thus


    have bipolar? The answer is thus yes, but of course not.

    IV.

    You think you can explain why bipolar disorder isn’t


    schizophrenia?

    To show how hard this really is, try it with animals: explain
    why a unicorn is not a rhinoceros.

    Your immediate reflex will be to call up some other agreed


    upon sign, and compare it to that: “A unicorn is like a
    horse…”

    Ok, horse— but is it a type of horse? Is it more of a horse than


    a rhino? If it is— if unicornness is closer to horseness than
    rhinoness, then why did Marco Polo think a rhino was a
    unicorn but the horse he rode on wasn’t?

    What’s a triceratops, then?

    These difficulties exist with animals that everyone knows on


    sight. Now, imagine trying to identify an animal without some
    common ideal type, just based on the reaction of the animal to
    something.

    V.

    We do that already, and we do it badly. If I tell you “scaly cold


    blooded quadruped climbing a tree” you’ll at best say, “umm,
    it’s a lizard.” But if I tell you that the animal in question
    changes colors— boom, “it’s a chameleon!”

    And now you are able to make numerous predictions about it,
    without ever seeing it: (e.g. changes color for camouflage.)
    But it could be a gecko, right? So at what level of taxonomy
    did you make the error?

    Kingdom: Animal
    Phylum: Chordata (vertebrate)
    Class: Reptilia
    Order: Squamata (lizards, snakes, worm-lizards; not
    crocodiles (crocodilia) or turtles (testudines)
    Family: ?

    Forget species, forget genus. You’re stumped at the family


    level. That’s how wrong you are. Gekkonidae vs.
    Chamaeleonidae. In order to do better than this, without
    resorting to an ideal image of the animal, you need not just
    more information, but exponentially more information.

    That’s reflected in their common names: “gecko” and


    “chameleon” are derivations of the family name. This is for
    animals which exist, that everyone “knows when you see it.”

    Psychiatric diagnoses suffer from the same exponential


    information function. When you call someone a schizophrenic,
    all you’re sure about is that he’s either a snake or some kind of
    lizard, but not a crocodile.
    don’t lump me in with these freaks

    VI.

    It seems like lunacy for someone to criticize evidence


    collection as a basis for an empirical science, but here we go.

    If you gave Aristotle ten thousand unplugged computers of


    different makes and models, no matter how systematically he
    analyzed them he’d not only be wrong, he’d be misleadingly
    wrong. He would find that they were related by shape—
    rectangles/squares; by color— black, white, or tan.
    Size/weight; material.

    Aristotle was smart, but there is nothing he could ever learn


    about computers from his investigations. His science is all
    wrong for what he was doing. But Aristotle would think he
    knew a terrible amount about computers from his studies. In
    fact, he’d probably be considered an expert. “To fix this
    computer, we need to make it more rectangular. Get chopping,
    malaka.”

    That’s where we are now. But modern science is so


    “advanced,” surely it can come closer to the truth? No. But
    surely the amount of data we have on psychiatric diseases
    must amount to something? No.

    The last time they did this kind of taxonomy, they built a
    brontosaurus and told us it was real.

    And they, at least, had real bones to work with.

    VII.

    I understand the temptation to refine a paradigm that’s worked


    ok so far.

    And I understand that there’s a feeling that we’re on the right


    track. “No matter what you say, I know a schizophrenic when I
    see one.”

    I know you do, that’s not my argument. My argument is that


    what you think you know is lessening your knowledge, not
    increasing it. When you say he has schizophrenia, you may
    know what you mean by that, but I don’t know if it isn’t a
    seizure.

    You have it backwards. You think saying “schizophrenia” is


    some kind of detection, a whittling down of possibilities,
    informative. Similarly: “I’ve screened him for ADHD, I think
    he has it.” But those diagnoses don’t exclude any other
    possibilities at all. Do they mean he doesn’t have a seizure,
    depression, pesticide poisoning? Your ghost term doesn’t
    exclude any real things.

    You think you’re telling me “he has a cluster of symptoms and


    behaviors that generally resemble X.” But every time we make
    a diagnosis, the world pauses: oh, so that’s what’s wrong with
    him.

    How long would the Omani man have had “treatment resistant
    schizophrenia” without an uncalled for Lamictal prescription
    or a waste of money SPECT scan? Forever. “We just need to
    improve our diagnostic skills, tests.” You’re not listening: the
    diagnosis of schizophrenia was the specific reason he wasn’t
    given a SPECT scan.

    “We need to improve the accuracy of the diagnosis.” No. The


    diagnosis isn’t going to get more precise the more we know;
    the diagnosis is going to disappear, replaced by thirty other
    more specific diagnoses.

    Sure, in the meantime I’m happy to go with “schizophrenia”


    and chuck dopamine blockers at everyone, because that’s the
    best we can do today. But why the pretense that we need to
    refine the diagnosis, or the whole DSM, when we don’t have
    the tools to do it? Shifting around consonants and vowels,
    substituting one fairy tale for another doesn’t make it more
    accurate. Schizophrenia vs. bipolar isn’t a distinction, it’s a
    distraction. “I don’t think he has a demon, I think he has too
    much black bile.” Then it’s settled. Send the priest home and
    bring out the leeches.

    http://twitter.com/thelastpsych
    Which Is Healthier: A
    Dunkin Donuts Bagel,
    Muffin, or Donut?
    June 21, 2010

    too bad the prices aren’t also variable

    Bagels:

    Dunkin Donuts has a “DDSmart” menu, which means it’s


    healthier. That should be obvious.
    Except that there is nothing about the multigraining which
    makes it healthier. It has more calories and more fat (due to the
    oil they need to add to make it soft). They say “reduced fat
    cream cheese” only adds 100 cal and half the fat (8g) but that’s
    if the cheese is spread by a bee.

    Donuts:
    Three points:

    1. No worse than the bagels. More fat, less carbs… you


    decide.
    2. Anything labeled “cake” or “crumb” should be avoided
    like the clap. And if it claims to have a fruit in it, get
    tested for gonorrhea as well. The apple/blueberry crumb
    has 470 calories, none of which are delicious.
    3. Most of the other donuts (cruller, frosteds, jelly, pudding
    kremes (boston, bavarian, etc)— are all about 250
    calories.

    Munchkins:

    Munchkins all look like this:


    i.e. they are identical in proportions to their adult counterparts.
    So know thyself: which is more psychologically satisfying,
    one donut or 5 munchkins?

    Muffins:

    Muffins are the Matrix’s punishment for our arrogance,


    believing we can make birthday party cupcakes healthier
    simply by making them larger and renaming them.
    On the positive side, as of October 15, 2007, all DD products
    were trans fat free.

    Cookies:

    What I’m about to show you is not suitable for pregnant


    women or patients recovering from surgery.

    Here are the stats on the Triple Chocolate Chunk Cookie, as


    told by DD (orange and white) and an independent site called
    Calorie Count:

    If you add up the fat, carbs, and protein, the DD stats equal
    72g, and the Calorie Count stats add to 110g. The actual
    cookie I bought today weighs 140g. So is Dunkin Donuts
    telling me that the other half of the cookie is water and
    oxygen?

    So I’m going to bake this cookie until it becomes a cracker.


    Check back tomorrow for the results of the cookie analysis.
    —

    http://twitter.com/thelastpsych
    Are Certain Behaviors—
    And Jobs— More
    Masculine? And Out Of Our
    Control?
    June 22, 2010

    wouldn’t you know it, all the best derivatives traders are
    lesbians

    II.

    There are many reasons to think testosterone affects behavioral


    outcomes. Just on semantics, high testosterone would be
    expected to correlate to virility, aggression, and leads in action
    movies.

    But what is the effect of brief, intra-uterine testosterone? Do


    people who were exposed to higher testosterone in the womb
    become/behave different/ly?

    An example: fraternal twins. Does the girl’s stewing in the


    boy’s testosterone make her a better athlete, President or serial
    killer?

    In an attempt to answer that, there’s been considerable


    research on the effects of intrauterine testosterone on later life
    outcomes.

    I. (This is how you construct a lie: don’t answer the question


    that was asked, answer the question you want to answer.)

    III.

    An example, a somewhat famous study. Researchers examined


    a group of financial traders:

    (Introduction) We therefore formulated the hypothesis


    that higher prenatal testosterone exposure would improve
    a trader’s performance.

    (Discussion) The finding that a marker of prenatal


    testosterone levels predicts a trader’s long-term
    profitability…

    The success and longevity of traders exposed to high


    levels of prenatal androgens further suggests that
    financial markets may select for biological traits rather
    than rational expectations.

    And from Time:

    Earlier studies indicated that prenatal exposure to


    testosterone… increases a person’s sensitivity to the
    effects of the hormone much later in life. The greater the
    exposure as a fetus, in other words, the higher the levels
    of confidence, vigilance or risk appetite triggered by
    testosterone in an adult.

    It’s not hard to see why financial traders exposed to


    testosterone might be better at trading. And now you have to
    think about society: maybe there are real sex differences in
    performance in the workplace. It’s perfectly ok to select a
    lingerie model on the basis of femininity. Is it— should it—
    okay to pick options traders the other way? And how can we
    level the playing field for those with a slight biological
    disadvantage?

    A.

    First Principles: what do the authors want to be true?

    None of the studies linking biology to behavior are about


    either the biology or the behavior, they are only about the link.

    The question that they are answering isn’t “does environment


    matter more than genetics?” It’s a more subtle, sneaky, social-
    policy questionr: “since we now know that genetics isn’t as
    deterministic as we hoped, is there something else that we can
    focus on which is equally out of our control? What about the
    goings-on in utero? So that the environment factors matter
    only at that time, not later? Then we can safely say that
    behavior is “innate” and out of our control, while still leaving
    us the door to intervene in people’s lives for their benefit.”

    No one in the behavioral sciences discovers something, and


    then constructs policy recommendations. “We learned that
    people are like this, so…”

    It’s the other way around. The policies come first; the money
    is spent on the research that supports them.

    In questions about evolutionary psychology and behavior, the


    question they want to answer is always of the form, “how is it
    not the individual’s fault, but we can meddle anyway?”

    IV.

    Back to testosterone. In order to tell if trading is related to that


    brief in utero burst of testosterone, we need a proxy: the ratio
    of the index finger to the ring finger. Bigger ring finger (and
    smaller 2D:4D ratio) = more testosterone in utero.

    There are many such studies, of very different behaviors:


    aggression, lesbianism, athleticism, success, risk appetite—
    and they are all surprisingly robust, there really does appear to
    be some kind of link. And it helps that the behaviors all have
    an intuitive connection to “masculinization”— (which was the
    whole point of the testosterone.)

    And the associations are just as revealing when they’re absent.


    A recent study found no association to ADHD: “These
    findings challenge the hypothesis that fetal testosterone
    exposure plays a prominent role in the aetiology of ADHD.”
    So it must be something else…

    B.

    The problem isn’t the data, but the words.

    None— read it again, none— of the studies found any link


    between the behavior and fetal testosterone. All of them found
    the link between the behavior and finger lengths, which are
    proxies for fetal testosterone.

    But what if finger ratios aren’t actually proxies for


    testosterone?

    “Then those studies are crap. Another example of science


    overreaching. All that research money wasted.”

    Oh, no, Murdock, it’s much worse than that. The studies are
    valid, the data are solid— finger ratios do indeed correlate
    well to these behaviors— but all of the inferences you’ve
    invented about them are wrong.

    A recent article discovered that in birds, the correlation was


    between digit length and estrogen receptors. If that turned out
    to be true for humans, what are you going to do with all the
    stories about “masculine” traits? You can’t simply say, “oh, it
    doesn’t have to do with testosterone after all.” You must now
    explain why it does have to do with estrogen. Are these
    feminine behaviors? What?

    There are other studies which similarly find the


    testosterone/finger story to be suspect or even backwards.

    So the data aren’t wrong— they’re right; they’re just about


    something else. The social implications of the studies— the
    very point of doing the studies— are wrong. You can’t dismiss
    the studies because they’re still true— you have to go back
    and explain how you got it backwards.

    Anyone who had taken a moment to look at the whole


    hypothesis— masculine—> testosterone—> finger lengths—>
    behaviors would have said, “there are way too many loose
    connections to take this seriously.” But no one would have
    taken you seriously. “Science” is three dimensional: “look at
    the stack of studies that find a relationship between
    testosterone and behaviors!” No one questions the intervening
    proxy (digit span) because to do so is perceived to be
    unrigorous. When you say, “I don’t believe this testosterone
    link” they politely say, “look at the stack!” but if you say you
    don’t buy the digit length, they roll their eyes: another amateur
    who doesn’t understand how science is done. They do this
    because there’s no other argument to make. “This is how
    we’ve been doing it for decades, and it’s a quite satisfactory
    method.” Yeah. That’s what they said about missionary, too.

    Because there are so many researchers, and so many in the


    public willing to run with it, and so much time in between,
    there’s no one to point to as responsible. You can’t blame
    Cambridge University for the obviously preposterous notion
    that masculine traits make for better traders any more than you
    can blame the head of BP for the oil spill. Both situations are
    your fault. You wanted what they were offering, even though it
    was bad for you.

    Either we’re going to kill Iraqis, or we’re going to kill ducks.


    It’s the world’s one and only truth, the law of equivalent
    exchange. For every barrel of oil, you need to replace it with a
    barrel of blood.

    C.

    But they are to blame, because when they presented you with
    their products, they knew exactly what you were going to do
    with them.

    V.

    I’m telling you this not because I care about finger lengths, but
    because you are being corrupted.

    The article doesn’t even have to spell it out for you: they just
    have to write “there’s a relationship to testosterone ” and we’ll
    make the cultural/social value judgments ourselves. But they
    leave nothing to chance; thus Time Magazine.

    That’s not an unfortunate, unexpected by product of science—


    it is the very point of it. In order for you to obtain this
    knowledge, you have to lose some other knowledge of
    equivalent value.

    Once it’s happened, once you’ve allowed this into your brain,
    there is no escape, ever, any more than there is an escape from
    oil. No matter what else they discover, you will always have
    the suspicion that trading— and lesbianism and risk taking and
    hand eye coordination— are masculine traits.

    Until, of course, new guys come in with a new story to tell.


    “Thanks Dr. Kohut, we’ll take it from here.”

    VI.

    The science error of our generation is this: If A is strongly


    associated with B, and B is strongly associated with C, then A
    is strongly associated to C.

    That’s not just wrong, it is extremely wrong. If that seems


    counterintuitive to you, then you are the problem. Not in the
    way Robespierre was the problem, but in the way the French
    were the problem. “Sounds about right to me. And there’s a
    guillotining at 6:94!”

    It’s not your fault, you weren’t trained to understand this,


    indeed, you were trained specifically not to understand this.
    “Let’s look closely at the statistics” (not the words.)

    Science in the service of social policy is all about giving you


    everything you need to lie to yourself.

    D.

    I repeat: I have enough rum to get through what’s left of my


    life, but the rest of you should heed my warning: if you do not
    rein in your social scientists, your civilization is doomed.

    http://twitter.com/thelastpsych
    Another Diagnosis Of
    Schizophrenia, This Time
    With Cats
    June 25, 2010

    my boyfriend hates my cat but he loves my


    Part 1 here.

    The patient’s family asks, “what causes schizophrenia?” And


    you give them the speech: “there are probably many causes:
    genetics, some say an in utero infection, or in the old days they
    said it was the schizophrenogenic mother.” And then chuckle
    like you possess any knowledge that allows you such
    dismissive confidence. I’m not saying it’s true, I’m saying you
    have no idea if it’s true.

    The problem is that those aren’t all potential causes of


    schizophrenia, they are causes of different kinds of
    schizophrenia, none of which you are making any attempt to
    distinguish.

    II.
    Toxoplasmosis is an organism that lives part of it’s life
    relatively benignly in the intestine of a cat, gets pooped out,
    and then taken up by rats where it lodges in the brain, not
    benignly. That’s the cycle, back and forth. It also can be taken
    up by humans, especially little fetuses.

    Going from cat to rat is easy. But how is it supposed to get


    back to cat? Rats run away from cats, not towards them.
    Indeed, this is innate: even rats that have never seen a cat in
    hundreds of generations still freak out when confronted with
    cat odor.

    There’s been plenty of research observing that schizophrenics


    are more likely to have been exposed to toxoplasmosis in utero
    than normals. So what? So this.

    Researchers took 60 rats, and infected 30 with brain munching


    toxoplasmosis (verified at the end by autopsy) and the other 30
    with terrible, evil saline. And then they gave them a choice of
    scented cages to explore. The scents were either: their own,
    water, rabbit, or cat.

    Comparing infected to non-infected rats, there was only one


    difference in their preference for cage exploration:
    i.e. the infected rats are insane.

    Note that the toxoplasmosis didn’t make them more


    exploratory in general, only dispatched them to their likely
    doom. (No, it didn’t interfere with their sense of smell.)

    Taking the most active infected vs. non-infected mice, and


    watching them over multiple explorations, not only do they
    not avoid the cat cage, but they develop a preference for it
    over other cages:

    One might say that toxoplasmosis is a chronic, worsening


    condition characterized by poor judgment…

    The rats don’t simply defy danger; they specifically want to


    die by cat. Rats can also get killed by minks, but minks don’t
    hunt them. A similar study gave rats a choice of mink maze
    and cat maze, the infected rats chose cat— they chose their
    specific predator.
    It’s a truly odd coincidence that while the cat is the mortal
    enemy of the rat, the cat is the natural home of toxoplasmosis.
    One might even be tempted to say that somehow the
    toxoplasmosis willed the rat to go against its nature. “That’s
    dangerous talk around here, lefty, better mind your tongue.”
    Apologies.

    But the other way to look at it is

    Studies investigating the neurological basis of anxiety,


    which often use the reaction of potential prey to cat
    stimuli as a model, have found that blocking the normally
    anxiogenic N-methyl-D-aspartic acid receptors in the
    amygdala, and/or provision of serotonin (5-HT)
    antagonists, causes rats to approach cat odors “fearlessly,”
    in much the same way that T. gondii-infected rats do.

    So the rats become less anxious, more daring? Odd


    coincidence: the toxoplasmosis infection rate in 1974 was 22%
    for the Brits, 84% for the French. Maybe it makes humans
    chase pussy as well?

    Lafferty, in 2006, found rates of 45% in the French and 6.6%


    in the Brits. How have people changed since the 1970s?
    Maybe the reason “there are no real men” is because all the
    antibiotics have “sterilized” them.
    III.

    Let’s assume that these studies show causation and not simply
    staggeringly awful correlations. The semantic problem posed
    here is that you could choose to label the toxoplasmosis as
    either “schizophrenogenic” or “anxiolytic.” Both are equally
    valid, by which I mean completely meaningless. The only
    thing you know for sure is that it was caused by the
    toxoplasmosis.

    Toxoplamosis is not a cause of schizophrenia, it is a cause of


    toxoplasmosis infection. The schizophrenia part never existed.

    IV.

    If all this wasn’t troubling enough, there’s this:

    Following a similar model as above, a group of infected rats


    were also given the treatment for toxoplasmosis
    (pyrimethamine and Dapsone). Predictably, this cured the rat
    and stopped their crazy cat seeking behavior.

    However, so did Depakote and Haldol, sometimes even better:

    Look at this as the chance of being in the cat cage. a) is all


    behaviors, and b) teases them out. You can see that untreated
    rats like cat cages, treated rats don’t.

    What happened? There’s the obvious behavioral explanation


    (Haldol treated the psychosis); though Haldol does also block
    toxoplasmosis growth and infection.

    Which means if you gave Haldol to a “schizophrenic,” and


    saw “improvement,” you would not really know if it was
    blocking D2 receptors or killing parasites.
    And what would you have assumed had the Depakote worked?

    V.

    No one says syphilis is a cause of schizophrenia, but the same


    people would say toxoplasmosis is. I hope you see there is no
    difference.

    http://twitter.com/thelastpsych
    Are Women Prone To
    Paranormal Beliefs?
    June 29, 2010

    you have a better explanation?

    A reader sends me this email:

    Subject: Guilty as charged.

    http://thelastpsychiatrist.com/2010/06/are_certain_behavi
    ors—_and_jo.html

    http://www.bakadesuyo.com/is-belief-in-the-paranormal-
    a-feminine-trait

    Does this mean I’m a bad person?

    —
    Eric Barker
    Blog | http://bakadesuyo.com/

    No, it doesn’t make you a bad person, but the author of the
    study is suspect.

    II.

    The title of the article Barker had linked to contrast with mine
    is, Who wants to believe? Associations between digit ratio
    (2D:4D) and paranormal and superstitious beliefs.

    Abstract: […] This evidence may be informative for


    narrowing down possible developmental pathways of
    paranormal and superstitious beliefs. Propensities
    contributing to sex and individual differences in these
    beliefs probably arise in utero, may partly be due to
    prenatal testosterone and other prenatal programming
    effects, but less likely due to pubertal-adolescent
    androgen action or developmental instability.

    Who wants to guess which way the association goes? Of


    course it does.

    III.

    These articles rely on the fact that you’re not going to read
    them. Only the titles. Since they are done by academics, they
    are appeals to authority. A leading title, a leading abstract—
    let the public extrapolate from there.

    And who can sit through these articles? They are intermittently
    seductive and impenetrable. Open with the sexual differences
    in schizophrenia, then the similarities between it and
    paranormal beliefs, and close: “All of this points to a possible
    role of sex hormones for a suite of related or overlapping traits
    that include paranormal beliefs, schizotypy, and psychosis-
    proneness.” Game on.
    And if you do venture further into the paper, it’s protected by
    landmines like this one:

    Directional asymmetry in digit ratios was calculated as


    DR−L = R2D:4D-L2D:4D. Composite standardised
    fluctuating asymmetry (Møller & Swaddle, 1997) of 2D
    and 4D was calculated as FA = {Σd |Rd-Ld|/[(Rd +
    Ld)/2]}/2, whereby d = 2D and 4D, and expressed as a
    percentage of trait size (i.e., multiplied by 100).

    That means there’s science being done in there, got it? By


    experts, who can tell a nuclear reactor from an UPS truck. Stay
    the hell out, just read what you’re told to read, i.e.:

    In sum, the current data suggest biologically based,


    prenatally programmed influences on paranormal and
    superstitious beliefs. Or, paraphrasing the probably best
    known slogan from the defining X-Files television series:
    it may well be that some of the truth is in the womb rather
    than out there.

    (“Wait a second— wasn’t the X-Files audience mostly men?” I


    said shut your hole.)

    The article expects you do not bother to read this:

    For women, corresponding relations were all not


    significant. Second, among women, finger length was
    significantly negatively associated with total and positive
    superstition scores (and marginally significantly
    associated with negative superstitions). And third,
    associations of paranormal or superstitious beliefs with
    DR−L or finger FA were directionally erratic and for both
    sexes throughout not significant.
    Or this:

    Corresponding associations among women were


    throughout not significant, and directional asymmetry in
    digit ratios (DR−L) was neither associated with
    paranormal nor superstitious beliefs in men or in
    women…. Paranormal and superstitious beliefs are
    female-typed traits, so the current results are exactly the
    other way round. For now, it is difficult to put forward
    plausible explanations for this pattern.

    Because those things say, “oops.”

    IIIb.

    Where the study went wrong is that last sentence, “paranormal


    beliefs are female-typed traits.” I’m not sure why that is stated
    as if it were obvious, but leave that aside: that was what they
    study set out to show, right? So you can’t make that the basis
    for the interpretation of the results. “We wanted to determine
    whether this drug cures cancer. Since we already know that
    this drug cures cancer, the fact that it didn’t cure cancer is
    difficult to explain using conventional paradigms. Further
    research is warranted.”

    IV.

    The point of research isn’t discovery, it’s confirmation. And


    the purpose of research articles isn’t to convey information,
    but plausible deniability, exactly like in the intelligence game.

    Did the author lie? Nope. Is the article methodologically


    flawed? Nope. Everything in there is factually accurate. But.

    The beauty of the paper is that at no point did he have to say,


    “chicks will believe anything.” He got you to say it.
    Did he say paranormal beliefs were feminine traits? “I didn’t
    write that, you guys misinterpreted the study.” But that was the
    purpose of writing it that way. If you didn’t want it
    misunderstood you would have titled the paper, “My Baffling
    Discovery That Paranormal Beliefs Don’t Follow The Sex-
    Specific Patterns I Wanted Them To, WTF, I’m Going On
    Break.”

    Nor do I suspect he’s malicious. He truly believes they are


    feminine traits, and amazingly his own study is unlikely to
    have dissuaded him. He knows he’s right. The science is just
    padding. Even if all the studies turn out to be negative, he just
    needs to point at the stack: “look at all the research that has
    been done on the question of paranormal behavior and sex
    differences!” You look at the stack, five meters high, and
    think, “guess it makes sense. Chicks will believe anything.”

    V.

    Do you think I staged this? That it’s a coincidence that


    bakadesuyo.com guy sent me this article, that happened to
    conform to what I’m saying? This is the norm, not the
    exception. There are no exceptions. All of this is about
    handing you all the tools you need to lie to yourself.

    You make a false distinction between “politics” and “science,”


    one based on argument and the other on “objectivity.” They
    are of exactly the same form, conducted in exactly the same
    way, by exactly the same people.

    Both are done by humans, humans who want. Whatever truth


    is out there is barely detectable through the mist of envy and
    need and hope. They will make their words and their numbers
    say anything they need them to.

    You want something uplifting, well, here you go: we have


    enough excellent raw data that we could make huge leaps in
    science without performing one further experiment. We could
    take all the, say, antidepressant data, and run it through the
    Machines to determine that it cures the flu in whites born in
    Virgo but only left handed ones who eat lots of broccoli— and
    we have no idea why— as long as we were willing to put aside
    our attachments to words like “antidepressant” and “Virgo”
    and “flu.”

    But that would require us to ignore all the previous


    interpretations of these studies which form the basis for our
    current postulates. Can you unlearn what you think you know
    “feminine” means? Not without a biological EMP.

    I’m not making some philosophical/positivist case for the


    limits of human knowledge, I’m simply observing that when
    they want that brown square in the sat photo to be a nuclear
    reactor, then you’ll want it to be a nuclear reactor, no matter
    how fast it’s going.

    –-

    http://twitter.com/thelastpsych
    Why A Story About Russian
    Spies Who Use Facebook?
    July 2, 2010

    this is called promoting synergy

    They did dead drops, passed bags of money to each other, and
    went to parties. And sympathized with Castro, which is so
    moronic as to be its own punishment.
    high value targets

    But they have been charged merely with conspiracy to act


    as an unregistered agent for a foreign government and
    with conspiracy to commit money laundering. No
    espionage charges were filed because of the simple fact
    that they were never observed sending classified
    information. Their dispatches were the kind of stuff you’d
    find on the web, such as the outlook for the global gold
    market and President Obama’s goals for a summit in
    Russia.
    Which begs the question, why should Moscow have
    bothered?

    The answer is that Moscow thinks it’s 1971. Not to say they’re
    dump or importent, but there’s a mixture of denial and wishful
    thinking akin to a midlife crisis: if we toss the ball around like
    it’s the old days, then we still got it.

    They don’t.

    The past 15 years of Russian history can be summarized with


    these two charts:
    Which means this:

    and everything else you can surmise.

    While the youth of Russia live by the internet, the government


    really doesn’t get it. At Davos, Michael Dell asked Putin how
    he/companies can help build IT infrastructure in Russia.
    Putin’s response: “You know, the trick is we’re not someone in
    need of help. We’re not invalids.”

    So while Russians are inventing Chatroulette and banging out


    the warez, this is what’s going on in upper management:
    I have absolutely no doubt that every word of that caption is
    true. Meanwhile, Fox News would drown in its own ejaculate
    if Obama ever used a phone given by the Russians.

    For the most part, the country’s security services are run by the
    very old (Lebedev, Shlyakturov), non-technical (Fradkov,
    Shlyakturov), ex-KGB, miltary dreamers, and Darths. Without
    the Force.

    II.

    As far as I know, Russia has never admitted anyone was a spy


    for them, let alone 11 people. So why admit it now?

    Because they were admitting it to Russians. “See? We still go


    it.”

    III.

    Where it gets messy is here: why would America admit it?


    Why is such a non-event all over the news? Why does the
    American media care so much about this story?

    (CNN) The Russian Foreign Ministry said in a statement


    the arrests are “unfounded and have unseemly goals.”
    “We do not understand the reasons why the U.S.
    Department of Justice has made a public statement in the
    spirit of the Cold War,” said the statement, posted on the
    ministry’s website. “Such incidents have occurred in the
    past, when our relations were on the rise. In any case it is
    regrettable that all these things are happening on the
    background of the ‘reset’ in Russian-U.S. relations
    announced by the U.S. administration.”

    The question isn’t just why, the question is why now:


    The Russian operation was believed to date back to the
    1990s… the FBI conducted extensive electronic
    surveillance of the suspects for years, including secretly
    recording and videotaping them and surreptitiously
    entering residences to take photographs and copy
    documents.

    Public choice theory is about private choice practicality, and


    the inevitable question: who benefits?
    Government and media on the same page. “Time to get control
    of the internet.”
    Should School Start Later?
    July 6, 2010

    so let me get this straight: you want me to start eating worms

    In Harvard Business Review, Christoph Randler explains his


    research: a survey of 367 college students on their proactivity.
    Hint: the title is, “Proactive people are early risers.”

    The finding is not simply that they wake themselves and get
    going; there’s a biological involvement. Early risers were
    those who got up at the same time on the weekends as on the
    weekdays, i.e that was what was natural. Actual amount of
    sleep didn’t matter here.

    Other traits, like conscientiousness, were also associated with


    early rising. The hook in his research is that early risers don’t
    simply have more time to do work, are not better rested or,
    drink less alcohol. Being an early riser is something innate—
    he estimates 50% of it is due to genetics.

    II.

    There is a point— and I’ve seen it frequently— where late


    night and early morning converge.

    It is my observation, N=1, that I feel more rested if I can get


    up an hour later than normal than if I actually got more total
    sleep.

    III.

    CHICAGO - Giving teens 30 extra minutes to start their


    school day leads to more alertness in class, better moods,
    less tardiness, and even healthier breakfasts, a small study
    found.
    “The results were stunning. There’s no other word to use”

    Could this be about morning kids vs. night owls?

    From the abstract:

    Conclusions A modest delay in school start time was


    associated with significant improvements in measures of
    adolescent alertness, mood, and health.

    If you were told that school or work would from now on be an


    hour later, what would you do? What I’d do is stay up an extra
    hour (or four) so that total sleep time was the same, just
    shifted.

    The teens didn’t do that.

    Results After the start time delay, mean school night sleep
    duration increased by 45 minutes, and average bedtime
    advanced by 18 minutes

    Why didn’t they stay up later? Because these were boarding


    school kids, and lights out was lights out.

    So their improved mood and behavior may be simply due to


    more sleep, not a later time, per se.

    IV.

    See that “advanced 18 minutes”? I blew past it without


    appreciating its technical significance:

    When school start time was moved a half hour later (S2), these
    idiots didn’t stay up longer, they actually went to bed earlier.

    V.

    So the study shows, basically, that kids do better with more


    sleep, and if you start school later, they get more sleep.

    This doesn’t lend anything to Randler’s thesis, because when


    you sleep— his biological predilection to mornings or
    evenings— wasn’t really tested. It was just less vs. more.

    The reasons we run the world as morning people are myriad.


    I’m sure it started with the stupid sun; older people naturally
    get up later, and older people set the meetings. All night owls
    are expected to adjust their natures.

    The effects of this on kids, especially pubescent through mid


    twenties, ages when the sleep cycle naturally favors later
    mornings, are not obvious. But they’re pretty suspect. Jocks
    are supposed to be dumb but how smart can you be if you
    were up at 5am running laps? But that’s the system we have.
    I’ve rarely met an ADHD kid who sleeps enough, and I’ve
    never met an ADHD adult or adolescent who does. When a
    kid is sleep deprived, he gets hyper; they are too tired to be
    inhibited, too tired to exert self-control. Not for nothing,
    Ritalin is a stimulant.

    Which is why, for me, the real message of the study should
    have been this:

    The daily class schedule is from 8 AM to 3 PM, 4 days per


    week; 8 AM to 1 PM on Wednesday; and 8 to 11 AM on
    Saturday. From January 6 to March 6, 2009, the school start
    time was delayed to 8:30 AM. To avoid extending the length
    of the school day, academic and nonacademic periods
    (student life, music programs, etc), assemblies, and
    afternoon activities (ie, athletics, theater, etc) were reduced
    by 5 to 10 minutes.

    That’s how you run a school.

    http://twitter.com/thelastpsych
    Why Parents Hate Parenting
    July 7, 2010

    no, i don’t hate you, i just hate what I didn’t become

    New York Magazine’s article, All Joy And No Fun: Why


    Parents Hate Parenting, has 19 million pages of quotes and
    examples, but no answer. Too bad; the answer is right there.

    Here’s how the article starts:

    There was a day a few weeks ago when I found my 2½-


    year-old son sitting on our building doorstep, waiting for
    me to come home. He spotted me as I was rounding the
    corner, and the scene that followed was one of
    inexpressible loveliness, right out of the movie I’d
    played to myself before actually having a child, with
    him popping out of his babysitter’s arms and barreling
    down the street to greet me.

    For the new readers, that’s your sign that there’s a contagion
    nearby, suit up. When a person sees their life as a movie, that
    means they’re the main character and everyone else is merely
    supporting cast. And when one of the extras— in this case, the
    kid— goes off script, she doesn’t just get upset, she has a full
    blown existential crisis:

    I recited the rules of the house (no throwing, no hitting).


    He picked up another large wooden plank. I ducked. He
    reached for the screwdriver. The scene ended with a time-
    out in his crib… Two hundred and 40 seconds earlier, I’d
    been in a state of pair-bonded bliss; now I was guided by
    nerves, trawling the cabinets for alcohol. My emotional
    life looks a lot like this these days. I suspect it does for
    many parents…

    Wow! Her 2½-year-old acts like he’s 3½, and four minutes
    later she’s willing to settle for vanilla extract.

    It is at this point, only two paragraphs in, that it should have


    occurred to the writer that the reason “parents are unhappy”
    may not have anything to do with the kids. That insight,
    however, most emphatically does not occur to her or anyone
    connected with the article.

    Which is why it is accurate, though mysterious, to say that the


    reason parents are unhappy is these articles.

    II.

    To illustrate the unique unhappiness of parents, i.e. NY


    Magazine parents, the article describes a UCLA study in
    which researchers analyzed 1500 hours of video from 32
    middle class families in their homes. The clip described in the
    article is this: a mom trying to get her 8 year old son to stop
    watching TV and do his homework. Ponder that.

    The director of research in this study has watched this


    scene many times. The reason she believes it’s so
    powerful is because it shows how painfully parents
    experience the pressure of making their children do their
    schoolwork. They seem to feel this pressure even more
    acutely than their children feel it themselves.

    Powerful, got it? As in pay attention to this clip. You can


    imagine what the clip shows, we’ve all been there, some of us
    on both ends. The clip shows a struggle millions of parents can
    relate to.

    But for that reason, it’s quite ordinary. What makes it


    powerful?

    In order to understand the real importance of this clip, forget


    about what actually happens in the video and focus on what
    people saw in the video.

    This is what the writer of the article saw:

    It’s a weekday evening, and the mother in this videotape,


    a trim brunette with her hair in a bun and glasses propped
    up on her head, has already worked a full day and made
    dinner. Now she is approaching her 8-year-old son, the
    oldest of two, who’s seated at the computer in the den,
    absorbed in a movie. At issue is his homework, which he
    still hasn’t done.

    No, that’s not the issue, it barely receives a mention. Maybe


    it’s the rum talking, but am I the only one who read that
    description of the clip and thought “the mom sounds hot?”
    That’s the issue. The issue is that she is a trim brunette with a
    bun, with glasses, with a look, whose relative perfection is
    being marred by the time burglar in the den. The issue isn’t the
    homework, the issue is her. Trim brunette with glasses and a
    bun=put together mom who has it all, so why isn’t she happy?

    I’m not saying that mom thinks that— I’m saying that the
    writer of the article thinks that; she devoted the majority of the
    paragraph and almost all of her emotional energy to describing
    her. But it’s a non-sequitor, if the point is about getting the kid
    to do homework, what difference does it make how she looks
    or what she’s cooked?

    It doesn’t. But the writer cannot grasp this, because the main
    character in the movie is the mom, the story is about her.
    Surely, how she looks must have some importance.

    I hope it requires no elaboration that had the writer chosen to


    see the clip as a story about a curious but bored child
    tormented by a descriptionless gadfly, this would have been a
    very different article indeed. But it wouldn’t be in NY
    Magazine, it would be in Omni.

    III.

    It would be a pointless act of euthanasia to criticize the article,


    except that these popular press articles are more than bathroom
    reading, they are the template for how to think about these
    social issues, in the same way that you can’t think about
    Obama without resorting to language implanted by CNN or
    the New York Times. Try it. It’s impossible.

    These articles offer you the freedom to argue about the


    conclusions, but trick you into accepting the form of the
    argument.

    Here’s an example. Passive readers of this article, e.g.


    everyone on the toilet, will feel the comparative emphasis of
    the description of the mom and unconsciously assume it is
    relevant to the thesis. You’re going to read “trim brunette” and
    infer “put together mom” and then you’re going to try to figure
    out why the “put together mom” is having such trouble with
    the entropy machine her husband gave her. Whatever
    conclusion you reach, the form of that conclusion will be, “the
    reason otherwise well put together moms are not happy is…”

    From which you can derive every other insanity common to


    such articles, which in this case the writer does explicitly for
    you anyway:

    One hates to invoke Scandinavia in stories about child-


    rearing, but.. If you are no longer fretting about spending
    too little time with your children after they’re born
    (because you have a year of paid maternity leave), if
    you’re no longer anxious about finding affordable child
    care once you go back to work (because the state
    subsidizes it), if you’re no longer wondering how to pay
    for your children’s education and health care (because
    they’re free)—well, it stands to reason that your own
    mental health would improve.

    Because, you know, no Scandinavian women ever kill


    themselves at double the rate of Americans.

    None of this will make you a happier parent, let alone a better
    one. The article itself makes the point that, “parents’
    dissatisfaction only grew the more money they had, even
    though they had the purchasing power to buy more child care.”
    So why bring up Scandinavia? Because it jives with some
    other incompletely thought out political position?

    These articles are cognitive parasites, that’s what makes them


    dangerous. They change the way you think. Even if you
    disagreed with the conclusion, you’re still going to approach
    this problem from, “why aren’t put together moms happy?”
    This will never lead you to the answer.

    The real form of the question, the one that generates the
    correct answer simply in its asking, is, “why doesn’t having
    kids— or getting married or getting a better job or getting laid
    or anything else I try to do— make me happy? Oh. I get it. I’ll
    shut up now.”
    I was sure that color coordinating the baby and the bathroom
    would make me happier but it didn’t… should I have gone
    with lavender?

    IV.

    Two other short examples.

    As per the article, fathers apparently suffer more than mothers.


    At first I thought it was because they were single fathers, but
    no, these were married ones. Not what I would have guessed,
    but I’m open to new information. Per the article, most
    arguments a couple has— “40%”— are about the kids.

    “And that 40 percent is merely the number that was


    explicitly about kids, I’m guessing, right?” This is a
    former patient of [a couples counselor], an entrepreneur
    and father of two. “How many other arguments were
    those couples having because everyone was on a short
    fuse, or tired, or stressed out?” This man is very frank
    about the strain his children put on his marriage,
    especially his firstborn…

    This man is very frank. It took, what, 6 months of therapy? to


    discover that many of the arguments with his spouse are
    related to stress.

    He may be frank, but he’s obviously clueless:

    …This man is very frank about the strain his children put
    on his marriage, especially his firstborn. “I already felt
    neglected,” he says. “In my mind, anyway. And once we
    had the kid, it became so pronounced; it went from zero
    to negative 50. And I was like, I can deal with zero. But
    not negative 50.”

    The guy was in a relationship without any kids, and he felt


    neglected. What the hell did he think was going to happen
    when he had kids? Daily oral? The article writer doesn’t detect
    anything remarkable there, I’m guessing because she probably
    thinks it’s not remarkable to feel neglected in a relationship.

    Unfortunately, here’s what the article writer does think is


    remarkable. This is what she wants you to understand from
    that interview, this is the very next sentence:

    This is the brutal reality about children—they’re such


    powerful stressors that small perforations in relationships
    can turn into deep fault lines.

    Got it? It was all working until the kids came.

    Note also the arrogance of the parents relative to the Catimini


    clothing models that live with them. Can you be vaguely
    dissatisfied, unfulfilled and possibly even resentful of your
    marriage, yet fake it enough that your spouse thinks you love
    them more than anything? So why do you think you can fool
    your 8 year old? Because he’s 8? He smells it on you, it reeks,
    like sepsis. And yes, it will spread to him eventually.

    Jim Gaffigan, in between jobs

    V.

    Another example:

    A psychologist offers the article’s one useful insight about


    unhappy parents: “They become parents later in life. There’s a
    loss of freedom, a loss of autonomy.”

    Ok, sounds plausible. This, however, is the article’s


    interpretation of that insight:

    It wouldn’t be a particularly bold inference to say that the


    longer we put off having kids, the greater our
    expectations. “There’s all this buildup—as soon as I get
    this done, I’m going to have a baby, and it’s going to be a
    great reward!” says Ada Calhoun, the author of
    Instinctive Parenting and founding editor-in-chief of
    Babble, the online parenting site. “And then you’re like,
    ‘Wait, this is my reward? This nineteen-year grind?’ ”

    The author of a parenting book still cannot help but see


    children as a reward, as a cherry on top of a cake, not because
    she is brain damaged but because for 40 years she has been
    told by people, like herself, like New York Magazine, that they
    were.

    There’s a word for all of this, but everyone gets queasy when I
    use it.

    VI.

    I have a surprising piece of advice for parents, which I hope


    will be taken in the spirit it is offered: your kid doesn’t want to
    be around you that much. No one does. This isn’t because
    you’re a bad person but because you’re an ordinary person.
    You are not such a unique, creative, intelligent or even
    interesting person that the kid benefits from constant exposure
    to you. When you have something to offer, maximize and
    concentrate that time, and then get the hell out of the way.

    This advice is quite practical. Parents often don’t know what


    to do with their kids, so they overwhelm them with their
    attention instead. What no parent realizes is that the vast
    majority of that overinvolved time is spent irritated. Add it up
    yourself. Nagging, bored, looking at your mobile. The obvious
    message is that you’re not satisfied.

    That’s the template you’ve offered him.

    I don’t know if helicopter parenting will turn the kid into a


    wimp as many claim, but I do know that it will make the kid
    hate you. The natural individuation that will occur in
    adolescence is going to be a lot more severe, get ready. Of
    course, by that time the parents will be too emotionally
    exhausted to keep on helicoptering, so you get the awesome
    combination of a lifelong history of overcontrol, with a sudden
    removal of nearly all of it, exactly at the time the kid discovers
    meth. Well played, New York Magazine parents, well played.

    Also: Don’t Settle For The Man You Want

    http://twitter.com/thelastpsych
    “Nobody will understand
    what went on in this house to
    drive my dad to this level of
    insanity”
    July 14, 2010

    let me take a shot


    An article in Marie Claire making the rounds via Jezebel and
    wherever binary political judgments are favored.
    This is a version:

    Around the sprawling, sunbaked campus of Dysart High


    School in El Mirage, Arizona, not many people knew
    about the double life of a pretty, dark-haired girl…
    At school, she was known as a fun-loving student who
    made friends easily. She played tennis in a T-shirt
    emblazoned with the school mascot — a baby demon in a
    diaper. She liked to watch Heroes and eat at Chipotle.
    Sometimes she talked in a goofy Keanu Reeves voice.
    She wore dark jeans, jeweled sandals, and flowy tops
    from Forever 21. She texted constantly and called her
    friends “dude.” In other words, she was an American girl
    much like any other.
    But at home, [she] inhabited a darker world.

    I’ll fast forward to the end: her father runs her and her 43 year
    old female friend over with his Jeep in the parking lot of a
    Mexican restaurant. He then swings the Jeep around for a
    second pass. When he’s done, he flees to Mexico.

    No need to speculate on Mexican illegals; lesbians, drugs or


    mental illness, or other go-to media explanations. In this case,
    everything you need is right there in the title: An American
    Honor Killing. Yeah, they’re Iraqi.

    II.
    The fact that the Almaleki family is from Iraq is integral, by
    which I mean incidental, to the story.

    But honor killings in America are a chilling new trend. In


    Texas, teen sisters Amina and Sarah Said were shot dead
    in 2008, allegedly by their father because they had
    boyfriends…25-year-old Sandeela Kanwal was allegedly
    strangled by her father for wanting to leave an arranged
    marriage… Aasiya Hassan, 37, was murdered in perhaps
    the most gruesome way imaginable: She was beheaded
    [by her husband]… for reportedly seeking a divorce. And
    this past spring, 19-year-old Tawana Thompson’s
    husband gunned her down in Illinois, reportedly
    following arguments about her American-style clothing.

    None of the people in that paragraph are Iraqi. The Saids are
    Egyptian. Kanwal and Hassan are Pakistani; Thompson’s
    husband was black and a convicted drug dealer who killed her,
    their 7 month old and two nieces, 3 and 16, apparently on the
    advice of voices in his head. If you can spot what they have in
    common, call me.
    “They’re all Muslim, dummy.” Oh, the religion takes
    precedence over everything. So that’s why Iraq and Iran get
    along so well.

    III.

    No, I didn’t turn Left at the internet, I am not gunning for a


    spot in The Chronicle of Higher Education [sic.] Of course it
    has to do with their being Muslim, but not in the easy way the
    article wants it to be.
    First Law of Media: offer the reader the opportunity to debate
    the conclusions, but force him to accept the form of the
    argument.
    You get to argue about whether Islam allows honor killings:
    “religion of peace!” “No, religion of hatred!” or whether this is
    generalizable to all Muslims, as long as you accept their
    premise that she did something that deeply offended her father
    and Islam. Put it in the article with an apologetic cop-out:

    Although honor crimes aren’t officially sanctioned by


    Islam, they’re associated with predominantly Muslim
    countries

    They’re not associated with Muslim countries, that’s what


    they’re called when they are associated with Muslim countries.
    When they’re associated with rich black guys, they’re called
    OJ Simpson.

    III.

    An aside: if you’re going to argue about something solely on


    the basis of your personal prejudices, at least pick the side
    whose consequences support your worldview. So a practical
    reason why you don’t want this to have anything to do with
    religion is that it is very easy to make the explanation for a
    murder become the excuse for it as well.

    Imagine that by calling this an honor killing, you make it


    impossible to give him the death penalty because the defense
    can argue that this is really an anti-Muslim political show trial.
    I realize that sounds far fetched.

    [Arizona Republic:] “An open process provides some


    level of assurance that there is no appearance that a
    Christian is seeking to execute a Muslim for racial,
    political, religious or cultural beliefs,” (public defender)
    Little wrote, referring to [prosecutor] Andrew Thomas’
    Christian faith.

    The debate stopped there. On Tuesday, [prosecutors] filed


    a motion indicating prosecutors would not seek the death
    penalty… a spokesman for the County Attorney’s Office
    declined to comment on the decision.

    In law, like in anything else, you get what you pay for.

    IV.

    The problem with the “Muslim honor killing because she


    turned her back on traditional values and wanted to be more
    American” logic is that she was already an American,
    Americanized, eyeballs deep in Americana well before he
    killed her. Nothing in the article suggests that her life was
    ruled by a strict Muslim code. The father recently became an
    American citizen; the kids went to regular schools, texted,
    MySpaced, listened to Oasis (why?), worked at Chipotle. This
    is her brother’s profile on Facebook:
    I guess it’s possible an Iraqi “fundamentalist” could wear U.S.
    Army camo pants because Sharia law doesn’t preclude irony,
    but a more likely reason is he isn’t a fundamentalist. Just
    guessing.
    But the article insists that this is about straying from her
    expected Muslim path. e.g., in her senior year, 2007:

    Noor would hint at threats from her father to send her


    back to Iraq (where, he said, she would “learn to be a
    good girl”), but no one really took him seriously….
    Friends say her father had had enough of Noor asserting
    her independence and talking to American guys, so he
    and her mother tricked her into traveling to Iraq, telling
    her they needed to visit a sick relative. Only upon arrival
    did Noor learn of the real reason for their trip: to marry
    her off.

    This is a typical paragraph from the article, all which try to


    paint the picture that her Dad wanted her to be a certain
    Muslim way, she didn’t, and so he killed her.

    …by May 2008, the family was in full crisis. Noor’s


    father had found a photo of her with male friends on
    MySpace, and he didn’t like it. The situation became so
    heated that she started talking about moving out. One day,
    when Noor took the family car to visit a cousin, her father
    reported it stolen. When she learned what he’d done, she
    left the car on the side of the road and walked away.
    According to police records, her father wanted to file
    criminal charges against Noor to “teach her a lesson,”
    telling police she was “disgracing the family” and that it
    didn’t “look good” that she was moving out. Eventually
    she did move in with a friend. But after repeated run-ins
    with her father, and after learning that her mother was
    casting “spells” on her host family, she gave up and
    returned home.

    …And in the spring of 2009, Noor got her own


    apartment… The next few weeks brought happier
    times… To pay the rent, Noor worked at a local Chipotle;
    she’d also begun attending Glendale Community College.

    When Noor’s parents learned where she was working,


    they started showing up and insisting that she move back
    home, so she got a job… as a hostess at Applebee’s. They
    turned up there too, leaving her no choice but to abandon
    that job as well. With no source of income, she was
    forced to return home once more.

    There is nothing in those paragraphs that would explain what


    would enrage the father so much as to want to kill her; or, put
    differently, all of these things already happened and he didn’t
    try to murder her. What here requires him to kill her?
    V.
    If you need cognitive anchor for interpreting this article, here
    it is: people routinely scrutinize every word of a New York or
    Washington Times article for bias, yet an article in Marie
    Claire is taken to be the whole story.
    VI.
    The moment you say, “wait a second, this is for Marie Claire
    readers?” you start to see the sentences differently. They are
    phrased in such matter of fact, Marie Claire simplicity that
    you miss that they are asinine. You buy into them immediately.
    The final blowup came that summer. In June 2009,
    longtime family friend Amal Khalaf awoke to find Noor
    sleeping in the family’s van, parked in the driveway. Noor
    said her parents had hit her; Amal, a mother of four, took
    her in. To Noor’s family, this was the ultimate indignity:
    Their daughter had chosen to live with another Iraqi
    family instead of her own.

    Why would living with another Iraqi family be the ultimate


    indignity? I’m not even clear why it would be an indignity at
    all, but the ultimate? Worse than moving in with a Jewish
    boyfriend? But on passive reading “living with a different
    Iraqi family” somehow makes sense and you stop there. You
    don’t think to ask if there was not something else that was
    enraging about it, you go along with the Marie Claire, “she
    offended her father and his values of Islam” theory. And there
    was something else but the article barely mentions it, let alone
    explores the intricacies of it. 6 pages, 5000 words long, and
    this is all they say:

    It’s unclear whether a wedding actually took place. Some


    friends say she only attended an engagement ceremony;
    others tell me they believe she did get married, albeit
    against her will. Still others say Noor was given a choice
    of five brothers, but her parents didn’t like the one she
    chose, so the wedding was called off. Noor’s parents, in
    police documents, maintain that a marriage did, in fact,
    occur. Whatever the case, Noor returned to Arizona a few
    months later without a husband, and moved back in with
    her family. She missed her younger siblings, friends say,
    and her parents needed help caring for them.

    Why didn’t he kill her when she when she first started talking
    to boys? Why didn’t he kill her when she started wearing
    American clothes at age 4?
    The answer is: they lived in America for 16 years, where that
    behavior doesn’t shame him. He may not like it, but there is no
    one who would look down on him here. Shame is exposure,
    and as long as all these behaviors stay in Phoenix, no one
    knows what “s/he’s” done.
    It all fell apart because he sent her to Iraq. When he committed
    to the all-in, hail mary plan of sending his daughter to Iraq to
    get married, where she either rejected five men as
    unsuitable(!) or worse, got married to one of them and then
    went on cavorting with men in the U.S. (!!!!)…
    … never mind what Allah thinks, now everyone in Iraq knows
    what kind of a man he is.

    VII.
    The article doesn’t mention any such communications; it
    barely references the marriage. The article wants it to be about
    a woman finding herself, and struggling to separate from her
    father. In other words, it’s a domestic abuse story that they
    package as a honor killing story.
    If you are an immigrant or of immigrant parents then you’ll
    know: that man was in daily communication with people in
    Iraq thanks to the stupid internet and mobiles. He was better
    connected to some Iraqi 3rd uncle than he was to his next door
    neighbor. And, especially after his daughter returned, those
    communications were torture. Explaining what went wrong
    with his daughter, why she wasn’t being honorable, why he
    couldn’t control her, how it was his wife’s fault, his sons’
    faults— in short, constantly on the defensive about how he
    couldn’t keep his house in order, constantly subject to the
    criticisms and patronizing responses of an extended family
    that is so much a part of his identity and so little a part of hers.
    Not only was he ashamed, but worse, she was not ashamed at
    all. She didn’t even care what they thought! How could this
    animal not understand that how relatives In Iraq she never met
    viewed her was far more important than any internal sense of
    self-worth?
    And more practically, how do you explain to her “husband”
    and his family, back in Iraq, that his daughter is an adulteress?
    That’s got to be frustrating.

    VIII.

    This is what her brother wrote on Facebook:

    What grabs the most attention from this situation is the fact that this is a Middle Eastern
    family. This happens quite often in the U.S., parent(s) hurting or killing their child(ren). The
    “Freedom of Speech” given to you guys, have made you all senseless, arrogant, mindless
    pricks. Everyone just talks, and has NO IDEA what they’re talking about. The media, has
    drawn this image that Noor, RIP, was a saint, and my Dad as the Devil. Don’t believe the
    reasoning behind this as “Too Westernized.” As I have said before, me, my two younger
    sisters, and my three younger brothers are all “Westernized.” Goes with the saying, “When in
    Rome, do as the Romans do.” One of the biggest problems with society is that they believe
    whatever they see on the tube. “Too Westernized” has absolutely nothing to do with this. I’m
    not advocating what my Dad has done.

    Another thing people don’t understand is the fine line between Islam and Iraqi Culture. Iraqi
    Culture is misconstrued and manipulated form of Islam, that is strict on every level, and
    much harsh on women.

    This wasn’t an “Honor Killing.” Media just pulls fiction out their asses. This wasn’t planned.
    You guys be careful what you say, that’s my father you’re talking about. And my father is a
    loving man. He loved Noor. That may raise eyebrows, and you guys are asking “Why would
    he do this if he loved her?” He lost his mind. Nobody deserves this, and this never should’ve
    happened. And nobody will ever understand the kind of pain my family is enduring.

    As I said, the only reason this situation grabbed attention for so long is because where my
    family comes from. Nobody will understand what went on in this house to drive my dad to
    this level of insanity. You guys keep talking, your words mean nothing to me. I know what
    happened, I know the truth.

    I lost MY sister, and am losing MY father.

    IX.
    Go back to the asinine statement of living with another Iraqi
    family being the ultimate indignity. In fact, that statement was
    dead on though I doubt intentionally so. If she had moved in
    with a Jewish boyfriend he would have been horrified and
    enraged, but moving in with the Iraqi Muslim family was
    immediately worse because— and this is the entire point—
    now everyone in Iraq is going to know. And since those people
    are his whole identity, he’s screwed.
    This is why discussions about honor killings get mired in a
    nonsensical theory debate about whether Islam promotes this.
    Even if it did, the part that requires the violence isn’t some
    internal sense of right and wrong or “against Islam”, but
    exposure to other human beings who will look down on them.
    He doesn’t care that she’s Americanized or even an adulteress.
    He cares that people are laughing at him.
    This is narcissism, and here I do not hesitate to spell it out
    explicitly. The obvious is that he sees her only as an extension
    of himself, only as she impacts his own existence and not as an
    independent entity. He’s not better than her, she’s just not a
    fully formed character, she’s an extra. But the more telling and
    scary part of the narcissism is that he thinks that by killing her,
    he has not merely stopped her but fixed things, erased his
    shame, as if it never happened. As if the people back in Iraq
    aren’t still snickering, as if human nature and reality are
    subservient to the magical thinking of a man who believes a
    Jeep can alter what God already saw.
    X.
    Two constants in stories about honor killings. First, some
    ridiculous multicultural idiocy that honor is extremely
    important in such societies. The word is incorrectly used,
    because it means different things to West and East. Honor in a
    western sense something earned (even by dynasty), like a hero
    might have. It is internal, and while honor can be tarnished it
    had to be acquired first. No one would say that the Chrysler
    mechanic downtown is honorable, you’d just say he’s a good
    guy, etc. But the word “honor” as it applies in “honor killings”
    denotes an absence of shame. Honor in that sense is a baseline,
    under constant threat of exposure and entirely at the discretion
    of everyone else.
    Partly this is a function of education, partly of culture, partly
    of religion, but inevitably the result of shaky identity that
    draws its strength in the way other people see them.
    The second constant is the shocked surprise that the mother or
    brothers helped the man get away with it (or commit it.) Why
    would that be surprising? If his family didn’t understand, if his
    family would be shocked and horrified and appalled at what
    kind of a man would murder his own daughter, then he
    wouldn’t be doing it. Again, he’s not doing it out of internal
    sense of justice, he’s doing it to alter how he is viewed by
    others around him.

    XII.
    I am aware of the obvious links between honor killings and
    Islam and I am aware of the various arguments concerning the
    extent to which this is cultural, tribal, religious or educational.
    I don’t care. Practically, when you link honor killings with
    Islam, you make it impossible to stop them because either a)
    people are thrilled at the chance to attack Islam, which allows
    the rebuttal, “oh, you just hate Islam!” or b) people are too
    nervous to attack Islam, so it goes unchecked.
    The first step in preventing these murders isn’t targeting the
    potential murderer, but everyone else around him. You don’t
    debate the cultural aspects or the nuances of Muslim theology
    because those are red herrings, and treading carefully on
    cultural sensitivities makes it that much easier for the son of a
    potential honor killer to say, “I don’t condone it, but I
    understand, and you don’t, you’re not Muslim.”
    Change the form of the argument. You have to make the
    narcissistic honor killing a thing of even greater shame; you
    have to speak their language. Don’t say it’s wrong— they
    don’t care if it’s wrong— don’t say it’s against Allah, don’t
    say it’s tribal, don’t say it’s a backwards practice, none of
    those things matter. Say it is a sign of weakness and
    impotence. Keep repeating that they aren’t signals that you
    were strong and steadfast in your faith, but signals that you so
    petty and unfocused such that you had to resort to this.
    Remind them how stupid it is to think that people are now
    going to forget that you’re the father of a harlot and you’re a
    cowardly murderer. No Iraqi will send his sons over to the
    U.S. to marry your other daughter, and for sure no American
    will. Keep saying that, not so the potential murderer hears it
    but so the kids hear it.
    You might think that the American internet is the obvious
    place to do this, but it’s not. Consider Metafilter, the online
    forum where no topic is too controversial for an opinion
    grounded in either reason or expletives. What did the
    community that fears neither God nor the NSA have to say
    about this case?

    This post was deleted for the following reason: This is


    awful, but we’ve had posts discussing honor killings in
    general and specific incidents before and I’m not sure
    what good is going to come from this one.— [moderator]

    That’s why it’s going to happen again.


    –

    Another Honor Killing, this time in Iraq.


    Why Is Mel Gibson So
    Angry?
    July 16, 2010

    should’ve stuck to the plan


    Time Magazine:

    “I’ve witnessed thousand of arguments at this point and


    in my opinion this is not typical,” says Sharon Rivkin,
    psychotherapist who specializes in arguments and affairs
    and is author of last year’s Breaking the Argument Cycle.
    “I think he’s got some very serious psychological
    problems. I think he’s dangerous at this point. This goes
    beyond just a bad relationship. Even if he’s been
    drinking, that’s too much… I’ll bet every penny I’ve ever
    made that he was abusive in all his previous
    relationships.”

    Paypal button is on the right, as long as it’s under 14 grand it’s


    not reportable.

    She couldn’t be more wrong, every single word is exactly


    wrong.

    First, this isn’t extreme, it’s not even uncommon, these rants
    happen all the time in relationships everywhere. And the men
    who yell like this are rarely bipolar, panicking, or even
    drinkers (and if he was drinking, getting sober isn’t going to
    change this.)

    Just like Olga, the women aren’t screaming back, they are
    mostly mute (which drives the men bananas) or sporadically
    say something infuriating. These exact same arguments
    happen all the time. (This isn’t to justify them or lessen their
    severity.) And I doubt very much that he’s dangerous, though
    he is quite intimidating and scary.

    I should write more about this later, but five things that jump
    out at me:

    1. Coiled spring.

    Whatever it is he’s arguing about is just the switch to bring up


    every other sleight he’s ever experienced, many that don’t
    have anything to do with her (e.g. ex-wife.) It’s not that he’s
    been looking for an excuse to yell about those things, but he
    sees them as logically connected to his arguments now. She
    thinks, “what does that have to do with anything?” and he
    thinks, “see, just like this thing!” He’s angry at her, but he’s
    really angry at this “pattern of things that are always being
    done to me.”

    NB: the one constant in all of your failed endeavors is you.

    2. The threat that is a gift.

    She accuses him of something (being crazy, being mean) to


    which he responds, “oh, you think this is crazy/mean? You
    don’t know what mean is!” I could hurt you, but I’m not,
    because I’m a good, anyone else this angry would hurt you.
    Usually, that move is reserved for people you “love,” or are
    jealous of. His expectation is that she will realize how good he
    is because he’s not hurting her, because he is so wrapped up
    with her, that she will come around: “oh my God, you’re right,
    how could I have been so stupid? I’ll make it up to you, let’s
    get someone to videotape us having sex!”

    3. Sex, sex, sex, sex, sex, sex. He’s not yelling at an ugly
    chick. You might think that he’d be happy to have her, and one
    missed blowjob isn’t a big deal (apparently she fell asleep
    before he got to bed.) But that anger isn’t about missing the
    blowjob. It’s that she missed a blowjob, but for sure she never
    missed an opportunity to blow her past boyfriends. She liked
    giving them blowjobs. She was way more wild, sexual, open
    with the other guys. Why not him?

    Man: Don’t show you love me by marrying me, of course


    people would want to marry me, show me you love me
    by being a slut for me, the way you were for the other
    guys! In other words, prove it!

    Woman: That doesn’t make sense! And I’m way more


    sexual with you than I’ve ever been with any other man!

    Man: Didn’t you one time have sex in a car?! Ah ha!

    Woman: What?

    Man: And remember that time you had a one night stand
    with a guy at the beach, right there in the open? See?!

    Woman: But didn’t you have one night stands in your


    life…?

    Man: Not with you! You never had a one night stand with
    me! You gave that to someone else! You didn’t think I
    was sexy enough to have a one night stand with!

    Woman: ?!??

    Man: !!!!
    If you’ve never had that fight, you’ll think it impossible. If you
    have had that fight, exhale; it happens all the time.

    4. Violence up to the line, and a peek over

    Pulling a gun and punching her in the mouth are abuse, but
    he’s not beating her to a pulp. (Not justifying it, please follow
    along.) The violence is explosive and terrifying— and then
    restrained. He sounds out of control, he wants to convey the
    impression he’s out of control, but he’s not actually
    uncontrolled. Though sometimes it gets out of control. He
    wants to hit her, but the point is to show it. He doesn’t want to
    get in trouble for it. He is aware of rule outside himself and
    fears them. He doesn’t want to be known as a guy who hits
    women.

    What would provoke a man like this to actually commit


    extreme violence? Shame, with backup support. She has to do
    something to him that destroys the image of him in the eyes of
    others (gee, like, say, leaking phone tapes) and he has to find
    enough people willing to do a Chris Rock: “I’m not saying he
    should have killed her— but I understand.” As long as the
    violence has less shame than the thing that originally shamed
    him, it becomes a possibility.

    5. Envy

    I lost my money, I lost my career, I lost my family… you have


    big breasts, you’re hot, people desire you, you don’t desire me,
    you have all these friend and I have no friends— but you
    know, your friends aren’t really your friends, only I’m your
    friend and you don’t even desire me—

    It would have been much better if your presence around me


    proved to me and everyone else that I’m awesome. But you’re
    getting older, and so am I, we don’t look as good— and
    besides, every time they see you they realize you’re only with
    me because I’m Mel Gibson, so everyone envies you but no
    one envies me, they think I settled for a Russian whore. And
    the irony of it is… you’re not actually a whore so I don’t even
    get that!

    Practical solution:

    You split up. I know that seems obvious, but even though this
    kind of a fight is about other baggage, it implies the
    relationship itself is an outgrowth of that other baggage (e.g.
    he picked her because to show the world he could still get
    models) and thus doomed to failure. You don’t love each other,
    you want to love each other.

    I’ll point out that it is also typical that once these fights start
    happening, you’ll probably stick together for another decade
    or so.
    Inception Explanation
    July 20, 2010

    that’s as good an explanation as any


    (There are a number of sites which offer a scene by scene
    explanation. But this one is better. Here there be spoilers.
    Also, see: The Ultimate Explanation Of Inception.)

    Was it all a dream?

    Inception cannot be interpreted in a vacuum. It draws from our


    collective unconscious, which is depicted by other movies.

    It is impossible not to compare Inception to The Matrix, and


    Nolan, eyeballs deep in post-modernism, must know this. He
    actually begs us to to make the comparisons— Ariadne
    touching the mirror (which, rather than passing through it, she
    shatters); the tailored clothes (“residual self image”), the
    gravity defying fight scenes; the bullet time explosions. I
    doubt these are gratuitous or even an homage, he’s responding
    to the Matrix using Matrix language, which is ultimately our
    language since we the language of media. And his response—
    the same one in Memento and, The Dark Knight, is that what
    you do, not what you think, defines you.

    The Matrix was a straightforward, though awesome, story of


    narcissism; a single man for whom reality is incidental to ego,
    who defines himself not on what he does (initially, he does
    nothing except hack computers) but who he thinks he is. He is
    the main character in his own movie— maybe not the best, not
    the strongest, but the main one. Everyone else is supporting
    cast. All he needs is the right cluster of magical (think like a 2
    year old) events and the awesomeness that he knows is inside
    him will become real. Note also that everyone is perfectly
    content being the supporting cast. Everything they think or do
    is about and for him.

    Inception is the exact opposite. It doesn’t matter whether you


    think it’s all a dream, or just some of it, or it’s actually
    someone else’s dream, or it’s all real. The main point— and
    Nolan makes it twice— is that you can’t hide from yourself.

    Second main character Fisher could choose to coast, identity


    handed to him by his father— pretend he is who everyone says
    he is— but he wouldn’t have actually done anything himself.
    He would be the person who hasn’t done things, but everyone
    still thinks he has. His only choice is to grow up, find his own
    way, define himself.

    Cobb— a former Architect— can dream anything he wants;


    his wife begs him to stay with him, and many characters admit
    that ten years or a lifetime in a dream is just as good as real—
    “who’s to say?”

    But though Cobb can do that, it’s still no solace because it


    doesn’t work. No matter what world he picks, the guilt follows
    him, the guilt defines him. Cobb can’t pretend to be anyone,
    he can’t hope to become anyone, and not clothes or guns or
    drugs or genetics or hypnosis or even being in someone else’s
    dreams will change who he is.

    It’s almost impossible, in real life, for any of us to understand


    how a single emotion can be so defining; it’s the stuff of
    movies, and we prefer to define ourselves rather than wait for
    events to shape us. Usually, movies try to make that defining
    emotion love, but that fails because it’s idealized love that
    doesn’t take into account that there is someone else on the
    other side who has their own ideas about love. Nolan doesn’t
    go that way— this isn’t a love story. Nolan chooses (twice)
    death. When someone very close to you is abruptly,
    unexpectedly, incorrectly taken from you, everything else is
    contaminated by that.

    The death of a parent is different because it is never


    completely unexpected (unless you’re a child) and it is
    understood to be something to overcome by moving forward.
    Fisher succeeds. But there is no forward when your child or
    your spouse dies. The only way forwards is downwards.

    If you’ve not lost such a person, you wouldn’t know that every
    morning before you open your eyes, you spend a moment
    trying to change reality: I am going to wake up, and
    everything will turn out to have been a dream. Cobb doesn’t
    wait for morning to try this.

    Did the top stop spinning? Probably not— it spins a very long
    time, given that it started well before the camera fixed on it.
    But that’s totally beside the point: the audience was rooting for
    it to stop. We have an instinctive aversion to other people’s
    false realities because they aren’t our realities.

    Cobb doesn’t bother to check the top at the end because it


    doesn’t matter whether he is dreaming or not. No matter what,
    he’s the same person that the same things happened to.
    Nothing else is real.

    ––-
    These are just random thoughts I had about the movie, feel
    free to add or correct them; I’d like to write something better
    about this movie when I have thought about it more.

    Totems are for people to project their ambivalence (e.g. hate)


    about others.
    Magical thinking is the “omnipotence of thought”— that your
    thoughts can alter the world
    Last line of Totem and Taboo: In the beginning was the deed.
    Ariadne = the woman who helped Theseus navigate the
    minotaur’s labyrinth (ball of red thread— follow Saito’s blood
    trail); Ariadne was eventually abandoned by Theseus— left
    sleeping on the beach at Naxos. Didn’t Ariadne and Arthur
    share a kiss, and later wind up on the beach?
    Ariadne’s totem/token was a PAWN; Arthur’s was a loaded
    dice.
    All dreams are always wish-fulfillments.
    Matrix references abound; “you have to dream bigger” (of a
    bigger gun); the fights, defying gravity. Perfectly tailored
    suits, hair— “residual self image?” Signals the dream world?
    Totems, like tattoos (Memento)– physical reminders of reality
    Architect = Revolutions?

    If it’s a dream, who is “watching” the top spinning all by


    itself?

    Suits also call up the old aesthetic that so many post-modern


    films have (Dark City, the Matrix, The Thirteenth Floor, etc.)
    Leads to “Eames” (the forger)— likely Charles Eames, the
    modernist designer and ARCHITECT who also made some
    experimetnal films… like 1969’s “Tops. “Tops are born, they
    live, and then they die.”
    First scene with Mal (= “mal”)— he ties a rope to her chair to
    hold him as he goes out the window, but the chair slips empty
    — she is not his anchor.
    Fisher is the audience, the mark. We/he need to have an idea
    incepted, we need to experience the drama, the dream, and the
    catharsis.
    Each level of the movie was a different kind of film: The
    kidnapping is a thriller, the hotel is a heist, and the
    mountaintop was an action film. Each also had different hues:
    first Saito meeting was red/yellow, kidnapping=blue,
    hotel/heist=brown, mountaintop=white. Think Matrix
    reality=brown, in the Matrix=green

    Were all the totems game pieces? pawn, poker chip, top,
    loaded die. Why?
    This movie can also be seen a a metaphor for movies. Cobb is
    the director, Eames is the actor, Arthur the producer, Ariadne
    is the writer.
    You can tell a dream because you can’t remember how you got
    there; much like scenes in a movie, which either have an
    establishing shot (e.g. a wide shot of a building where the
    scene will take place) but Inception noticeably lacks these
    establishing shots— you’re dropped right into action.
    The top at the end is for us to see if it’s a dream, not for him—
    he doesn’t even wait— but the truth is that he’s in a movie, not
    a dream, so complete is our suspension of disbelief.
    Why is it called Inception? If they’re doing the “opposite” of
    extractions, it should be Insertion.
    Raskolnikov’s guilt was over the murder of a PAWNbroker
    There was a scene after dreaming that he runs to the bathroom
    to check the top, but he is interrupted. From that point on, all
    bets are off as to whether we are still in dreamworld.
    MAl CObb is played by MArion COtillard, who also played
    Edith Piaf in “La Vie En Rose.” Edith Piaf is the singer in the
    song played on headphones to time the wake up (“Je ne
    regrette rien.”)
    The top is Mal’s totem, not his. His totem is his wedding ring.

    A more complete explanation can be found here: The Ultimate


    Explanation Of Inception.
    The Ultimate Explanation Of
    Inception
    July 29, 2010

    the object circled in red is a distraction


    (spoilers; you may want to start with this intro post first.)

    I’ll start at the end: the top will fall.

    Take a moment. How do you feel? You’re probably not


    satisfied, whether you agree or not. There’s no relief to it, no
    “aha!” moment, no catharsis. That’s because the top doesn’t
    matter. You are looking at the wrong thing.

    To explain how this can be known, you have to consider three


    metaphors that Nolan makes explicit.

    A.

    First, the labyrinth:


    Oh, look, a maze. And Ariadne auditions for Cobb by drawing
    mazes, and builds model mazes; and of course her name is
    neck deep in the metaphor of the maze.

    But then nowhere in the movie is there an actual or


    metaphorical maze. Arthur says they need a maze to better
    hide from the projections, but they don’t actually do this,
    right? When Ariadne draws her mazes for Cobb, he rejects the
    square mazes and is satisfied/stumped only by the circular
    classical labyrinth.

    And anyway, mythological Ariadne didn’t construct the


    Minotaur’s labyrinth— Daedalus constructed it for her— she
    merely showed Theseus how to get out of it. But she didn’t
    need to: a classical labyrinth doesn’t have multiple dead ends;
    it is a single winding path that leads either in or out.

    But Theseus, like the audience, upon being shoved inside


    wouldn’t have known the form of the labyrinth— dead ends or
    single path? So to be able to find the Minotaur, he needed to
    know which way to go, and Daedalus told him: downwards is
    the only way forwards.

    B.

    And so it becomes clear: it’s not an actual maze, it’s a


    labyrinth, which brings us to the second metaphor: the
    paradoxical staircase.

    A single path, that ends up back on itself.

    The staircase defies geometry because it is fixed in a single


    perspective. If you alter that perspective, then the illusion is
    revealed.

    Hence, Arthur and Ariadne can walk around and around the
    stairs passing the woman who had dropped her papers; and
    Arthur could sneak up on his attacker by going down the
    stairwell. When the perspective changed, then Ariadne and
    Arthur had to stop walking; then the surprised attacker could
    be pushed off a ledge.

    But each of those times required a choice by Arthur to “see”


    the staircase from another perspective. Seeing it from a
    different perspective changed the reality.

    Cobb’s not trapped in a maze, he’s trapped in a paradoxical


    staircase, covering the same ground over and over. He doesn’t
    need Ariadne to lead him out; he needs her to clue him into
    another perspective.

    II.

    The third metaphor seems to be the wedding ring. When he’s


    in a dream, he wears a ring; when he is in real life there is no
    ring. So easy? Then why did Cobb insist on using the top—
    something that Mal had touched and hence defeats the purpose
    of a totem? Why not just look at his ring? Well, give it a try
    yourself:

    Pay close attention to how difficult it is to see Cobb’s left


    hand. Right hands abound; left hands are hidden in pockets,
    under tables, in shadows. Now that I’ve said it, you’ll be
    astonished at how obviously deliberate it is that DiCaprio is
    hiding his left hand from us— except at certain moments.
    Nolan is actively frustrating your attempts at determining
    whether it’s a dream or not.

    Why so many long gun battles and fight scenes? Can’t they
    just dream of being at the safe or past the bad guys? No. That’s
    how we signify (male) conflict in movies; on the way to
    catharsis, you have to fight.

    All of this is the expression of the third metaphor, which is


    really the theme of the movie: resistance.

    I said I only want to be shot from the right

    III.

    Does Inception remind you of The Matrix? The Matrix


    brothers wanted you to reference Baudrillard’s idea of a
    simulated reality substituting for “real” reality. However, their
    execution was flawed.

    The Matrix is a great movie but a poor expression of


    Baudrillard’s philosophy. The Matrix is quite
    straightforward, there’s no confusion, no paradox: you’re
    either in the Matrix, or you’re in the real world. You may
    not know you’re in the Matrix, but that doesn’t change
    the fact that you are, or are not, in it.
    A true Baudrillard Matrix would be a single fake world
    that became so real that you no longer needed the
    original. The whole world becomes a fake; there is no
    recourse to the real world. You’ll know it happened when
    you look at a copy of something, the original of which
    you have had no actual knowledge, and say, “oh, that’s so
    authentic.”

    The dream does not have an external reference, it is not an


    illusion of reality, but a simulation not based on anything real.
    Cobb is specific about this when teaching dream architecture
    to Ariadne-don’t use memories (which reference reality). What
    becomes real for Cobb and every other dreamer is the
    simulation. The dreamer merges their memory of reality with
    the architect’s imagination into the symbolic. Only death is
    beyond the scope of the simulation— and even that, levels
    deep, was a real possibility. Other than that the simulation
    becomes the reality. Fischer never reconciled with his dad, but
    Eames set him up to dream that he did, and upon waking
    behaves as if he did. He was shown a simulation of a
    reconciliation and merged into it his memories and wishes. Is
    that not real?

    Cobb had the same catharsis. He dreamt— four levels down—


    a catharsis with his wife that never actually happened “in real
    life.” But that doesn’t matter, not for Cobb or his kids.

    What makes the film so perplexing is precisely the ambiguity


    necessary to get across the point about simulation. If the
    narrative clearly identified totems, who was dreaming, and
    how many levels down we were, it would be clear to us the
    audience the difference between simulation and reality. But
    that’s not the point of the narrative, indeed, it tries to frustrate
    that inclination. The point is catharsis.

    IIIb.

    The problem with making the distinction “dream vs. not


    dream” is that it fails to get you off the staircase. It’s
    debatable, but probably likely, that Cobb was on the phone
    with his kids in real life, and dreaming when with Ariadne in
    the cafe. But why should we believe that he’s wanted for his
    wife’s murder? And that a Japanese tycoon can alter a gigantic
    criminal justice bureaucracy with a ten second phone call?
    Why doesn’t he just move his kids out to Paris? It’s more
    plausible that “the police want to get me” is a projection of his
    guilt; I can’t go home...I can’t face my kids… Looked at from
    this perspective, what’s dream and what’s not is irrelevant to
    Cobb. If it matters to you, that’s your own baggage.

    You want to know what’s real? His wife is still dead. That’s
    real, very real, everything else in the world, no matter how
    real, is less real than that. But they had their time together,
    (however brief and incomplete it may have been in real life,
    however sudden and savage and wrong was her death.)

    It’s time to let her go.

    What’s keeping you on the staircase is the fear that getting off
    the staircase means you’ll never see her again.

    IV.

    In the warehouse, Cobb explains that Mal was possessed “by


    the idea that their world wasn’t real.” Adriadne tries to
    comfort him: “you’re not responsible for the idea that killed
    her.” But of course he thinks he was. He implanted that idea
    into her head in their 50 year dream life, she lay on the tracks
    with him so they could die/wake up, but that idea stuck into
    her real life— so she jumped from a building. That event gave
    him his guilt. It is irrelevant whether her jumping happened in
    a dream or in real life— he still carried a guilt around with
    him.

    The top isn’t the totem, and the wedding ring isn’t his totem.
    The totem is his guilt— “this is my fault.” It is his origin. It is
    his inception.
    He incepted himself.

    V.

    Miscellany: many trains, Kyoto, freight train in the street,


    Cobb and Mal’s suicide train, the train underneath the moving
    bridge which Yusuf drives off. Train is a common metaphor
    for thought, one track mind, train of thought, get back on
    track.

    Water: stream of consciousness, put under, sleep deeply.


    Symbol of the unconscious: fear death by water.

    VI.

    If you’re busy looking for what’s dream and what’s not, you’re
    just trapped running the staircase. You need to change the
    perspective.

    Cobb has Fischer hostage in the warehouse; he tosses Eames


    disguised as Browning next to him and says, “you have one
    hour!” (to figure out “the combination” to the safe.) Exactly
    one hour later (yes, I timed it), Fischer and the real Browning
    escape from the submerged van and swim to the shore, where
    Fischer proclaims he will break up the company. Yay, the plan
    worked, inception worked.

    But if that dream time matches our (the audience’s) real time,
    then are we dreaming?

    Inception is also an allegory of filmmaking or narrative


    construction. It’s a movie about it’s own making. It describes
    how the simulation (movie) is constructed and manipulated so
    as to become the reality.

    So change the perspective. Forget about the top, forget about


    the ring, look elsewhere. The children are wearing black shoes
    throughout the movie, until the final scene where they are
    wearing white sneakers.
    But be careful, that doesn’t tell you what’s dream and what’s
    not, it tells you that they have changed. That’s what’s
    important. It may be a dream or it may be real, but they are
    now different— they aren’t a memory.

    Others have observed that in imdb, the children are played by


    two pairs of actors, two years apart. In a movie about narrative
    structure, are we supposed to ignore the structure of that
    movie?

    (“We have to buy out the cabin… and the first class flight
    attendant.” I know just the gal; and I’ll throw in a kid, for
    free.)

    So either he is truly awake at the end and about two years have
    passed since Mal’s death; or he’s still asleep, but has moved
    past staricasing memories and moved into new dreamspace. It
    doesn’t matter to Cobb.

    What matters isn’t whether the top stopped spinning; what


    matters is that Cobb didn’t bother to find out.

    –-

    (special thanks to pastabagel for his perspective)

    http://twitter.com/thelastpsych
    Did BP Fake A Picture? Yes,
    But We Did Even Worse
    July 22, 2010

    what’s wrong with this picture? Answer: half of it is missing

    Did BP fake a pic?

    Yes. Why? Probably to make them look busy. They placed it


    on their press page.

    By now you’ve no doubt seen the original photo. Where did


    you see it? Think hard. I saw the story about the photo being
    detected on Americablog in the Washington Post. Is that where
    I saw the original?
    No.

    Maybe I saw it on AP? Chicago Tribune? LA Times? CBS?


    Nope. They either show you only the altered photo, or no
    photo at all— just the headline, “What Did We Tell You: BP Is
    A Bunch Of Lying Bastards.”

    Where you see the original is on blogs. Americablog detected


    the alteration, and have multiple shots of the original and a
    guide to alterations. Gawker and Gizmodo are writing about
    the alterations, so the originals and details are there. Why do I
    have to go to blogs to get a fuller story than on the Washington
    Post?

    Sure, the news links to the original, but that’s not the same
    thing. If the news media was serious about being serious, they
    would ALWAYS present the altered photo along with the
    original; and NEVER simply as a scary headline.

    But if you do that, then there’s no story.

    There’s no hesitation in showing both an original and the


    alteration when doing so tells the story they want to tell, e.g.:
    (MSNBC) “Plus sized model ‘shocked’ at being made to look
    thinner”

    New York Times:


    In this NYT article, they quote from the apology from editor
    of The Economist:

    I asked for [the alteration] because I wanted readers to


    focus on Mr. Obama, not because I wanted to make him
    look isolated. That wasn’t the point of the story.

    Maybe; but it was certainly the point of the New York Times
    story to show that he wasn’t alone.

    I chose these two examples not because of their power but


    because they both occurred this month. It’s not like there’s
    been any time for standards and practices to change.

    But showing both BP images simultaneously is dangerous. On


    the one hand, it proves there was an alteration; on the other
    hand, it proves the news media is petty. “Are you guys just
    looking for any reason to jump on BP?” Best just to show the
    alteration with a catchy title, and let the mind run with it.

    The major American news outlets aren’t writing a story about


    a picture that was altered, and the context of that alteration,
    and perhaps the cultural/political significance of that alteration
    in an objective manner befitting The Froth Estate. They are
    instead writing a story that panders to the bottom level of
    American tastes, the populist meme of the day, “big business
    is screwing us!” I already knew that; I guess I was hoping the
    press would be better.

    Doing it this way gives the Post plausible deniability. “We


    didn’t lie to you, we just reported the facts. We did our jobs
    admirably.” Yes. You gave us all the tools we need to lie to
    ourselves.

    –-

    http://twitter.com/thelastpsych
    Mel Gibson Audio Tapes: A
    Closer Look At What Was
    Said
    July 26, 2010

    ain’t we a pair, raggedy man

    The purpose is not to criticize either one or to place blame; the


    purpose is to prevent this from happening to you.

    (transcript from Salon.com, with corrections made by me


    listening to the tapes on Radaronline.)

    Tape 1:
    How Do You Lose Weight?
    Which Diet Is The Best?
    August 1, 2010

    There are a lot of studies about diets and even more studies
    about weight loss drugs. So why can’t we decide which is the
    best diet?

    There’s a stack of studies a meter high. “Look,” they say, “the


    evidence is pretty strong that they are all the same.” Really?
    That seems intuitively wrong— shouldn’t some diets be better
    for certain people? And yet, there’s the stack.

    This post won’t tell you which is the best diet. You can go
    back to Oprah.com now.

    This post is about why the studies can’t tell you this.

    I.

    Most clinical trials have high dropout rates. What do you do


    with them?

    1. You could use only the data of people who finish the trial,
    so you can say, “it had a 100% cure rate for the 13 people that
    didn’t explode.”

    2. You could leave the last recorded score intact, and just carry
    it to the end.

    Clinical trials have usually employed #2: LOCF: the last


    observation carried forward.

    Researchers regularly remind us that this type of analysis can


    potentially underestimate the effect of a treatment. If a patient
    drops out because of side effects after one day his score will
    remain “sick”, bringing the overall average down. Perhaps had
    he stayed on the medicine, he may have been cured.

    Example: consider N=2. One person gets cured, the other


    person dropped out on day 1 (no improvement.) So the study
    found that Drug A gets you 50% improvement. Unhelpful.

    II.

    Here is an unrealistic example for the purposes of illustration.


    Take a bunch of 300 lb individuals. I give half a 100 calorie
    diet, and the other half a 5000 calorie diet. Read it again.
    Which will result in more weight loss?

    After one day, most of the 100 calorie diet group drop out—
    “this sucks”— and so their last weight carried forward is 300
    lbs. Average weight loss at the end= 0 lbs. If the 5000 calorie
    people can stick to the donut-ham-hamburger diet and lose
    even a single pound, the study would conclude that the 5000
    calorie diet resulted in more weight loss.

    The study isn’t useless, because it tells you something very


    important: across a population, the 100 calorie diet is going to
    fail— most people like dessert.

    But that doesn’t tell you what to do. This study does not help
    with that decision at all. In fact, it may confuse you because
    now you are confronted with the evidence that the 5000
    calorie diet is better, or at least not worse. Bacon up.
    Studies can be further misapplied when they (read: media)
    overgeneralize the results. Are all obese people obese by the
    same mechanism?

    Point: in an LOCF study, dropouts don’t just minimize the


    importance of the study, they ruin the study if all you are doing
    is looking at the primary outcome. Point 2: you can’t take the
    results of an LOCF study and simply apply it to an individual
    in front of you. You have to consider the contex. “Most of the
    people who dropped out did so because of X. Is this likely for
    my current patient?”

    III.

    Now consider an FDA trial of an appetite suppressant.

    Lorcaserin is a new 5HT2C agonist (think opposite of


    Remeron) that theoretically promotes satiety and/or suppresses
    appetite. What happens when you give it vs. placebo to a
    bunch of 100kg people who are told to exercise and eat 600
    less calories a day, for a year?

    You see that the placebo group lost an average 2.2 kg, which
    was 2% of their baseline body weight, while the lorcaserin
    people lost about 5.8 kg, which is 5.8% of their body weight.
    Is that 3.5 kg difference meaningful? No: according to the
    FDA, you have to beat placebo by 5% or you don’t get FDA
    approval. To the FDA, this failed a primary efficacy measure.

    However, in theory, the drug should work in certain kinds of


    people— maybe those whose obesity is a function of hunger?
    How many people were able to lose significant weight, like
    10kg? Answer: three times more than with dieting alone.

    Is this a drug you’d be willing to try? There is a group of


    people for whom the drug might be awesome— if you could
    predict who those people were.

    The study becomes difficult to interpret because 50% of the


    people dropped out. When did they drop out? Doesn’t say. But
    if 25% of them had dropped out by the fourth month (4kg or
    less weight loss)— let alone earlier— the rest of the people
    would have had to have lost about 7kg in order to generate an
    overall average of 5.8kg of loss— and those guys would have
    met the required 5% superiority required by the FDA.

    I’m not saying that happened (or didn’t happen.) I’m saying
    that for the purposes of practicing medicine, you cannot say
    “studies show this drug works/fails” without an understanding
    of why it worked/failed.
    IV.

    Now take the Atkins diet: is it better than conventional “low


    fat” diets? Let’s ask the gated community socialists at the New
    England Journal of Mendacity:

    (from N Engl J Med 2003; 348:2082-2090)

    You can see that at 6 months, the Atkins diet people lost more
    weight.

    But, it’s LOCF: by month 3, 30% of the conventional diet


    people bailed, vs. only 15% of the Atkins. If you assume that
    very little weight loss went on in the first three months, then
    the weights for the conventional diet will appear heavier than
    they could have been, dragged “up” by the dropouts who lost
    no weight because they didn’t stick to it.

    We won’t know what could have happened if all of those


    conventional dieters stuck to the plan. This isn’t to say Atkins
    didn’t work; it is to say that it may not have been better.

    Analyze the data a different way. Instead of using the morally


    weak quitter’s last score to carry forward, the authors reverted
    to their baseline score (e.g. no weight loss), no matter how
    much weight they had lost in their brief time in the study.

    If you take the curve using this analysis (B above) and


    compare to the LOCF (A below), then there are three
    possibilities:

    If they initially lost a lot of weight, then this analysis would


    “artificially” worsen the curve (i.e. make it appear like there
    was no weight loss.) A curve would be higher than B curve.

    If they had magically gained weight before dropping out, then


    this analysis would hide that fact and the B curve would
    appear lower.

    If my assumption is correct— that they didn’t lose much


    weight in those early months, then the curves should be the
    same.

    Note that for the conventional diet, the curves are almost the
    same: they didn’t lose much weight, and they dropped out.
    The effect at month 6, therefore, is to make the overall weight
    loss of the conventional group appear less.

    In other words, conventional diets may not be as good; or they


    may better. The same can be said about Atkins, which is to
    say, nothing can be said at all.

    The point here is about the studies showing Atkins is superior:


    they really mean only that more people stick to it.

    V.

    Now to the meat of the issue. What about all the studies that
    show that the diets are the same? Surely those aren’t flawed?
    Let’s find out if the percentage of fats, carbs, and protein
    matter for weight loss. Let’s pull a major study from the stack,
    something from the NEJM:

    800 people put on various diets: high/low protein, high/low


    fat, and a range of carbs, e.g.,

    20% fat, 15% protein, 65% carb


    20% fat, 25% protein, 55% carb
    40% fat, 15% protein, 45% carb
    40% fat, 25% protein, 35% carb

    Check back at the midterm elections. Which was the best?


    From the Discussion:

    Discussion
    In this population-based trial, participants were assigned
    to and taught about diets that emphasized different
    contents of carbohydrates, fat, and protein and were given
    reinforcement for 2 years through group and individual
    sessions. The principal finding is that the diets were
    equally successful in promoting clinically meaningful
    weight loss and the maintenance of weight loss over the
    course of 2 years. Satiety, hunger, satisfaction with the
    diet, and attendance at group sessions were similar for all
    diets.

    Or, from the abstract:


    All diets resulted in the same weight loss! This proves it! Oh,
    wait, this was published in NEJM, where peer review= spell
    check. Better look more closely.

    Though patients were told to eat a high fat (40%) vs. low fat
    (20%) diet, using a fixed protein amount, here’s what they
    actually ate:

    That difference of 20% has been reduced to a difference of


    7%, i.e. what should have been a difference of 33g of fat is
    now a difference of 11g.

    What about high (25%) vs. low (15%) protein diets?


    That 15% vs. 25% difference in average vs. high protein diets
    has been reduced to no difference whatsoever. In fact, these
    people all managed to eat 20% protein no matter what diet
    they were supposed to be on.

    So this study did not test various diets against one another; it
    tested essentially the same diet four times. And it found that
    pretending to be on a high/low protein/fat diet has very little
    effect on the outcome, which if written that way would never
    made it into Children’s Highlights, let alone NEJM.

    Strangely, that’s not the finding reported in the media— or


    even by the lead author himself:
    How could it matter if it wasn’t actually different?

    VI.

    So what do these studies stacked a meter tall tell us? That


    lorcaserin doesn’t work (except when it does work
    awesomely); conventional diets suck (except in those who
    stick to them); Atkins diets may work or suck, and most
    people give up after Labor Day anyway, just in time for the
    season premiere of The Bachelorette. (FYI: She’s on Pinot and
    apples diet.)

    If you were hoping the effect size or p values were going to


    guide you would have been lead astray. Those p values aren’t
    telling you anything useful, they are at best confusing and at
    worst misleading. A glance at the methodology has more
    practical value than the little asterisk above a score at month 6.

    Look at that stack of studies a meter high. I’ve just fed them to
    a goat. Tasty. Can you use them to say whether you should
    take lorcaserin? Whether Atkins was better than conventional
    diet? Can you use them to guide your decision about whether
    you should eat more bacon or more ice cream? Nope. And
    they will never be able to, because the purpose of these studies
    is not to determine the answer, the purpose of these studies is
    to be published, truth be damned.

    So I’m sticking to bacon. And getting my sugar from you


    know what.

    –-

    http://twitter.com/thelastpsych
    This Is Why The American
    Dream Is Out Of Reach
    August 2, 2010

    That’s 90% of the answer right there

    Scott, a 24 year old dean’s list college grad, is smart but


    unemployed. According to the New York Times, in five
    months, only one job has given him an offer: $40k as an
    insurance claims adjuster.

    Scott said no, because

    Rather than waste early years in dead-end work, he


    reasoned, he would hold out for a corporate position that
    would draw on his college training and put him, as he
    sees it, on the bottom rungs of a career ladder.

    Now, the easy way to go here would be to call Scott an idiot


    for giving up a $40k/yr job in the midst of a recession.
    However, a) the recession ended last year; b) 1487 NYT
    commenters did the heavy lifting. No, I’m going this way:

    “The conversation I’m going to have with my parents


    now that I’ve turned down this job is more of a concern
    to me than turning down the job,” he said.
    He was braced for the conversation with his father in
    particular. While Scott Nicholson viewed the Hanover job
    as likely to stunt his career, David Nicholson, 57,
    accustomed to better times and easier mobility, viewed it
    as an opportunity.

    A long time ago, before psychiatry and rum, I seriously


    considered a job in intelligence. Among other things I had
    some Russian, and I knew another guy who was fluent in
    Russian and was actively being recruited by the CIA. He
    decided not to do it because… his Dad wouldn’t let him. At
    that time it struck me as curious that you’d be more worried
    about your dad than the Russians, but I have since understood:
    we were living in a time where there was no right and wrong,
    no objective truths, all things were relative except the
    inviolable Law of Growing Up American: go to college, then
    get a job. Your dad’s sole purpose was to make sure you
    followed that rule. If you raped a murder victim then your Dad
    would get you a good lawyer, but if you showed any proclivity
    towards anything other than a future 9 to 5 in a field he
    understood, it was your ass.

    I’ll grant you up front that Scott probably suffers from a


    mixture of ennui and myopia and absolutely no chance of
    STDs, who apparently feels neither shame in nor fear about
    sabotaging his job prospects by appearing in these
    photographs, to the fury of every other American who sees
    them:
    This is a guy whose entire job search is conducted online in
    the mornings. Anybody want to hire this go-getter?

    But for me, you have to start at what’s known to be a fact: this
    is the New York Times.
    You almost have to wonder why they would photograph him
    in this way if they weren’t trying to sabotage him, trying to
    make him look like a privileged (white) out of touch jerk, just
    to bring out the populist backlinks. This is the NYT after all,
    where playing to the lowest common populist denominator is
    the next best thing to running a Page 3 Girls. “Do you mind
    pouring a Gatorade? We’re trying to show how the millennials
    won’t let their unemployment stand in the way of their thirst.
    Sigh, iced tea will do.”

    So I’ll grant you that Scott is responsible for his own plight in
    the way that everyone carries the burden of their own choices,
    but Scott wasn’t born in a vacuum, he was born to parents,
    parents who think this:

    “I view what is happening to Scott with dismay,” said the


    grandfather, who has concluded, in part from reading The
    Economist, that Europe has surpassed America in offering
    opportunity for an ambitious young man.
    Huh? He read The Economist, or an economist? There is
    absolutely no way that anyone who reads The Economist can
    have concluded that Europe has surpassed America in
    anything not involving riots, in the way that no one who reads
    Maxim can conclude that acne is in vogue. Unless he meant
    China, but that’s not in Europe yet, is it?

    II.

    “I am beginning to realize that refusal [to take the


    insurance job] is going to have repercussions,” [Scott]
    said. “My parents are subtly pointing out that beyond
    room and board, they are also paying other expenses for
    me, like my cellphone charges and the premiums on a life
    insurance policy.”

    Shoot/fish/barrel that Scott’s a retread, but in his defense he


    doesn’t think about life insurance policies because he was
    never taught to think about life insurance policies. That was
    going to be taken care of by the “salary plus bennies”
    pornography he was raised on since kindergarten. For him to
    now learn that a life insurance policy could also be an
    investment would be like slapping him with some tranny porn
    and yelling, “this is how it’s done in the real world!”

    Not unusually, his parents themselves did not follow Scott’s


    path: his grandfather came out of the war and went to work for
    his father-in-law who had started a brokerage; and his Dad
    went to work with a friend who had just opened a factory.
    These men were right at the start of businesses, they didn’t
    slide into middle management at Sterility Corp. But after
    taking those chances that ultimately resulted in prosperity and
    blah blah blah, they taught their children to do the opposite:
    look for new parents. Someone else to pay the life insurance
    policy. I submit to you that any guy who doesn’t know his life
    insurance premium is exactly the same guy you complained
    had a fear of commitment and never grew up. Well, now you
    know why; his parents told him not to bother.

    “Scott has got to find somebody who knows someone,”


    the grandfather said, “someone who can get him to the
    head of the line.”

    Is this Russia? This is diabolically terrible advice, it betrays a


    paranoid, cynical vision of reality where everything is a
    network, exclusionary, no one is desirable for their talent and
    the only thing that prevents supersuccess is not being in the
    right clubs or friendly with the right people. I get that those
    things give you an advantage, of course, but does not having
    them mean a career in holes?

    The parents and grandparents, like so many parents today, are


    disappointed in the boy because he’s not taking their advice,
    but in fact he is taking their advice all the way to its
    conclusion: he’s holding out for the perfect corporate job.
    What they meant to advise him was to improvise towards a
    career like hopping a creek; but what they taught him to do
    was wait for the package.

    BTW, for any women still reading this after three porn jokes:
    that’s exactly what he’s waiting for in a relationship. You’re
    welcome. Paypal is at the bottom.

    III.

    “They are better educated than previous generations and


    they were raised by baby boomers who lavished a lot of
    attention on their children,” said Andrew Kohut [the
    director of the Pew Research Center.]

    WRONGALONGADINGDONG. They’re not better educated,


    they just have more degrees. Were you smarter at 21 post
    college than your Dad was at 21? And whatever the difference,
    was it worth the $50k-$200k he paid to get you it? No, but
    every parent of a high school kid I’ve talked to about this says
    the same thing: “I know, I know, but I just want her to get that
    piece of paper.” So work this out in your head: either this
    parent is a solitary genius who is the sole possessor of the
    knowledge that the college degree is merely a brand and not a
    mark of knowledge; or every employer in the world already
    knows this. So if we all agree the degree doesn’t mean
    anything close to what we are pretending it means, then what’s
    the point of piling on? Isn’t this technically a Ponzi scheme?

    There is no arguing with such parents, they’re not going to


    sacrifice their kid’s future by calling America’s bluff, sure, I
    get it. I am sympathetic. But these are parents who never
    thought it was wrong to force their kid into violin lessons
    because it would help them get into college. Did it work? Of
    course it worked, but at what cost?

    Two generations of parents have knowingly fed the Ponzi


    scheme while simultaneously crushing their kids’ spirit.
    IV.

    Where Scott is going wrong is not that he is holding out for a


    “better” job that isn’t there; he’s holding out for a job that
    shouldn’t be there. We don’t need more corporate management
    guys. The 1980s business schools created a market for those
    ideas (and graduates) and America quickly became a
    “management” country, at the expense of everything else.
    What we need are more businesses.

    Scott and his friends at the Irish Pub are in the best position
    imaginable: young, smart, living debt free with their parents.
    Four of these guys, each borrowing 10k personally (at 4% —
    $400 a year to pursue your dreams?) they will have 40k startup
    capital to do anything they want. If they’re really serious, they
    could indeed do anything, from putting out a comic book to
    starting a high end tutoring/home schooling service (pays the
    bills at the Washington Post!) to integrating Flash with the
    iPad to inventing something to whatever etc, etc, what, you
    need me to hand you ideas as well? If they are serious, they
    cannot fail, and if they do fail, we have the most liberal
    bankruptcy laws on the planet. The point of those laws is to
    encourage you to try. All the pieces are in place for success at
    almost no risk. And he’ll be a better man just for trying.

    However, what Scott is doing— and what his grandfather is


    horrifyingly encouraging him to do— is pursue these kind of
    dead end management jobs in another country. If we don’t
    need that crap here, why would they need it in Europe?

    The problem with Scott and his generation— and this is most
    decidedly not Scott’s fault but is the fault of his dad and
    grandfather’s generations— is that Scott just can’t imagine
    playing without a net. “No, I’ll just wait here, thank you, got
    myself an iced tea.” This is what happens when you go
    through four years of college and don’t at least read On The
    Road, let alone try it. “Start a business? From nothing? I don’t
    know…” For him, debt should only be for a house, a school,
    and Polo shirts.
    Here’s a little factoid about the medical school I work for: very
    few graduates go into hang-a-shingle private practice. They go
    to work for hospitals, clinics, etc— established places where
    they get a salary plus benefits. Even psychiatry grads— no
    overhead, see people out of your house— run to group
    practices.

    Here’s why: never in med school or residency we were taught


    how to start a practice or the business side of medicine. So we
    defaulted to what we’ve been taught in the first few decades of
    life: get a good job working for someone else. “I don’t want to
    deal with all that billing.” Of course you don’t.

    No one told them how to open an office, hire three therapists


    and three NPs, bill insurances. But you know who owns all the
    private psych group practices? Foreign medical graduates, i.e.
    people who were comfortable “playing without a net,”
    improvising, seizing opportunity. (Sigh. Now I sound like my
    own father.)

    V.

    “Well, we can’t all become entrepreneurs. What about all those


    guys in college who are smart, hard working, but are better
    suited to working for someone else?” Then go do it! If you
    need a job and they’re offering, take it! But if they’re not
    offering a job, what are you going to do instead? XBox?

    I’m not here offering a solution for the 45 year old guy with
    three kids. I am offering encouragement to a crop of college
    kids infantilized by terrible advice from parents and TV who
    have the freedom and opportunity to try something; while
    simultaneously describing the only long term solution to
    America’s economic problems: more businesses. Jobs
    programs and stimulus packages are debatably good or bad,
    but assuredly temporary. Remember “the children are or
    future?” How about encouraging them a little? Maybe
    someday they’ll pay for your social security.

    –
    http://twitter.com/thelastpsych
    No One Likes A Sure Thing
    August 9, 2010

    Parkinson’s patients had their dopamine agonists (Sinemet)


    stopped, and were then told that they would be assigned to one
    of 4 groups:

    You have been randomly assigned, like pulling numbers


    out of a hat, to Group A. As you read in the consent form,
    this means that you have a 25% chance, or 1 in 4 chance,
    of receiving active Sinemet… We took one real Sinemet
    pill and three placebos and shook them up and withdrew
    one. This is what we are giving you.

    Group B was 50%, C was 75%, and D was 100% chance of


    getting Sinemet.

    In reality, everyone got placebo; all that was different was the
    patient’s expectation of receiving Sinemet.
    Those who were told they had a 75% chance of getting
    Sinemet exhibited a maximal (placebo) response. It was the
    same amount of clinical improvement, and the same amount of
    actual dopamine release, as they exhibited back when they
    were still taking their meds.

    This is actual dopamine release (as measured by the decline of


    a tracer):

    and this is clinical improvement:


    Interpret this as “less than 50% chance of getting Sinemet
    meant very little response; more than 50% meant more
    response.”

    Perhaps they had a placebo response to the symptoms (“hey, I


    feel better”) which then caused a subsequent release of
    dopamine, especially in the nucleus accumbens which is the
    “reward center”? No: dopamine release was entirely dependent
    on the expectation of the medication.

    Think about the words. When you are told it’s a 50% chance
    of it being Sinemet, you are checking with your body to see if
    it is Sinemet. When you are told it is 75% chance, you are
    expecting it to be Sinemet. 50% marks a turning point between
    skepticism and expectation.

    Now think of the placebo effect in most other scenarios, e.g.


    clinical trials: “you’re going to get drug or placebo.” Imagine,
    instead, that they told you, “there’s a 75% probability of
    receiving placebo.”

    II.

    So what would happen if you were told that there was a 100%
    chance of receiving Sinemet, i.e. you were lied to?
    Why would 100% certainty result in less dopamine release,
    and less clinical improvement, than 75%?

    Because the placebo response is not simply the body


    reproducing the effect of the real drug. The placebo response
    is a reward; and if there is no reward, there is no response.

    It doesn’t matter what kind of placebo response you want—


    pain/endorphin release may not seem dopamine related, but
    the results would probably be identical. It appears that all
    placebo responses are substantially mediated by the reward
    circuits. These are unconscious and immediate. Expecting a
    response is the same as expecting a cookie, the same pathways
    are used; and, conceivably, they can be destroyed in the same
    way.

    A more scientific explanation is that the tonic, sustained


    increases in dopaminergic activity preceding the presentation
    of a reward are related to the level of uncertainty. 50%
    probability of reward represents maximal uncertainty, and
    hence maximum dopaminergic activity. (“Is it going to
    happen?”) It declines like an inverted U from there (“I’m more
    sure it is/is not going to happen”) to zero when you are
    completely sure.

    Another way to say it is: the more that you are unconsciously
    making a reward prediction (nucleus accumbens), the greater
    the effect; but certainty bypasses this, leaving no reward
    contribution to the final clinical effect. In that case, it’s all up
    to the pill.

    III.

    Feel free to extrapolate.


    Narcissism Run Rampant
    August 11, 2010

    we’ll have the sex so you don’t have to

    Is narcissism on the rise in college kids?

    According to Prof. Jean Twenge at San Diego State, it is; to Prof.


    Chris Ferguson in The Chronicle of Higher Education, it is not:

    The evidence just isn’t there for an epidemic of narcissism or


    anything else. Social scientists would do well to exercise a
    degree of caution when interpreting data. Just like with the little
    boy who cries wolf, people are bound to notice too many
    phantom epidemics. The price to be paid is the credibility of
    social science itself.

    At the core is the study by Twnege finding that college kids are
    becoming more narcissistic over the years.
    The Chronicle disagrees, taking the perspective that data is
    conflicting, and anyway “epidemics” and “crises” are often fads of
    the social sciences.

    So Twenge says it’s on the rise in college kids and Ferguson says it’s
    not. My question is, who cares? Seriously, so what? I admit it’s
    annoying though enlightening to be in a bar near them, but
    otherwise, does it matter? The problem isn’t the college kids, the
    problem is the adults.

    II.

    Take a developmental perspective.

    If you follow that narcissism is more appropriate in adolescence than


    in middle age, then it may just be that adolescence has been
    extended into your late 20s, i.e. that we really should be comparing
    the narcissism of college kids in 2010 to the narcissism of 10th
    grades in the 80s. This isn’t a slander/libel, it’s to put the social
    context out front. If you adults— media, parents, givernment,
    colleges, banks— created a society that promotes lingering
    adolescences, you can hardly blame college kids for lingering.
    Right? When Vanderbilt University spent $150M to create a walled
    garden for their freshman nymphs and satyrs, did you expect them to
    instead join the Marine Corps? If I went to Vanderbilt now, you
    know what would happen? I’d be pregnant. Yeah. Figure that one
    out.
    you want us to grow up… why?

    I don’t want kids to be narcissists, of course, but I simply don’t


    know if what Twenge detected is pathological narcissism, a
    relatively stable trait over time, or developmentally appropriate
    though tremendously expensive adolescent narcissism.

    It is completely useless to talk about the narcissism of kids without


    first yelling about why they have whatever level of narcissism they
    do have: adults. You made them this way. Honestly, I doubt if you
    (an individual parent) could have done anything differently, the
    entire structure was built for that purpose— kids have disposable
    income so let’s build a giant marketing network around that, along
    with TV and movies and people you want to be like, and probably
    adults will want to be part of the youth crowd because being an adult
    blows so you know what to do for them: create a show called
    Friends, then replace with Sex and The City, then Cashmere Mafia,
    which are all the same show but less funny but either way they will
    buy shoes.

    “They’re going to have to grow up eventually!” First, I hear


    contempt in your voice, like you can’t wait till they have to suffer.
    That’s narcissism. Get that out of you, why should you be happy that
    they’re going to suffer? Do you see how you take their lives and
    reduce it to how it impacts yours? Fix that, forget about them. It’s a
    miserable way to live, your own successes will never be enough to
    make you happy. Ask Mel Gibson.
    But here’s an alternative response: really? do they have to grow up?
    Haven’t you constructed a society where you can credit your way to
    a simulacra of branded prosperity for the next few decades?
    Healthcare, social security, unemployment and extremely cheap
    food? I know, I heard it to, the Dutch have it better in Sweden.

    What we should be asking is not how the kids got this way, but how
    the 50 year olds got this way. It’s the same answer.

    III.

    One thing you should know about the study done by Twenge: it uses
    the NPI as a measure. The Narcissistic Personality Inventory is a
    valid and reliable measure of the kind of narcissism a layman thinks
    of when he thinks of narcissism: someone on The Bachelor.
    Extraverted, grandiose, vain, overconfident, exhibitionistic.

    Here’s the guy the NPI does not detect. Nor the guy who kills his
    family, nor the suffering 40 year old man who can’t seem to get a
    date despite how much time he spends learning how women think
    and what tricks to use.

    IV.

    If you’re on a desert island and you’re a narcissist, it doesn’t matter.


    It only matters as it affects other people.

    Were a narcissism epidemic truly striking the United States, we


    ought to be seeing signs of it, but we’re not. Violence among
    young people is at the lowest levels since the late 1960s. Rates
    of teen pregnancy, substance abuse, smoking, and dropping out
    of high school are all down as well.. more high-school students
    are taking difficult courses like calculus and advanced
    science… achievement in reading and math among
    schoolchildren has either remained stable or improved in recent
    years (and that is on standardized exams, so grade inflation is
    not the issue). And, as far as selfishness goes, evidence
    suggests that young people are engaged in community service
    and other civic activities more than before.

    So what does that tell you? If violence and teen pregnancy and all
    that is a mark of narcissism, and theses kids have lower rates than
    previous generations, what does that tell you about the previous
    generations?

    The Chronicle of Higher Education.

    Do you see?

    http://twitter.com/thelastpsych

    Short post on Twenge’s study


    Why The Latest Season Of
    Mad Men Blows
    August 13, 2010

    Dr. Faye Miller, a marketing psychologist who specializes in


    figuring out the consumer’s hidden motivations, is offering her
    sympathy to Don Draper for his divorce. “Don’t worry, she
    says, “you’ll be married in a year.” “What?” he says. “Oh, I’m
    sorry,” she replies, “no one likes to think they’re a type.”

    I tried to switch the channel to A Serbian Film but it hadn’t


    come out yet. I’ll accept that Don Draper is a type, but when
    did he become a caricature of a type? End of Season 3?

    Gone are the subtle distinctions between a womanizing bastard


    who seduces everyone and the womanizing bastard who
    seduces everyone except certain women because you
    shouldn’t. Gone are any subtleties whatsoever, this is a CBS
    spinoff about good guys vs. bad guys. (Spoiler: the bad guys
    are wearing ties.)

    Here’s a race example: In Season 1 there was was a scene in


    which young Pete Campbell is trying to get some insight into
    the African American market by asking the elevator operator a
    few “innocuous” questions, but the operator ain’t going out
    like that. He knows that any conversation with a white
    executive can go all kinds of sideways, and he has to trickily
    be respectful while not saying a damn thing. It’s a great scene,
    discussed from many perspectives all over the internet.

    Here’s the Season 4 approach to this: four white guys are


    sitting at a Christmas party, and one says, “if they pass civil
    rights, it’ll be a slippery slope.” That’s all he says. Get it?
    White male privilege. Never mind that the phrase “slippery
    slope” wasn’t in popular rotation in the sixties— it’s only there
    to call to mind its use by the cast of Fox News and The
    Supreme Court who cry “slippery slope” at every progressive
    agenda. Got it.

    It only gets better, i.e. worse. Here is another guy’s immediate


    response to that comment: “If they pass Medicare, they won’t
    stop until they ban personal property.” Because white men are
    too dumb to embrace Medicare. Ok. But how is that a response
    to the civil rights comment? Who has conversations like that?
    Not even the Fox News improv troupe talk in disconnected
    non-sequitors. “Michael Jordan was the best ever.” “I punch
    animals.” “My eyes smell like barbecue!”

    And I’ll wager a bottle of rum on this: the writers must have
    thought they were pretty clever when they wrote the Medicare
    line to be delivered by guy who played the Chief of Staff on
    ER.
    Ooooohhh. I get it. It’s post-modern, or something.

    White people hating on white people, and its derivatives. An


    old story, frequently played out on NPR, NYT, or wherever
    this photo is considered interesting:

    I’ll help you with the context: the brown stuff at the bottom is
    Saudi Arabia and the black thing in the middle is Maureen
    Dowd. No, I’m not kidding. Yes, she is great.

    Whites hating whites doesn’t mean they like blacks, of course,


    or Arabs or anyone else. It’s all about the hate, that’s what
    drives people, not a love of the oppressed but hatred of
    “oppressors.” If that generates the same outcome I guess it’s a
    viable social policy, but it’s hard for me to buy into what leads
    to cognitive dissonance, as with poor Maureen Dowd: she
    hates America for what we do to them but hates them for what
    they do to women. After a night at the Ritz Carlton the
    solution she comes up with is to agree to the abaya but wear a
    snorkel at the same time. That’ll show ‘em.
    II.

    The often cited draw of Mad Men was its authenticity (uh oh),
    including character authenticity. The elevator scene shows that
    Campbell can be ignorant but not malicious— he thinks he’s
    just getting information, but is reinforcing the social disparity
    between them. What Campbell asked that elevator operator is
    on the order of, “hey, what’s up with you people and chicken?
    How can I get you to buy more of it?” which is simultaneously
    a societal prejudice and a personal observation. That’s what
    makes the scene interesting. Quoting Dave Chappelle: “all this
    time I thought I liked chicken because it was delicious, turns
    out I was genetically predisposed to liking it.”

    Campbell wasn’t being purposely demeaning, he was being


    Campbell, he didn’t understand that merely bringing up the
    question is an act of aggression. That’s “show don’t tell”
    writing.

    What would have made it very racist (and unbelievable) was if


    he pretended not to be aware of societal prejudices: “so, tell
    me… I love chicken… what do you think of chicken…?”

    This is where Mad Men is failing. I know racism and sexism


    are bad, I know they existed, I don’t need this show to tell me
    that. But was every white guy who didn’t vote for Kennedy a
    gigantic POS? I want you to figure out how to show me how a
    man in the 1960s can simultaneously be a good person yet still
    think women are inferior; how he can be a womanizing pig
    who still respects women enough to give one the coveted
    office. In other words, I want the character depth of Season 1,
    not an off-Broadway rendition of The Huffington Post.

    III.
    The examples are endless: the (parody of the) egotistical client
    who makes demeans the advertisers on purpose, because he
    can. Do you think he gets inappropriate with one of the
    oblivious wives who thinks he’s funny/charming/handsome,
    while the husband stares on helplessly? True/False: is
    cuckolding implied? Yay obvious.

    Or the fall down drunk Don Draper who has sex with his
    wide-eyed secretary who is just so thrilled to be with this
    sloppy mess, and so surprised that he would dismiss her the
    next day. “He was too drunk to see the couch and he didn’t
    even pull his pants down, but he did manage to ejaculate
    before he even got hard, so I’m ordering dinnerware.” Hint:
    this means men are pigs.

    The problem with the current season’s approach to the


    characters is it’s using them to describe the era, not using the
    era to describe the characters. I know what happened in the
    1960s, I don’t know what happened to Peggy. Tell me that.
    Season 1 Peggy was exploited and exploiting, I couldn’t tell if
    I wanted to strangle her or Campbell and so I was hooked—
    what kind of a woman is this? According to Season 4, she’s a
    budding superhero. Are you telling me they had superheros in
    the 1960s?
    The writers of Mad Men owe their responsibility to the
    characters, that’s why people watch the show. When you pass
    on this responsibility in order to tackle social issues, then you
    better have something new to say about them, otherwise why
    do we care? If I want a 3rd grade approach to gender equality,
    I have Eat Pray Love.

    http://twitter.com/thelastpsych
    The Worst Thing That Can
    Happen Is You Succeed
    August 16, 2010

    a market research firm that should have done a bit more


    market research

    DO YOU REALLY BLAME SCOTT’S PARENTS FOR HIS


    INABILITY TO FIND A GREAT JOB AND HIS
    AMBIVALENCE TOWARDS THE ONE IN FRONT OF
    HIM?

    No, just for the second. Ambivalence is learned.

    WELL, WHO DO YOU BLAME FOR THE FIRST? THE


    MEDIA? THE GIVERNMENT?

    They’re all working together: overpromise, underdeliver, and


    apologize with aspirational goods. “Here’s the lease for your
    new Honda. Why don’t you drive it to college? For only $20k
    a year you can pretend you’re employable.”

    The media designs the fantasy. They show you the cars and the
    clothes and the life, and your parents— misty about their
    unfulfilled dreams but thankful they can put food on the table,
    fill in the blanks: “to get that, you need to go to school.”

    I TRIED TO DO IT ON MY OWN. BUT IT’S NOT SO


    SIMPLE AS “JUST DO IT.” WHAT I NEED IS ONE GOOD
    BREAK. ALL I NEED IS AN OPPORTUNITY, THEN–

    I frequently get requests: “I love your blog, do you ever accept


    submissions?”

    I’m sure these people are creative and hardworking. So what


    do they need me for?

    Working for someone else means the payoff is visible.


    There’s some lack of confidence in their own work, but a
    complete absence of confidence in the market’s ability to
    realistically value it. That’s what happens when bad
    output is routinely subsidized for political ends: people
    will think it’s all rigged. So they want an expert to
    appraise their output. Immediate validation. No
    uncertainty, e.g. “am I really a writer?” If Random House
    says you are, then you are.

    They’re willing to work hard for someone else, while toying


    with their own dreams at internet cafes. (“Hey, should I open
    an internet cafe?”)

    Resistance:

    resistance in a dream is symbolized by being frozen or


    stuck;
    resistance in dating is manifested as obsessive
    strategizing, running scenarios, going over your audition;
    resistance in pursuit of a life goal is created with endless
    schooling, ADHD/caffeine/marijuana, and “I just need to
    tighten a few things up…”
    All of those are the same: “I’ll do whatever it takes not to
    move towards success, because then I will never have failed.”

    SO IT’S FEAR OF FAILING AT YOUR ATTAINING YOUR


    GOAL?

    Oh, no, this is America, no one fails in America, it’s always


    the fault of circumstance. No, it’s not fear of attaining success;
    it’s fear of sustaining it. “Oh God, how long before they figure
    out I’m faking it?” That’s the American horror movie.

    You know how in the horror movie the killer is chasing the
    girl, and she trips or the car won’t start? That’s resistance: “I
    need to be punished for the earlier use of my pleasure centers
    — because if I get away with it, what kind of a person am I?”

    And the boyfriend wants to save her, but the door won’t open
    or he can’t get to her in time, so he has to watch her be killed.
    That’s resistance: “If I manage to bust in there, what am I
    supposed to do then?”

    If you become President, will you know what to do? If you get
    that part in a movie, will you actually be able to act? If you
    manage to pick up the ultrahottie at the bar, will you be able to
    not blow it and/or your load on the car ride home? “We can
    watch a couple Michael Cera movies, he’s wicked. I love your
    shoes. You already have herpes, right?”

    Working for someone else creates a buffer: they guided me


    through the first success, they’ll guide me through the next
    one. That’s what fathers are for, after all.

    A DEFICIENCY OF SELF-CONFIDENCE?

    How do you explain how this generation is (supposedly) the


    most attended to, protected, educated, well fed, anti-bullied,
    antibacterial, sunblocked generation in history, yet they lack
    self-confidence to make even easy choices like whether to chat
    up the brunette at the other table in the internet cafe who is
    equally terrified of what she’s capable of? Or did you think
    those were separate things?

    WHAT ABOUT WOMEN?

    I went back to that New York Times story about Scott and his
    crazy corporate fantasies, and I replaced “Scott” with “Anne.”
    You know what happened? The article became a parody. Yup.
    Check The Onion.

    Would Anne just sit around the house waiting for the “perfect”
    job? Would the father and grandfather be so anxious about her
    future career? Would her grandfather recommend she move to
    Europe? Would she be allowed/allow herself to be
    photographed drinking iced tea?

    Imagine if Anne had said this:

    I am beginning to realize that refusal is going to have


    repercussions… My parents are subtly pointing out that
    beyond room and board, they are also paying other
    expenses for me, like my cellphone charges and the
    premiums on a life insurance policy.

    Which term/s would the 1487 NYT commentors use most


    often:

    1. slut
    2. pig
    3. cunt
    4. bitch
    5. savvy go-getter
    6. airhead
    7. casualty of outsourcing and illegal immigration
    8. bimbo
    There are other obstacles for women, but they do have an
    advantage in navigating the traditional path of college to job or
    grad school because they were historically told NOT to pursue
    that path, so they don’t seem to take it for granted (though I
    expect that to change in another generation.) And they do not
    have Scott’s luxury of unlimited time. Nothing trumps
    ambivalence like a looming deadline.

    Of course, that just messes things up for Scott. Why would


    Scott take a job for $40k when his girlfriend, who worked just
    a bit harder in school, has one for $50k? “Well, because 40k+
    50k = 90k.” No, 50k+40k = 90k. 40k+50k=0; they’re
    eventually going to break up.

    YOU’RE SUCH A SEXIST PIG.

    Sigh, maybe, whatever. Interesting, however, that you assumed


    he was breaking up with her. Ha! Personal prejudice ZING!

    Here’s a little secret. No woman wants to be with the kind of


    guy who can’t accept a woman who is smarter or who makes
    more money than him; but no woman wants a guy who is too
    comfortable with that, either. Oh look, another guy in the
    passenger seat of his girlfriend’s Honda. Betcha he controls
    the radio. I know, I know, it’s temporary, someday he’ll be
    buying his girl anything she wants. Too bad that if that day
    ever comes, it’ll be a different girl.

    CAN YOU REALLY BLAME PARENTS FOR PUSHING


    THEIR KIDS INTO THE SAFETY OF COLLEGE AND
    JOBS?

    Of course not, I don’t know any father that wouldn’t advise his
    kid to take the job— any job.

    He is afraid of you going out on your own because he is


    worried about failure, of course; and he has a looming
    deadline of his own. “If I die, what is going to happen to this
    kid?” That’s what all non-opiate dependent parents are
    thinking, all the time, at dinner, on the toilet, during
    masturbation, all the time. Sometimes parents even have
    recurrent dreams in which they die and beg God for two more
    hours back on Earth so they can bury a box of money in the
    back yard and leave a coded map, only to wake up and realize
    they live in an apartment.

    WHAT?

    Absinthe. Part of it is the normal cycle of father-son. The


    father looks at his 20 year old son and thinks there is no way
    this kid is going to make it on his own, he’s not strong
    enough/the world’s too complicated; but this is the same thing
    his father thought about him and all the way back to the
    Thetans. So the parent tries to shortcut the maturing process by
    getting the kid into a stable job ASAP.

    The problem is that each successive generation is being raised


    in less gravity, so the bones are weak. The grandfather says,
    “my son’s a bit of a wimp, but at least there’s no war so he’ll
    probably be okay.” Then that kid becomes a parent and says,
    “my kid’s an idiot, but at least he can get a college degree and
    that will protect him.” Then that kid grows up and becomes a
    parent, and you know what he says? “My kid needs a bike
    helmet.”

    “How can you know what kind of a man you if you’ve never
    been in a fight?” Ed Norton asks himself in Fight Club. Well,
    there are other ways, but the point’s solid.

    Take a look at Scott’s trajectory and you’ll see something not


    at all unusual. Just as parents try to shortcut maturity with the
    safety of a good job, kids rebel against these shortcuts by
    choosing a shortcut to manhood: the military. “If I do four
    years of this, then my Dad will have to let me do anything I
    want.”

    This isn’t to discourage joining the military; if you are brave


    and focused and want to pull a Wittgenstein, go; but if you are
    doing it because you are afraid of your Dad‘s disapproval of
    your ambivalence, then aren’t there easier ways to
    “individuate?” Scott appears not to have thought this through
    very well, he quit after a year of ROTC then tries a half-assed
    attempt at officer candidate school and then “the sheen wore
    off.” Oh. Has there ever been a previous instance of the words
    “sheen” and “Marine Corps” appearing in the same sentence?

    WHY ARE YOU FOCUSING ONLY ON


    ENTREPRENEURS, THE CREATIVE, AND THE SELF-
    EMPLOYED?

    Because they’re worth the investment. I can’t help them


    succeed, but sometimes the the single thing standing between
    trying and not trying is encouragement.

    –-

    http://twitter.com/thelastpsych
    Real Or Fake? (Fake.)
    August 18, 2010

    a corollary to Parkinson’s Law of Triviality


    If you have trouble following my rants about misdirection and
    manipulation in the media, this is a good example of the
    mechanism. Don’t be fooled by the triviality of it.

    It’s a slideshow called “Real Or Fake.” Look closely.


    FYI: the answer is real.

    You can see at the bottom the rest of the people are Rihanna,
    Pam Anderson, Jennifer Love Hewitt, Playboy Playmates, etc.

    But rather than the slideshow being about the obvious— about
    the thing that got me to go to it— it pretends to be about
    something else:
    Ooh. Tricky. And it continues in this vein:
    Get it? Bait and switch, without the switch.

    You are enticed to look at it because it makes you think it’s


    about famous women’s boobs. But CBS can’t just become the
    CW, it has big brand advertisers it needs to satisfy with its
    high level of integrity. Acura isn’t paying just for eyeballs, it’s
    paying for positioning and loyalty. “The kind of person who
    likes CBS is the kind of person who likes Acura.” And vise
    versa. So the captions afford it plausible deniability even as
    they pull in the internet clicks.

    And there are plenty of clicks. Go to the CBS site— the same
    slideshow is playing on CBS affiliates throughout the land—
    and scroll through the 27 slide show (turn off your adblock.)
    Every new slide refreshes the ads. So if each ad pays $x per
    1000 displays, the slideshow has the potential to bring in $27x.

    It’s the same with the NYT or any other site that has multiple
    pages to a single article that you need to click through— all of
    those allow the ads to refresh.

    So an article of $x can potentially generate $4x.

    II.

    In Network, the news division simply didn’t bring in the


    revenue like an entertainment show did; but it was argued that
    the news division is too important, profit be damned. Is that
    realistic? No. It makes tons of money for the network.

    The primary motive for the media company (not the individual
    news outlet) is to draw in ad money and traffic. So an
    unwatched show on CBS like the Miss Universe Pageant
    generates tons of money for CBS in other ways (e.g. Access
    Hollywood. “You’ll never believe what happened!” I didn’t
    think I cared what happened, but I guess I do?)

    Same with the news. The news can legitimize a story


    sufficiently to allow it to get play everywhere else on the
    network. “CBS News is reporting that Mel Gibson…” Or it
    can play in the reverse. Rolling Stone magazine is expected to
    have the naked cast of True Blood on their cover, CBS News
    couldn’t get away with that. Solution? CBS News does a story
    about the Rolling Stone cover, which in turn legitimizes it
    further.

    All “shows” are responsible to their advertisers (not the


    public) but in a way that circumvents clear accountability.
    Does Acura really want a fake boobs story on CBS? No. But
    would it allow a “how celebrities deceive their public?” story?
    Go get ‘em.

    So the news wants to give you pornography, but it still has to


    pretend it is giving you information.
    III.

    For example (British paper The Daily Mail):

    So why would a newspaper want to publish a story about a


    woman upset about breastfeeding bullies?
    They wouldn’t; the only part of the story that makes it
    interesting to them is that the bully is supermodel Gisele.
    Without the link to Gisele, the article has no draw.

    But even so, why would a paper care what some mom thinks
    about what Gisele says? It would only do so if the “mom” was
    some kind of a celebrity herself already; and Denise is
    apparently some kind of celebrity over in the UK, having
    judged a talent show and been naked in public.

    Meanwhile, how does a D list celebrity keep herself in the


    spotlight post baby? Not by talking about breastfeeding (meh)
    but by attacking Gisele (oooohhh!)

    For clarification, the real reason Denise doesn’t breast feed is:

    “I can’t be sitting in Starbucks and breast feeding,


    because they (photographers) are taking pictures.”

    That’s media today. The story is used by Denise to keep


    herself in the spotlight and then by the publisher as three kinds
    of linkbait: Denise, Gisele, and breastfeeding.

    The point that must be emphasized is that the purpose of the


    story is to get you to go there. That’s it.

    III.

    I’ve chosen silly examples to make the method obvious and


    the purpose clear.

    A more subtle example of this manipulation is the current


    controversy over the “Mosque at Ground Zero.” This is
    manufactured controversy if there ever was one, but instead of
    being being manufactured by politicians for political purposes,
    it’s by media for the purposes of bringing in clicks.
    Never mind it’s not at Ground Zero. It’s two blocks away, well
    guarded by St. Peter’s Church, The Department of Health, and
    the University of Phoenix. Feel safer? Furthermore, the Amish
    are stationed right next door.

    And never mind that it is already a mosque. Another mosque


    four blocks from Ground Zero got full, and so they were
    having services at the Burlington Coat Factory— the site of
    the proposed mosque.

    The only thing that matters is keeping the controversy alive so


    that people go to the story. Fox will tell you it’s at Ground
    Zero, CNN will be careful to mention that it’s only near
    Ground Zero, but anyone is free to use the controversy to
    bring in the clicks:
    etc.

    Interestingly, the CS Monitor gets it exactly right, I’m sure by


    accident:

    –-

    http://twitter.com/thelastpsych
    Life’s Possibilities As Seen
    By Men And Women
    August 19, 2010

    time to change your perspective to include getting more


    glasses

    Life’s Possibilities As Seen By Men And Women


    the problem isn’t that one is right and the other is wrong; the
    problem is that they are different
    Do Cougars Exist?
    August 20, 2010

    she appears to be whatever age that puts her out of reach

    Does modern society really want hot older women with


    shirtless, hairless college boys? Time Magazine, always on the
    cutting edge, says no:

    Michael Dunn isn’t buying it. The noted psychology


    researcher at the University of Wales Institute in Cardiff
    has just released a study that he insists renders the cougar
    craze a “myth.” After examining the age preferences
    expressed in 22,400 singles ads on popular dating
    websites in North America, Europe, Australia and Japan,
    he found no sizable cohort of women seeking younger
    men.

    If that were the simple finding I could shake my head at the


    ignorance, but that wasn’t exactly the conclusion that Dr.
    Dunn wanted to reach, the one which Time Magazine was
    fortunately too bored to discuss.
    First, his results: when he looked at online dating profiles of
    22k people, he found that men of all ages preferred women
    their age or younger; and women of all ages preferred men
    their age or older. Oh. So why is the Discussion section 5
    pages long?

    It’s five pages long because he writes like this:

    It would appear that the sex-role reversal lifestyles of the


    rich and famous as exemplified in the popular press, more
    specifically pertaining to the tendency for older females
    to form relationships with younger men, is in no way
    reflective of the desires evident in the general population.
    Indeed the toy boy phenomenon may be illusory, being
    restricted universally to an insignificant elite, as cross-
    culturally men and women appear to conform to
    strategies consistent with evolutionary hypotheses.

    That’s just the first sentence. No one could read that; Time
    certainly didn’t. And so they missed his real “conclusions” and
    why they’re wrong.

    II.

    The study appears in the journal Evolution and Human


    Behavior. The whole point of this study is to show that mating
    is “consistent with evolutionary hypotheses. “

    Contrary to the evolutionary perspective on sex


    differences in age preferences are theorists who posit that
    any sex differences that do exist do so primarily due to
    both sexes conforming to sociocultural expectations,
    economic predicaments or “arbitrary norms.” By
    opposing or at least de-emphasising an adaptive strategies
    interpretation for these differences such theorists by
    default if not by direct advocacy subscribe to the view
    that age cues as attractiveness indices may indeed be
    more flexible cross-culturally and historically with the
    capacity to change periodically due to for example
    changing sociopolitical and/or economic conditions.

    If you are reading a story in which the words “adaptive


    strategies interpretation” are used as a noun, then you are
    experiencing the linguistic equivalent of The Human
    Centipede:

    One does the talking, everyone else has to eat it.

    What he means to say is that there are certain people in this


    world (e.g. me) who thinks our “mating strategies” aren’t
    guided by evolution but by “sociocultural expectations.” I may
    be all in on evolutionary theory, but not when it comes to
    human beings mating, not in 2010, not when the media has
    already decided how I’m going to talk, think, and feel. If
    evolution isn’t driving your decision to drink 10 cans of Diet
    Coke a day, how could it possibly be driving my choice of sex
    partner, let alone wife? Birthing hips? Really?
    I’ll pass

    III.

    Here’s where he study goes wrong.

    An opportunistic sample of 22,400 participants’ age


    preferences were collected between November 2008 and
    January 2010… taken from each of the 14 countries and
    two religious groupings

    That’s supposed to make you feel like this is a study about


    human beings, i.e. evolution. It isn’t: guess what isn’t one of
    the 14 countries? The U.S. Huh?

    This isn’t my nationalism, it’s important to the methodology.


    You can’t attack a “social constructivist” hypothesis and leave
    out the very nation that is doing the constructing. Yes, I realize
    that they included Canada which is technically part of Buffalo,
    but you can’t rely on Canadians’ stated dating preferences if
    “Take Any Offer” isn’t available as one of the choices. Damn
    Canucks coming down here to steal our women. Strengthen
    the borders is all I’m saying.
    you only wish Canadian women looked like this

    The use of dating website profiles is also flawed because it


    does not represent ordinary mating. It’s probably an
    oversimplification to say “they can’t get laid on their own”,
    but it is impossible to take explicitly stated— i.e. cognitive—
    preferences as reflective of instinctual preferences. If you want
    to measure innate preferences maybe you can show some
    pictures but for God’s sake, you can’t ask them. “I like a guy
    with a sense of humor…” I’ll self-servingly assume that’s code
    for “heavy penis.”

    Cameron told me he’s hilarious

    IV.

    But the biggest problem with the study is its misunderstanding


    of the significance of the cougar phenomenon.

    Men don’t want older women; and women don’t want younger
    men, in reality. They do, or do not, based on the usual things
    men and women look for in mates. But middle aged men
    fantasize that middle aged women are with young men. The
    point of it isn’t the age difference but the fantasy of wanton
    sexuality that they (the men) can’t participate in.
    Evolutionary theory can’t explain this. You have to turn to
    those media driven “sociocultural expectations” for the
    insights. Quoting Marshall McLuhan: “it’s way easier to
    masturbate to horny bitches your age, then it is to penetrate
    horny bitches your age.”

    –-

    http://twitter.com/thelastpsych
    Love The Way You Lie (With
    Me)
    August 26, 2010

    wrong video
    On Eminem’s official Facebook page, he invites you to check
    out the world premiere of his album… on MySpace. That’s the
    first sign that you’re in for a demography problem, yo.

    In his latest video, “Love The Way You Lie,” starring Megan
    Fox and Dominic Monaghan (Charlie from Lost) Eminem raps
    about what everyone is calling an abusive relationship. Stop.
    When you hear the words “abusive relationship” what do you
    think we’re about to see?

    a) guy beats girl


    b) girl beats guy
    c) they beat each other

    You probably amended your answer as you read the choices,


    but grant me that most people reflexively choose a. The
    Huffington Post did: “Megan Fox Abused in [said video.]”

    The video is decidedly not about that kind of abusive


    relationship. Megan Fox throws the first punch— while
    Dominic is still asleep. And the second, and the third through
    the tenth, and pretty much all of the punches. The first 55
    seconds of that video can be aptly retitled, “This Crazy Bitch
    Is Crazy, Why All These Bitches Gotta Be So Crazy?”

    This didn’t stop a lot of people from holding this up as an


    example of male aggressor domestic violence, and that is
    because they didn’t really watch the video, they saw a guy in a
    tank top and went to Defcon 1.
    In fact, the only people Dominic Monaghan does hit are a) a
    wall; b) some American Eagle wearing mofo in a bar; c) a
    mirror.
    Ok, ok, not totally true: he does hit Megan Fox once at 3:45,
    and if I am interpreting this video correctly, it is because she
    was asking for it..

    II.
    Slow down, I hear you, check your prejudgmentices at the
    door.
    What Dominic (and Eminem) do a lot of is talk tough. Threats,
    yelling, intimidation, punching objects, “I’m feeling a lot!”
    these are the tools of male weakness, aptly embodied in
    Dominic Monaghan. I liked him in Lost, but is anyone buying
    this guy is a physical threat to anyone? Not wearing a shirt
    only makes you look like a better fighter, but you’ll still need
    to sneak up on your target and hit them in the face with a
    bottle. This next sentence is 100% accurate: I could take out
    Dominic Monaghan, Megan Fox, and Eminem, all together,
    even if they were all armed with toasters and I was asleep in a
    bathtub. This isn’t bragging, it’s just that tattoos don’t actually
    make you strong or else every girl I knew at the beach was a
    superhero.
    “I guess I didn’t even know my own strength,” says (Eminem
    speaking as) the abusing boyfriend. Nope, that’s what you
    want me to think, because you don’t want me to realize that I
    just witnessed your maximum strength. Bristle that fur,
    wildman, bristle bristle. “I’m a man, STRONG, yes I hit you
    and it was wrong but you should also know that I restrained
    myself because I love you, if I really let my anger out you
    wouldn’t stand a chance.” Yeah, yeah, you’d have to sucker-
    bottle me first.
    In these relationships, the hold over the woman isn’t physical,
    it’s nourishing. The song isn’t about Domestic Violence
    (capital letters, you are in the presence of a construct) but
    about a kind of love that substitutes magnitude of emotions for
    quality of emotions because that’s the next best thing. I don’t
    mean this next part as an insult: toddlers do this. They want
    you to extra love them up, but if you’re watching the
    Radiation King they’ll not hesitate to lick an electrical socket
    to get attention. They would rather you yell at them than
    ignore them, and that emotional charge they get temporarily
    sustains them. Spam isn’t ham, but if you’re starving it’ll do.
    And yes, eventually you will get used to, and even like, Spam.
    It is repetition compulsion and it is inevitable. Look, in the
    video Dominic is strolling through the vodka aisle and he can
    steal anything he wants and he chooses to steal… Stolichnaya.
    Freud was right.
    This is why it is so hard for women and men in such
    relationships to leave. Yes they are afraid but the real fear is
    abandonment, starvation: this is your whole life, how do you
    walk away from everything you know? You know it got
    violent yesterday, but you also feel emotionally full: the
    contrast between yesterday’s anger and today’s teddy bear gift
    is so gigantic that your emotions top out, like cocaine or
    winning at blackjack. The absolute value of that love may be
    much less than “a good man’s,” but he can’t provide the
    differential. That’s the toddler problem.
    Asking them to stop battling each other is to ask them to fast,
    what should they do when they get hungry? They both feel no
    one will ever love them as much, and dopamine or whatever is
    going on in their brain confirms it. While you’re yelling from
    the outside “get away from him!” from the inside they try to
    deflect with high emotion substitutes: drugs, pregnancy,
    cheating. After a while, your life is that cycle. You can break
    up, sure, but each of you will probably repeat that pattern
    elsewhere, because the problem isn’t the specific partner in
    front of you but the way you sustain your relationships. And
    when you both work off the same patterns, you’ll be together
    ten years longer than you should be. When you’re hungry, you
    gotta eat, and you may have heard of hunting and cooking and
    peeling garlic but Spam is SO EASY and you know
    EXACTLY how to get it. Bonus: it now comes with Stoli.
    The only solution I have ever seen work is that one of the
    people has to change the way they respond to the other. You
    hate me when I bring up certain topics, so I’ll give you a
    parable; one thing I’ve noticed about the mutually abusive is
    their clinging to spirituality because when you live by no rules
    the psyche demands you to impose them from without:

    And when the toddler comes ferociously upon you and


    yells, “I AM TWO AND I AM UNCONTAINED!” do
    you beat him like a dog? Teach him that the rest of your
    life will have to wait while you unleash your anger on
    him— so central is his existence? Or rather, do you
    calmly show restraint, neither do you reward his mania
    with your emotion? They are filled by your love, but they
    will settle for your attention. He who feeds a Chaos will
    raise a Demon.

    I’ll let you work out the details for adults.


    III.
    Let’s just dispense with one thing, formally, right now: hip-
    hop is not a periscope on the black experience, and Eminem is
    evidence. This isn’t to say that it may not speak to/about
    blacks, but it speaks to Kansas white girls a whole heck of a
    lot as well. The myth that Top 40 hip hop is still black is
    mostly perpetuated by culture writers who a) have no other
    contact with blacks whatsoever, and desperately need this as a
    source of information and to pretend to be diverse; or b)
    culture writers who don’t like blacks, don’t really know why
    they don’t like them, and need an easy target.

    Here’s an example, and I hope my terrible writing skills will


    be able to effectively articulate this because it is extremely
    important.

    Here’s how a writer at The Atlantic describes the video:

    I suppose I genuinely sympathize with both of them.


    Rihanna went through a public, awful domestic violence
    incident that she’s clearly tried to work through

    Note the exaggerated “awfulness.” The only person who


    would describe it that way is a person with no personal interest
    in it. How do you know it was awful? I’m not saying Rihanna
    liked it, but… isn’t Rihanna saying she did? Isn’t that the
    whole reason she is in the video in the first place?

    Her (the writer’s) thinking is infinitely narcissistic, it refuses


    to even attempt to understand the experience from the other
    person’s perspective because it does not CARE. Of course it
    was awful, but what, precisely, did Rihanna think about it?
    This thinking chooses a label, and then tries softening the use
    of that label by feigning outrage or sympathy. You’ll see it
    often/always when race is the topic; an earnest by self-
    absorbed white person will reveal their unconscious racism but
    hide behind their progressiveness and intellect:

    “We’re being ironic!” No you’re not, you’re idiots.

    Here is the primary difference between The Atlantic’s


    perspective and Eminem’s audience’s perspective of the video:
    to the former, the video is a discussion of an issue; to the latter,
    it is CCTV of their lives. And probably a routine Thursday at
    the Inem house. It is too real and too usual for them to
    describe it as an “awful domestic violence incident,” any more
    than they would describe their dinner as “a reliable spaghetti
    scenario.”

    The Atlantic writer discusses the song in that same superficial,


    deeply ignorant, aloof manner.
    But this just feels incredibly self-indulgent. Eminem’s
    slow. Rihanna’s autotuney.

    That’s written by someone who needs to pretend to like hip


    hop music, i.e. a poser. “The wine has a smoky, fruity
    aftertaste.” ? “The painting was minimalist but jarring, an
    amazing use of color.” ?? But why do you have to pose? You
    don’t have to like hip hop, or understand it, to write something
    about it; you could simply write as an outsider, “look, I have
    no idea what the hell I’m looking at, but here’s what I see” and
    still give the reader something valuable; but the reason she is
    writing isn’t to teach the reader anything but to convey the
    impression that she is a serious critic of hip-hop. She’s not
    writing for you, she’s writing for herself, for her identity. This
    is how she began the article:

    I tend to be a defender of Eminem’s poppier impulses, as


    long as they make good use of his skill set.

    This is when I reflexively bit through the neck of my rum


    bottle, yes it hurt, but it saved me from a stroke. This woman
    doesn’t really care about hip hop, though I’d bet big stacks she
    truly believes she does; and she doesn’t really care about
    domestic violence though I’d double down on those big stacks
    that she really, really, believes she does. It’s all a show.

    Eminem has no interest in glorifying domestic violence. He is


    speaking to the majority of his audience who completely,
    utterly, deeply “get” the song:

    “This song completely changed my life”


    “I love this song”
    “I want a relationship like this, intoxicating just like a
    drug”
    “I know every word”
    “there’s no words to describe how much your music
    turned my life around and also saved my life”
    “this song, so deep, so awesome”

    And that’s just the women.

    This song isn’t about Domestic Violence, it’s about people.

    IV.

    Why does the song have to be about “Domestic Violence”


    anyway? Why can’t it just be about two screwed up people,
    one of whom is a soccer hooligan? Because there are certain
    themes that are not allowed to be merely depictions— they
    have to be about “awareness” and “sending a positive
    message.” Domestic violence is one of those things, and
    before you say anything observe that homicide is not one of
    those things. Neither is adultery or cannibalism. We choose
    our causes based on something other than the cause.

    Yet you’re going to find a lot of people who can’t wait to say:
    “it’s not a positive message to send to kids.” Fine, but this is
    when you pipe up? Someone on the Huffington Post used this
    video to offer up the warning signs of domestic abuse, here
    they are for your education: Jealousy, Controlling Behavior,
    Blames Others, Cruel, Past Battering. I stand vigilant. Prior to
    revealing these insights, said writer includes this caveat:
    “remembering that though these warnings are written in the
    guise of straight man/straight woman, abuse knows no gender
    or sexual preference boundaries. ” That’s what she needs to tell
    you, “I’m sensitive to lots of things, battered women and
    sexual orientations,” that’s where her head is at. The article
    has no value in preventing Domestic Violence, it is all about
    identifying her.

    I may not like Eminem’s music, but I am able to see how his
    lyrics speak to a lot of people that no one else is speaking to,
    unless it’s down to. If you want to know why there’s Domestic
    Violence, that’s why.
    V.

    Maybe you can’t feel the song because you don’t have a
    personal connection to that kind of relationship. Ok, let me use
    a different example. There’s an other video, Airplanes, not
    Eminem’s but he does rap on it:

    alright lets pretend Marshall Mathers never picked up a pen


    lets pretend things would have been no different
    pretend he procrastinated had no motivation
    pretend he just made excuses that were so paper thin they
    could blow away with the wind
    Marshall you’re never gonna make it makes no sense to play
    the game there ain’t no way that you’ll win
    pretend he just stayed outside all day and played with his
    friends
    pretend he even had a friend to say was his friend
    and it wasn’t time to move and schools were changing again
    he wasn’t socially awkward and just strange as a kid
    he had a father and his mother wasn’t crazy as shit
    and he never dreamed he could rip stadiums and just lazy as
    shit
    fuck a talent show in a gymnasium bitch, you won’t amount to
    shit quit daydreaming kid
    you need to get your cranium checked you thinking like an
    alien it just ain’t realistic
    now pretend they ain’t just make him angry with this shit and
    there was no one he could even aim when he’s pissed it
    and his alarm went off to wake him off but he didn’t make it to
    the rap Olympics, slept through his plane and he missed it
    he’s gonna have a hard time explaining to Hailey and Laney
    these food stamps and this WIC shit
    cause he never risked shit, he hopes and he wished it but it
    didn’t fall in his lap so he ain’t even hear it
    he pretends that…

    You can complain about who is glorifying what and how


    someone is being represented as whatever, but in doing so you
    ignore the millions of people— kids— who are feeling
    neglected by you and represented only by Eminem et al. If you
    focus on Domestic Violence and miss their internal struggle,
    then you will neither stop Domestic Violence nor affect their
    lives, and they will abandon you. They already have.

    Maybe this song doesn’t speak to you, fine, okay, but trust me
    on this: there is someone who is hearing it, and if you are
    hearing it, it’s for you.

    More on rap music: Jay-Z

    http://twitter.com/thelastpsych
    If I’ve Won Cronkite, I’ve
    Won America
    August 27, 2010

    PFC Jessica Ogilvy

    Yesterday, on the Ron & Fez show (XM202— this is a stellar


    show), the director of The Tillman Story was interviewed. The
    Tillman Story is a docu-drama on the the cover-up of the death
    of Pat Tillman.

    I haven’t seen the movie yet; but something the director said to
    host Ron Bennington completely floored me.

    If you can remember the Jessica Lynch story, she was


    ambushed and attacked by Iraqi soldiers, and, apparently,
    ninjas, who stabbed and tortured her and then hospitalized her.
    Then came the daring rescue operation with Rangers and
    Seals, the first ever military rescue of a POW (?) We’ve since
    learned that that there were no ninjas in Jessica’s ambush, and
    the rescue footage was staged and edited by the military.
    “this is impressive”

    That the military would manufacture the truth doesn’t surprise


    me. I’ve seen enough action movies to know that a) it’s always
    a cover-up; b) it goes all the way to the top. Poor Arnold
    Schwarzenegger, an Austrian immigrant, was the victim of a
    military cover-up 11 times between 1984 and 1999. It’s a
    wonder he wasn’t later killed by a drunk driver in a terrible hit
    and run accident, but I guess they figured keep your enemies
    closer.
    Sully chose to take the blue pill

    Because of the 2007 Congressional hearings, we have finally


    been able to see the real, unedited footage of that rescue, and it
    shows… well, it’s boring. No bad guys, no radio for air
    support, no one needs to shoot two pistols at once. They do
    actually get her, but you clearly get the sense that this less for
    Jessica’s benefit than for the camera’s.

    I know, I know, it was Evil George Bush and the Republicans


    hiding the truth, trying to get us flag waving. For the record, I
    didn’t expect it to change at all under Obama, and so far so
    right. No one who sits in that chair is going to willingly give
    up any power. He can barely make things work with all that
    power, “how am I going to do this with less?” Power corrupts
    and absolute blah blah blah. Maybe instead of pardons, an
    outgoing President could sign away powers?

    So this is what the director of The Tillman Story said, and I’m
    trying to quote from memory:

    Ron: And the other thing I found fascinating was how the
    news networks went along with it.

    Amir: I’m so glad you brought this up, because this is


    really the real story. That unedited footage (of Lynch’s
    rescue) we show in the movie didn’t come from some
    undercover/hacker network, it wasn’t Deep Throat— we
    got that footage from the regular news media. They had
    both the edited and unedited footage the whole time, but
    they chose to run the edited footage because it was more
    dramatic.

    Holy crap. You almost expect it from Fox News, ok; maybe
    even CNN, they just want ratings, fine. But did no one in 2003
    think to show the unedited footage? Even selfishly to boost
    their own ratings, did no one try to make the story, “Hey,
    Look, the MSM Is Lying To You!”

    When they pretend not to know the truth about some pop
    culture story, the real shame is on me for expecting truthful
    reporting on nonsense. But for the media to pretend not to
    know the truth about something like this— dozens of news
    outlets, all playing chicken hoping no one blinks first and tells
    the truth…

    II.

    There’s a lot written about the causes of the failings of the


    Froth Estate: beholden to ratings, a dumbed down America,
    having to compete with other media, but I submit a slightly
    different cause: there’s too many of them.

    Back in the day, when there were three networks giving


    America the news, if any one of them went a different way, it
    would have been big news. “If I’ve lost Cronkite,” President
    Johnson maybe said, “I’ve lost America” and he was right for
    a different reason than he meant: he wasn’t the window to
    America, he was the filter of the information. Cronkite wasn’t
    filtering anymore.

    In fact, the intellectually snobby thing to do circa 1969 was


    pretend to read the foreign press. If you read Le Monde you
    were sophisticated, and if you read Izvestiya and Pravda—
    smuggled out or transcribed from memory, of course— you
    were outing yourself as an intelligence analyst.
    Now there are news outlets everywhere, all competing with
    each other— hence the focus isn’t truth but survival, and
    survival means more boob pictures and a willingness to play
    by the government’s rules because if they cut you off, you’re
    done.

    There’s an even worse factor in play: the multitude of news


    outlets makes you think they’re all checking on each other,
    that even if one gets it wrong the other 19 won’t. But most are
    getting their story from the same single source, the AP.

    “So where do we go for objective news?” I don’t think that’s


    the question, because the market requests it, and the way to get
    the market to request it is for all of us to be aware of the tricks
    and manipulations of media.

    I make fun of John Stewart because it seems silly to me, but


    maybe shows like his are the only thing standing between us
    and, well, CNN.

    http://twitter.com/thelatpsych
    Wasted Billions In Iraq
    August 30, 2010

    even worse than that

    In March 2004, the Corps of Engineers awarded a $40


    million contract to global construction and engineering
    firm Parsons Corp. to design and build a prison for 3,600
    inmates, along with educational and vocational facilities.
    Work was set to finish in November 2005.

    But violence was escalating in the area, home to a volatile


    mix of Sunni and Shiite extremists. The project started six
    months late and continued to fall behind schedule,
    according to a report by the inspector general.

    The U.S. government pulled the plug on Parsons in June


    2006, citing “continued schedule slips and … massive cost
    overruns,” but later awarded three more contracts to other
    companies. Pasadena, Calif.-based Parsons said it did its
    best under difficult and violent circumstances.

    Citing security concerns, the U.S. finally abandoned the


    project in June 2007 and handed over the unfinished
    facility to Iraq’s Justice Ministry.

    Wait a second:

    but where are the projects?


    and if:
    then
    did they get the money anyway?

    http://twitter.com/thelastpsych
    When Was The Last Time
    You Got Your Ass Kicked?
    September 2, 2010

    the problem is that the answer is never

    On <i>Louie</i>, super-comic Louie CK and a date end up at


    a late night donut shop. Five teens roll in, obnoxious and
    expansive, and Louie turns and tells them to keep it down.
    One teen comes over and threatens Louie. He does it in the
    pseudo-friendly, control the conversation way that is 100% the
    sign of someone trying to size you up; the longer it goes on,
    the more sure he is.

    30 second clip tells you all you need to know:

    “Hi, my name is Sean. What’s your name?” And extends his


    hand.
    Louie sighs. “Nice to meet you,” he says resignedly.
    “‘Nice to meet you?’ Is that your name? ‘Nice to meet you?’”
    “No, it’s Louie.”
    “Oh, Louie. Hmm. Hi, ‘Loo-ey.’” [Smirks.]

    Etc. It escalates to threats, “tell me, Louie, how long has it


    been since you’ve had your ass kicked?” and ends with the kid
    forcing Louie to beg: “Please do not kick my ass.”

    Right before he leaves, the kid says, “that was painful to


    watch.” He’s right.

    II.
    The whole mess is complicated/dominated by the presence of
    Louie’s date. What’s a chick going to make of this? The scene
    concludes: Louie’s date says, “mentally I know you did the
    right thing by not fighting, but emotionally, primally— that
    was a turn off. That was pretty humiliating, watching another
    guy dominate you like that.”
    Let me amend that: what would a guy think a chick is going to
    make of this?

    III.
    Louis CK is prime timingly perceptive about men; but he’s
    way off about women.
    On the one hand, you get no points for beating up a 17 year
    old; on the other hand, points off for getting beaten up by a 17
    year old. Using this scoring, Louie should have clocked him.
    But then there’s that whole jail thing.
    But there’s the secret deduction: points off simply for allowing
    a teen to bully you for ten minutes.
    “Well what would you do?” I’m asked as if what a
    misanthropic rummy would do and what you should do are
    even compatible. But they’re asking about the date: “I don’t
    want to humiliate myself in front of her. I don’t want her to
    think I’m not a man.” Ok, so fight. “Well, I’m being honest
    here— I’m not a fighter.”
    America isn’t obsessed with sex and violence; it’s obsessed
    with authenticity (or avoiding it). It just so happens that sex
    and violence are the only two things that you can’t fake, and
    we keep coming back to them as the definitive “measures of
    the man.” We can fake wealth, intellect, status, kindness,
    political acumen, parenting, looks— there’s no objective
    measure of any of these things, a man can construct any
    identity he wants, people might not buy it but who are they to
    say? But a fight isn’t a matter of opinion, it is too real.
    Same with sex. “Listen baby, I’m a great lover.” Well, we’ll
    know in fifteen minutes. “Am I a real man?” The response
    stands.
    The anxiety over a fight when your date is right there is that
    she will find out the truth about your masculinity. You’ll take
    verbal humiliation over a beat down not because it hurts less
    but because (you think) it lets the question “am I a man?” rest
    unanswered. Plausible deniability.

    IV.
    Louis CK went for the dichotomy between what a woman
    wants intellectually and primally; that even though women
    may be anti-violence (e.g. Megan Fox) they still feel drawn to
    dominant men. But Louie got the subtlety wrong. A woman
    doesn’t want the best fighter, she just doesn’t want a man who
    won’t stand up for himself.
    What would happen if he lost the fight to the 17yo? Would she
    leave him for the 17yo? Cheat on him with a tough guy some
    Saturday night? (The cuckold problem.) “I just don’t want her
    to think I’m less of a man.”
    Listen to the language: “I don’t want her to think…” That’s the
    infection of narcissism in the thinking. Don’t you think she has
    her own perspective? Don’t you think that she already knows
    whether you are tough or not? Unless you have a secret
    identity, she already knows who would win the fight. Do you
    think you can fool her with words?
    If she is a reasonably attractive woman— defined as not
    bathing in smallpox— then all that she gets, all day, is practice
    appraising men and filtering through their words.
    She already knows who you are. That’s why she is, or is not,
    with you, despite your attempts to convince her you are
    someone else. Losing a fight won’t drive her to another man
    because if it would, she’d already be gone.

    V.
    The cuckold fantasy is when the girl cheats on her man with
    better, stronger, more masculine men. The cuckold problem is
    this: the cuckold fantasy is a male fantasy.
    VI.
    The question no one ever asks is: how did the 17 year old
    know he could pick on you? Why do you think he can sense
    something that your girlfriend can’t? Feminist response: “See?
    Men don’t think women can have their own opinions.” No,
    we’re not sexist, we’re narcissists: it’s not about you, it’s about
    us. Men believe they can convince people of their identity—
    convince a girl to like them. The whole male grammar is
    structured like this: get her into bed; get her to go out with me;
    show her what kind of a person I am. We think we can fool
    women for the same reason a 3 year old thinks he can
    manipulate his parents: sometimes they let us because they
    were going to do it anyway.

    You think you can convince her you’re tougher than you are,
    but you worry you can’t fool another guy because he “knows”
    toughness. But why would he know it any better than she? She
    knows you better than he does; and she knows men— and
    posturing and puffing up the chest— better than either of you.
    The only person who doesn’t know what kind of a person you
    are is you.

    VII.
    Disagree if you want, but there’s one thing that’s indisputable:
    this whole scenario reads differently if the kid were black. A
    17 yo black teen comes up to your table, and it goes from
    being an ego battle to a felony in progress. You think Louie
    would have told 5 black teens to keep it down?

    Universal agreement: no one would think any less of you for


    backing down from a 17 yo black teen than if you backed
    down from a grizzly bear. “Dude, a grizzly bear tried to eat
    me, so I just gave him my lunch!” The hell you say.
    And if you fight— even if you lose— no one is going to say,
    “ha ha, you got beat by a kid!” because everyone knows a 17
    year old black kid has the strength of ten men. It’s in the
    Constitution.
    You think the cops are going to arrest you for fighting a
    juvenile?
    I’ll even go a step further: it would be the exact same if it was
    a 17 year old black girl.
    There’s a sense that blacks are violently unpredictable, that’s
    what TV told me, anyway. You know that white kid in the
    Louie clip isn’t going to murder you with the same certainty
    that you know this black kid might murder you.
    While we’re at it, we can all agree this would be a completely
    different scenario if it was a white kid rolling up on a middle
    aged black man on a date; or a black kid vs. black adult. No
    matter how equal opportunity you think you are all of those
    are different. Black kid on white adult is crime/poverty; white
    kid on black adult is racism; and black on black is “one of
    those things, you don’t get involved.” Unless you’re black,
    then you don’t have much of a choice.
    If you want to know why we see these things differently, check
    with The Atlantic, they have all the answers that George Bush
    stole from us to give to Katrina. My purpose in using these
    scenarios is to lead you to realize that “what would you do
    if…?” is an impossible question because a situation doesn’t
    happen to you, you are the situation. Louie wasn’t the random
    target, he was chosen. The kid didn’t pick on the woman,
    right? Nor did he threaten an empty chair. In other words,
    “what would you do if a teen comes up on you?” was already
    answered by the teen on the way to coming up on you:
    nothing. There’s a chance he could be wrong. But probably
    not.

    VIII.
    Go back to Louie. Where did the whole thing go wrong?
    An observation about the middle class: they have it deep
    inside their psyche that though they are taught to make
    prejudicial judgments based on hearsay, they are not allowed
    to show that they made them. The middle class think they are
    lawyers.
    That kid was up to no good. You knew it as he walked to
    Louie’s table, even before he opened his mouth. You knew it.
    But Louie/we were constructed to act only on what happens,
    not what you think is happening. Since the kid was polite,
    Louie had to be polite back, even though the kid was
    obviously being a bully— you’re not allowed to respond to
    that. “Hey, I was just being friendly!” And prove he wasn’t.
    The kid offers to shake Louie’s hand, “Hi, I’m Sean,” and
    Louie has to shake it because so far the kid is being polite. We
    relate things to our future cross examination: “isn’t it true, sir,
    that sticks and stones can break your bones but names can
    never harm you?”
    Since we’re already knee deep in race: back when I lived in
    various bars in NYC, I frequently saw what I assume to be
    intelligent people allow what I assume to be dangerous black
    males come up to them at 2 am and ask them if they knew “the
    way to get to 44th St.” Just for my Danish and German readers
    who generously donate, here’s a geography lesson: Manhattan
    is a grid, in numerical order. Asking a New Yorker which way
    is 44th St. is like asking a Florida orange farmer which way is
    sky. But these white devils were willing to put their lives at
    risk— not because they didn’t want to appear racist, I saw the
    same hypnotized compliance when the perp was a white guy—
    but because they are amateur lawyers: “he didn’t do anything
    bad to me first.” So we follow the script: guy asks for
    directions= “ten blocks up make a left.” Guy pulls a gun=
    “look, I have 50 bucks, just don’t hurt me.”

    do you mind drawing it on a map?

    IX.
    The Bully Dialogue— where they spend ten minutes chatting
    nicely even though both of you know you’re eventually going
    to get stuffed in a locker— is another Cognitive Kill Switch,
    which is about reversing power and dominance. The
    aggressive “Hi, what’s your name, that’s a nice shirt you got
    there” works because you’re not willing— you feel you’re not
    allowed— to respond to the situation for what it is: a bully
    trying to dominate the conversation. You feel obligated to
    reply to their words, and not the meaning. So the bully gets to
    bully the conversation for ten minutes, after which point it
    hardly matters whether you get stuffed in a locker or not.
    There’s a model for everything in childhood. In this case it’s
    when the parent, rather than a direct confrontation (i.e. teach
    the kid how to be a man) tries to lead and trap the kid, like a
    jealous woman trying to catch her man in a lie. “So, Tommy,
    how was school? Anything interesting happen today?” At this
    moment everyone knows it’s a trap. Dad knows what
    happened, and Tommy knows what happened, and now
    Tommy knows that Dad knows, but Tommy still has to say,
    “oh, nothing really, ” all the while thinking, “oh, great, I got to
    play this nutty game now? When I turn 18 I am so outta here.”

    X.
    Back to Louie. When that kid appeared at his table, everyone
    knew why he was there. So this is how the scene should have
    gone, though I’ll admit it wouldn’t have been theatric enough
    for TV:
    “Hi, my name’s Sean, what’s your name?”
    “Get your punk-ass away from me, I don’t want to know you.”
    Now the kid’s either going to fight you, or back down— which
    is the same thing that was going to happen anyway, but at least
    you stood up for yourself. She noticed.

    http://twitter.com/thelastpsych
    8 Characteristics of Family
    Annihilators
    September 8, 2010

    guess why
    The case of Hugh McFall (from the BBC):

    [He] beat his wife and daughter to death with a rubber


    mallet before hanging himself…
    Hugh McFall, 48, of Oswestry, Shropshire, was found
    hanged on 5 February, hours after wife Susan, 55, and
    Francesca, 18, were found dead.
    An inquest heard how he left a note by his body saying “I
    hope I rot in hell”.

    Why did he do it? More specifically: why does the news report
    say he did it?

    I.

    No one is surprised when the news reports murders; they’re


    interesting in a pornographic way. (“Now I have these
    feelings, whatever shall I do with them?”)

    But the murder is secondary to the report; the murder is an


    excuse to release an already worked out narrative. Murder
    suspects and victims become unpaid actors for a reality show
    CBS calls “The News.”

    An example from this week:

    “Hundreds Attend Vigil for Slain Kansas Cheerleader.”

    When you click on the link, what do you want to see?

    Here is a picture of a tiger and nitrogen while you consider


    your prejudices:

    Be honest: you want to see a picture of a cheerleader. You sure


    as hell don’t want to see a picture of a vigil— but “vigil” =
    “pics of her while alive.” Also: “Kansas”= white, which means
    she’s hot. Otherwise they wouldn’t have used the word
    “Kansas,” they would have used the word “Trenton.”

    And what kind of a guy would kill her? How about “Rocco?”

    Three burly cops=“violent predator.” Do I need to tell you


    what his criminal history is? If I told you that Rocco has a
    history of burglary but no prior rapes or sex offenses, would
    that make you suspect him less? No, because we all
    understand how a cheerleader might end up dead. Well, how
    did you come to understand that?

    GREAT BEND, Kan. — A 14-year-old central Kansas


    girl whose charred remains were found at an asphalt plant
    last week was a vivacious teen who loved bright colors
    and preferred wearing flip flops over any other type of
    shoes, according to those who knew her.

    Hmm. Doesn’t really match the cheerleader type. In fact, this


    girl wasn’t really a cheerleader— she was going to be a
    cheerleader when she started 9th grade in the fall. She was
    also going to be in geometry class, but they left that out.

    That he killed a cheerleader makes sense; but killing some


    random 8th grader— was he a first time pedophile?— makes
    less sense.

    Calling her a cheerleader certainly draws in the viewers, but at


    a huge societal cost. Most of us learn about murder through
    the news, and empirical evidence (news stories) tell us they’re
    right, so we adopt their narratives. Narratives aren’t
    necessarily bad— unless they’re wrong. I’m not saying he
    did/didn’t do it; I am saying that when you put “cheerleader”
    in the headline, I am surer that he did it in spite of my attempts
    at being objective. I’m surer because you’re surer.

    And narratives are hard to unlearn. Now that we know that


    she’s an 8th grader and that he has no history of prior sex
    offenses, do we double back and give him the benefit of the
    doubt?
    II.

    Filicides, the killing of your kids, is no different.

    There are broadly five types: altruistic, psychotic, unwanted


    child, accident by neglect, spousal revenge. Although filicide
    is perpetrated in equal numbers by mothers and fathers, spouse
    + kid murderers are overwhelmingly men.

    That said, the media like to report on only three of these types
    of filicides: mothers who are psychotic (weak) ; women who
    are looking to get/please a new man (evil); and fathers
    committing “altruistic filicide” in which the father thinks he is
    sparing his family worse suffering by killing them (snapped).

    The case of Hugh McFall (from the BBC):

    A florist beat his wife and daughter to death with a rubber


    mallet before hanging himself amid fears he would lose a
    big customer, an inquest heard.
    Hugh McFall, 48… was found hanged on 5 February,
    hours after wife Susan, 55, and Francesca, 18, were found
    dead.
    An inquest heard how he left a note by his body saying “I
    hope I rot in hell”.

    We’re about to get a standard altruistic murder story


    highlighting the role of the employment, which completely
    misses the important subtleties. Here are the more important
    ones, with some interventions.

    1. He’s not losing a job, he’s losing his ability to keep up the
    lifestyle:

    The self-employed flower salesman was facing


    accusations of invoice discrepancies from his main
    customer - which had suspended his contract - and feared
    a police investigation into his accounts… “His financial
    world had collapsed, his source of business income or at
    least 90 to 95% of it, had disappeared in a moment. Their
    lifestyle, as he knew it, would be over.”

    1b. The lifestyle often involves some kind of “soft” illegality


    (accounting irregularities, the use of drugs, etc). The news
    may cite jail as the main stressor; but the general fear is the
    irrreproducibility of the lifestyle (e.g. even if he doesn’t go to
    jail, he’ll never be able to make that kind of money again,
    legally.)

    2. A sudden, temporary, but unshakable realization that


    there is no way out of this. “This is the end of me,” “it’s
    over,” “I’m dead,” etc.

    Business associates told the hearing that Mr McFall had


    considered himself “finished” after a meeting about
    alleged invoice discrepancies the day before his death.

    If you hear a man say, “I’m finished”, believe it. Especially if


    it doesn’t seem as bad as he thinks it is. It’s his inability to see
    alternatives (which would require another person’s
    perspective) that makes him dangerous.

    3. While anyone can see how severe the problem is, no one
    else sees the problem as insurmountable— except him.
    “Why didn’t he just…?”

    West Mercia Police said the case would probably not


    have ended up in court but an investigation would have
    been started if the owners of Stans Superstore had taken
    their concerns to police.

    This is his inability to see things from another perspective


    except his own. What’s obvious to you is not obvious to him,
    and opportunities to intervene can be missed if you think he
    “would have thought of that himself.” Be concrete, be basic.
    “Look, are you a legal scholar now? Let’s get a lawyer.” A
    lawyer? Really? “Yeah— I know a guy— and let him tell you
    what he sees; if they can get OJ off, they can get you off. If
    nothing else, it’s going to buy you some time…”
    The longer he can experience his shame, the longer he will be
    able to live with his shame (or create a rationalization that will
    let himself live with it. The goal isn’t to solve his problems,
    but delay him until he can think straight.

    4. Media says family murders= financial problems, but the


    money is merely the cover for the real shame:

    The coroner said Mr McFall’s fears about his sexual


    health may have been “going through his mind” when he
    killed his family, as well as his business worries and
    concerns over his “social standing”.

    And from another article:

    A computer expert and senior forensic investigator told


    the inquest he had examined two computers as part of the
    investigation, one from the McFall’s home and the other
    from his business premises. [An investigator] said
    someone had been accessing pornography, escort and
    massage parlour sites and seeking advice for diagnosing
    HIV.

    Illegal activity, affairs, drugs… the money is important


    because it hides those things, allows him to present himself as
    something he wants to be.
    Sometimes the financial narrative is so compelling it seduces
    even experienced criminologists. Criminology professor David
    Wilson:

    “They’ve previously had wealth, had possessions, they


    went on foreign holidays. The annihilator feels ‘given
    that I can’t give my family any of this any longer’ as an
    act of almost mercy, as they would see it, ‘I’ll take their
    lives so as to prevent them having experiences of any
    hardship’.”

    Wrong, always. It is impossible to think your children are


    better off dead unless you are unable to see their perspective.
    If you asked them, what would they say? Why wouldn’t you
    believe them? Why do you think you know better than they
    do?

    They aren’t better off dead; you’re better off if they’re dead.
    That’s the secret that must be undone.

    5. SHAME.

    “I can’t give them what they deserve” is a deflection from “I


    can’t give them what they deserve.” The panic is about them
    becoming aware of your failure.

    [the criminologist] believes where they lived was a


    factor: “Oswestry is a face-to-face society. Those kinds of
    societies often provide a great deal of support, but if the
    wheel comes off in this type of society, then everybody
    knows your business… It’s not like they are in a big city
    where they can simply disappear and become
    anonymous.

    The same applies to honor killings.


    The money is most often the final straw; without the money,
    you can’t keep up the appearances…

    Murders happen before the exposure, before “everyone finds


    out.” Once they’ve found out, there is no reason for the
    murder. So either tell his family, or make him think you have.
    But then:

    6. Sometimes he kills himself, and sometimes he doesn’t.


    He kills his family because he can’t face them knowing. He
    kills himself because he can’t face that they know.
    The other reason for the suicide is the sheer number of people
    who are going to know— can’t kill ‘em all.
    The likelihood of suicide increases as guilt increases, and
    decreases the more you can be convinced other people won’t
    know/won’t care.

    7. A very fine line: it was both spontaneous, and


    premeditated.
    Two years ago another family murder took place near Hugh
    McFall’s town, and McFall was horrified:

    I remember Hugh saying ‘How could you do that? How


    can it get so bad that you could do that to your family?…
    It just doesn’t make sense, surely there’s other ways out
    however bad things get?’”

    And certainly he wasn’t thinking about killing his family


    before the financial problems hit. But as soon as he decides
    he’s “finished,” he starts planning the murders—
    weapons/tools obtained, the biggest threat is killed first (i.e.
    wife before kids), etc.

    7. Get out of the house, or at least the bedroom.


    75% occur in the home, usually in the bedroom. It is extremely
    unusual (6%) for the man to kill only the children and not the
    wife. Since the purpose of this is to avoid shame, leaving the
    wife alive would be contrary to the point.
    If you’re the wife, don’t go home, especially if he says he’ll
    kill the kids if you don’t.

    More on family annihilators


    A case of one such man
    A case of American honor killing
    Are People Attracted To
    Good Dancers?
    September 9, 2010

    Chris Rock: a father’s only responsibility is to keep his


    daughter off the pole

    “Study: Flamboyant male dancing attracts women best”

    LONDON - John Travolta was onto something. Women


    are most attracted to male dancers who have big,
    flamboyant moves similar to the actor’s trademark style,
    British scientists say in a new study.

    Awesome, another “front page” science article that misses the


    point.

    The researchers filmed some men dancing, and then CGI’d


    them into silhouette avatars which they forced sober women to
    watch.

    “There are lots of cues females use when choosing a


    mate, like a peacock puffing out its tail,” [some
    evolutionary behaviorist guy] said. “Dancing for humans
    could signal whether a male is fit because it requires the
    expenditure of a lot of energy.”

    It could also signal you have to pee. On the one hand, the
    study itself gets it wrong; and on the other hand, the reporting
    gets it even more wrong. Two wrongs make a post.

    II.

    The actual study found that:

    According to the women, the best dancers were those


    who had a wide range of dance moves and focused on the
    head, neck and torso [and not arm and leg movements]

    Somehow this got translated to “women are attracted to good


    dancers” but it only says they liked that kind of dancing, it did
    not say the women thought those men were more attractive,
    especially since they weren’t men but CGI humanicons with
    no visible external genitalia such as tattoos or Nautica T-shirts.
    Extending “I like his dancing” to “he’s hot” is the sexual
    equivalent of extending “he has good penmanship” to “he
    writes like Balzac. I’m so looking him up on Facebook.”

    And you can’t bring up examples like the professionals at


    Dancing With The Stars because they possess what’s called a
    “confounding variable,” namely that they are all extremely
    attractive CGI humanicons with prominently displayed
    external genitalia that I have never DVR-paused to get a good
    look at, even as I have never fast-forwarded through their
    ridiculous interpretations of the cha-cha to get to Brooke
    Burke.

    Of course women will like good dancing more than bad


    dancing, but I am not sure that women are attracted to better
    dancers— which is the only reason evolutionary psychologists
    would be interested in the question. If it doesn’t lead to
    penetration, they don’t want to hear about it. But here, “more
    attractive as a mate” does not logically follow from “better
    dancer.” A Craig Ferguson joke: “A new study reports that
    women are attracted to better dancers. The ironic thing is that
    they’re all gay.”

    (Thanks DL for the vid)

    III.

    But the more serious problem with the study this:

    He and his colleagues think dance is an honest signal to


    women of the man’s strength and health, just as it is in
    crabs and hummingbirds… It makes sense that women
    would care about men’s ability to dance, says Helen
    Fisher, a biological anthropologist at Rutgers University
    in New Brunswick, New Jersey. “For millions of years,
    a man with well-coordinated movements of the head,
    neck, and trunk [which he used when throwing
    weapons] probably signaled his ability to provide”

    This is completely crazy. She could have used that same


    explanation if flailing arm movements were what was more
    attractive, she just has to replace “head neck and trunk” with
    any body part that was preferred and she can win tenure. I also
    don’t know if she’s aware that the words “man” and “millions”
    and “throwing weapons” and “well-coordinated”have no
    business being in the same sentence, unless that sentence is the
    one I just wrote.

    Consider also that this is dancing today, in western Earth. If


    this is supposed to be a generalizable observation about
    intraspecies attractiveness, how would we rate the hotness of
    the dances people did in the middle ages, the ones with the
    ribbons attached to poles? Wasn’t Maypole dancing itself
    derived from a pagan fertility dance whose purpose was to get
    you knocked up?

    If this study is valid at all, then it is only valid only for


    modern, culturally created attractiveness. It is identical to
    saying “women prefer men with body hair because it signals
    virility.” When was this? The only people who find 1970s
    pornstars attractive are 1960s pornstars, and communists,
    which are the same thing.

    Maybe somebody can explain to me how evolutionary


    psychology can make predictions on a non-evolutionary time
    scale without resorting to genes, which it can’t do anyway
    because it doesn’t know of any.

    Besides: natural selection stopped being applicable to human


    beings the moment we allowed other people to tell us what is
    attractive to us.

    Is the hourglass figure the ideal?


    –

    http://twitter.com/thelastpsych
    We Are All Skyscrapers Now
    September 11, 2010

    which photo can you see?

    On September 11, 2001 I was nowhere doing nothing while


    2000 people were dying almost simultaneously.

    A week later we had the Anthrax attacks, which, like the 9/11
    attacks, have never been solved. Whoever the Antraxer was, he
    did manage to infect one of the 9/11 hijackers, and so he
    stands as the only person to have at least injured one of the
    terrorists.

    That was also when we got the text scroll at the bottom of
    CNN and the definitive end of actionable information from
    CNN.

    This is something I wrote a few weeks after 9/11. It is what it


    is. A lot has happened since.

    If the TV is any guide, 9/11 is a dramatic miniseries about two


    buildings collapsing on firefighters, with the premiere being
    brought to us commercial free. Gotta build an audience.

    There’s enormous coverage, but no news. None of this is


    news, it is drama, portraits of courage and sadness. Last phone
    calls between loved ones, “the last time I saw him was
    when…”, “when I saw the first Tower fall I…”

    And firefighters. Lots of firefighters. America wants its real


    life heroes unarmed and unthreatening.

    Lots of sadness, but no anger. No one on TV is angry? The


    Towers didn’t fall, they were kicked in the face. How many
    politicians do I have to watch cry on TV? STOP CRYING. I
    already know it’s sad. Don’t tell me we are resilient, don’t tell
    me we’ll go on, are there people worried they won’t go on?
    Show me the country has some men in it, show me that we
    aren’t five year olds.

    But we are. Cry on TV and people will think you’re sensitive,


    but bang a fist on the podium and you’re unstable. “He can’t
    control his emotions.” What?

    According to the TV, the real events of 9/11 happened not on


    the 95th floor, but on the ground floor. I’ve been looking in the
    wrong place.

    People tell me that this coverage isn’t about the terrorists, it’s
    about the aftermath, the victims; that there are other shows
    about the terrorists.

    Separating shows this way fosters a separation between the


    cause and the effect; we are focusing only on the effect,
    because it is very hard for us to get our heads around the
    cause. In doing this we are repackaging this event into a
    natural disaster. Something that we have no power over, no
    way to prevent, but something that must by necessity bring us
    together in our grief and our loss, and something that we must
    get past. No sense in describing why earthquakes happen, so
    let’s delve into the victims’ stories.
    Observe that the media has unilaterally decided that no
    American will ever again see the
    images of the planes being slammed into the Towers. “Come
    on, you’ve seen it enough times, nothing to be gained from
    that. Here’s a firefighter.”

    I’m told anger serves no useful purpose. But sadness isn’t


    going to prevent this from happening again, sadness isn’t
    going to restructure the planet so that people don’t want to do
    these things. You might say anger won’t either, but I’ll take
    my chances.

    They say the hijackers were armed only with box cutters. If
    that’s true, that tells me a lot about how they perceive
    Americans: they expected no resistance. Not even from the
    pilots. Would they have brought boxcutters to El-Al or
    Aeroflot hijacking?

    When Timothy Mcveigh and Terry Nichols blew up the OK


    City Federal building, the media went right for the throat,it
    wasn’t a natural disaster but an violent attack to which we
    immediately ascribed blame. And they were free to speculate:
    right wingers, militias, neo-nazis. But 9/11 is different, we
    don’t know what to do with it so we do nothing with it. Say
    “they attacked us” and then off to the victims. You know the
    names of both OKC bombers, but you can’t name one hijacker
    other than Mohammed Atta, who is the designated ringleader
    because his is the only name we can pronounce.

    We don’t even know what to call the attacks, so we call it by


    its date: “9/11.” Just another day that we’ll remember where
    we were when. “That was such a sad and scary day.” Yeah.

    “We are all Americans now,” announced Le Monde, with no


    understanding at all. How can they sympathize with how we
    feel when we ourselves don’t know what we feel? This attack
    happened because we’re not all Americans, not even us
    Americans. Just a group of individuals now slowly distancing
    ourselves. “I mean, I sort of knew him, I’d seen him around
    and all, but we weren’t close or anything…”

    “We are all Americans” means to the writer at Le Monde: “we


    could be next.” That’s all he cares about. He’s right on that
    count, I guess, dead right— the next attack has to happen in a
    different country if it is to have global impact.

    If Le Monde wanted accuracy, it would have announced that


    we are all skyscrapers now, each of us standing mightily and
    individually, who is taller? who is greater? Living in proximity
    but not in connection. Waiting to be knocked down.

    And when it happens to someone, our explanations will really


    be about why it didn’t happen to us: well, that skyscraper
    wasn’t built right and that skyscraper was too tall, too proud.
    What happened to that skyscraper has nothing to do with me,
    I’m different, I’m better, and besides, why would anyone hate
    me?

    Because you’re a skyscraper, dummy.

    When the towers fell and the pulverized remains of people


    who might have been your friends poured through the
    aerosolized into the streets of lower New York, what did you
    feel? Which did you blame, America or Israel? Oh, both.
    When someone asks you now about 9/11, do you answer “I am
    sad” or “I am angry”? Or do you externalize your answer and
    put it in the past tense, as if the emotion was something that
    came at you from the outside, “it was sad”, or “I felt angry”?
    Are you not sad or angry anymore? How long did it take you
    to get over the worst attack on America in history? A day, a
    week? How long before “cooler heads prevailed”? Do you
    know people who you think “overreacted” to the slaughter of
    3000 Americans? As others dance while the bodies are
    excavated in NYC, are you able to connect with the story?
    How do you dialogue? Maybe you should cope on this for a
    while, until your cooler heads prevail. Go shopping. Have a
    nap.

    I don’t want to cope. I want to see the videos of the planes


    being flown into the Towers. If we allow ourselves to choose
    the path of sadness, then nothing has been accomplished,
    everyone died for nothing. It will have been nothing more than
    an earthquake.

    I don’t want to get past this. Nor do I want it to get past me.

    http://twitter.com/thelastpsych
    How To Promote Energy
    Conservation
    September 13, 2010

    won’t help

    1. “A 2000 W dishwasher typically uses 2000 units of energy


    in one hour. How many units of energy do you think each of
    the following devices typically uses in one hour?”

    central air conditioner


    electric clothes dryer
    laptop computer

    Repeat your answers so you don’t change them later.

    2. “How many units of energy would each of the following


    changes save?”
    Drying clothes on a line for one load (i.e. not using the
    dryer for one load)
    Changing washer temperature from hot wash/warm rinse
    to warm wash/cold rinse for one load
    In the winter, turning down the thermostat (make home
    colder) by 5 degrees

    Repeat your answers so you don’t change them later.

    II.

    Please forgive the odd phrasing: I copied it exactly from the


    survey. The study, Public Perceptions of Energy Consumption
    and Savings, in PNAS, asks two questions. The first is, “what
    are the public’s perceptions?” The second is, “why do they
    have these perceptions?”

    Here are the results of the study of 500 people:


    Ignore the X-axis, look at only the y-axis, “Perception.” As
    you can see, the perception was that most objects used about
    300Wh (between 100 and 600.)

    Look at your answers, above. My guess is your guesses were


    in the 1000+ Wh range, which if true is important because:

    There is a 5-10x difference between you and the people


    surveyed
    You were more accurate

    So what accounts for this? Run the possibilities. Are you


    smarter? Are they idiots?

    II.

    The anchor: I told you about a 2000W dishwasher; the original


    survey said:

    A 100W light bulb uses 100 units of energy in one hour.


    How many units of energy do you think each of the
    following devices typically uses in one hour?

    One clue that you’re in the presence of anchoring bias is when


    lots of people get the answer wrong in the same direction by
    the same amount. As in the graph below, nearly all appliances
    were underestimated— because they were sucked towards a
    100W bulb as an anchor.

    Additionally, they had more appliances to rate, which


    themselves form anchors. The gravitational pull of stereo,
    laptop, and light bulb overwhelm the unknown quantities of
    dishwasher.

    If you wanted people to guess more accurately, you could try


    to teach them about each machine; but its probably easier to
    simply give them one better, larger, anchor.

    II.

    The anchoring bias is everywhere, described formally in 1974


    by Tversky. This was his example: Guess the answer in 5
    seconds:

    8 x 7 x 6 x 5 x 4 x 3 x 2 x1 = ?

    vs.

    1x2x3x4x5x6x7x8=?

    The median guess was 2250 for the first descending sequence,
    and 512 for the ascending— half the people guessed a number
    smaller than this. The answer is 40320.

    Neither does the anchor need to have anything to do with the


    question. Tversky describes asking subjects the percentage of
    African countries in the UN, but first they watched a wheel
    randomly pick a number. For the groups that saw the wheel
    pick 10, their median guess was 25. For those who saw the
    wheel pick 65, their median guess was 45.

    III.

    The main problem with promoting energy efficiency or energy


    use reduction is that these are solutions to a problem most
    people do not feel they actually have. “Meh. I try to turn off
    the lights, but it doesn’t seem to affect my bill.”

    Secondarily, energy conservation is presented as an ethical


    problem. I probably don’t need to explain why this fails.

    All social policies— the most rigorously considered to ill-


    conceived— are ultimately dispatched by marketing.

    In any new product launch, a market is served or a market is


    created, but in either case the appeal is to the individual, not
    the market. You can argue that Lilly created the market for
    antidepressants or it served an existing market. Either way, the
    success of Prozac was due to it appealing to each individual
    user of Prozac. Not: “Come on America, you all need Prozac!”
    but “you, woman in her mid thirties feeling lost and depleted,
    need Prozac.”

    Energy efficiency/conservation fails as a marketing strategy,


    because it appeals to all of us as a society. We hate that.
    “What’s in it for me?” Well, I’m glad you asked…

    But follow the analogy to the end: when Pharma sells the
    drugs, the customer is the doctor, not the patient. The patient
    can’t really affect the market because they don’t really know
    the alternatives. “Oh, I should take Prozac? Ok. Should I be
    buying Blu-ray or HD-DVD? I heard HD-DVD is better?”

    Ultimately, a society can’t possibly conserve as much as a


    more efficient machines can save.

    The prescribers of energy consumption are the companies that


    make the products, and Pharma is the government. If you want
    GE and GM to make energy efficient products, you have to
    incentivize them to do so.

    In the end, we’ll buy whatever the ads tell us to buy.

    http://twitter.com/thelastpsych
    Refusing To Answer The
    Feds
    September 13, 2010

    you’re not the boss of me

    Paul Lucaks wrote a post called, “I Am Detained By The Feds


    For Not Answering Questions.”

    Imagine the rest, but here’s his first sentence:

    I was detained last night by federal authorities at San


    Francisco International Airport for refusing to answer
    questions about why I had traveled outside the United
    States.

    There’s a few ways to go with this, but here’s a start: this


    article was written 4/24/2010. It received 700+ comments. He
    wrote a follow-up article to this yesterday.

    “Why were you in China?” asked the passport control


    officer, a woman with the appearance and disposition of a
    prison matron.

    “None of your business,” I said.


    Her eyes widened in disbelief.

    “Excuse me?” she asked.

    “I’m not going to be interrogated as a pre-condition of re-


    entering my own country,” I said.

    In other words, this is what he was thinking about on 9/11.

    II.

    The easy interpretation is that he is/is not an idiot for baiting


    the border patrol. Yes, it’s his right not to answer questions (or
    not to show ID at security, which I tried), but for a man who
    has had 5 months to reconsider his position he’s apparently
    learned nothing.

    The real question, however, is why he did this. The only way
    this form of protest is meaningful is if it is done in public. In
    other words, the only reason for him to do this is so that he
    could tell us about it.

    He thinks this is a battle between himself and the border patrol


    as representatives of the US Government. That would be a
    gigantic example of not seeing the other person, not seeing
    their perspective. That border agent isn’t a representative of
    the government, he’s an employee of it. Look at them closely
    — they don’t look like Dick Cheney at all. These aren’t arms
    of the Executive Branch that thrive on suppressing the human
    dignity of liberals, these are people who enjoy Schlitz and
    masturbation. Just like any other decent American. You can’t
    change anything by yelling at him, and Lukacs knows that.
    And he doesn’t care. Lukacs is the main character in his own
    movie, and he is yelling at the character designated as “mean
    border agent.” Note that he didn’t bother to take the names of
    any of the fascists who were mauling his civil rights. In the
    credits, they will appear as #1, #2, #3, etc.
    Paul doesn’t think he is the best or smartest or sexiest
    character in his movie, but it is quite evident that he thinks he
    is the only one.

    III.

    This isn’t to say he’s a narcissist; in some other situations he


    may be quite empathic and contemplative; but power
    dynamics trip him up emotionally, so he regresses. If you read
    his article and get the feeling he’s behaving a little like spoiled
    toddler, there you go.

    IV.

    Lukacs claims they have no power over him. But Lukacs


    doesn’t understand at all how power works; he is confusing
    law and power, and that confusion bought him an hour in the
    chairs. “The Feds” have complete power over him. The fact
    that he doesn’t understand how utterly manipulated he was
    demonstrates this. The moment they “led me into a waiting
    room with about thirty chairs” they already knew he wasn’t a
    threat. They knew he was just a troublemaker, specifically
    making trouble for the officers who were unlucky enough to
    have him in their line. They ran his name in a federal database.
    Maybe they did a google search as well, which would return
    his photo and reveal that he’s little more than some blowhard
    lawyer.

    But it’s at the moment they decide that he isn’t a threat that the
    demonstration of their power begins, and he complies. They
    tell him to sit, and he sits. They tell him to follow, and he does.
    They know they can’t legally do anything with him, so they
    play with him. “Six other people were waiting.” What did he
    think those six people were they doing there? They were just
    like him. They didn’t answer the questions. Lukacs writes,
    “This must not happen often, because several of the officers
    involved seemed thrown by my refusal to meekly bend to their
    whim.” Setting aside that asking the questions they are
    instructed to ask isn’t a whim, and that not everyone who
    doesn’t want to be inconvenienced because they value their
    time is “meek”, he is incorrect. It happens often enough that
    they built a room for it, in every airport. With lots of chairs.

    Lukacs gets it wrong because he thinks he has disrupted the


    process by refusing to answer. Wrongtanomo. That is the
    process. Just a slightly less-used branch on the Process
    Flowchart. The room and chairs are there because the
    government assumes that people will exercise their rights and
    not answer. The room is exactly the same as the line he was in
    at first, except for a different group of people. The room is
    there to remind you that it costs you something to enforce your
    rights (time and aggravation) and costs them nothing to
    impose that cost on you.

    I’m not supporting or endorsing what they did to him any


    more than I support what he did. But understand this, it makes
    no difference to the agents, this game. They punch out at the
    same time everyday. How they spend their 7.5 hours at work is
    largely irrelevant. Maybe some guy was a nuisance for an hour
    or two. Whatever. They’re still back home in time to get
    annoyed by their kids.

    Lukacs thinks he is fighting the government, and the


    government is fighting back. In reality, the government doesn’t
    feel this fight at all. Border agents do; I’m annoyed at him and
    I’m at home, I can imagine how they felt. So they took what
    power they had, and used it.

    V.

    There’s a subtle but powerful Strangeglovian brilliance to the


    system in place. By giving the officers this permission to do
    what’s necessary— it subtly shifts Lukacs grievance away
    from the government’s policy to the easily defended/“solved”
    actions of the agents on the ground.

    This is similar to what happens at G8 riots or political


    demonstrations - the demonstrators clash with police, literally
    instigating fights with riot police sometimes, thinking it will
    further their cause. But the police don’t represent the interests
    behind any political agenda any more than the demonstrators
    do. They are there simply to maintain order while the
    protesters exercise their rights. The protesters’ real grievance
    is with people they don’t dare fight in any way (including not
    buying their products). So they use the supporting cast of
    police officers as some kind of character exposition in their
    movie: “in this scene, I’m a protester fighting the bad police.”

    Governments know this, this is the structure of power. The


    more cops on the street maintaining order, the more likely the
    situation will decay into disorder as protesters confuse
    challenging the authority of the policymakers with challenging
    the power of the police. So they fight, and the media goes with
    the story that’s for you: unruly protestors clashing with police,
    pick a side, and thereby quietly removing from the story the
    real and legitimate political grievance that initiated the protest
    in the first place.

    What Lukacs doesn’t realize that his legitimate desire to


    challenge the authority of the government was transformed
    into a confrontation over the reasonableness of the use of the
    government’s power by its agents. He isn’t defending any right
    great or small, he’s simple playing out his part in feeding the
    machine.

    VI.

    What would Lukacs have done if the border patrol agents were
    all robots? Narcissistic thinking never works on robots. A
    person may completely ignore how another person is thinking,
    but everyone always understands a robot’s perspective. With
    robots, it is explicitly understood that they are operating on a
    flowchart, that they have a definite way of thinking of their
    own that has nothing to do with who you think you are. You
    can’t force your thinking on a robot. So Lukacs wouldn’t dare
    disobey anything upon which he cannot impose his will.
    That’s why he’s fighting border agents, and not the
    government.
    –
    Co-written by Pastabagel

    http://twitter.com/thelastpsych
    Hot Sports Reporter Ines
    Sainz Was Sexually Harassed
    September 14, 2010

    according to my script, I’m supposed to be crying

    NEW YORK (KABC) — The New York Jets are playing


    defense off the field, after allegations that players and
    coaches sexually harassed a female reporter.

    Ines Sainz, reporter from Mexican TV, somehow slipped


    across the border undetected to steal our jobs, only to have
    players throwing the ball towards her so they could bump up
    against her, and when she went to the locker room to interview
    the QB, they started “making remarks.”

    Complicating the matter is that the reporter in question looked


    like this:
    Two camps:

    another example of men acting disgustingly, and


    protected by the NFL; women being degraded and
    disrespected, being treated as objects.
    Look at her, she asked for it! Dressed like that, what did
    she expect. Listen, ladies, you can’t flaunt it and then get
    angry when someone notices.

    Yes, if only either of these two had anything to do with the real
    issue. Come on, people, first principles: What do the writers
    want to be true?

    II.

    While it’s not a justification, it is a perfectly legitimate query:


    how can you dress like that and not expect the attention?

    Attention is one thing, lewd comments maybe another, but as


    Marc Maron pointed out, sexiness isn’t a smart bomb, you
    can’t select your targets, you put it out there and there’s going
    to be some collateral damage.
    “I don’t want to be thought of only as a sex object.” You don’t
    see the irony of your thinking. You want people to have a
    certain thought, yet you also demand that they don’t only have
    a certain thought. You’re trying to control their minds just as
    much as you claim they’re labeling you.

    You don’t get to make that decision, ever. As much as anyone


    wishes they could make everyone else accept the identity
    they’ve invented for themselves, the ugly existential truth is
    everyone has their own mind and they seem to have decided
    that you are a sex object. They may be wrong, they may be
    right, you can certainly try and alter this perception, but you
    cannot tell other people not to have it.

    “You can’t label me!” Throw the cognitive kill switch, after
    which I’m supposed to be left shuddering, did I label her? All I
    meant was, hey you got me all wrong, wait a second, that’s not
    what I meant (is it?)…

    Well, I ain’t going out like that. I’ll accept that I’m a big jerk
    for thinking what I think, I’ll accept that I may even be wrong,
    but I will not accept that my limited experience as a human
    and the information you are giving me has lead me to a few
    conclusions about you that I am not allowed to have.

    “I know who I am.” No you don’t, that’s my point, if you


    knew who you were you wouldn’t be playing multiple
    characters, in this case eye candy and serious reporter. “Well, I
    have to act this way for the job, for TV.” They didn’t spring
    this on you last minute. It may be wrong to expect a reporter to
    be sexy on TV, but if you say you have to be sexy as part of
    the job, you can’t double back and say you weren’t being sexy.

    What you want is to be able to behave sexy, or rude, or


    ridiculous, or offensive— and still demand to be seen the way
    you want to be seen.

    It may be unfair, but it is the most important fact of human


    existence: people exist independently of you.
    III.

    Before all the men form a celebratory circle jerk, let me back
    up: it’s 2010. ‘Well, what did she expect?’ doesn’t fly in
    Human Resources’s America. Like it or not, that’s reality, and
    you don’t get to change reality. She’s not a ninja, and if she
    feels harassed she’s going to fight back using whatever she’s
    got, and if what’s she’s got are lawyers, well, what did you
    expect?

    “We don’t want her to fight back, we just want her to take it.”
    Got it. See II.

    IV.

    Note the power set up. All you fools think that female
    reporters are in the locker rooms because it is some sort of
    measure of equality, “why should the males get the best
    interviews?” that this is somehow a success for equality,
    something that women had to struggle to earn, and you think
    that because you were told that.

    Women didn’t earn this over the resistance of an old boy


    network; the media conglomerates decided it would be
    awesome to televise a hyperfemale in a locker room with a
    nearly naked hypermale and pretend there’s no sexuality
    implied. So anything that goes wrong is between individuals,
    nothing to do with the Machine.

    CFNM, right there on ESPN.

    V.

    Take a look at another sideline picture of her:


    I can’t believe I am the only one to notice this: she has a big
    ass, and 70% of the Jets are black. Hi.

    “What’s that got to do with it?” That has everything to do with


    it. Sandy Flatbutt and Ines Sainz both want an interview. Who
    does Marquice Cole choose to talk to longer? Which interview
    is going to have more sexual tension to display TV, so that
    everyone in America can think, “look at this guy, he hasn’t
    heard a word she said, all he wants to do is–”

    no, seriously, it’s not real leather

    That’s how “professional news” is run. Bring the sexual


    energy as high as you can and then pretend it isn’t there.
    Quoting Marshall McLuhan, “make sure the message has a
    nice ass.”

    VI.

    But now we’re in the middle of it.

    Whatever else you may think about Sainz, this is a woman


    who can handle herself, and men, and players. That’s the
    problem.

    I want to say that I’m not the one who made the charge
    (of harassment), because I didn’t even feel bad about
    that… the ones who say that there was something wrong
    was the rest of the media.

    Uh oh. So nothing I wrote in this post applies to Ines Sainz; in


    fact, none of the controversy you are hearing applies to her,
    because she didn’t care that much. If she can handle players, if
    she can dismiss this as boys will be boys, what are the other
    reporters supposed to do?

    The question isn’t whether the players’ behavior will be


    tolerated by Sainz; the question is will Sainz’s behavior be
    tolerated by other reporters, like a hussy walking past the First
    Wives Club. Oh, hell no. She cannot be allowed to walk away
    from this. Meanwhile, the networks couldn’t be happier even if
    they planned this, which they did, which is the whole point.

    I can see the unfair advantage that if she’s ok with it and


    someone else isn’t, she’ll get all the good interviews, but I
    would like to point out that this is the contract you media fools
    started, the Pretend Contract, we all pretend her looks weren’t
    part of the reason she got the job, and she pretends no one is
    looking at her that way.

    Oops— she broke the contract, stupid Mexican, by labeling


    herself the Hottest Sports Reporter. She’s made subtext into
    text, and everyone in media knows you don’t do that, ever.
    “Cat’s out of the bag, mofos, what are we going to do?”

    Plan B: rewrite the story.

    http://twitter.com/thelastpsych
    The Terrible, Awful Truth
    About The Tax Cuts
    September 22, 2010

    won’t help

    I. The $250,000 Question: Will Atlas Shrug? No, He’s A


    Punk

    So they’re going to uncut taxes for the rich, as defined as over


    $250k/yr. Everyone seems to know the answer: is $250k a year
    rich, and why do they say they can’t afford it?

    Which really isn’t what the arguing is about. That 4% tax


    increase is not on 250k but on any money above 250k, which
    means if you make 300k you’re taxed an extra 4% on the 50k.
    Oh well, no ki-ran burgers for a week.

    The real controversy, brought to you in HD, is about


    “fairness,” which is defined not by the ends but by the means
    — that’s the only way to excite the amygdala enough to get
    you to tune in. Ask John Galt why Americans will soberly and
    willingly part with 80% of their income if it makes sense to do
    so/they want an Acura, but try and take 4% and they’ll gas an
    elementary school.
    II. “I’m telling!”

    Who decides fair? In the U.S., fair could mean democracy, so


    let’s ask them: what do the majority of Americans want? They
    want 2% of you to pay more taxes. If you don’t like it, you can
    move to the Caymans. Your business is already there, isn’t it?

    If this logic appeals to you, then you’re not going to like the
    next part: this isn’t a democracy, it’s a businessocracy, which
    means the government isn’t going to obey the will of the
    majority of the voters, but the majority of corporations. So:
    according to the gerrymandered voting of the S&P 500, what
    will taxes do?

    Answer: they’re still going up, because the corporations don’t


    care about AGI, they care about corporate taxes, which are
    never going to go up, not if you want to keep your job. “Labor
    costs” is the answer to every political and economic question.
    All that other stuff about rich and poor are for ratings, to draw
    you into the electric coffeehouses and get you agitated, and for
    politicians who need a mulligan. In other words, it’s for
    suckers. You’re not a sucker, are you?

    I understand that tax policies have serious effects on people,


    but the setting of tax policy has much less to do with revenue
    generation than giving voters a fairness boner. We spent $3.6T
    this year; these tax uncuts are going to generate $700B over
    ten years, assuming they don’t simply get recut in four years
    anyway. So why are we bothering?

    “The rich have to pay their fair share!” Let’s look at the
    Adjusted Gross Income of the United States Government.

    Corporate Tax: 12.9%

    Individual Income Tax: 52%

    Employment Tax: 32.2%


    Estate Taxes: 1.1%

    Excise Taxes: 1.9%

    Take a moment and redistribute your fairness points.

    III. Why a Tax on The Rich?

    Why $250k? That number didn’t come from the Bible, it is the
    income level that accounts for about 50% of the income tax
    revenue. Fortunately, it is also only about 2% of the
    population, so you only have to piss off 750,000 people. That’s
    democracy. Eat it.

    Why not just crush their spirits and raise their taxes 20%
    instead of just 4%? Because they’re not stupid, they’ll alter the
    way they get paid. W-2s become 1099s, 1099s become non-
    cash compensation (car, homes, etc.) And more business
    deductions, I for one will try to deduct rum expenses under
    fuel costs. The proof is in the writing.

    “We won’t employ contractors and nannies!” Yes you will,


    come on, you don’t know how to entertain a 2 year old any
    more than you know how to put up dry wall. None of that
    matters anyway, not hiring another contractor pales in
    comparison to what Pfizer will do if Obama raises corporate
    taxes, or, more rigorously accurately, what Pfizer will threaten
    to do if Obama threatens to raise corporate taxes. Those 39
    words and 4 commas may seem confusing to you, but— and
    this is the point— they are not confusing to Obama. Hence, a
    tax increase on the rich.

    IV. The Terrible, Ugly Truth

    50% of the budget goes to Social Security, Medic*, and


    unemployment/welfare. Add another 20% for defense, and
    that’s pretty much the blueberry piechart. I have no ability to
    assign relative moralopolitical value to these things, but I can
    state with certainty that none of them pay for themselves.
    Unless DoD spending yields practical nuclear fusion or robot
    lawn mowers, most of that money is just a form of white
    collar, defense industry (and everyone they employ) welfare.
    And the real problem isn’t today, it’s over time. The baby
    boomers have only started to retire, and they won’t be cheap.

    There is a terrible, terrible, ugly truth underlying all of this,


    and that is that taxes don’t matter to a government that can
    print money. The government collected $2.4T and spent $3.6T.
    They’ll take what they get, of course, but if they had collected
    $2T or $3T you/they would not have noticed. The country
    isn’t a household, it is a bank, and as long as the rest of the
    world believes “we’re good for it,” then we are. When it
    decides otherwise, look out. The US will go Lehman Brothers
    faster than you can say Bear Stearns.

    V. Were We Wrong?

    Some fundamental assumptions have turned out wrong. For


    example, we always talk about income. But we never talk
    about wealth. In France, they tax wealth— literally a tax on
    assets. They earned 4.5 billion euros from that and France’s
    population is 1/4th as large and not nearly as wealthy or funny.
    Furthermore, every country in Europe has a VAT tax, which is
    quite high, sometimes over 20% on consumer products. But a
    VAT is completely unAmerican because the US’s entire
    existence is predicated on consumption. France has lots of
    other taxes that are probably socialist, but then again, isn’t a
    $700B TARP fund socialist? It’s as annoying.

    More to the point, if the TARP fund was necessary to prevent


    large scale social disruption among all workers (not just the
    finance industry), and the 2008 crisis was simply the result of
    people behaving unethically/injudiciously but otherwise
    legally, then (a) some crisis was inevitable because you can’t
    legislate ethics for every possible scenario, and therefore (b)
    US-style capitalism is only possible in the buffer of emergency
    sharp turns into socialism. To phrase it in terms of books
    everyone has heard of but no one has actually read, Disaster
    Capitalism relies on The Black Swan event which is ultimately
    a consequence of the institutional structure of capitalism (not a
    natural disaster) to periodically deploy the Shock Doctrine to
    prevent the institution from actually changing. Long Tail that
    one, wildman.

    VI. So Socialism Is The Answer?

    To what? You don’t even know what the question is.

    The tax code many be complicated, all the talk on CNBC may
    seem technical, but our problem here is concrete, all you need
    are the numbers: we took in $2.4T and spent $3.6T. Anyone
    who attempts to discuss tax policy without including those two
    numbers has a whole different agenda which probably includes
    giving you AIDS. Run.

    $2.4T in, $3.6T out. That’s everything. And don’t tell me that
    some of our expenses are one-offs, like Katrinas or Iraqs, it is
    no different than blaming your budget deficit on your vacation
    to Disneyland. Next year you’ll want to go to Disneyworld or
    Paris or carpetbomb Iran or tow California back out of the
    ocean, there’s always another unexpected expense. And truth
    up, even if there were no unexpected expenses you wouldn’t
    save the money, you’d spend it on drugs and shoes.

    So what can be done?

    Well, here are some ideas that I got from science fiction
    movies, along with tube cars and blinky lights on our hands
    telling us it’s time to go:

    You could raise corporate taxes by 1-3%. I understand the


    Pfizer result here (firing people) but the reality is they fired
    people anyway, so what was the point? That they won’t fire
    more people? LABOR COSTS. The move towards
    globalization is happening independent of tax policy, the
    limiting factor isn’t Pfizer’s willingness to do it but Romania’s
    willingness to go along with it. I don’t need to defend my
    capitalism credentials, but if the ultimate end of capitalism is
    to convince you you need high fructose corn syrup, the system
    needs some adjustment, and that adjustment is about 3%.

    Or a VAT. Or a tax on wealth. Warren Buffet observed that he


    pays little income tax because he has little income. A 1% tax
    on wealth over some number could bring in a lot. Buffett has
    $40B, you could get $400M out of him alone, and he seems up
    for it. The combined net worth of the Fortune 400 is $1.2T;
    1% of that is $12B a year, and here you’d only have to piss of
    400 people. But, as I said, that’s democracy.

    Aren’t these ideas anti-capitalist? It doesn’t matter, they’ll


    never happen. $2.4T in, $3.6T out. That’s all that matters.

    VII. The Other Ugly Truth

    If you doubled income tax receipts on the rich, you still


    wouldn’t cover the deficit.

    VIII. Is $250,000 rich?

    Fun fact: how much money does it take to raise kids? To quote
    the great Ron Bennington: “All of it.” You’ll spend 10x more
    to send them to a 1.5x better school. Who could fault you? The
    alternative is school loans, which end up being a mortgage on
    a house you can never sell. Those time burglars are also gonna
    need iPads.

    “Is $250,000 rich?” is a question that wants to be written, “the


    country needs the money, where can we get the money from?”

    Which makes this next part so easy. The deficit is 10% of the
    GDP, a generational high. Either we cut spending or we raise
    our GDP, e.g. by inventing fusion engines or robot
    lawnmowers.
    So if we’re not willing to cut spending, we have to turn to
    business. It’s that simple, because the country can’t generate
    the revenue any other way. We rely on corporations for
    everything, jobs, insurance, lifestyle, products, mate selection.
    Say whatever you want at the CNN podium, bash the rich,
    shame the poor, it makes no difference. You may as well
    double down on the market and ride out the bump, because if
    it doesn’t go up you’ll have bigger problems than your
    portfolio. Pretending to reduce greenhouse gases or paying for
    MRIs or supporting welfare cheats or killing Muslims all costs
    money, if the government wants to keep doing these things and
    more the market has to go up. It is inevitable.

    $2.4T in and $3.6T out. That’s all. The reason why “is
    $250,000 rich?” is so hard to answer and pointless to ask is the
    same reason the government is in trouble. If you spend more
    than you take in, it doesn’t matter how much money you
    make. You’re not rich, you’re doomed.

    –
    (pastabagel gets another writing credit)

    http://twitter.com/thelastpsych
    The Paycheck Cycle
    September 24, 2010

    Problem 1: if you need to point out the card number…


    Problem 2: this is not a paycheck

    The CEO of WalMart, discussing how he manages the


    fluctuations in day to day consumer spending:

    The paycheck cycle… remains extreme. It is our


    responsibility to figure out how to sell in that
    environment… large pack at sizes the beginning of the
    month, small pack sizes at the end of the month. And to
    figure out how to deal with what is an ever-increasing
    amount of transactions being paid for with government
    assistance.

    He is describing how Walmat customers spend more when


    they get their check, and less at the end of the month.
    But:

    And you need not go further than one of our stores on


    midnight at the end of the month. And it’s real interesting
    to watch, about 11 p.m., customers start to come in and
    shop, fill their grocery basket with basic items, baby
    formula, milk, bread, eggs,and continue to shop and mill
    about the store until midnight, when electronic —
    government electronic benefits cards get activated and
    then the checkout starts and occurs. And our sales for
    those first few hours on the first of the month are
    substantially and significantly higher.

    What’s in your mind right now? Above are a bunch of words.


    What do you infer from them?

    Ib.

    Clear your mind, just think about this strategically. Ok, these
    women— they are women, right?— are waiting for the
    government money to be activated. Fine. But why are they
    there at midnight?

    Ic.

    And if you really think about it, the only reason


    somebody gets out in the middle of the night and buys
    baby formula is that they need it, and they’ve been
    waiting for it. Otherwise, we are open 24 hours… But if
    you are there at midnight, you are there for a reason.

    What he’s telling you is that on the 29th of the month, kids are
    running out of food.

    II.

    The conclusion that there are kids without food is obviously


    obvious, and undoubtedly you already knew that there were
    hungry kids in America. But what was your actual first
    conclusion when you read customers were milling around at
    11pm?

    Your mind jumped to the causes of that behavior, not the


    consequence. Are they wasting their money, what?
    And your solutions to “that problem” are related to your
    perception of that person in the store. But the kid didn’t ask for
    this life, and whatever solution you come up with has an effect
    on that kid. Or, stated more clearly: if your solution doesn’t
    help that kid, it is not a solution; it is a self-aggrandizing
    political stance. Masturbation is fun, but don’t expect anything
    productive to come from it. And you will be shamed if you get
    caught.

    III.

    Note the date on this story: September 2010. What does it


    mean? It means people in America are struggling right now,
    living paycheck to paycheck. We hear about the
    bankers/bailout, we hear about unemployment, but here are
    some untold stories about the devastating impact of the
    economic crisis on ordinary Americans.

    FALSE. This has nothing to do with the current economic


    situation, this has been going on for decades. It is framed as
    related to a current “crisis” so that you are less attuned to the
    ordinariness of this.

    “It’s the recession.” No, the recession “ended” last year; again,
    what you see outside is normal. What you saw for the past 20
    years was CGI.

    III.

    Maslow’s and his hierarchy suggest that in individualistic


    cultures, failing to meet basic needs results in anxiety and
    inhibited development. So if these kids are underfed regularly
    at the end of the month, their basic needs aren’t being met. So
    we’d expect them to be more anxious and tense. Hence,
    psychiatry.

    Maybe ADHD is an invented diagnosis, maybe not. But the


    symptoms are exactly what one might expect when the basic
    needs aren’t met.
    Note, however, that the institutional response to this very basic
    problem is the total mobilization of an unrelated service sector.
    Medicaid will happily pay $50 a patient visit to prescribe
    Ritalin, not because Ritalin works or doesn’t but because it is
    cheaper than spending $1000 a month to feed the family.

    That’s the truth about mental health parity, about healthcare


    reform. The government needs you to have access to
    healthcare way more than you actually do.

    Or, as Maslow put it: if all you have is a hammer, then


    everything looks like a nail.

    IV.

    So we should increase welfare payments?

    Won’t help. Evidently, middle class Americans cannot


    effectively manage their own mortgages. Why would we
    expect poor people to be better at it?

    How big a welfare check should be is a separate question.


    When data reveals widespread patterns of behavior in society
    (e.g. paycheck cycle), then something in the society creates
    that behavior. If many poor parents can’t manage their
    families’ (no sic) meals, it suggests failure in social services or
    education.

    A simple example. Note the welfare recipients are waiting for


    their monthly allowance to be activated electronically on their
    cards. But since it’s all electronic, why can’t the money be
    activated weekly? Or, if the data reveal that that results in
    faster spending (so now 4 days per month the kids are hungry
    rather than one day), the cards could be filled every 6 months.
    Or, based on the pattern of spending, each individual would be
    given the money in different amounts at different times.
    V.
    The irony: this story occurs at Walmart, notorious for paying
    people low wages and etc.
    That’s actually not irony, it is the whole point: labor costs.
    The solution that the system has conditioned you to believe is
    the answer is to give them something. The political divide
    differs only on what to give them: outright cash payments?
    Jobs?
    What you need to focus on is the why. Solving this isn’t a
    simple matter of raising the food benefit by an amount
    equivalent to one more day. The system needs to educate the
    poor on how to live life as a poor person.

    But then the system has to confront the reality that it produces
    the children who are more likely to grow into poor adults as a
    direct consequence of treating poor people as an aberration of
    the system, rather than as a fully predictable if unintentional
    result. In other words, the systematic treatment of poor people
    as a unexpected result of the system is the very part of the
    system that maintains the poverty.
    The Legend Of Steven
    Colbert
    September 29, 2010

    if he’s the last man on earth, to whom is he a legend?


    a.

    The global capitalist system is approaching an


    apocalyptic zero point… comprised by an ecological
    crisis, the consequences of a biogenetic revolution,
    imbalances within the system itself, and the explosive
    growth of social divisions and exclusions.

    So goes the premise of Slavoj Zizek’s new book, Living In


    End Times. It’s analyses are seductive, and from what you’ll
    hear other people tell you about the book that no one will read,
    you will conclude, “this is a guy who gets it!” Well, he
    doesn’t.
    This is a very good rule of thumb: anyone who tells you we
    are living in end times is wrong about pretty much everything.
    I. To Whom Am I A Legend?
    I Am Legend is the third substantial retelling of the novel by
    the same name (1954), the other two movies being The Last
    Man On Earth (1964) and The Omega Man (1971).
    All four stories follow similar plots. A plague has killed off
    humanity, except for some who have been turned into
    zombies/vampires. One human, Neville, survives.
    A series of remakes can often be a window into the evolution
    of a culture, and so it’s useful to look at what’s the same and
    what’s different over time.
    In the book (1954), Neville fights against vampires, but also a
    group of infected but still human creatures. They finally
    capture and execute him, not least because he is different, the
    last of a dead race. These infected humans have a functioning
    society of their own; as the majority survivors, the world
    belongs to them. Neville sees that they look at him with fear
    and disgust, the way he looks at them. As he is executed he
    realizes that they will remember him as a legend(ary monster.)
    This is a truly multicultural theme, Neville’s human tradition
    parallel but not superior to the infected’s. (History is written
    by the victors.)
    The first movie slightly but importantly changes the ending.
    Instead of being executed, he escapes to a church, but he is
    finally speared on the altar. Defiant to the end, Neville says he
    is the last true human, and the rest merely freaks.
    By The Omega Man, the multicultural theme is avoided. Here,
    the survivors are a mutant species of humans. Crazy as they
    are, they voluntarily choose to live away from technology and
    modernism because that’s what got them into this mess in the
    first place. Neville, however, has found a cure, so even if
    Neville represents something terrible and fearful to the
    mutants, he is still the normal while the mutants are pathology.

    In I Am Legend (2007), the multicultural reversal is


    completely extinguished. Will Smith (thinks he) is the last
    human, and at war with the vampires. He later discovers a
    woman and a boy trying to meet up with other survivors living
    in Vermont in a walled compound. In the final scenes Neville
    “adopts her fundamentalist perspective and adopts a
    Christological identification”: he stays behind to fight the
    vampires (and dies) allowing the human survivors to escape
    with the cure. So Neville becomes a “legend for the new
    humanity whose rebirth was made possible by his invention
    and sacrifice.”

    II. Multiculturalism On The March/Decline


    So goes the reading of the movies by Zizek. It is the evolution
    of multiculturalism played out in cinema. So far, so good.
    But Zizek has a point to make, and that point is that
    Hollywood got it backwards. Why would Hollywood insist on
    making less multicultural movies, while real society becomes
    more so? In 1954 multiculturalism was nonexistent; in 2007
    it’s practically an official ideology. If there was a society that
    was “ready” for a movie that puts all traditions on an equal
    level it would be eyeballs-deep Multicultural America, where
    every reference to another society is qualified by, “but we have
    to respect their traditions/what makes our ways better than
    theirs?”

    The answer is that we have regressed; what should be the


    correct, multicultural, understanding of reality (all traditions
    are equal in value) was ducked, and a lie reinstated (we’re
    better) in order to preserve the existing (though dying) social
    order. More plainly: conservatives have taken over
    Hollywood. These are all tricks to protect global capitalism.

    III. Write This, Not That

    If you’re having trouble with that line of thinking, you’ll have


    trouble with his whole philosophy, aptly summarized on page
    3 of the Introduction:
    In today’s post-political democracy, the traditional
    bipolarity between a Social-Democratic Center-Left and a
    Conservative Center-Right is gradually being replaced by
    a new bipolarity between politics and post-politics: the
    technocratic-liberal multiculturalist-tolerant party of post-
    political administration and its Rightist-populist
    counterpart of passionate political struggle— no wonder
    the old Centrist opponents (Conservatives or Christian
    Democrats and Social Democrats or Liberals) are often
    compelled to join forces against the common enemy.

    I’m not going to make the dozen easy jokes, I’ll say simply
    this: when writing becomes so complicated that only the
    initiated can understand it, then it is meant only for them. Who
    is he going to convince by hyphenating every third word set?
    Nobody. It’s masturbation, though considerably more difficult.

    IV. Will Smith Is Black???

    I Am Legend probably never had so much analysis, but let me


    throw in something Zizek missed: Neville is black. There’s
    your multiculturalism, at least all human races are equal in
    their superiority to vampires.

    They could have easily made the vampires a functioning


    society instead of animalistic marauders, thus allowing for a
    deeper multicultural comparison. For example, why not a 9/11
    allegory? Black and white rural Americans united against New
    York Muslims? A few days after 9/11, MTV interviewed the
    Wu-Tang Clan’s Method Man about what should be done to
    prevent another attack. His response was (paraphrasing), we’re
    going to have to start searching Muslims, stop them in their
    cars and at airports, etc. That the usual prime target of every
    possible kind of profiling was now suggesting that the solution
    was more racial profiling was an irony totally lost on him. But
    nevertheless a film that shifted the players in the multicultural
    hierarchy but kept the theme intact should have been welcome
    in 2007. It wasn’t.

    The question is why it wasn’t. There are huge ethnic divides in


    the world, not to mention poverty; “invisible people”
    marginalized, contained, unrecognized. So why does
    Hollywood insist on making movies that inferiorize the other?
    Zizek’s answer is, “collective fetishistic disavowal,” which is
    denial. We know the global capitalist system is in crisis, but
    we’re going to carry on like it’s not. Hollywood facilitates this.
    Important point: Hollywood facilitates this, not reflects this,
    because Hollywood is an extension of global capitalism.

    V. Do You Swear To Tell The Truthiness?

    Steven Colbert appeared before the House immigration


    subcommittee as an
    “expert witness”
    on migrant workers. Pause for effect.
    Steven Colbert is a person, but you have undoubtedly only
    seen the character Steven Colbert. What’s he like in real life?
    Who cares. That’s not what you pay him for.
    This wasn’t the typical Hollywood Star Testifying Before
    Congress routine, and at least those actors have the decency to
    signify that they are experts by wearing glasses they don’t
    need. No, he stayed in character the whole time, so his
    appearance before the Committee was jarring, seemingly
    uncanny. What next, Robocop? Was it appropriate to play a
    fictional character before Congress?
    And many congressmen/people said no, which on first
    consideration seems correct. But.
    But if you’re focusing on a man playing a character for the
    benefit of TV cameras, you are looking in the wrong place.
    Those hearings themselves are staged. They are purely for
    display, as a means of getting things into the public record.
    This isn’t a metaphor, this is the literal truth; there is no
    institutional expectation that real work is conducted there or
    that they even reflect the actual beliefs of the individuals
    speaking. They’re reading their lines. “What’s my motivation?
    Oh yeah, Monsanto.” Real business is conducted in the back.
    Steven Colbert is a character that the public has voted on to
    several seasons of TV. He’s sticking with what works.
    Congressmen are no more “real” than he; molded to represent
    the will of their perceived constituents. Or did John McCain
    really think of himself as a maverick? George Bush and Dick
    Cheney were anti-gay? Those are characters.
    No to mention that Colbert’s character is decidedly more
    consistent. How many people pictured above have to please
    their voters even as they must serve their donators?
    Steve Colbert didn’t crash the party, he was invited. No one
    refused to appear with him. No one criticized the fact of his
    appearance, only what he said or the way he said it. “I think
    his testimony was not appropriate,” House Majority Leader
    Steny Hoyer (D-Md.) said. “What he had to say was not the
    way it should have been said.”
    The most you can argue is that Colbert wasn’t an expert in the
    testimony he was giving, but, as he pointed out,
    “Does one day working in the field make you an expert
    witness, do you think?” Rep. Lamar Smith (R- Texas)
    asked scornfully.

    “I believe one day of me studying anything makes me an


    expert on something,” Colbert replied confidently.

    “Is that to say it’s more work than you’ve ever done
    before, right?” Smith followed.

    “It’s certainly harder work than this,” the comedian


    deadpanned.

    He’s not an expert, but he had, at that moment, more


    experience with the question than most everyone else in the
    room. (This is the person who engages in argument to
    undermine the system (treats the problem as symptom rather
    than fetish), but who also distances himself from his position
    through the process of critical analysis (i.e. he knows what he
    is doing)).
    And the very difficult thing to accept is that he also has more
    power. I realize that TV guys don’t vote on immigration
    policy, but I can absolutely swear to you unconditionally
    without any qualification, that immigration policy will go the
    way TV wants it to. They control the horizontal.

    VI. The False Choice

    Here’s a typical Zizek line of thinking. Say you want


    homosexuality to be accepted. So The Powers That Be tell
    you, “on penalty of death, do not dare make insulting
    comments about gays.” Got it.
    Or, TPTB can go postmodern on you, and instead say, “look,
    you have freedom of speech to say anything you want, but it’s
    ignorant to make insulting comments about gays.” That’s the
    approach in place now, and it’s much more powerful. It offers
    you a false choice, but you understand that you have to keep
    your remarks to yourself, or else something will happen.
    This description makes perfect sense. Americans of every
    political persuasion feel this false choice. They’re told they
    have these freedoms that, in fact, they really don’t. And the
    false choices are everywhere: watch whatever news you want,
    but everyone knows these are the only legitimate choices. No
    one can dare tell you what kind of diet you have to have, but
    your choice is high fructose corn syrup or aspartame. Eat it.
    From this very clear description of the problem comes the
    most terrible solution imaginable: let’s go back to the
    authoritarian approach. It’s more honest, and in this way we
    can effectively build a better society. You proletariat are either
    going to be controlled directly, or indirectly, but controlled you
    will be. At least if you can get the right people controlling you,
    they’d at least force you to eat something better than high
    fructose corn syrup. That’s what he thinks would happen.

    Well, they already tried this in a movie, and it was called


    Soylent Green.

    VII. I Am Legend In The Only Place That Counts

    You’ll observe that the title of the movie is I Am Legend, not


    We Human Beings Are Legends. I. The point that has escaped
    Zizek’s notice is that the I in I Am Legend doesn’t depend on
    the presence of other people. Note that Neville makes jokes
    and stays “in character” even though he’s talking to
    mannequins or a dog or no one. He can’t help it: he’s a human,
    and he was born after 1960. Zizek is worried about some
    fantastical move by the culturally powerful to elevate
    themselves and others to a superior state, but that would be a
    dramatic misunderstanding of the situation. The correct
    interpretation— i.e. the only one that is correct— is that from
    1954 to now we have moved from human cultures in conflict
    with weird, strange, other cultures (e.g. the Italians), to a near
    total awareness of all existing cultures that we find annoying.
    The result? We hate everyone equally. We are perfectly aware
    that to the vampires and Muslims we are evil, scary creatures,
    but that doesn’t make them less scary or dangerous.

    Hollywood got the evolution of the culture right, not wrong.


    The next remake will be titled, I Am A Main Character In My
    Own Movie, everyone else be damned.

    VIII. Who Would Win In A Fight?

    Back to Zizek and his key error. If you take him at his word,
    there are “inherent contradictions” in the very structure of
    capitalism that make it untenable; no one needs to destroy it, it
    will implode on itself. Similarly, the media moguls don’t have
    to be in cahoots with capitalists because the media itself (that
    structure) is part of capitalism (it creates wants, branding, etc.)

    The media creating wants and branding has nothing to do with


    capitalism, it has everything to do with human psychology.
    Even in a perfect (communist) utopia you could not kill off
    capitalism because capitalism is the sublimation, the
    “correcting” of the natural human impulse of envy. It either
    bubbles up and corrupts you, or you create a natural outlet for
    it. There aren’t alternatives. If global capitalism implodes from
    the weight of its inherent contradictions, it will simply be
    replaced by… global capitalism. Because it’s run by humans.
    But none of that matters, because even Zizek doesn’t believe
    his own theory. He can write 600 pages but in the end what he
    blames are individuals.
    Zizek, like all important bearded lefty communist who can
    outthink you Central Time NFL lunatics, derives his entire
    philosophical system from one single axiom: the powerful
    control the powerless. It may be phrased in terms of competing
    narratives or systemic contradictions, but it’s all George
    Bush’s fault nonetheless, and it is also Kim Jong Il’s and
    Putin’s and Maos’s in as much as they (as individuals) are part
    of the capitalist system. His solution is “a return to a Marxian
    critique of political economy.” When you hear someone in the
    front seat say that, hold your breath, you’re driving by a
    graveyard.
    There is no concerted effort to promote global capitalism, not
    in theory and not in practice. There’s no concerted effort to do
    anything, which is itself a problem but at least puts the Marxist
    angle to rest. These things you see happening aren’t
    capitalism’s fault, they are people’s fault. There are
    corporations and individuals with their own personal interests
    that sometimes align and sometimes don’t. I’m sure the CEO
    of Exxon and the CEO of Apple often apply their considerable
    power towards similar goals, but the moment Steve Jobs
    discovers cold fusion we’ll all be lamenting how pancreatic
    cancer takes the best of us.
    “They pressure the government to keep their corporate taxes
    low at the expense of healthcare!” Wrong. Each corporation
    pressures the government to keep their own corporate taxes
    low, period. That they’re all temporarily united on this is
    convenience, if Apple’s taxes have to go up in order for
    Exxon’s to stay low, we’re all going to have Droids. “But they
    all serve on each others corporate boards!” That’s not
    collusion, that’s keeping your enemies closer.
    I can say all this with confidence because, as far as I know,
    corporations and governments are made of human beings, and
    human beings are envious, petty, anxious, and above all
    mortal. What sets us apart from each other is how we manage
    those inherent flaws. All of their power is the power of
    individuals. When you say “Exxon tricks us by offering us a
    false choice of oil vs. unicycle!” you really mean that this guy
    is tricking you:
    Really? Look closely. Really?
    That’s the problem with his “false choice” model above: there
    aren’t any Powers That Be trying to trick you. Maybe in 1960
    when we had superpower politics, and in 1939, but not now.
    There’s no concerted effort to control society, so there is
    nothing to rebel against. The false choices work on you not
    because TPTB are devious but because you will murder your
    own family to avoid shame. All the control is self-imposed.
    And don’t let Zizek hoodwink you; he’ll say that the power
    isn’t in individuals but in the structure of capitalism itself—
    the rules and the initial allocation of rights that results in the
    outcome you see—no one has to act deliberately. That makes
    for good theory, but Zizek doesn’t believe it himself: it is still
    the execution by individual actors (who are part of the system,
    I’ll admit) that must actively work to keep capitalism propped
    up. Otherwise, according to him, it would be gone by now.
    So to Colbert. It would be awesome if all of this was planned,
    if there were some secret cabal who brought Colbert in
    specifically to mask the contrived meaninglessness of the
    Congressional Hearings, i.e. to make them seem more real
    than his simulated reality, and no doubt Zizek would see
    something along those lines. And it would be comforting to
    know that the chaos around us was really under someone’s
    watchful eye. But the truth is there is no such cabal. If you
    extraordinary renditioned Steven Colbert and waterboarded
    him to name names, he wouldn’t know what the hell to say to
    you. As far as he’s concerned, he duped them.None of this was
    planned, indeed, none of it has any point whatsoever. They
    invited Steven Colbert because… he’s Steven Colbert. There is
    no meaning behind it at all.

    IX. Will Smith Is Black?

    Zizek holds up I Am Legend as an example of preserving the


    current state of global capitalism, but in fact that movie is the
    perfect example of Hollywood’s disinterest in preserving
    anything except it’s own immediate survival. They put Will
    Smith in the movie not because he is black and it offers a
    different version of multiculturalism, but for the simple reason
    that he is the most bankable actor in Hollywood. In other
    words, not because they like him but because we like him.

    Furthermore, the ending of I Am Legend that you see today—


    the non-multicultural, kill all the mofos one— is the revised
    ending. The original ending was the multicultural one—
    Neville realizes the vampires have their own society, returns
    the girl to them, and they part ways, parallel traditions,
    humans living one way and vampires living the other way.

    This was the ending Hollywood wanted, but it was rejected by


    the (test) audiences. So Hollywood changed it, not to serve
    capitalism but to make a profit for themselves. It was that
    simple.

    What you see isn’t a systematic attempt to hide the truth from
    you, but the accidentally organized and random conflict of
    various individuals which has resulted in both iPads and
    temporary 10% unemployment. It is comforting to blame this
    on some flaw in the system, but there is no system, there is
    only people, and they have no time for theory. In theory, there
    is no “they”— just psychology the result of language mediated
    by these capitalist interactions. Bu tin practice, there are lots of
    theys, and they act in completely unpredictable ways—
    unpredictable if you’re looking at them as cogs in a system.
    Over beers and hash we can debate whether global capitalism
    requires emergency shifts into socialism, or not, but don’t
    think for a moment it is organized or hierarchical. And thank
    God.

    Real control— positive and negative— comes from within.


    Those guys don’t have to lie to you. You are being lied to, by
    yourself. If you want to change it, now you know where to
    start.

    –
    Addendum: too many emails about Bernie Madoff, so:

    So, you know, there is a structural problem beneath all


    this psychological topic of the greedy bankers, which is,
    that’s how capitalism works, my God, which is why even
    concerning our beloved model—Bernard Madoff, no?—I
    didn’t like it how they focused on him. He was just the
    radical version of where the system is pushing you. Now,
    I’m not saying—I’m not crazy—“which is why we need
    to nationalize all banks and introduce immediately
    socialist dictatorship” or what. What I’m just saying is,
    let’s not get rid of the problem by too easily making it
    into a psychological problem. You know, you can be an
    evil guy, but there must be very precise institutional,
    economic, and so on, coordinates, background, which
    allows you to do what you do.

    That it’s not a psychological problem is an odd thing for a


    psychoanalyst to say. But nevertheless, that Bernie Madoff
    knew how to work the system is different than saying the
    system allowed him to do it, or that the system creates Bernie
    Madoffs, or that he is simply an extreme case of what the
    system creates. The system doesn’t do anything, you do it all
    in reaction to the system. Bernie Madoff did those things
    because of… Bernie Madoff. To the extent that the institution
    itself is to blame, he should get less time, otherwise it is
    merely revenge; which it is, because there’s no system: it is
    punishment handed out by individuals against another
    individual, or, more accurately, individuals manipulating the
    system to get the outcome they want.

    http://twitter.com/thelastpsych
    Fanapt: Deconstructing A
    Promotional Slide Deck
    September 30, 2010

    Lesson 1: it’s pronounced (fa NAPT.) I know, I know.


    The intention here isn’t to catch Big Pharma in a lie, but to
    show the data for Fanapt while also showing you the “behind
    the slides” context. I’ve done something similar for Geodon
    and Seroquel (multiple times.)

    Some of this material overlaps with the otherst, but I’ve


    repeated it here so it could stand alone.

    I made these slides mostly from memory or from the PI using


    MS Paint. They appear different/more professional in the
    promotional materials, I can assure you.

    ––-

    First, an apocryphal story: Fanapt was named after the Greek


    word “phaneros” which means to manifest, to make obvious. It
    was done because the CEO/Founder of Vanda Pharmaceuticals
    was Greek (Polymeropoulos.)

    Slide 1: Pharmacology
    Those affinity constants on the right side don’t tell you how
    much of each effect you’ll get; they tell the order of binding. It
    tells you, for example, that the antihistamine effect will occur
    at a much higher dose than what’s needed for the antipsychotic
    effect.

    So what can we expect to happen with these numbers?

    1. At the lower doses, it will act a lot like Risperdal:


    selective and relatively equal 5HT2a and D2 blockade
    (Ki between 0.1 and 7nM).
    2. However, it has a1 blockade— so I expect to see more
    orthostatic hypotension/sedation than Risperdal,
    especially as the dose is increased.
    3. Based on the in vitro affinities shown here (which are
    often poor proxies for in vivo, but I can only work with
    what I have)— I’d expect EPS, prolactin, TD, akathisia
    rates to be superior to Risperdal, comparable to Zyprexa,
    and worse than Seroquel.
    (from Seeman 2004)

    On the side it tells you about the 2 active metabolites. The P95
    metabolite only shows affinity for serotonin and noradrenergic
    alpha1 receptors. What does that mean to psychiatry? Nothing:
    P95 doesn’t cross the blood brain barrier. What does it mean to
    the rest of the body? Orthostatic hypotension.

    See that 5HT7 early on in dosing? That receptor is involved in


    circadian rhythm. I don’t know what that means yet, but as far
    as I know it is unique to this drug.

    Slide 2: Pharmacodynamics
    This slide is here to tell you that people who are poor
    metabolizers of CYP2D6 chemicals (e.g. Fanapt) will have
    higher blood levels. Clinically relevant people are 10% of
    caucasians and 5% of blacks none of whom you will ever be
    able to detect. Also relevant are drugs that inhibit 2D6 and
    3A4 (Prozac, Paxil).

    In drug drug interactions, the order of the drugs is very


    important. If you are already on Prozac, (hopefully) the
    doctor will simply observe that you needed less dose for the
    effect, regardless of whether he was even aware of the reason
    you needed less (the interaction.) But if you’re on Fanapt
    already, and then get put on Prozac, your Fanapt levels will
    rise.

    Slide 3: QTc
    To put this in perspective: giving the max dose in one week,
    further elevated by the presence of Prozac or Paxil and
    ketoconazole, still resulted in an increase (19ms) that is less
    than the normal within-day variability (about 25ms).

    The risk is fairly low.

    Also, scan the slide, what does the FDA tell you? It tells you
    beware of people with cardiac arrhythmias; other drugs that
    also prolong QT; the metabolic effects of certain drugs (e.g.
    Paxil); and be aware of (low) potassium and magnesium.

    It does not say to get an EKG. First, the average circadian


    variability is about 20-25ms. Second, a normal EKG today
    doesn’t predict a normal EKG tomorrow, especially when drug
    levels are changing (and patients often get used to QT effects,
    so the prolongation lessens.) So unless you plan on doing daily
    EKGs, you risk information bias, i.e. letting today’s normal
    EKG fool you into thinking all is well.

    Better to be aware of the above listed factors, such as


    potassium, or to be aware of them. For example, what things
    lead to low potassium (which would increase the risk of QTc
    prolongation?) Diuretics, vomiting, etc.

    Also be aware that order of drugs matters: a man on HCTZ


    for a year (potassium had time to normalize) who then gets
    Fanapt is at less risk than a man titrated to 24mg Fanapt who
    then gets HCTZ thrown on top.

    Slide 4: Rationale For Active Control

    The slide appears before any other description of the study.


    Why?

    This is not an “active comparator” study, it is an “active


    control” study. The purpose of the active control— something
    you know reliably beats placebo in these kinds of studies— is
    just a test to see whether the study “worked” (assay
    sensitivity.)
    If the drug that usually works fails here, then likely the
    study itself was a bust.
    If it works but Fanapt doesn’t, then Fanapt is a bust.

    The reason you can’t simply compare to the drug to your


    active control is twofold:

    1. there may not be enough patients in the active control


    arm— its results may come out worse than ordinarily. (if
    it fails in one guy, but you only have two guys…)
    2. the dose of the active control might be enough to usually
    beat placebo, but maybe not enough to beat 24mg of
    Fanapt. If you run a trial of 30mg Zyprexa (a lot) vs. 1mg
    Risperdal (a little) vs. placebo, both would beat placebo;
    but could you really infer that Zyprexa is a more
    efficacious drug than Risperdal?

    Slide 5: 4 Week Trial Design


    Why 4 weeks? Because dropouts in an 8 week study would
    decrease the power (e.g. sensitivity) of the study.

    Why Geodon? To maintain the blinding: it’s easy to tell if


    you’re on Zyprexa (sedation) or Haldol (akathisia), but
    Geodon is milder.

    “Geodon needs to be taken with food!” It was, they were


    careful, this is an inpatient study.

    Observe that they got to 24mg of Fanapt and 160mg Geodon


    in 1 week. That will seem amazingly fast, or amazingly slow,
    depending on your background.

    Slide 6: Primary Demographics

    While you may be tempted to skip this, don’t.

    ITT= intent to treat. If a guy drops out after taking only one
    pill, what do you do? ITT says he is still part of the study.
    How do we deal with dropouts?

    If you take their last observed score and carry it to the end, the
    overall average will appear sicker (and the drug may appear
    less effective than if they stayed on it.) Or, as here, you take
    into account the trajectory of the scores to infer where they
    would have gone if they stayed in the study. (More on LOCF,
    etc, here.)

    Note that the primary efficacy measure is change on the


    PANSS scale: 30 items, scored 1 (absent) -7 (extreme). So a
    completely normal person scores a 30.

    In order to be in the study, they needed to be sick enough to


    score above 70. And they were, at baseline, about 90.

    Slide 7: 4 Week Trial Results

    It’s apparent that Fanapt beat placebo, -12 to -7.1 However,


    they started at a baseline of 90-92, so they ended up around
    80. These patients are all still quite symptomatic— they’d
    still be eligible to participate in the study again!

    Note the lack of a Geodon curve. Where is it? I found it in the


    original study:

    The study makes numerous comparisons with Geodon:


    efficacy measures, safety, side effects, etc. As well they should
    — so why deliberately hide it in the promotional deck doesn’t.

    “Well, it shows that Geodon beat it, that’s why they hide it.”
    That’s the reflexive answer. But it is the FDA that does not
    allow comparisons between drugs in promotional materials.
    They do it to prevent unwarranted comparisons, fine, but that’s
    different than hiding the fact that it was already compared.

    Note that Geodon 160mg was slightly better than Fanapt


    24mg. While it’s impossible to speculate, I will anyway:
    perhaps a little less, say, 120mg of Geodon, is about the same
    as 24mg Fanapt?

    Slide 8: 6 Week Trial Design


    Similar to the 4 week trial, but note:

    in the 4 week trial, patients were on 24mg/d by the end of


    week 1. So these doses are either lower (high dose) or
    considerably lower (low dose)
    the active control is Risperdal. It took a week to get to
    160mg of Geodon, which is about 3-4mg Risperdal— in
    this study, patients were on 6mg Risperdal by the third
    day.

    Why did I say 160mg of Geodon is about 3-4mg Risperdal?


    Because about the same number of D2 receptors are blocked at
    those doses. Since the 4 week study revealed a slight
    superiority of 160mg of Geodon over 24mg Fanapt, I’d expect
    6mg Risperdal to blow it out of the water.
    Slide 9: 6 Week Trial Results

    If the results here were easy to interpret, you wouldn’t need


    me.

    The change from baseline, -4.3, -7.4, and -8.8, are numerically
    smaller differences than those in the 4 week study because it’s
    a different scale. This is the BPRS, not PANSS— their mean
    baseline score was 55. However, the results are comparable.

    Note that the low dose and high dose are both about the same
    until week 5, and even then there is only a slight benefit from
    a doubled dose. Stop at 12mg and assess; if you need more, go
    to 24mg, but don’t rush to 24mg as per the FDA approved
    titration. As you will see later, the side effects at 24mg are
    greater than at 12mg.

    Where’s Risperdal? Have to go to the internet:


    Risperdal 6mg, as predicted, was substantially “more”/better
    than 24mg Fanapt. Going by the conversion, we’d thus
    expect about 24mg Fanapt to be equivalent to 3mg of
    Risperdal to 120mg Geodon.

    Now for something odd:

    Look at the blue heading above the graph in the slide.


    “Excluding schizoaffective patients.” Huh? In the original
    study (3005) schizophrenics and schizoaffectives both were
    permitted, assuming they were psychotic enough. When both
    were included, the low dose Fanapt (<16mg) failed vs.
    placebo. Only when the sample was restricted to
    schizophrenics did the low dose beat placebo.

    This was a multi site, international study. Trouble was, none of


    the U.S. sites showed efficacy for either Fanapt or Risperdal.
    So all of the data you see here is very unamerican.

    So why the poor results?

    First, the Fanapt dose relative to Risperdal may be too low—


    so low, in fact, that people drop out due to lack of efficacy.
    Indeed: 23% of Fanapt vs. 8% of Risperdalers dropped out
    from lack of efficacy, early on in the study (Americans want
    everything immediately.)

    And so, secondly: this is an LOCF. When they drop out, they
    carry their early “sick” score to the end, making it look worse
    than it could have been. (2) So the 23% who dropped out early
    will drag the 6 week average up (sicker). When they went
    back and looked at the data using only patients who stayed on
    it for at least two weeks, the results of both doses and
    Risperdal were all comparable.

    Moral: LOCF can kill a study if they drop out early.

    To make sure, the FDA reanalyzed the data using MMRM


    (which doesn’t use a last score but extrapolates from the
    trajectory of the scores):

    which here shows slightly better Risperdal efficacy, but again,


    it’s 6-8mg, which is the inpatient equivalent of hitting them
    with a car.

    Slide 10: Discontinuation Due To Adverse Events


    Awesome. However, every slide which reports FDA blessed
    data only reports from a specific time after randomization. So
    in this case, that’s after Day 3. How many people dropped out
    in the first three days, “screening intolerability?” No idea.
    (NB: in long term maintenance trials, the randomization might
    not happen for months after patients are screened and
    stabilized, so those first few months would not be included in
    the overall data, e.g. this.)

    Slide 11: Adverse Events


    The problem with such slides is there’s no way to organize it
    in your head. Is there a reason why dizziness doubles with
    dose, but dry mouth doesn’t?

    Go back to slide 1 and imagine the fountain model of receptor


    affinity. alpha1— the receptor that causes orthostasis and
    probably “dizziness” and “somnolence” (and reflexive
    tachycardia) is a later receptor— the higher you push the dose,
    the more of that effect you will get.

    Slide 12: Extra Pyramidal Symptoms

    Rates of EPS appear to be low and don’t increase with


    increased dose. Why? Go back to Slide 1, point 3: if/since EPS
    is related to Fanapt’s affinity for blocking the D2 receptor, and
    its affinity lies somewhere between Zyprexa and Seroquel,
    then the EPS rates should also be somewhere between Zyprexa
    and Seroquel, i.e. very low. Also, note slide 9: Fanapt 20-
    24mg will be about equivalent to 10mg Zyprexa or 3mg
    Risperdal.

    Slide 13: Prolactin levels

    As above, D2 affinities predict prolactin levels somewhere


    comparable to Zyprexa, i.e. low. Rigorously, it should be noted
    that this is only data in the first month, not after a year of
    exposure; but if the affinity is weak enough that it only
    transiently binds to the receptor— and thus only transiently
    results in prolactin surges, then there will be less overall
    exposure.

    Extra credit: “If prolactin is related to D2 blockade and


    affinity at the D2 receptor, than why does Haldol cause less
    hyperprolactinemia than Risperdal, even though Rispderal;s
    affinity is less than Haldol’s?

    Most antipsychotics easily cross the blood brain barrier.


    Risperdal doesn’t (well). The pituitary is outside of the blood
    brain barrier. In order to get adequate penetration into the
    brain, a higher dose of Risperdal is used than would be if it
    could easily pass. So outside the BBB, the pituitary is exposed
    to much more Risperdal than Haldol, even though they block
    comparable amounts of D2 receptors inside the brain.

    Slide 14, 15: Clinically significant weight gain and Mean


    change in weight
    A tricky slide. It shows that 12-18% of patients have
    “significant weight gain,” defined as >7% of body weight. So
    about 10-15 lbs.

    However,

    If the mean weight change is 4.6 lbs, and 15% of them gained
    more than 10lbs, then that means that some people gained no
    weight, and may even have lost weight. The trick is to
    distinguish those people.

    Can the people at risk for greatest increase be predicted? We


    only have the lessons of Zyprexa:

    1. Those who gain weight do it early; what happens in the first


    three weeks are predictive
    2. The main dietary intervention should be reducing
    carbs/sugars, especially fructose, not total calories.
    Slide 16: Lipid Profile

    The point of the slide is that Fanapt doesn’t affect TG or


    cholesterol much from placebo.

    However:

    1. This is short term, one month. If the weight change is


    mechanistically like Zyprexa then it should show up in a
    month. But if it is like Risperdal, slower, and possibly tied to
    prolactin elevation (the effect of which can take months- a
    year) then this doesn’t tell you much.

    2. Why does the placebo TG have a negative? In other words,


    why does putting them on placebo make the TG go down?
    Recall the study design: real patients are taken off their meds,
    and randomized to Fanapt or placebo. Maybe taking them off
    Zyprexa is what did it? Nope. Most acute (vs. maintenance)
    studies are done inpatient; so patients are taken from the
    outside, where they eat terrible diets and smoke packs of
    cigarettes, and moved inpatient where they eat comparatively
    healthier food, and smoke much less.
    –-

    Addendum 6/1/11:

    This graph shows the in-vitro affinities of Fanapt from a study


    in 2001. Biggest bar is the highest affinity, which in this case
    is alpha1. Yet in the pharmacology slide:
    alpha1 is way down. The slide suggests that alpha1 blockade
    — orthostatic hypotension— happens at higher doses. Yet the
    graph above suggests that it should be the very first thing out
    of the box.

    Turns out… Novartis made a mistake with the decimal point.


    That’s not 36 nM, but 0.36 nM. Here’s the new slide:

    That is a gigantic oops. First, it means that orthostasis comes


    early and fast, which is bad enough. It also means you can’t
    rush the dose titration, which is what docs want to do in
    severe, acute situations.

    But it hurts the credibility of the company. Yes, it’s a mistake,


    a “small” one in the sense that it could be missed, but if a
    trader bought something at 100x more or less than it was
    worth. it would be labeled a catastrophe. Even accidentally
    overstating the clinical trial data is easier to apologize for
    because we all understand that clinical data is “in progress.”
    But pharmacology is supposed to be a drug’s true identity,
    outside of marketing, outside of spin.

    And the problem is that in order for Novartis to explain this in


    any way other than to say, “we made a gigantic mistake,” it
    must make absorb pharmacology into marketing; instead of
    merely saying, “yes, we have a lot of alpha1 blockade, just go
    slow and the patient will not notice” they have to change
    reality: “well that’s not really a big difference…”

    You might also enjoy:

    Deconstructing A Promotional Slide Deck: Geodon

    How Seroquel XR Works

    Seroquel For Bipolar Maintenance


    Rutgers Student Commits
    Suicide (After (Being Taped)
    (Having (Gay) Sex))?
    October 1, 2010

    this could go either way

    CNN:

    said to be devastated when his private sexual encounter


    with another man was secretly taped and streamed
    online…

    I’ll open by saying that, on the face of it, this is a tragic story.
    There’s the power differential, and the idea that a woman
    could be part of the bullying (for lack of a better word.) The
    subtext that gay sex isn’t sexy, but funny; and, of course, no
    matter what happened, suicide is horrible.

    But while the media has clearly established the cause and the
    effect, it doesn’t seem so clear when you follow the events.
    The biggest inaccuracy is that he didn’t just find out he was
    taped, he knew about it already.
    I.

    On 9/21, at 7:22 am, he writes on a message board, “so the


    other night…” and describes his roommate turning on a
    webcam, etc. Dharun’s twitter confirms the sex and the taping
    happened on Sunday, 9/19, between 6p and midnight.

    However, he doesn’t sound extremely upset; he talks about


    working things out with his roommate, his roommate isn’t a
    bad guy, etc.

    so the other night i had a guy over. I had talked to my


    roommate that afternoon and he had said it would be fine
    w/him. I checked his twitter today. he tweeted that I was
    using the room (which is obnoxious enough), AND that
    he went into somebody else’s room and remotely turned
    on his webcam and saw me making out with a guy. given
    the angle of the webcam I can be confident that that was
    all he could have seen.
    so my question is what next?
    I could just be more careful next time…make sure to turn
    the cam away…
    buttt…

    I’m kinda pissed at him (rightfully so I think, no?)


    and idk…if I could…it would be nice to get him in
    trouble
    but idk if I have enough to get him in trouble, i mean…he
    never saw anything pornographic…he never recorded
    anything…

    I feel like the only thing the school might do is find me


    another roommate, probably with me moving out…and
    i’d probably just end up with somebody worse than
    him….I mean aside from being an asshole from time to
    time, he’s a pretty decent roommate…
    the other thing is I that don’t wanna report him and then
    end up with nothing happening except him getting pissed
    at me…

    Then on 9/22, at 4:38 am— ???— he writes that he had asked


    his roommate to use the room again, but this time saw the
    webcam in advance.

    so I wanted to have the guy over again.


    I texted roomie around 7 asking for the room later tonight
    and he said it was fine.
    when I got back to the room I instantly noticed he had
    turned the webcam toward my bed. And he had posted
    online again….saying….“anyone want a free show just
    video chat me tonight”…or something similar to that….
    soooo after that…..
    I ran to the nearest RA and set this thing in motion…..
    we’ll see what happens……
    I haven’t even seen my roommate since sunday when i
    was asking for the room the first time…and him doing it
    again just set me off….so talking to him just didn’t seem
    like an option….
    meanwhile I turned off and unplugged his computer, went
    crazy looking for other hidden cams….and then had a
    great time.

    Someone writes back to him a minute later:

    You may want to take a screencap of his twitter feed if


    you want to go the legal route just so you have some
    evidence of his activity.

    oh haha already there baby


    Then on 9/22 at 6:17am he writes

    he seemed to take it seriously


    he asked me to email him a written paragraph about what
    exactly happened…
    I emailed it to him, and to two people above him…

    Later that night he facebooks: “jumping off the gw bridge.


    Sorry”. He apparently died around 9pm that night.

    Students are already having protests at Rutgers; and we can be


    sure some politicians will be at some podiums.

    I don’t know what to make of this, but it seems to me


    considerably more complicated than “guy discovers he was
    taped and commits suicide, distraught.”

    Which, if it is, would mark this as another example of media


    distorting reality for the purpose of getting viewers, with the
    important consequence of social and political action resulting
    from a false premise. “Statistics show that homophobia
    accounts for X suicides a year…”

    Again, I don’t know what happened, but what they say


    happened seems to be only a bit of the story. Maybe Rutgers
    finally got back to him and said, “nothing we can do”— which
    makes this more about feeling abandoned than shamed.

    One possibility, terrible as it may sound: what if he had


    wanted to attempt suicide not because he was distraught, but
    because it would punish his roommate? It’s not so unusual.
    What if he instead chose to punish his roommate by killing
    him?

    I am not accusing him of this and I am not even speculating


    that this is even true. I am contrasting two media popular
    “competing narratives” to show that what we think we know is
    very often what someone else wants to be true. And once
    they’ve decided, you almost never get to change it.
    How Not To Prevent Military
    Suicides
    October 4, 2010

    bear

    If you had a a family member commit suicide in the military,


    then please do not read this post. It is not for you, and running
    back over it all, wondering what was to blame and whether
    there was anything anyone could do is masochism, you will
    not find anything comforting here.
    Probably the only consolation possible:

    Now there is one thing I can tell you: you will


    [eventually] enjoy certain pleasures you would not
    fathom now. When you still had your mother you often
    thought of the days when you would have her no longer.
    Now you will often think of days past when you had her.
    When you are used to this horrible thing that they will
    forever be cast into the past, then you will gently feel her
    revive, returning to take her place, her entire place, beside
    you. At the present time, this is not yet possible.
    Let yourself be inert, wait till the incomprehensible
    power … that has broken you restores you a little, I say a
    little, for henceforth you will always keep something
    broken about you. Tell yourself this, too, for it is a kind of
    pleasure to know that you will never love less, that you
    will never be consoled, that you will constantly remember
    more and more.

    I.
    For the rest of us, this is how you don’t reduce military
    suicides.

    Military suicide prevention efforts fail: report

    Here are the cited reasons:

    Each branch of the services rushed to create a suicide


    prevention program, but there was no coordination.
    prevention training often failed because those running the
    sessions did not understand their importance
    “It is not just the perception that they will be treated
    differently or somehow that it will affect their career, but
    it is also distrust in the system and distrust that mental
    health professionals can help them”
    “A large percentage of our servicemen, our veterans, do
    not come in to get help”
    “They don’t trust us. They believe we speak with forked
    tongues,” Bradley said.

    Or, the conclusion of General Peter Chiarelli, vice chief of


    staff of the Army, before the Senate Armed Services Military
    Personnel Subcommittee:
    “I think it is the cumulative effect of deployments from
    12 to 15 months”

    Of course: war is hell, and sometimes it’s too much for some
    people. Right?

    II.
    You might think that would be the last thing a general would
    say, especially since deployments are scheduled to get longer.
    And there’s a substantial political desire for it to be true, to
    have yet another reason to end the wars. I don’t blame them;
    nor am I saying I wouldn’t similarly manipulate the truth if I
    thought it would save lives, but I don’t lie to myself. You keep
    two books, not no books.

    III.
    Here’s the important part of the data that is usually not
    included, not here or here or many other heres: 30% were
    deployed, 35% were post-deployment, and 35% were never
    deployed.
    Those three populations are totally different. Whatever it was
    that happened in battle could not have happened before you
    got to the battle. This suggests that the approach for the never
    deployed be different than the currently deployed. Duh?
    Second, in showing the official conclusion of the military, you
    might ask what they don’t want the answer to be. In other
    words, not what is the benefit from this being the answer, but
    what is the benefit in it not being something else. And that
    something else is physical traumatic brain injury.
    And now we’re into a longstanding, very real, military
    question: what is PTS(D)? Is it all physical, all mental, or
    both? What about mild traumatic brain injury— all
    concussion, more than concussion, what? You can get
    “treatment” at any VA hospital regardless of what you call it,
    and (hopefully) doctors will look at the MRIs or the psych
    scales and treat what they need to treat, but the military won’t
    formally call it anything until the money side is worked out.
    That money side is Congress’s willingness to cover disablities
    and liabilities, and that willingness is entirely dependent on the
    reaction of the voters to the price tag. In other words, whether
    the suicides are the result of psychiatry, neurology, biology,
    divorces or explosions depends mostly on you.

    III.
    Here’s a first step: take the management of suicidality in the
    currently deployed combat soldiers out of psychiatry.

    What do you want to do here? Is the goal to reduce suicides or


    is the goal to “offer services” and “promote awareness?” It
    doesn’t matter if suicidality is 100% genetic, you approach it
    like it’s not.

    Here is a statement, your reaction to which will quickly


    determine your interests lay: the only thing less effective than
    telling these soldiers that the solution is psychiatry is to add
    that the psychiatrists are all gay. Pray on this.

    If we’re pretending these psychiatric illnesses are real medical


    diseases, then we must defer to the patient’s prejudices. And,
    my experience: soldiers don’t like shrinks unless they’re trying
    to be ex-soldiers, and then they only pretend to like us. And
    they don’t trust that shrinks are not a sandwich away from
    going Columbine themselves, not least because one of them
    actually went Columbine, well after we were supposed to be
    “aware” of the “causes” of Columbine, and none of the other
    psychiatrists noticed.

    Some of them maintain themselves on bravado and denial,


    they think that if they get their arm blown off in a fight,
    they’re just going to special forces everybody down with the
    good hand. Why would they admit to a mental illness, even if
    that’s actually the problem?
    You most emphatically cannot tell them that depression is a
    real medical illness with biological underpinnings that can
    affect anyone, from the Denver housewife to an Airborne
    Ranger, because you cannot make a soldier feel that his
    situation has anything in common with a Denver housewife’s.
    At all. Because the more he believes you the more he won’t
    show up.
    It’s revealing that the conclusion everyone has reached about
    these suicides is that “war is hell,” yet the proposed solution
    has nothing to do with war. It more closely mirrors the kind of
    management I give a man traumatized in a waverunner
    accident. Are they similar?
    Hence, the way to approach suicide prevention is to make
    suicidality/stress a rare, though entirely expected consequence
    of battle. Not to over analyze it, but to acknowledge it. In
    short, not to pathologize it, but to mainstream it: “Yeah, me
    too.”

    IV.
    You can stop sending more psychiatrists: 40% of the suicides
    are already in treatment and on meds. In regular America, only
    25% of suicides have never seen a psychiatrist.
    But if only it were so easy. Here are three factors that make
    military life nearly unbearable, that we don’t hear about:
    One: deployed soldiers are still in contact. Not only do they
    have the stress of war, but they also have an almost real-time
    update of the stresses at home. In Vietnam your wife wouldn’t
    bother to mention the boiler broke down, now you get to know
    that fact the same day you shot/got shot by 6 people. You are
    doubly burdened and doubly powerless. Not to mention get to
    watch your marriage deteriorate in serialized emails while
    you’re statused about her increasing happiness through
    facebook.
    Third: 2% of the Army’s drug screens come back positive. 2%.
    Includes Afghanistan. Where they invented heroin. 2%. Even
    as 25% admit to abusing— not using, abusing— painkillers.
    Fourth: gangs: it’s not the crimes, but the hostility, the fear and
    the marginalization. Try being an enlisted guy on a carrier
    looking to use the gym. Want to know what movie ordinary
    Army life isn’t like? The Hurt Locker. What it is it like?
    Training Day. I’m exaggerating?

    1. Those are bazookas.


    2. Those are gang signs.
    3. Those are women.
    V.

    Psychiatry may be the way to handle the non-combat suicides,


    but it clearly isn’t working for the combat/post- combat
    PTS(D) group. So there’s this:

    Here’s what PTSD is like, and why people kill


    themselves over it. Think of life like a cave. If I send you
    into a cave with a lantern and tell you there are no bears
    in the cave, you feel safe. You will walk around the cave
    and enjoy yourself. Now what if I give you a lantern and
    a gun and tell you that there is a bear in there? You can
    still go down, but you’ll be careful to look for the bear
    and ready to run or shoot if you see it. Now, what if I
    send you down there with a gun but no lantern and simply
    say “bear” to you? Pretty soon, you’re in there, you can’t
    see the way out, and every rock you bump into feels like
    a bear. After a long enough time being down in the cave,
    you realize you don’t have enough ammo to shoot
    everything that might be a bear. It has nothing to do with
    running out of food or water or feeling like you’re
    fighting some unwinnable battle with the bear. You just
    get sick and tired of the uncertainty. Are you going to live
    through the night? Are you going to wake up to a bear
    gnawing your intestines? You get to the point where you
    just wish the bear would come along and end it. And
    when he doesn’t come, you decide to do it yourself.

    Couple that with a winning facebook update, and you’re set.

    http://twitter.com/thelastpsych
    Catfish: The Real Danger Of
    Social Media
    October 6, 2010

    wild guess… is it a catfish?


    Catfish is a movie about a guy who has a facebook
    relationship with a woman, and then goes to meet her and
    discovers… should I say “spoilers below?”
    Spoil what? “The twist ending!” What twist? Darth Vader is
    Luke’s father is a twist, Katherine Heigl is annoying is not a
    twist, it’s a premise. Saying there is a twist ending is a vicious
    restructuring of the definitions of “twist” and “is.”
    “You’ll never believe what happens…” Yes you will. Exactly
    what you think happens, happens. The real mystery is why he
    never thought this would happen.
    But you should see the movie anyway.

    Cue trailer:
    Not a twist: Uber-hott 19 yo Megan isn’t really uber-hott, 19,
    or Megan. Huh. The only thing you don’t know is if when he
    looks in that garage he sees Chthulu eating fetuses, or nothing.
    Twist: nothing.
    But you’re not watching this movie for the twist. This is,
    surprisingly, a movie you can watch a dozen times for reasons
    different than the critics noted.
    Here’s the plot: Nev gets drawn into on online relationship
    with a really hot 19 year old. Nine (9) months later begins to
    suspect something is not right, and so he drives the surviving
    members of REM up to her Michigan farm to get to the truth.

    The truth is that “Megan” is really “Angela”: a middle age,


    middle America homely housewife with a facebook account.
    What does it all mean? Cue obligatory “on the internet, no one
    knows you’re a dog.”

    II.

    And:
    But what’s most interesting about Catfish isn’t that the
    Internet allowed a smart filmmaker to be bamboozled for
    months by a make-believe Michigan family. It’s that the
    Internet allowed him to figure it out, track them down and
    make a movie about it.

    Funny, that’s not what I thought was interesting. Maybe it was


    the subtitles, but the Korean bootleg I saw was about three
    megalomaniacs who actually believed it was completely ok to
    go a woman’s house in the middle of the night, unannounced.

    Don’t be sucked in by the perspective, which in the movie is


    all theirs. Pretend you’re the coroner: two people are reading
    the other’s potentially unreliable online information, and one
    of them starts driving towards the other. Is that the version you
    saw in the theater? That’s the real plot of the movie, and when
    you’re able to see it like that you see that the true problem of
    online contact isn’t what’s posted online but who is reading. If
    a murderer posts a fake bikini facebook photo, and you show
    up at his house with suntan oil and a inflated expectations,
    you’re the problem.

    The problem of perspective is the true caution of the movie,


    missed by everyone. We value Nev’s perspective more
    because he made the movie, but also because it features (not
    just uses) cameras, Google Maps, all of which are signals of
    neutrality, objectivity. If someone else made the movie about
    him and these events, you’d be aware of his insanity
    immediately. But by cleverly making the movie a POV, you’re
    drawn into seeing things only his way.

    Even the above Gawker critic couldn’t not see it from Nev’s
    perspective. Of course the woman lied to him, but didn’t he
    then turn and force himself into her real life only to make a
    movie? Isn’t that worse? Make no mistake, this is a
    documentary of narcissism supported by the Apple catalog. If
    there was any movie that exemplified “a narcissist is one who
    sees himself as the main character in his own movie, and
    everyone else is merely supporting cast,” it’s Catfish. At one
    point he’s frustrated by how his director-brother is pushing
    him to continue in the movie, and he says angrily but with no
    irony, “yeah, but this is about my life, okay?” Okay, wildman,
    settle down, we got it, it’s your life, not hers.

    III.

    Here’s the first clue you’re in the presence of delusionality: at


    no point do any of these three ask the most basic and obvious
    question, why would this chick be interested in Nev? This isn’t
    an insult, this is a legit query. Why would she want him? We
    understand why he would want her, but for the nine months of
    the movie, he has no sex with any other woman. “Well we
    can’t all be as smooth as you.” I sympathize, but you’re
    missing the point: no one else who can see him wants him, but
    she does? That doesn’t require some self-reflection?

    “He charmed her.” Slow down. “Megan” probably has had


    some experience being charmed, right? At one point, she texts
    that she’s baking a pie, “I’ll save you a piece.” Guess what he
    does with that. No, you’ll never guess. Comedy gold. This guy
    delivers the obvious like he’s writing for Daniel Tosh.

    There is an absence of self-awareness coupled with an


    overflow of self-absorption. “Of course me!”

    Put this in the reverse: at the end, when he discovers that he’s
    been talking to a homely midwest mom, his friends explain
    that the mom is probably in love with him— implying that of
    course a fat midwestern mom would fall for dashing New
    York sophisticate. That makes total sense. Even when they
    know that Megan must be an imposter, it never occurs to
    them that whoever the woman actually is might take one look
    at Nev and say, “hold on, you can’t be the guy… is this a radio
    bit?”

    The problem of this movie— which perfectly encapsulates the


    most basic problem with America— is that it doesn’t occur to
    the audience either. We’ve tricked ourselves into thinking that
    it’s a completely expected that people will see us the way we
    want to be seen. And so any divergences from this must be
    quite obviously mean the other person is a jerk.

    IV.

    An example. Let’s review some basic facts about Nev because


    he considers them important enough to put in his movie. First,
    he wears a retainer. I know, I know, it’s not cosmetic, it’s for
    TMJ. Second, he spends an awful lot of time hanging out in
    his bed in nothing but his briefs, which only look like
    Spiderman Underoos because they are red. They’re not
    Underoos. They’re just red.

    He loves the feel of a fluffy down comforter on his naked skin,


    that much is obvious.

    See that pic, above, where he’s sneaking up the dark driveway
    to peer into the garage of the mystery family that for all he
    knows could be cannibals? He’s barefoot. When he’s thinking
    about the malleability of identity he likes to stick his hand
    down his pants. In fact, what he likes on his body even more
    than a down comforter is his hands— he is constantly
    touching, rubbing, hugging his own body. I can say with
    complete certainty that this guy pees sitting down and still gets
    the seat wet. And you know how some guys think it’s sexy
    when a girl has a tattoo of a sun or wings on their tailbone?
    Well, Nev likes them so much he has one on his tailbone. I’m
    sure there’s a funny story behind that, but I can assure you it’s
    irrelevant.
    So? So my reaction to all this was that Nev was utterly,
    genuinely, hateable, somewhere on the level of a Snookie or a
    David Hasselhoff or the Asian chick on Grey’s Anatomy. He
    smiles like a Scientologist, he’s monumentally passive
    aggressive— I hated this guy. Hold on— I realize that my own
    natural self-loathing hovers around an unhealthy 105%, hence
    the rum, but the point is that Nev— as portrayed in this movie
    — would never imagine that he generates this reaction in
    anyone. He probably can imagine people not liking the movie,
    but why would anyone hate him? It’s inconceivable!

    V.

    One final example. Angela lives with two severely retarded


    children. They are stepsons; this is the life she chose. Through
    tears, she tells Nev that when she got married, she knew she’d
    be making some sacrifices, but she didn’t realize that in fact
    she’d be “resigning from her own life.”

    So, she’s telling him this because she wants some affirmation,
    not because she wants him to fix it. How could he? But Nev
    doesn’t hesitate to repeat all of this to the husband during his
    interview. “You know, Angela told me that she feels like she
    gave up a lot…” There are two possibilities. One is that Nev
    thought he was so much more intelligent and empathic and
    nuanced than this stupid hick— never mind that he’s been able
    to support a very pretty and well maintained home, and
    everyone in there seems happy, keeps all their needs and a
    decade long marriage intact— that aside, Douchekata figures
    he can Dr. Phil a decade long wound in their marriage with
    nine seconds of HD footage. The second possibility is that he
    didn’t even want to do that, he just wanted to split the wound
    open because he needed the shot. I’m not sure which is worse,
    but I hated him just in case it was both.

    VI.

    Go another way: so Angela lied to them about her identity. So


    what? Who says they were entitled to the truth?
    When they arrive at Megan/Angela’s house and meet everyone
    they are on edge, what’s going on here, none of this seems like
    Facebook? The family, especially the husband, is very friendly
    and cordial, but it could have gone the other way: what kind of
    nuts are these? He traveled all this way to meet a girl? That
    makes it normal? “We want answers.” You better keep your
    hands where I can see them. And why does Nev expect others
    to assume he is trustworthy? Because of what he wrote about
    himself on facebook? Haven’t we established that that stuff is
    unreliable?

    Well, let’s look at his facebook, then: he’s cut out a picture of
    her, naked, and put it onto a picture of himself, naked. You
    know who does that? People who narrate their reality.

    “It rubs the lotion on its skin or it gets the hose.” This photo
    creeps me out so much I had to stop drinking. Yeah. On the
    drive to her house, shouldn’t he have to call the Michigan
    police and register, or something?

    It cannot occur to them that what they are doing is wrong


    because it isn’t wrong— there are no Right and Wrongs, there
    are only his right and wrongs. They have a need to know, they
    want to meet her, so it’s all ok. The movie trailer plays like a
    horror movie, yet they don’t feel any fear at all, which is
    weird, right? You know Megan isn’t Megan and you know
    you’re wearing red underwear, shouldn’t you bring backup or
    something? As bad, neither do they worry that someone might
    be scared of three strange men in the dark. Look up at that
    picture. Why should anyone trust them? If you come at me and
    say, “hey, are you the guy who writes The Last Psychiatrist?”
    then you better come at me strong because I will take you
    down.

    The critics will deftly signal without spoiling that this isn’t
    really a horror movie. Let me correct that right now: it is
    absolutely a horror movie. Fortunately for Angela, the
    psychopaths just happen to be pussies.

    VII.

    There is a line, and that line is online. The agreement we’ve all
    accepted, it is there in your ISP contract, is that we are willing
    to trade exhibitionism/voyeurism for greater respect in real
    life. Or, less privacy online for more privacy offline. The girl
    on facebook “agrees” to use a bikini profile pic because you
    agree not to stalk her, in fact, you agree not to mention it to her
    in person at all. That’s the deal. If you say, “hey, I saw your
    pics on facebook and I wanted to meet you,” she is
    allowed/encouraged to go Desert Shield on you. That’s the
    deal.

    This is why huge corporations can’t fire people based on what


    they did online. “Well, we don’t want that kind of person
    working here.” They’re all that kind of person, you’re that
    kind of person, every one of us carries around multiple shames
    that would exclude us from society, let alone Walmart. It is
    information bias, just because you know she is a slut or he is a
    racist doesn’t mean that everyone else isn’t. Why does so
    much of us have to be in the job? Jobs suck, we do them in
    spite of ourselves. Asking me to clean up my online profile
    because you want to pay me $11/hr is a bit much. Shut it.

    It’s the same deal that goes with sexy clothing. The contract is,
    you show a lot of cleavage, we don’t stare. That’s the deal, not
    the reverse, not the “well she put it out there so I can stare.”
    None of this is conscious, explicit, it’s SOCIETY. When we
    start staring too much, they’ll start covering up/getting private
    security. And society changes. It’s a symbiosis that is always
    in flux, and this is where it stands 2010. Like it or not.

    “Well, sometimes they want you to stare at their breasts. How


    can you be sure it’s not you they want? Easiest question in the
    world: if you’re not sure, it’s not you. She’ll let you look
    obliquely because she doesn’t have control over the velocity of
    light, but if you stare too long expect a manicured finger in
    your eye. That’s the deal.

    Nev breaks the deal. You can’t fault him for googling and
    investigating, but he’s not permitted to go to her house. That’s
    the deal.

    At the end of the movie, he reveals that Megan is actually


    Aimee Gonzales.

    Note that he did all this because he thought she was real. Now
    that everyone in America knows she’s real…

    To be clear: I don’t fault Nev et al for making a good movie


    about himself, I deeply fault all the critics (and audience
    members) for celebrating the wrong message. Only— and I
    can’t believe I’m about to say this— a male dominated,
    female-as-commodity narcissistic perspective would think that
    the moral of the movie is that a man might get fooled. The real
    moral is that some men will drive 300 miles just on the chance
    that you are hot. Imagine how far they’ll go to kill you.
    –

    http://twitter.com/thelastpsych
    How To Be Powerful, And
    Why You Are Not
    October 8, 2010

    she has assumed the position

    Which guy appears more powerful? They guy with leaning


    back in a chair, feet up, hands behind his head? Or the guy
    hunched forward, hands together in his lap?

    Which guy do you think feels more powerful?

    The study found that assuming the 2 power positions (vs. non-
    power) for 1 min each had three results:
    1. Subjects rated themselves as more powerful (2.84 vs. 1.87
    on a 1 to 4 scale)

    2. When offered a choice of keeping $2 versus betting it all on


    dice, 86% of the power group chose to gamble, vs. 60% of the
    non-power

    3a. Their testosterone went up about 15% or down 10% from


    baseline, respectively:

    3b. Power position also significantly lowered cortisol levels by


    about 15%, while adopting the low-power position had a
    limited, but upwards effect. Cortisol is usually secreted during
    acute stress.
    All this, from two minutes of a posture change. True for men
    and women equally.

    II.

    In fact, the subjects weren’t told to sit powerfully, they were


    told that they needed to sit like that to get a better EKG
    reading. So power itself was not suggested to the subject. It
    was merely the act of sitting in that way that made these
    changes.

    This suggests that it was the posture itself that


    unconsciously(?) altered both self-perception and actual
    physiology. So, sit up straight.

    But it’s logical that if that posture unconsciously affects self-


    perception— i.e. it wasn’t a mechanical effect of having your
    hands above your head— then that posture itself serves as the
    cue. So whether you see it, or position in it, it should have a
    similar effect.

    So not only will sitting like that have an effect on you, but
    sitting like that will have an effect on whoever is looking at
    you.

    It is a story best told about dating, and in reverse: if a woman


    sees you hunched over, she’ll be biased towards assuming
    you’re not “powerful”, and you yourself will feel less
    powerful.

    III.

    This isn’t anything new, it’s long been known that forcing a
    physical maneuver can alter mood. Forced smiling can make
    you happier; clenching the fist makes men more aggressive
    and women feel less in control; method actors key off of
    physical movements to get their head in gear. And yoga exists.

    It should also be obvious that this shouldn’t work. How out of


    touch with our own bodies must we be if we can
    unconsciously change our mood by accidentally sitting a
    certain kind of way? And so how much does it therefore suck
    to be a computer geek hunched over a keyboard 13 hours a
    day? Time to do some push ups. (I do 40 every hour, between
    midnight and 2am; take that, guy who hates my physical
    bravado but is ok with my sexism, raging alcoholism and
    piracy.)

    Some readers will come back with a notion of a mind-body


    feedback loop, fine, no argument from me; but if these
    principles are so well known, why don’t people do them more
    often? Why, during a presentation, do some people still hunch
    over? Why do guys still timidly try to talk to a woman, instead
    of at least faking confidence and assertiveness? Or at least
    standing up straight?

    IV.

    Let’s grant that the study is accurate. So if you’re a young lad,


    adopting a powerful position improves your chances of
    “reproductive success” because she sees you as more
    powerful, and you feel more powerful, and you have more
    testosterone angering the blood. Check.
    However:

    if you consciously adopt a powerful state— puff up your


    chest and say, “hey baby, nice stems”, and it fails, you’re
    going to look like an idiot. Shame.
    Your more natural, timid posture coupled with inevitable
    rejection is sad but not unexpected. There is less shame.

    Similarly, even though an presentation’s chances for success


    are greater if you speak with confidence and stand up straight,
    doing it that way and failing is a greater blow to your ego.

    Notice that the rejection is the same in both cases, but it is felt
    more severely if you act confidently, posture accordingly.
    There is more shame.

    Thus, increasing your chances of failing is a defense against


    shame.

    V.

    That shame is the result of faking it, of putting on an identity


    that isn’t really you (I’m powerful) and having it exposed
    (rejected.)

    The solution is to not fake it. That doesn’t mean not try, that
    means instead of sitting up straight before the presentation, sit
    up straight all the time. At least train your body to naturally
    adopt what your mind is too nervous/self-conscious to do.

    If this study is at all representative of the truth, it means that


    eventually you will physically change into the person your
    body is pretending to be.

    http://twitter.com/thelastpsych
    The Military And PTSD: A
    Star Wars Guide
    October 14, 2010

    In The Empire Strikes Back, the Millennium Falcon is being


    pursued by Imperial Star Destroyers and several TIE fighters.

    Something hits the Falcon. “That’s not a laser blast…” says


    Han.

    “Asteroids!” yells Leia from the cockpit. They are


    everywhere. She quickly gets up to allow Han to take control.

    He makes a snap decision. “Chewie, set 271.”

    She didn’t expect him to say that. “What are you doing?….
    You’re not actually going into an asteroid field, are you?”

    “They’d be crazy to follow us, wouldn’t they?”


    Han Solo deftly turns and flips the ship, trying to doge the
    both the asteroids and the laser blasts from the remaining TIE
    fighters. Leia, Chewie and C3PO stare powerlessly as asteroid
    after asteroid almost obliterates them.

    It becomes obvious to all that this was a terrible idea.

    “You said you wanted to be around when I made a mistake,”


    Solo deadpans. “Well, this could be it.”

    “I take it back….we’re going to get pulverized if we stay out


    here any longer!” Leia says.

    “Can’t argue with you there. I’m going in closer to one of the
    big ones.”

    “Closer?!”

    Take a good look at the expressions on their faces. Solo


    focused, almost angry. Leia terrified. Chewbacca fearful and
    incredulous.

    This is a kind of exposition, the character’s personalities being


    revealed through a trial.

    They all come out ok, but let’s say they didn’t. Excepting the
    metallic version of Professor Smith, who there is most likely
    to get PTSD?

    Chewbacca is an ex-soldier who has seen all kinds of war


    horrors. Leia’s been tortured, seen her home planet be
    destroyed, been in gun fights, so it’s not like she hasn’t been
    stressed. But looking at their faces, it’s evident that they are
    more terrified, there’s something about Solo that lets him
    manage his fear and his response to it. Genetics? Toughness
    derived from years of hardships? Alcohol?

    It may not be any of these things. It may simply be that Han


    Solo is driving.
    II.

    Thanks to a reader, 2LT Timlin for turning me on to Sebastian


    Junger’s War, a book I had never heard of and which
    apparently no one in the military has either.

    The Navy study compared stress levels of the pilots [who


    have to land on tiny aircraft carrier landing strips] to that
    of their radar intercept officers, who sat immediately
    behind them but had no control over the two-man aircraft.
    The experiment involved taking [cortisol] samples of
    both men on no-mission days as well as immediately after
    carrier landings… Radar intercept officers lived day-to-
    day with higher levels of stress — possibly due to the fact
    that their fate was in someone else’s hands — but on
    mission days the pilots’ stress levels were far higher. The
    huge responsibility borne by the pilots gave them an ease
    of mind on their days off that they paid for when actually
    landing the plane.

    The study was duplicated in 1966 with a twelve-man


    Special Forces team in an isolated camp near the
    Cambodian border in South Vietnam… There was a
    serious possibility that the base would be overrun, in
    which case it was generally accepted that it would be
    “every man for himself.” The two officers saw their
    cortisol levels climb steadily until the day of the expected
    attack and then diminish as it failed to materialize.
    Among the enlisted men, however, the stress levels were
    exactly the opposite: their cortisol levels dropped as the
    attack drew near, and then started to rise when it became
    clear that they weren’t going to get hit… “The members
    of this Special Forces team demonstrated an
    overwhelming emphasis on self-reliance, often to the
    point of omnipotence,” they wrote. “These subjects were
    action-oriented individuals who characteristically spent
    little time in introspection. Their response to any
    environmental threat was to engage in a furor of activity
    which rapidly dissipated the developing tension.”
    Specifically, the men strung C-wire and laid additional
    mines around the perimeter of the base. It was something
    they knew how to do and were good at, and the very act
    of doing it calmed their nerves. In a way that few
    civilians could understand, they were more at ease facing
    a known threat than languishing in the tropical heat
    facing an unknown one.

    Two things to note: one is the perception of powerlessness as a


    factor in stress; the other is that action is useful for its own
    sake. Action according to logic or training can be empowering
    even if it is itself purposeless.

    III.

    Junger starts his book with this epigraph, from Lord Moran’s
    Anatomy of Courage:

    By cowardice I do not mean fear. Cowardice… is a label we reserve for something a man
    does. What passes through his mind is his own affair.

    The quote is popular all over the internet, but it’s a misquote.
    This version conveys the impression that everyone feels fear,
    but only a coward acts on it.

    By cowardice I do not mean fear. Fear is the response of


    the instinct of self preservation to danger. It is only
    morbid, as Aristotle taught, when it is out of proportion to
    the degree of the danger. In invincible fear— ‘fear
    stronger than I am’— the soldier has to struggle with a
    flood of emotion; he is made that way. But fear even
    when morbid is not cowardice. That is a label we reserve
    for something that a man does. What passes through his
    mind is his own affair.

    The forces that go into creating cowardice were often outside


    of the coward’s control. He probably didn’t want to be a
    coward; he wasn’t trained not to be.

    IV.

    One of the most puzzling things about fear is that it is


    only loosely related to the level of danger. During World
    War II, several airborne units that experienced some of
    the fiercest fighting of the war also reported some of the
    lowest psychiatric casualty rates in the U.S. military.
    Combat units typically suffer one psychiatric casualty for
    every physical one, and during Israel’s Yom Kippur War
    of 1973, frontline casualty rates were roughly consistent
    with that ratio. But Israeli logistics units, which were
    subject to far less danger, suffered three psychiatric cases
    for every physical one. And even frontline troops showed
    enormous variation in their rate of psychological
    breakdown. Because many Israeli officers literally led
    from the front, they were four times more likely to be
    killed or wounded than their men were — and yet they
    suffered one-fifth the rate of psychological collapse. The
    primary factor determining breakdown in combat
    does not appear to be the objective level of danger so
    much as the feeling — even the illusion — of control.
    Highly trained men in extraordinarily dangerous
    circumstances are less likely to break down than
    untrained men in little danger.

    The division between those who feel in control of their


    fate and those who don’t can occur even within the same
    close-knit group. During World War II, British and
    American bomber crews experienced casualty rates as
    high as 70 percent over the course of their tour; they
    effectively flew missions until they were killed. On those
    planes, pilots reported experiencing less fear than their
    turret gunners, who were crucial to operations but had no
    direct control over the aircraft. Fighter pilots, who
    suffered casualty rates almost as high as bomber crews,
    nevertheless reported extremely low levels of fear. They
    were both highly trained and entirely in control of their
    own fate, and that allowed them to ignore the statistical
    reality that they had only a fifty-fifty chance of surviving
    their tour.

    Note again the relationship of the feeling of control— not the


    actual possession of control— to the reduction of fear.

    And note the wording of the last sentence: “allowed them to


    ignore… reality.”

    IV.

    Marshall McLuhan once said, “if everything around you is a


    nail, then get a really strong hammer.” So the psychodynamic
    hammer: if narcissism is the exertion of will towards the
    maintenance of ego— trying to get everyone to see you the
    way you want to be seen, and to get them to act the way you
    need them to act— then a narcissistic injury would be the
    discovery of the limitations of your own power.

    If the Americanized culture of the past two generations has


    deliberately encouraged narcissism as a positive personality
    structure, then we can expect higher rates of PTSD than in
    WWII not because the physical stresses are more severe— in
    fact, they are most often less severe— but because the
    discovery of the limitations of our own power shock us more
    deeply than it shocked them.

    Typically, avoidance and flashbacks are the proxies for the


    diagnosis of PTSD, but these are drawn from experience with
    soldiers from a different time and a different culture. Today,
    the primary symptom of a traumatic reaction to the discovery
    of powerlessness wouldn’t be fear but rage. Hence, new onset
    domestic violence is more sensitive than nightmares. “Being
    there” (suddenly staring off into the distance) more specific
    than reliving the traumatic event.

    It follows that a PTSD soldier at home would be much less


    traumatized by a terrible car accident than by the suspicion
    that his wife is cheating.
    IVb.

    I’m not saying soldiers are narcissists; but that’s the culture we
    were taught from the day of our birth. The military should
    have made an effort to understand the psychic vulnerabilities
    of the culture it was recruiting from, and adjusted its training
    to anticipate those vulnerabilities.

    More broadly, a nation that chooses to go to war— for good


    reasons or bad— should train its population to be more
    selfless, to establish as obvious that each person is merely part
    of a far more important whole, and to incentivize displays of
    that thinking with explicit rewards.

    and you wonder why there are no other Wookies in V and VI

    If it cannot do this, if it can’t institutionalize this, it shouldn’t


    go to war, most practically because it will not win.

    V.
    I wasn’t so young 30 years ago that I shouldn’t have known
    better.

    After Vader tells Luke he is his father, he implores Luke to


    join him, “together we can rule the galaxy!” etc.

    I remember thinking, why doesn’t Luke just lie? Why doesn’t


    he just pretend to join Vader, and then light saber him in the
    head or poison his rebreather later on? Instead, he jumps like a
    Stoic.

    Short term yes, long term no. Turns out Lucas/Campbell was
    right and I was wrong. In extreme scenarios, for example
    torture or being a prisoner of war, lying and pretending gives
    short term gain but accelerates your mental breakdown.
    People who have survived have done so not by toughing it out
    — me vs. you— but focusing on something they considered
    more important than their own survival. “This hurts, but it’s
    far better than bowing down to them.”

    In the language of learned helplessness: there is a vicarious


    learning in watching yourself apparently break down and give
    them what they want. Furthermore, it reveals the limits of your
    power: I had no other options but acquiescence.

    The military’s immediate problem is that this advice must now


    be learned in adulthood; there hasn’t been 20 years of practice.
    It is not reflexive; narcissism is. I hope it requires no
    elaboration that the people we are currently fighting have
    exactly the opposite circumstance.

    IV.

    Many of the solutions propose themselves, but with respect to


    the military, and any organization that rises or falls on the
    tenacity and relentlessness of its members, Lord Moran offers
    this generally unpalatable perspective:

    Leadership only concerns me when it hastens or delays


    the using up of a soldier’s will power. But discipline runs
    through this part of my book like an undertone. Men are
    everywhere demanding whether a discipline which was
    designed for the illiterate is still suitable for an army with
    considerable number of thinking men in its ranks. I have
    turned over in my mind whether it is possible to relax that
    discipline without impairing a soldier’s efficiency as a
    fighting man, and I can only find one answer…

    The answer is no.

    http://twitter.com/thelastpsych
    Miners Get Paid, As
    Expected
    October 15, 2010

    real American heroes

    Are they tough? Damn straight. Are they heroes? No way,


    Jose.

    COPIAPO, Chile - The first three rescued Chilean miners


    out of the hospital celebrated their new lives as national
    heroes Friday, as word emerged that the 33 want to
    closely guard their story so they can fairly divide the
    spoils of their overnight media stardom.

    There’s a subtlety to this story that might have been missed:


    they were already anticipating big paydays while they were
    still in the hole.

    If society wants to pay them for the human interest story; if


    there’s a market for that, I certainly won’t stand in their way,
    but don’t ask me to participate in the alteration of reality that
    these guys are heroes. Put me in a hole for 69 days with no
    hope of rescue— call me a hero. Put me in a hole for 69 days
    with no hope of rescue but every probability of a big pay day,
    and this stops being heroism and starts being a reality show.

    “This is not a reality TV show,” he said.

    He’s half right— it’s not reality, it’s meta reality: pretend to be
    miners trapped in a hole. Pretend not to be miners trapped in a
    hole about to get paid.

    Ramirez, as you’d expect from a man who embraces the


    risks of his profession [mining], scoffed at the need for all
    the psychological treatment.
    “When we first spoke to the miners down below … they
    weren’t in bad shape,” he said. “Psychologically, they
    weren’t in bad shape at all.”
    But being thrust from the dark chambers of a gold mine
    into the limelight — and knowing how to cope with
    overnight fame — is quite another matter.

    Note that the last sentence appears in the form of a reversal:


    that’s narrative construction to keep you interested in a story,
    but it is factually inaccurate. They weren’t psychologically
    tough and now have to deal with overnight fame; they were
    psychologically tough because they were anticipating
    overnight fame. Which isn’t to say that they wouldn’t have
    survived even if there was no money— who knows?

    So now they’re going to make a TV show about them? I’d like


    someone to explain to me how a movie about their ordeal
    differs from the news coverage of their ordeal, except that it is
    temporally contiguous. Did the news not capture the drama?
    Did the news not sex it up?

    The real mind bender for the media is: how do you tell the
    story about heroism, when the “heroism” exists precisely
    because of the story?

    II.

    God told Abraham to take his only son, Isaac, to Moriah and
    sacrifice him. The popular telling of the story is that this was a
    test of Abraham’s faith. Abraham obeyed God; but at the
    moment he was about to plunge the knife into Isaac’s heart,
    God called to him and stopped him

    for now I know that you fear God, seeing you have not
    withheld your son, your only son, from Me.

    Abraham passed the test! Yay!

    But what did he really do? If God tells you to do something,


    there’s no issue. He’s the highest law, so you obey. Abraham’s
    actions— murder— would neither be wrong (God is the
    highest law, he decides what’s right and wrong) nor heroic: I
    did this because God said to. All Abraham did was exhibit a
    preference for God over his son. In the logic of the Bible, is
    that such a big deal?

    St. Paul adds:

    By faith Abraham, when God tested him, offered Isaac as


    a sacrifice. He who had received the promises was about
    to sacrifice his one and only son… Abraham reasoned
    that God could raise the dead, and figuratively speaking,
    he did receive Isaac back from death.

    Abraham had in the back of his mind that God could even
    raise Isaac from the dead. So what’s the worry? And, despite
    God’s insistence that Isaac was his only son, he had a backup
    in the woods somewhere. Just call him Ishmael.
    This is a painting of Abraham leading Isaac to sacrifice in
    what I assume is colonial Williamsburg. Domenichino thought
    it important enough to paint three palm trees, but you know
    what he didn’t paint? God. Because he’s not there.

    Could Abraham actually hear God? Of course not— so he


    could only assume that what he thinks he heard was God
    telling him to kill Isaac. Otherwise he was insane. If he heard
    God, there’s no test of faith, only a test of preference— God or
    Isaac. But not hearing God, he had to both prefer God and
    believe he had heard Him.

    If Abraham had actually killed Isaac, then Abraham would


    actually be a murderer, punishable by whatever they did back
    then. And he would know that, but he would have to kill Isaac
    anyway.

    But neither was belief in God enough. He had to believe in


    God and simultaneously have faith that such a God would not
    allow Isaac to die. “I believe God wants me to do this, but I
    have faith that this kind of God would not allow me to do
    something wrong, and no, even I’m not sure about any of
    this.” The real test God was challenging him with was, “do
    you believe in the right kind of Me?”
    “All of this is absurd.” That’s why he’s anxious. But the
    question is, what’s Isaac to make of all this?

    III.

    Bible study is over. Now to NYC, where the city has paid
    about $1B since 2000 in settlements for claims against the
    NYPD.

    “Right now it’s open season against the city. Just file a
    lawsuit, and you’re going to get money,” said City
    Council member Peter Vallone, who has sponsored a bill
    he hopes will make it impossible to pay out dubious
    claims.

    I realize many are legitimate, their legitimacy is not my


    concern. “Some multimillion-dollar settlements have gone to
    officers themselves for on-the-job injuries.” Fine.

    NY public hospital claims were almost $3B.

    There’s a shortage of money but a plethora of lottery tickets,


    and you can’t fault a person for playing the numbers. There are
    too many other people in the world, sufficiently odd looking to
    be slightly unreal, and so only a tiny, tiny amount of the
    world’s attention, help, concern, love, is directed at you. Hell,
    your own wife doesn’t like you that much. So if a transit bus
    happily breaks your leg, there’s no shame in taking a 100
    grand with you into your isolation.

    But there’s no honor in it, either.

    The money, the narcissism, makes even good men go the


    wrong way. Why not me? Why not get paid for my suffering?
    And the answer is: there is no reason, you earned it. I guess.

    But don’t call it heroism. Have the dignity to hide it from


    everyone, you may have earned that money but you did not
    deserve it. It is not a mark of distinction, any more than
    sleeping with your sister-in-law.

    A real hero would come out of that hole, take one look at the
    nonsense around him, and say, “Fuck you. Fuck you and your
    cameras. I’m getting a sandwich.” That would be a show of
    inner strength, people would wonder “how did he do it? how
    could he survive? how could he not make a statement?” and
    they would be infuriated by their inability to tie it to something
    outside, to tie it to their own shame.

    But they very preposterousness, the impossibility of even


    conceiving this kind of response shows that if we were
    Abraham, Isaac would be dead.

    http://twitter.com/thelastpsych
    Charles Manson’s Single
    Moment Of Clarity
    October 16, 2010

    Too late.
    Why Zyprexa (And Other
    Atypical Antipsychotics)
    Make You Fat
    October 18, 2010

    this post does not apply to her, she only eats apples

    Strange finding: Zyprexa makes free fatty acids level go down.

    Wait, isn’t that a good thing?

    II. Zyprexa’s effects on glucose and insulin are bad.

    In a rat study of rats, using rats, Zyprexa raised glucose levels


    by 20%, both in fed and fasting states.

    It didn’t much increase insulin in fed states (already high) but


    it kept insulin high even in fasting states: at 14h post meal, it
    was 140% higher than it should have been. All that exposure
    to insulin, for so long. At the coffee cart, we doctors would
    call that bad.
    III. Zyprexa’s effect on triglycerides is… weird.

    Zyprexa made circulating triglyceride levels fall— it promoted


    the uptake of free fatty acids by various tissues:

    All those tissues taking up fatty acids— what did they do with
    it?

    IV. Zyprexa Makes Your Body Use Fat, Not Carbs, As Fuel

    Normally, after eating, your body uses carbohydrate as the


    main energy source. After a long time hungry, it switches to
    fat.

    Zyprexa made the body use fat all the time:


    RER (respiratory exchange ratio) tells you what’s being used:
    1= carbs, 0.85= carb/fat mix, and .7 is all fat. You eat, and
    your body uses carbs. After a few hours, your body switches to
    fat utilization.

    In graph A, in the first 3 hours the body should have been


    using carbs and fat; but with Zyprexa, it was preferring mostly
    fat.

    In graph B, every time you got a Zyprexa dose, your body


    switched to fat utilization instead of carbs.

    V. Wait a second, why would increased utilization of fat be


    a bad thing?

    If the body is churning through the fat, what do you think it is


    doing with all the sugar? Answer: turning your arteries into
    Twizzlers. Yum!

    The typical thinking is that hyperglycemia leads to insulin


    resistance leads to increased fatty acid utilization. But that
    might be the wrong direction: it seems that the increased fatty
    acid utilization means sugar is unused (hyperglycemia) and
    remains high well into the fasting state, with consequent high
    levels of insulin. Insulin high too long becomes tolerance to
    insulin becomes insulin resistance becomes BKA.
    VI. SUMMARY: A class effect, to varying degrees; and
    eating less may not help.

    1. Food intake was the same between controls and Zyprexaers.


    You get these effects even if you eat the same.

    2. This effect is shared by other atypicals, in a predictable


    fashion:

    In the fed state, Zyprexa and Clozaril do a massive conversion


    to fat utilization, Risperdal a medium, and sulpiride minimal
    covnersion.

    In the fasting state:


    Geodon has a lesser effect than Zyprexa, and appears to
    normalize; Abilify and Haldol seem close to normal.

    3. These effects are consistent with Lilly’s own studies that the
    majority of weight gain happens in the first month, and not
    suddenly after a year of use.

    4. There is still a hunger component to weight gain that is


    separate from the metabolic effect. Some drugs will make you
    hungry, change your metabolism, or some mixture of the two.
    Hunger appears to be a H1 mediated process (Seroquel,
    Zyprexa, Clozaril, Remeron, Paxil>Prozac, etc.)

    5. The immediate clinical consequence of this information is


    probably (paradoxically) to tell the patients to eat less sugar.

    Unless you dramatically cut fat out of your diet, the body will
    still churn through what fat you do eat at the expense of
    carbohydrate. Better, and easier, to reduce the carb load that
    lingers in your body (and likely ultimately gets stored.)

    VII. Is that all the bad news?

    No, of course not!

    In another study (same authors, same topic, same time— two


    completely different journals; thanks promotions committee,
    turning academics into bloggers one study at a time) they
    found that while there was increased lipogenesis (storage), the
    rats didn’t have a change in body weight.

    In other words, Zyprexa didn’t make them heavier, it made


    them fatter. It increased their body fat while decreasing the
    lean body mass. Bright side: now they can float!

    Add to this that it though caloric intake was the same, it


    dramatically decreased locomotor activity. So same calories,
    but less calorie need.

    VIII. Well thank God doctors are finally going to know the
    truth about Zyprexa!

    From who(m)?

    The reality is I found these two articles by accident,


    researching a blog post about something else entirely. I would
    never have found this article, let alone the other article, on my
    own. And I read a lot.

    Ordinarily, this kind of information would have come to me


    through my Abilify rep: “see? Zyprexa blows!” But the FDA
    now forbids anti-competitor comparisons; and neither are the
    reps allowed to tell me that the study exists. Promotional
    speakers can’t mention this either. So? CME?
    BWAHAHAHAHAHAHAHAHA!

    Here’s the bottom line, and it applies to all speech everywhere:


    either you permit all kinds of speech, and let the truth battle on
    its merits; or you permit only one line of speech— and let the
    truth, if it was suppressed, come up like smoke through cracks.
    But when you permit some speech and block others— when
    you create gatekeepers of speech— it creates the impression
    that the truth is in the permitted speech. Most of the time, it’s
    not.

    POLL: What was the “other research” I was doing?


    Language And Behavior,
    Embodiement, and Chronic
    Pain
    October 22, 2010

    apparently, effective

    Fast food makes you… faster?

    57 college brats watched images flash for 12ms on a screen.


    That is too fast to consciously perceive. One group saw
    colored squares, the other saw fast food logos.

    Then they read a passage. The control group read it in 84


    seconds, the fast food group read it in 69.

    Repeat: 12ms is too fast to consciously appreciate.

    II. The embodiement of lying

    87 college kids were asked to either tell the truth, or lie, in one
    of two formats: a voice mail message or an email. They
    actually performed the message.

    Then they were asked to rate the desirability of some products,


    including mouthwash and hand sanitizer.

    When they lied with their mouth, they preferred mouthwash.


    When they lied with their fingers, they preferred hand
    sanitizer. When they told the truth with their fingers, they
    didn’t want hand sanitizer. They were already clean.

    III. Tylenol reduces psychic pain

    62 college kids took 500mg Tylenol BID, or placebo, for 3


    weeks. Every day they completed the “Hurt Feelings Scale”
    (e,g, “today being teased hurt my feelings.”)
    Tylenol users felt less psychological pain. However you want
    to explain this,
    it is evident that being on Tylenol made the brain work
    differently.

    IV. Locking up negative thoughts

    80 college students were asked to write about a recent decision


    they regretted. Half were asked to seal their answer in an
    envelope and turn it in, the others just turned it in.

    Those that sealed their answers reported feeling less upset, less
    negative than those that didn’t. The obvious but easily
    overlooked point is that the subjects didn’t seal their answers
    in order to gain closure; the increased closure was the
    “accidental” consequence of a physical behavior. This physical
    action produces a psychological analogue because Freud was
    right: the unconscious operates like a rebus. The act is read by
    the unconscious in its own way, abstractly, semantically.

    V.

    The point of all of this is not to suggest that we are desparately


    out of touch with our bodies, purposely disconnected,
    unwilling to accept that its flaws and strengths are intimately
    tied to our personalities and behavior, though this isn’t such a
    bad thing to suggest. The mind/body problem hasn’t been
    solved not because it is philosophically or scientifically
    insoluble, but because it is a psychological defense. You may
    be able to circumvent Darwin but you can’t beat Freud.

    Consider someone with somatoform disorder, who has


    physically manifested some psychological pain. You can’t
    logic this away, you can’t show them normal MRIs and blood
    tests as evidence that it’s psychological, because they’re not
    operating on a logic level, they’re not even operating on a
    verbal level. The ability to manifest the pain physically instead
    of psychologically means this is a more basic, unconscious
    maneuver. So it’s not that they don’t believe the MRI is
    normal, they are fully convinced of it; but they’re not making
    a distinction between mind and body the way you are.
    An analogy would be your computer crashes. So? You may be
    able to identify some of the internal parts and you know what
    Windows “is” but you have no idea how they work together,
    what affects what. So you say, “my computer won’t start” and
    the IT guy is frustrated, “you mean there’s no power, or there’s
    power but Windows doesn’t load, or…?”

    The fact that your brain made your lower back hurt is not
    qualitatively different than the fact that a tiger made your back
    hurt. The fact that Prozac makes your back feel better doesn’t
    mean it wasn’t “really” your back.

    Some of you will recoil from this thinking, and you’re the
    same people who ask if there’s no power or Windows itself
    won’t boot up. I sympathize, but you can’t talk his way out of
    this.

    Behavior got you into this mess, and behavior will get you out.
    The more words you use to explain/encourage/dissect/intimate
    the more the behaviors or symptoms dig in. Words are
    perceived as a trick, like a kid suspicious of mom talking up
    broccoli. The pain is there for a reason, and you’re trying to
    fool away the pain without taking away the reason.

    VI.

    The solution to managing this kind of mysterious chronic pain


    is to not manage the pain, but the behaviors. The problem of
    physically manifested psychic pain is the problem of learned
    helplessness, which means the longer you suffer like this, the
    more likely you are to give up trying not to suffer like this.

    Like a POW, you can’t tough your way through the pain, it
    will outlast you. You can’t trade short term benefit for long
    term set back because again, it will outlast you.

    This kind of pain I am talking about— crippling, debilitating,


    and infuriating to everyone else is more about the
    consequences of the pain than the pain itself. You may actually
    have been injured by a tiger, but what has paralyzed you now
    is your brain wondering:

    what’s going to happen to me?


    This will never get better.
    My husband will leave me because of this.
    I will never be able to work because of this.

    and a bunch of what ifs/if only:

    if only I hadn’t fed that tiger


    if only I had iced it sooner
    if only I could do it all over again I’d—
    what if this is a sign of something worse?

    That’s the part of the pain that is crippling. Anyone can


    tolerate any kind of pain as long as they know there’s an end in
    sight or that it doesn’t prevent you from being yourself.

    So you have to find a way to make your body do the things


    that are you:

    “I will never work again”–> what kind of job could I do?


    “it hurts much worse today”—> acknowledge the days
    when it hurts less
    “my husband will leave me”–> maybe this is a good
    opportunity to try a menage

    and stop planning things which are impossible, in the future,


    or delay tactics

    “I wish I hadn’t fought that tiger”


    “I’ll rest it for 6 weeks, then…”
    “I’ll order aquatherapy, then…”
    All that matters is what you are going to do today. Do
    something.

    http://twitter.com/thelastpsych
    How Not To Meet Women
    October 22, 2010

    and so man invented mermaids


    A diversion:

    As I was writing this, in a bookstore, a twenty something


    woman approaches a table two away from mine. Next a man
    approaches, and he chooses the table that is in between mine
    and hers. For the next fifteen minutes he pretends to read a
    book. He may as well be eating a plate of spiders or playing
    with uranium, it is impossible not to focus on him, his
    nonchalance is tremendously distracting.

    But the woman doesn’t notice him. She is engrossed in her


    magazine and soup. That is the lie he is telling himself.

    Of course she noticed him. She noticed him as soon as he


    walked in. Why do men assume pretty girls have visual field
    defects? Hope. The fact that she hasn’t looked up at him is
    evidence that she noticed. She doesn’t dare reveal it.

    I’ve seen this movie before, and I’ve also seen the sequels.
    What he should do, if this is the suicide mission he wants, is to
    walk up to her early on, “hi…” and do his audition. Then she
    could either ask for his headshot or tell him she really likes his
    work but she’s looking for someone who can play younger and
    less gay. But he doesn’t audition, Instead, he stalks her for the
    duration of her tolerance. There’s no other thing in the
    universe we get this way, not a job or food or airplane tickets,
    but somehow sitting at a table and not not looking at someone
    is somehow magically supposed to somehow result in anal.
    (Woah, that was jarring.)

    I can’t focus on either my computer or my sandwich, I am


    certain she can’t either. But she’s trapped in herself, too. She
    can’t read her book and she can’t get up and leave because it
    would be too obvious why she was leaving and she has that
    middle class guilt of making people feel rejected “for no
    reason.” So we three sit, each pretending we’re not aware of
    the others. None of us gets anything accomplished (well, this.)

    How long you wait before your audition is inversely


    proportional to how much she wants to talk to you. Read that
    again: not will be— is. That’s quantum mechanics.

    II.

    So how’s a modern woman supposed to politely decline the


    advances of a future parole violator? If you say, “I just want to
    read my book,” it’s easily taken as an insult by comparison,
    “what, I’m not more important than a stupid book? Who knew
    sluts could read. Oh, it’s Vogue and you’re just looking at the
    pictures. Dumb whore.” (Hey wildman, easy…)

    A good rejection can’t leave room for comparison. For


    example, what she could say is, “no thank you, I just came
    because I need some time alone.” A neutral, soft, non-ego
    threatening dismissal. You don’t know what’s going on in this
    woman’s life, something, but whatever it is it was enough for
    her to want to be Alone. Ok. No one, least of all the most
    pathological narcissist, will argue with the logic that self takes
    precedence over non-self.

    And this dismissal can also yield important information:


    anyone who doesn’t respect the message is probably registered
    in a database, because it always means: “well, my self is more
    important than your self.”

    III.

    “Hold on, Backbeard, I don’t know what kind of women you


    have trapped on the quarterdeck but how do you know she
    isn’t nervous herself, and wants you to come over?” Stop it.
    You’re going to meat [no sic] your future wife in a bookstore
    with an unrehearsed cold approach, Cat’s Cradle, and a triple
    espresso? Really? Has that ever worked for you before?

    “Well, no, if I’m being honest I just want to sleep with her.”
    Well, ho me wench. You’re that guy? Take a look at yourself.
    You’re so smooth you can operate in daylight? Sober? And
    she’s sober? You know there are security cameras around,
    right? You think you’re going to lay your ycombinator rap on
    her?

    “Well, some people can meet a girl in a bookstore.” NOT


    YOU. “It worked one time.” Then you didn’t stalk her, did
    you?

    I don’t blame the guy for being nervous, I blame him for
    thinking he can bend reality to his will. Figure out what kinds
    of environments you are good in, think where are the types of
    women that are right for you, go there. Being good at football
    doesn’t mean you are good at soccer. Or dancing. Or Spanish.
    Ask Chad Ochocinco. “But I like soccer!” Stop it. No one
    likes soccer. Don’t do this to yourself, or to some girl who will
    add the construct of you to her Fiend Folio and ruin it for the
    next potential soccer player who wants to audition/register.
    Oh, have I placed metaphors where they don’t belong?
    Exactly.

    Don’t torment and punish yourself with things you don’t really
    want anyway. Things you want for the wrong reasons.

    And don’t do it in public. We’re all trying to eat here.


    –

    http://twitter.com/thelastpsych
    Why Do Doctors Accept
    Gifts, And What Would
    Happen If They Didn’t?
    October 26, 2010

    fine, I’ll just do psych

    Is the acceptance of Pharma gifts/honoraria/grants a way of


    supplementing an income that the medical student expected he
    would earn, or expected he deserved, in the future— that
    didn’t materialize?

    Apparently not. A study of medical students found they


    underestimated their future incomes.
    Pre 1980, med students overestimated the salaries. After 1980,
    they underestimated them. Let it sink in, it’s pretty easy to
    retrofit an explanation: after the healthcare overhaul of the 80s
    (and the lead up to it), post 1980 medical students were trained
    by doctors who felt “harmed” by the changes. “Man, it was so
    much better 5 years ago…” and etc.

    The the Clinton years— both Clintons— and the prospect of


    even more severe changes made students even more
    pessimistic about their salaries.

    But think about this. In order for them to have underestimated,


    what they thought was going to happen must not have actually
    happened. e.g. a 1993 med student made a prediction based on
    Hillary Clinton’s reforms— which didn’t happen.

    So a medical student today, making predictions about the


    future based on the current health care debates, will either be
    accurate, or will underestimate.

    II.

    But, as usual, it’s more complicated than that.


    That graph shows the means of the students’ errors. How
    variable were the guesses? Hugely. 10% of the 4th year
    students overestimated the incomes by 40%. Did they go on to
    take Pharma money?

    While most specialties were underestimated, where did


    students overestimate? Psychiatry, by 23%!

    Worse, 10% of first year students overestimated incomes in


    surgery, pediatrics, and psychiatry by 60%. That would be a
    life plan oops, solved only by…

    So while the proposed reforms in internal medicine didn’t


    happen— or docs were able to compensate for them—
    psychiatry did, in fact, dramatically change. And, not
    surprisingly (from an economic standpoint) psychiatry found a
    stop gap.

    III.

    Along with expectations, there is the reality that doctor


    salaries (with notable exceptions) have been fairly static since
    1969:

    even as the cost of living, price of homes, college, etc have


    gone up. And medical school debt.

    But what’s not pictured here is how the atual work of medicine
    has changed, even if the incomes are the same. 1969
    psychiatry was slower, more therapy based than today’s 15
    minute med checks. You read medical journals— and books—
    at work. Now you don’t even read your text messages. You
    can argue the merits of either, but the current system
    incentivizes doctors to see more patients, faster, for more
    limited problems. In 1969 a GP would handle multiple
    problems; now multiple doctors handle each problem. I’d
    predict that the time spent by all 2010 docs collectively is still
    less than the one guy spent in 1969.

    Could a psychiatrist able to make Pharma money just turn his


    back on $40k extra a year? It’s a cold decision to make when
    you got one kid in college and another on deck, suddenly
    public ethics takes a back seat to private ethics: what would
    you do for your children? Jean Valjean a bakery? Sling crack?
    Sell it if it was legal? Rob a crack dealer? Well, you don’t have
    to yet: just give a lecture about Effexor.

    IV.

    The part of this that is absent from the healthcare debate is that
    the people who would most likely complain about the changes
    in psychiatry are less motivated to do so because their incomes
    are being supplemented by Pharma.

    My point here isn’t to engage in an ethical debate, but to bring


    up the practical one: if you stopped all Pharma money to those
    that receive most of it— e.g. academic docs who “also” get
    grants to do research, etc— it’s almost certain that they would
    mobilize to demand higher reimbursement rates, not passively
    accept lower ones. The healthcare debate would be turned
    upside down, from finding ways to “cut costs” to finding ways
    to “more fairly reimburse doctors.”

    “Psychiatrists shouldn’t do it only for the money!” Of course,


    but it’s hardly less honorable to not go into psychiatry and go
    into neurology instead. Leaving it to be staffed by NPs, which
    is the immediate problem in family practice. Of course I know
    most psychiatrists don’t take/aren’t offered Pharma money.
    But, to repeat, the ones who are likely to be most influential in
    setting healthcare policy— academics— do. As do the
    academic departments, who rely heavily on grants to pay for
    salaries, overhead, and that new Research Centre that just went
    up. I’m not blaming them, they may not even realize just how
    much of their existence is subsidized by Pharma, I’m simply
    stating a fact. Stop the Pharma money, and you are quite likely
    to arouse a sleeping giant. Harvard’s gotta eat.

    I am almost tempted to wonder if the rise of Pharma money


    1996-2008 wasn’t consciously encouraged by policymakers
    precisely to allow the policymakers the cover to get away with
    the sort of changes that happened in psychiatry. Another
    mercantilist conspiracy theory, I guess.

    No doubt people are going to respond that doctors make plenty


    of money already. This is not the point. Each individual doctor
    is making that determination for themselves, even if they’re
    wrong you won’t be able to convince them they’re wrong. And
    their perception, wrong or right, is going to drive them to
    make choices like: take Pharma money, go actually work for
    Pharma, go to another field, go to another job, do/not do only
    15 minute med checks, leave Cleveland for San Francisco, etc.

    No doubt, doctors universally would be happier with higher


    reimbursements and no Pharma money. It’s not obvious
    patients would be better served— psychoanalysis was not
    Pharma sponsored— but things would defintely change in
    some way.

    Time: “The new legislation adds a 10% bonus to primary-


    care physicians’ Medicare reimbursement salaries. But
    this is nowhere near enough. We need to see a 30% to
    50% increase in salaries overall to make any real change
    in the system,” says Dr. Lori Heim, president of the
    AAFP.
    But I’m not sure it’s actually possible.

    V.

    An interesting experiment is to open a forum to solicit


    practical ideas for reform that takes into account the
    unintended consequences of the reform, and accounts for
    them. To crowd source a crowd’s problem.

    It’s an experiment because— hypothesis— people don’t


    actually care about practical solutions, they are much more
    interested in their own anger, and will sabotage a potentially
    useful forum in order to vent it. They will sabotage the
    country, just to be able to yell.

    If I had to name the specific problem with political debate post


    1992, that would be it. And yes, there’s a word for it.

    More Like This:

    Diana Chiafair’s Hot, But Is She Illegal?

    Is More Regulation Needed?

    http://twitter.com/thelastpsych
    Charlie Sheen Has An
    Awesome Experience, This
    Time With Drugs and A
    Hooker, Which Was The
    Same As Last Time
    October 27, 2010

    next

    Charlie Sheen:

    Sheen appeared highly intoxicated when officers arrived


    to his room around 1:30 a.m., and a woman with him said
    they had been out drinking and partying that night,
    according to a law enforcement official. She said he was
    yelling and tossing furniture when they returned to the
    room

    The part not in this paragraph is that he was naked, she was
    naked, she was a prostitute, and she was hiding in the closet.
    Cocaine was probably involved. Also, he had just spent the
    day with his ex-wife and their kids, all who were asleep in the
    next room. That’s class.

    First, the drugs. I know this isn’t a particularly psychiatric


    thing for me to say, but I like dropping truth bombs on the
    unsuspecting: lots of people get drunk and high and… do
    nothing. Watch Craig Ferguson. Play Xbox. Take a nap. Go to
    work.

    I’m not condoning it, but our minds get tripped up at the drugs
    as if therein lies the majority of the explanation, and I’m sure
    Charlie et al would like us to stop there as well.

    This goes for psychiatric illness, should he have one. “He’s


    bipolar.” So? Seriously, what am I supposed to do with that?
    Society can’t have it both ways, you can’t tell me “it’s a
    hurtful stereotype that the mentally ill are violent” and then
    180 it and say “he got violent because he was mentally ill.”
    Sometimes they go together, sometimes they don’t, but you
    can’t offer either one as an “everybody knows that” and hide
    behind your postmodernism.

    Second, he has no incentive to stop. There’s a physical toll on


    his body, I guess, but meanwhile he’s having drunken sex with
    super hot women— so what if they’re prostitutes—partying,
    going to clubs, etc. He trashed the Plaza Hotel. That’s where
    he’s at with his addiction, the Plaza Hotel. He’s three
    moongates away from anything resembling rock bottom.

    When he gets caught, he gets a slap on the wrist and his show
    gets picked up for another season. The picture they splash all
    over the news that reflects his insanity is this one:
    I’m not advocating punishing him, but you can see that the
    whole system is set up to keep him going at this level.
    Surprise. He does. If you’re wondering why this nut doesn’t
    change his life, it’s because you pay him not to.

    II.

    “He’s not a bad guy, he just has a problem.” Actually, you


    have that backwards, he doesn’t have a problem, he is a bad
    guy. I know this because he beat up (allegedly, at least) two
    women. This isn’t the place to get into whether the bitch done
    deserved it, running her mouth all damn night long, the point
    is his thinking about it. If I (allegedly) beat up a girlfriend, I’d
    feel TREMENDOUS guilt, I would really have to rethink the
    need for my existence. I’d also be scared that she’d call the
    cops and shamed as a woman beater, ruining my life and/or
    career; and I’d be Ed Norton 25th Hour terrified of going to
    jail. Charlie Sheen apparently feels none of these fears, at all,
    ever. After he beat up the first bitch who deserved it he should
    have sworn of bitches just out of self-preservation, but no,
    back into the mix, and if the next one gets out of line she’ll be
    getting the People’s Elbow.

    That’s narcissism— “writ large” as they say in magazines that


    suck. Even if the drugs made him completely insane, the fact
    is that he regularly puts himself in situations that involve
    something getting punched, and the only explanation for that
    is that he doesn’t see rules as objectively applying to him, he
    only sees his behavior as situational, in his context. In other
    words, there’s always this: “well, hold on, this is a different
    situation, let me explain…” followed by two hours of words.
    There’s always an explanation, it’s always different this time,
    which just means it’s exactly the same.

    III.

    “It’s an addiction, he can’t stop.” Put the microphone down,


    wildman. Everyone can stop. You may be bad at math but your
    brain is doing math all the time and it calculates to the
    millivolt whether the reward is worth it. Internal forces
    conspire against you, for sure— maybe it values things
    wrongly and maybe your body tries to to trick you when you
    want to quit by making you more hungry so you eat more, or
    more anxious so you drink more, more bored, more angry,
    maybe you remember more vivdly that your wife cheated that
    one time, or that Karen is dead— whatever— but it still ends
    up being a binary question, “do I do it or not?” You can argue
    that the scales are loaded one way or another but it is a scale
    nonetheless. The secret of the universe is this: all decisions are
    binary. You will never be happy if you fight this.

    IV.

    I can help you with your choice, with varying success, but
    when you are punching other people and that isn’t enough to
    get you to stop no one can help you. Before you say, “I want to
    stop drinking” you have to first have thought it more important
    to say, out loud, “I want to stop punching people.” The latter is
    for the good of others; the former is for yourself, with the
    byproduct of being good for others. That’s why it fails.

    V.

    Denise Richards got him to the hospital, and is now trying to


    protect her kids from Charlie’s nonsense and media exposure.
    You know how I know that? She was on TV blabbing about it.
    I certainly don’t fault her, but the desire to interpret personal
    events in a public forum changes the meaning of the events.
    “My fans are going to want to know.” Sure they want to, but
    that doesn’t mean you should tell them. In fact, for your own
    good as well as theirs, you shouldn’t.

    The result is it goes from being outstandingly negative to


    almost positive. If you hired a prostitute or punched a
    girlfriend you’d hardly put it on your Facebook, but this gets
    written up in TMZ as Sheen The Party Wildman. Cool. The
    male deconstruction of it is, “man, if that was me, I wouldn’t
    be trashing the hotel room…” That’s where he went wrong,
    see? He took it too far, but the lifestyle sounds enviable… and
    anyway he sounds like he’d be fun to hang out with, right?
    Ladies? Am I right?

    I’m in

    If the repercussions for nonsense and punching your girlfriend


    is another girlfriend and more nonsense, it’s hard to identify a
    reason to stop. Which is why it won’t. But you’re being lied
    to, by yourself. And now I’m not talking about Charlie Sheen,
    I’m talking about you.

    –
    http://twitter.com/thelastpsych
    One Way Our Schools Are
    Training New Narcissists
    October 28, 2010

    let someone else play on it

    A bunch of first grade boys and girls were playing soccer at


    recess. One boy, Devastator, was particularly aggressive and
    slide tackled two kids. The playground rules is, “no slide
    tackles.”

    On the third slide tackle he hurts a boy who starts to cry.


    Devastator laughs and says, “sorry fucknuts, no crying in
    baseball!” and runs off. He is wearing goalie gloves. A girl
    says, “hey, no slide tackling— you’re going to hurt someone!”
    Devastator spits on the ground, comes over, gets right in her
    face, puts his fist up against her nose and says, “you better go
    back to where you came from, or you’re going to get exactly
    what’s coming to you.” I don’t know who taught this kid to
    talk. I assume TV.

    The game immediately resumes, no one challenges him. Soon,


    he slide tackles another boy. The same girl, in defiance of
    Devastator, yells, “hey, no slide tackles!”

    Devastator approaches slowly to close the distance, then


    suddenly sprints towards her. Another boy just manages to
    grab a shoulder but can’t hold it, so he slows Devastator down
    for only a second, but long enough for the girl to get a head
    start running. He chases her— she runs to the teacher and he
    quickly doubles back to the soccer field.

    The girl tells her story, and the teacher responds, “just don’t go
    near him. I’ll talk to him. Go play a different game, I don’t
    want him hurting you.”

    Later, the girl tells her mother, who calls the school. The
    teacher tells the mother that they have had a lot of trouble with
    that boy already, they are handling the problem, but in the
    meantime it’s best if the girl simply stay away from him. “She
    was really brave, but we don’t want her to get hurt or for him
    to fixate on her, so it’s best if she stays out of it.”

    II.

    Bullying? Or regular playground stuff? You can New York


    Magazine this story and say that Devastator is carrying around
    a lot of anger and the school needs to intervene. If he’s willing
    to threaten a girl and then actually try to attack her, he’s
    destined for trouble and a full Nautica wardrobe. Is this what
    we want?

    If that’s the magazine you like, then you have to wonder if the
    school is really doing enough to protect her and the others?
    And what’s their policy on violence towards women? If the
    girl hadn’t said anything, would he have gone unnoticed only
    to date rape a 3rd grader?

    But Devastator isn’t the important person in this story.

    This girl stood up to the bully not to protect herself but for the
    sake of others— and rather than supporting this behavior, the
    school crushed it in the interest of expediency and “safety.”

    If there is any value you do want to encourage in kids, it’s


    looking out for each other. The girl had it; the boy who tried to
    snag Devastator also had it. Those were reflexes, they didn’t
    plan this out over morning waffles, but whatever was going on
    at home and in their heads lead them to have, and to follow,
    those impulses.

    But the school fostered the reverse value: “don’t get involved,
    take care of yourself, let the Watchers handle it. That’s their
    job.” Note that the school didn’t inadvertently teach her not to
    look out for others, it specifically instructed her not to look out
    for others. “We’ll handle it.”

    I’m not saying she should have fought him (and I’m not not
    saying it, either), but what kind of school doesn’t want a kid to
    stand up to a bully, especially when they’re doing it to help
    someone else? What kind of crazy school wants you to back
    down— and get someone else to protect you? What kind of
    school indoctrinates kids that power is only possessed by a)
    bad people; b) the state?

    Oh. All of them.

    http://twitter.com/therlastpsych
    A Case Study On Why Policy
    Changes Fail: Pharma
    Paying Docs
    November 2, 2010

    The authors report no conflicts of interest


    The point here isn’t to weigh in on the Pharma debate but to
    illustrate what’s wrong with how Americans get things done.

    Two reporters’ investigations into docs who speak for Pharma


    have found:

    Fewer than half are formal educators affiliated with


    academic medical centers or prominent leaders in
    their medical societies. The rest are a mix of
    physicians with limited credentials or about whom
    little could be gleaned.
    Five of the top 43 are from Tennessee
    Eleven of the 43 have board certification in the small
    field of endocrinology… Eight physicians, the next-
    largest subgroup, hold no advanced certification,
    despite speaking on specialized diseases and
    treatments.
    Only three of the top earners are women—all
    endocrinologists
    More than half worked for two or three companies.
    One Tennessee diabetes physician worked for five.
    Seven earned money solely from Glaxo.

    A different article goes into more detail:

    And in Georgia, a state appeals court in 2004 upheld a


    hospital’s decision to kick Dr. Donald Ray Taylor off its
    staff. The anesthesiologist had admitted giving young
    female patients rectal and vaginal exams without
    documenting why. He’d also been accused of exposing
    women’s breasts during medical procedures. When
    confronted by a hospital official, Taylor said, “Maybe I
    am a pervert, I honestly don’t know,” according to the
    appellate court ruling.

    Last year, Taylor was Cephalon’s third-highest-paid


    speaker out of more than 900. He received $142,050 in
    2009 and another $52,400 through June.

    The underlying principle is, “Docs should not accept money


    from Pharma.” If this is indeed what you believe, then you
    should look upon these reports and articles with dismay:
    they’re helping Pharma.

    II.

    I have to wonder if as they uncovered all this stuff, there


    wasn’t a sense of glee, rubbing the hands together like Perez
    Hilton does when he discovers Lindsay Lohan’s gmail
    password. (It’s “velveteengirl”)

    But that’s all besides the point. While this information is


    interesting and salacious, it is masturbation: purposeless and
    for yourself only. From a (Machiavellian) policy perspective,
    the thing to do would be to bury this info about bad doctors,
    not publicize it.
    Approaching this from the “bad/crazy/uncredentialed docs
    speak for Pharma” angle changes the focus from the noun
    (docs) to the adjective (bad/crazy).

    This happens all the time in political debates, which is why


    nothing gets done.

    Because the outcome you’ve guaranteed is that Pharma


    tightens their speaker’s bureaus— and only uses top tier
    academics. So if you are worried your doc might give you
    Depakote because he gets paid by Abbott, imagine what will
    happen when your doc is told to use Depakote by the
    academics who write the journals and the reviews, who are
    paid by Abbott. You don’t have to imagine it, you just have to
    remember it, 1999-2006. Were you on Depakote? Yes. Did
    your doc speak for Abbott? No. Enjoy your liberal democracy.

    “Well, it shames the docs so they don’t accept the money!”


    Why would it shame them? In fact, it gives them a defense.
    “Since I’m not bad or crazy, since I do good clinical work,
    since I am not doing vaginal exams, therefore I can take
    Pharma money.”

    You can extend this to any social or political question. There’s


    an internal sense of “rightness” or “wrongness” to some issue,
    but lacking the information, logic, or simply the skills to
    defend the position, people resort to a core dump. They hope
    that either something will stick or the volume of criticism will
    speak for itself.

    But it doesn’t, it allows the other side to counter with logical,


    precise, and legitimate fixes to your myriad of complaints—
    all while keeping the main premise intact. “Ok, we shouldn’t
    pay docs to speak, we’ll only pay them to write.”

    If you think using oil is bad for the environment, don’t say that
    it also leaves us beholden to terrorist nations. I know you think
    that helps your case, but it doesn’t, it gives the other side a
    straw man to ignite. Argue from principle.

    Arguments with your spouse go bad for the same reason. Her
    chronic lateness is the problem, but you bring up her past
    infidelity, cooking skills, bitch friends, etc. Result: you’ve just
    given her three new options for a counterattack. If she can
    effectively defend any one of them, you lose the entire
    argument. “My husband is an ass.” She’s kind of right.

    III.

    The problem is that the principle is often a cover for more base
    instincts. Put down your Diet Coke for one second and really
    consider what I am about to tell you.

    While considerable investigative journalism went into finding


    out how much money speakers earned, their backgrounds,
    disciplinary actions, CVs, etc, not one single reporter has
    actually listened to one of their presentations. Think about this.
    Not one reporter thought it important enough to investigate
    what they said.

    No one’s even interviewed an attendee. “Hey, what goes on in


    there?”

    That should be your signal that they don’t care what was said,
    what matters is the money. Which makes this much less about
    Pharma influence on medicine, and much more about class
    warfare: why should they get to have so much money?
    While I completely understand the sentiments, this approach,
    let alone this sentiment, won’t make patients feel better or
    healthcare run better. (Which is why the solution I offered—
    simply making it illegal to accept any kind of Pharma money,
    at all— is the most honest way of approaching it. But, as I
    pointed out, it will have some consequences society may not
    be ready to accept.)

    If it’s class warfare you’re going for, be honest about it. Just
    say you don’t like docs getting paid so much, period, or you
    don’t like taxes so high, or so low, end of story. You hate
    welfare handouts. You hate how investment income is taxed at
    half the rate of earned income, it seems unfair to you. At least
    these are arguments that everyone can participate in because
    they’re honest, they are your true sentiments undisguised by
    intellectualization. If you’re ashamed to say these things,
    however, then perhaps you need to ponder why you believe
    them.

    If you pretend— even to yourself— that it’s really about


    Pharma causing doctors to do something they
    wouldn’t/shouldn’t do, then you have to explain how this
    happens. I’m not saying this is a hard thing to do, either, but it
    must be done, it’s not enough just to say it.

    But, and this is the point, if you have not really be honest
    about your principle, once you explain your reasons the other
    side will quickly dispatch a series of remedies which
    legitimately address each of your complaints, all while leaving
    the underlying principle untouched. And yes, now I’m talking
    about today’s elections.

    –
    You might also like:

    Ten Things Wrong With Medical Journals

    –
    http://twitter.com.thelastpsych
    Transgender Man Is On
    Women’s Basketball Team,
    Sort Of
    November 3, 2010

    ceci n’est pas une personne transgenderee


    From the NYT:

    But Monday was anything but ordinary because it was the


    day the world would learn about the decision Allums had
    embarked on one year earlier: to come out as a
    transgender man playing on a women’s basketball team.
    Advocates for transgender athletes said they believed
    Allums was the first Division I college basketball player
    to compete publicly as a transgender person… a George
    Washington official said Allums would remain on the
    women’s basketball team.

    Got it? Transgender man on women’s basketball team.


    “I didn’t choose to be born in this body and feel the way I
    do. I decided to transition … I am trying to help myself
    and others to be who they are.”

    II.

    In case you miss the nuance, here’s the title: “Transgender


    Man Is on Women’s Team.” So in a progressive society, what
    are we to do with this? Should a transgender man be on a
    man’s team, or a women’s team?

    But the more urgent question is, who decides what words
    mean?

    III.

    I defy you to read that article and figure out what the hell is
    going on. I know I’m not the only one confused, as evidenced
    by the comments on The Huffington Post, which I read when I
    have to go to the dentist.

    And here is the first paragraph of Salon:

    A transgender female-to-male basketball player at George


    Washington University is about to put the NCAA to the
    test. Kye Allums has been on the school’s women’s
    basketball team since 2008, but when the season starts
    later this month, the 20-year-old is premiering as a man.
    It will be the first time an openly transgender player has
    played Division 1 basketball

    It is almost perfectly clear that what is happening is a woman


    who is now “premiering as a man” is on the women’s
    basketball team. That this will still not generate any interest in
    women’s basketball is besides the point.

    The point is that what’s actually happening is very different


    than the report. Let me summarize: nothing. A person born as
    a female is playing women’s basketball. Also, she is still a
    female. She’s never had surgery, never taken hormones, has no
    genetic ambiguity. At autopsy even the most radical activist is
    going to mark “F.”

    However, she prefers to identify herself as a he. That’s it.

    There is no controversy here, at all. It’s just names. “From


    now on, I want you to refer to me as ‘The Situation.’”
    Whatever.

    This is a regular old female who is playing on the correct team


    (women’s) and wants other people to call her what she thinks
    she is. But there are plenty of idiots who are applauding the
    college for… letting her play. As a woman. On the woman’s
    basketball team.

    IV.

    Note that I have referred to her as “she,” while she prefers to


    be called “he.” The team has decided to call her “he” as well.

    The real issue— and why it’s in the NYT and why you should
    care very much— is who decides what words mean. I’ll admit
    that how I define “he” is based on one set of principles, and
    how she defines it is based on another, and we differ on how
    those words should be used.

    He is looking forward to Nov. 13, when Allums and the


    team will compete at the Best Buy Classic in
    Minneapolis. The game will be his public debut as a
    transgender man playing on a women’s team

    But the NYT is setting itself up as the arbiter, it is deciding for


    both of us what will be true. It’s not taking up a scientific
    analysis of the question, it isn’t even delving into the massive
    volume of mostly unreadable articles about gender issues. It is
    simply deciding.
    It doesn’t announce what it’s done, it pretends it is already
    established to think like this. “We’re writing it this way
    because of course everyone knows…” Are you telling me that
    one of the most prestigious papers in the world did not know
    that the article it was writing was misleading? Confusing? It
    did it on purpose. And so did the AP. And every other media
    outlet that “reported” the “story.” There’s no story! Nothing
    happened!

    But it has placed you— the 100% of the world that thought
    they already knew what words meant— on the defensive. “Oh,
    have I been doing this wrong all this time?”

    They didn’t do it because they care about the transgendered,


    they did it because they want to make it ordinary that the
    media decides what words mean.

    That’s the reason for the report, that’s the reason the story is
    everywhere.

    V.

    Speaking of The Situation, you may have heard that on the


    show Jersey Shore, Mike “The Situation” may have made out
    with…. a “trannie.”

    The “cast” is repeatedly heard saying, “if you have to think


    about it… it’s a trannie.” Point is, The Situation wasn’t sure it
    was a “trannie,” but it was.

    Or was it? GLAD got upset, and MTV apologized. I’m not
    sure what term they would have preferred, but I am sure of the
    purpose of the complaint— and no, it had nothing to do with
    the “offensive nature” of the word “trannie.”

    What’s obvious once I say it is that the “trannie” deliberately


    fooled Mike. He tricked him into thinking he was a woman.
    I’ll state the obvious: if a man tricked a lesbian and blah blah
    blah.
    There’s no outrage at all that the “trannie” fooled Mike, and,
    according to GLAD, you’re not even allowed to laugh about it.
    Partly its because the outrage has been usurped by GLAD,
    Cognitive Kill Switch style, and putting everyone on the
    defensive.

    But that was the plan: obliterate a word (“trannie”) that is


    derogatory but that has an actual definition. And that
    definition is: a man pretending to be a woman. Get rid of that
    word, and whatever word you use to replace it won’t have that
    definition, it will be its own thing. So it couldn’t have fooled
    Mike, it is what it is. It’s the legitimization of a 3rd sex.
    Something that “is” what it says it is— “a transgendered
    individual”— can’t ever be accused of pretending to be a
    woman.

    And if that made no sense to you, thank God.

    VI.

    You can go back to the distraction of gender politics and


    semantics, go ahead and be hypnotized into thinking you must
    take a side, like the NCAA had to do (“planning a review of its
    policies.”) Go ahead and believe your President is a socialist,
    or your former President s a racist, Kanye West has inside
    information. The game is over for me, I have enough rum to
    wait out the rest of my life. But the rest of you, especially the
    rest of you under 30, wake up. The day is approaching where
    the media will redefine what is right or meaningful, redefine
    you as meaningless.

    And you’ll believe it.

    http://twitter.com/thelastpsych
    Advertising’s Collateral
    Damage
    November 8, 2010

    John Mayer is a jerk, right?

    It’s an axiom of academic deconstructicons that advertising is


    a window on society, but it’s more accurate to say advertising
    is society’s window on you. And, looking at it this way, it
    becomes evident that society thinks you’re an idiot. Allow me
    to elaborate.

    You’ve probably never seen this ad, not because it isn’t played
    constantly, but because your mind self-defensively blocks
    traumatic images from consciousness. Stop acting like a 3rd
    grade girl at japanese horror marathon and force yourself to
    look carefully.

    I feel like I need to watch The Little Mermaid to detox. Ok,


    let’s go through it, were all the key demos represented?
    Hot yoga chick in lululemon? (Cut to windchimes):

    Extra gay gay guys with tattoos and accessories— (they sell
    skulls):

    Crazy stalker ex-GF?

    Esse w/ hopping car?


    Serial killer w/ mobile killing station?

    It’s easy to think that the ads are designed to draw in the demo
    shown in the ads, but that’s not the way advertising works, and
    consequently that’s not how America works. If you’re
    watching it, it’s for you. These ads play heavy during late and
    late late night talk shows: the target is boring middle aged
    white people. Blackberry isn’t targeting gays and limber
    blondes, it’s pretending they are already on board so you don’t
    feel like a dork without a touch screen.
    In other words, the target is the uptight khakis and Polo
    salarymen who are otherwise tempted to defect to the
    iphone/Android as a last ditch attempt at reassuring
    themselves that the person they were at 20 is still alive in
    there, underneath the carbgut.
    And you can’t be subtle with that demo, the message has to
    detonate like an Athens mailbomb. Here’s another Blackberry
    ad, showing a completely unposed, random human being
    talking about how he uses the Blackberry to promote his
    business:
    I heard that, yo. But the phone is white and he talks white, so
    he’s ok. “Oh my God, you’re such a racist jerk, and a
    misogynist and a homophobe.” Umm, would you mind calling
    back on a landline? Your iphone is breaking up.
    It is an irrelevant coincidence that minorities already purchase
    more blackberrys than iphones. It doesn’t matter to the Dave
    Mathews fan what they actually buy, what matters is what the
    image of them buys, and that image, because it does not exist
    in real life, has to be communicated, not observed. Hence ads.

    The point isn’t that the iphone isn’t cool, or useful, or a


    superior product, the point is that the demo blackberry is
    worried about are the ones who secretly worry their phone also
    brands them. Cool= black and gay, even if you hate black and
    gay, which you do, which is why they’re in the ads. You hate
    them because you’re envious of their freedom, affluence,
    seeming lack of responsibility, their easy dialogue with
    sexuality or power, their casual wardrobes.
    Hence also the gay guys. You might think gay decorators with
    bead bracelets are not ideal aspirational images for office
    workers, but that’s why you’re in sales and not marketing.
    What matters is the image: how awesome would it be if your
    sexual proclivities could be an overt 90% of your identity?
    Add also the evident self-care, self-absorption, and throw in a
    partner who doesn’t nag and is willing to play along. “Sounds
    ideal,” he replies as he pours utility coffee into an 8oz
    styrofoam cup. That ideal (we are told) buys Blackberrys, so
    it’s okay if you do, too.
    “What planet are you on? Heteros already broadcast their
    sexuality!” Oh no they don’t, not the ones who drink light
    beers, ask them. Ask them if they don’t feel like they have to
    keep their sexuality suppressed all the time, that they “can’t
    even compliment a woman on her dress” without a trip to HR.
    They think gay men get a pass on displaying lust, not to
    mention getting their own parade. It is this perception that
    makes flamboyant gay men the correct casting for advertising
    directed at people who cringe at the sight of flamboyant gay
    men. They know you better than you know yourself. Strike
    that: they know the lies you tell yourself better than you.
    As a marketing strategy this is, of course, doomed to failure.
    Your Dad can’t tell you he’s cool, he has to show you he’s
    cool, and he can’t because he’s your Dad, end of story.
    Blackberry can’t commandeer images to push their agenda,
    anymore than your Dad can put on a Raiders cap sideways and
    say, “yo, yo, yo, all my homies agree that abstinence is da
    bomb!” He has to come at you as Dad, because that’s what he
    is, regardless of what he says he is, anything else is
    immediately dismissed as a trick.
    Blackberry’s only chance is to invent an awesome phone,
    which they can’t because they’re Canadian (too drunk to do
    science.)

    II.
    But Blackberry’s market penetration isn’t my concern. What
    interests me is the collateral damage of these ads, of
    advertising in general. All ads which sell a product
    inadvertently sell another product, and that product is identity,
    and they sell it better than their own product. Using these
    images won’t/can’t convince you that Blackberry is cool, but
    they have inadvertently convinced you that these images are
    cool, that these are the standards of cool. Pick and choose what
    parts you envy. “Not me! I think for myself!” Of course you
    do, of course you do.

    –
    You might also like:

    Acura: I’m Not The One You Should Be Worried About


    China Needs Fewer TVs, Or A Billion Of Them
    –

    http://twitter.com/thelastpsych
    The Terrible, Awful Truth
    About Supplemental Security
    Income
    November 11, 2010

    “we’re going to need to deploy the psychiatrists. it would be a lot easier if they
    were nationalized “

    The email:

    The Simple Boring Reason Why Disability Insurance


    Exploded

    Ahem… just spot on stuff here…

    Sounds like a challenge.

    I don’t blame him. The idea that psychiatry and government


    are working together through the welfare system to patch holes
    in feudal America is hard to swallow, and when no less than
    The Washington Post explains it so concretely in a few
    PowerPoint ready graphs… it’s seductive, I sympathize.
    The Post article clearly explains that the explosion in the
    number of people receiving disability benefits is not really the
    fault of the economy; and, they will grudgingly admit, not the
    fault of “doctors [and applicants] conspiring to game the
    system somehow—” the default narrative of anti-corporate,
    pro-common sense This American Life, whose typical
    maneuver for depicting a complicated social process is to find
    an N of 1 living somewhere in Appalachia and imply that this
    nice but toothless baptist woman doesn’t know what’s good
    for her. “This week on This American Life, snark by Reductio
    Ad Absurdum, in four acts.”

    No, says the Post, the answer is more boring: people are
    getting older, and older people get more disabled.

    Pure common sense, no need for an appeal to “some other


    omnipotent entity.” Freakonomics would be proud . But I can
    do this drunk, ready, go.

    I.

    You have to start from first principles: what does the author
    want to be true? The Washington Post has a two part mission
    statement: 1. get you a higher SAT score or your money back;
    2. make sure nothing is Obama’s fault. I’m not saying
    anything is Obama’s fault, I’m saying that in 2008 they
    switched from “It’s Bush’s Fault” offense to “It’s Not Obama’s
    Fault” defense in hopes of keeping their last ten readers. Note
    that the Post’s site is called “WonkBlog,’ please also consider
    that anything branded with the word “wonk” is misdirection.

    The Post is making a bet that you won’t know the difference
    between SSDI and SSI, and you wouldn’t, no one does, it’s
    deliberately obfuscated and frequently conflated. They are
    totally different in terms of origin, budget and consequence,
    but both rely on “disability.” The only person who does know
    the difference is a guy actually on SSDI, so that when you ask
    him, “how long have you been on SSI?” he will freeze, pull
    out a knife, place it calmly on the table, and say, “listen lung
    transplant, I’m not on SSI, I’m on SSDI. I worked.”

    SSDI is “Social Security Disability Insurance.” It is what it


    says it is: you worked in the past, paid payroll taxes, “paid into
    the system,” and if you become disabled— not necessarily on
    the job, which is the requirement for collecting disability from
    the job, but for any reason— you can collect SSDI payments.

    The Post is explaining the trend in SSDI as the result of the


    aging population— not gaming the system, not the economy.

    The obvious retort to all this is, fine, so what? SSDI is


    meaningless, well, meaningful to you if you need it, but to the
    economy and to the progress of humanity it’s a wash. You’re
    telling me a guy pulled a 9 to 5 for a decade… and now
    “claims” he “can’t”? It’s not my ideal life plan, but if he
    decided at 45 to quit being a welder so he could downgrade by
    two thirds to the $15k a year baller lifestyle, well, I prefer my
    grog made of Zaya rum but I’m not going to begrduge this guy
    the well liquor if that’s the ship he wants to sail.

    What will sink the Earth into oblivion isn’t people who can no
    longer work, it is people who have never worked and will
    never have worked, who on the one hand will never pay into
    the system, on the other hand will never produce any output,
    and, thank you Zaphod, on the other hand will draw from it in
    a number of ways that perpetuate this draw. This is SSI, which
    stands not for “social security income” which would helpfully
    explain where it comes from, but “Supplemental Security
    Income,” which makes no sense, two of those words are lies.

    Some numbers are often useful to scare off the uninterested, so


    boo:

    Number of SSI recipients: 8M


    Average payment: $550/mo
    Total annual cost: $58B

    Number of SSDI recipients (ex-workers): 8M


    Average payment: $1100/mo
    Total annual cost: $120B. If you include family benefits, the
    total SSDI cost is $143B.

    “Hey, dummy, I thought you said the problem was SSI. 58 is


    more tinyer than 143.” Yes. My training in physics allows me
    to observe this as well, but the problem isn’t the money, the
    problem is the calendar.

    Since we like to defer our debts,here’s the future of America


    question: who is more likely to eventually go to work: the
    children of SSDI recipients, or the children of SSI recipients?
    The answer depends on whether there are class lines or
    multigenerational entrenchments of poverty in America, and
    there are, which means that while the kids of SSDI stand a
    chance, the kids of SSI are sunk. Fortunately, a lot of them are
    black, so there’s that.

    The welder who “gamed the system” at 45 at least caused his


    kid to observe him as a worker for the formative first 8 years
    of the kid’s life. It counts for something, it is not nothing.
    Possibilities exist. That guy may be a jerk, but he is not the
    problem.

    SSI is 100% a gimmick, but the gimmick is 100% hidden from


    you. The gimmick isn’t that poor people game the disability
    system to get cash payments, the gimmick is that the only way
    to deliver cash payments to poor people is through the
    pretense of disability, hence mental illness and pain disorders.
    Whether they are “disabled” or not is totally and completely
    irrelevant, poor people are going to get the money one way or
    another so that they don’t riot, but in order to prevent everyone
    else from rioting, deniability is created: “look, doctors—
    SCIENCE— said they are medically disabled, it’s out of our
    hands!” So your anger is safely diverted: “they’re gaming the
    system!” No. That is the system. If they were gaming it,
    someone would get caught. No one gets caught.

    “We need to create jobs.” There aren’t any to create. Robots


    and chinamen, that’s the future of unskilled labor. Sorry, I
    meant chinawomen. College won’t help either, you went to
    Barnard and you can’t find a job, what hope is there for the
    majority on SSI? Zero, not the way we’re doing it. TV tells
    them how to want, no one else is around to tell them
    otherwise. Here’s the advice you need to give your kid: either
    you find a knowledge based productive skill, from plumber to
    quantum programmer, or you will be living off the state,
    regardless of what company you think you’re working for.

    II.

    I know, the idea of people getting paid for nothing gives me


    the heebie jeebies as well, I’d want to shrug, too. But the point
    here is not whether poor people deserve living wages, the
    point, again, is that since this is precisely what they are
    getting, already and irrevocably, can we do it more efficiently,
    cheaply? Why do we have to go through all this bureaucracy
    that massively inflates the costs— for example, Medicaid (the
    poor have to first become “patients” and get meds to get
    disabled, after all)? Why not more efficiently deliver the
    “assistance”? Cut out the middlemen— send them directly to
    an ATM? I see how that might lead to an “entitlement culture”,
    but isn’t “disability culture” actually worse AND more
    expensive?

    But no one would stand for it. You, we, I, everyone, will
    gladly pay more in taxes or plunge deeper into galactic sized
    debt to not see the reality that some will get money just
    because, so that we can lie to ourselves that the “disability
    system” isn’t supposed to be used this way, they are gaming it.
    The problem is not economics, the problem is psychology.
    You’re paying extra for the deniability. Is it worth it?

    (posted at askmetafilter in response to a mostly unrelated


    question)

    I. I need to write this and get it posted before the


    Fingermen come and black bag me.

    So you want to file a psychiatric disability claim against your


    former employer? Too bad.
    Say you’re poor and have never worked. You apply for
    Welfare/cash payments and state Medicaid. You are obligated
    to try and find work or be enrolled in a jobs program in order
    to receive these benefits. But who needs that? Have a doctor
    fill out a form saying you are Temporarily Incapacitated due to
    Medical Illness. The doc will note the diagnosis, however, it
    doesn’t matter what your diagnosis is, it only matters that a
    doctor gives you one. So cancer and depression are both fine.

    Nor does it matter if he medicates you, or even believes you,


    so long as he signs the form and writes “depression.”(1) The
    doc can give you as much time off as he wants (6 months is
    typical) and you can return, repeatedly, to get another filled
    out. You can be on state medicaid and receive cash payments
    for up to 5 years. So as long as you show up to your psych
    appointments, you’ll receive benefits with no work obligation.

    in 2006 dollars. Which way does inflation go again?

    II. “That’s not how it works for me!”

    …you might say, which brings us to the whole point: it’s not
    for you. It is for the entire class of people we label as poor,
    about whom comic Greg Geraldo joked: “it’s easy to forget
    there’s so much poverty in the United States, because the poor
    people look just like black people.” Include rural whites and
    any hispanics, and this is how the government fights the War
    On Poverty.
    In the inner cities, the system is completely automated. Poor
    person rolls in to the clinic, fills out the paperwork (doc signs
    a stack of them at the end of the day), he sees a therapist
    therapist, a doctor, +/- medications, and gets his benefits.

    There’s no accountability, at all. I have never once been asked


    by the government whether the person deserved the money,
    the basis for my diagnosis— they don’t audit the charts, all
    that exists is my sig on a two page form. The system just is.

    see if you can find the one poor person hidden in this picture

    III. But what happens when your five years on the dole are
    up?

    Enter SSI, Supplemental Security Income. You can earn


    lifetime SSI benefits (about $600/mo + Medicaid) if “you” can
    “show” you are “Permanently Disabled” due to a “medical
    illness.”

    “You“= your doc who fills out a packet with specific questions;
    and maybe a lawyer who processes the massive amounts of
    other paperwork, and argues your case, and charges about 20%
    of a year’s award.

    “show” has a very specific legal definition: whatever the judge


    feels like that day. I have been involved in thousands of these
    SSI cases, and to describe the system as arbitrary is to describe
    Blake Lively as “fair.”

    this non-sequitor here entirely for my own benefit. Thank you for your patience

    “Permanently disabled” means the illness prevents you from


    ever working. “But what happens when you get cured?”
    Where are you calling from, the future? You can’t cure bipolar.

    “Medical illness” means anything. The diagnosis doesn’t


    matter, only that “you” show how the diagnosis makes it
    impossible for you to work. Some diagnoses are easier than
    others, but none are impossible. “Unable to work” has specific
    meaning, and specific questions are asked: ability to
    concentrate, ability to complete a workweek, work around
    others, take criticism from supervisors, remember and execute
    simple/moderately difficult/complex requests and tasks, etc.

    Fortunately, your chances of being awarded SSI are 100%.


    (“Not for me!” Again, it’s not for you.) You may be awarded it
    on the first try; you may be denied and then get it on appeal;
    you may need an SSI hearing before the judge; or you may
    apply five or six times and finally get it after ten years. But if
    you are persistent, you will get it. (2)

    IV. Why Would Anyone Permit Such A Flawed System?

    At this point you are probably wondering about abuse of the


    system, people lying, pretending they have psychiatric
    illnesses just to get the benefits. If you think this— a natural
    thought, I’ll admit— then you need to turn off the network
    news and go watch Network the movie. You’re being lied to,
    by yourself.

    i have no idea what’s going on in Darfur, so I called an expert

    The system isn’t flawed, it isn’t easily gamed: it is set up this


    way on purpose. The government wants you to get SSI,
    because it wants you off the state welfare budget and onto the
    federal budget, which, as you know, has unlimited funds
    because it can run deficits, print money, and invade nations
    and invent words.

    In 2009 SSI paid 8M people about $45B. 60% of those under


    65 had a “mental disorder.” Did many have a legitimate
    disorder? Sure. Whatever. But when the system ties benefits to
    a mental disorder, the point is the benefits, not the mental
    disorder.

    What you should be asking is why, if society has decided to


    give the poor a stipend of $600/month, does it do this through
    the medical establishment and not as a traditional social
    policy? And the answer is very simple:

    1. you, America, would go bananas if poor people got


    money for nothing, you can barely stand it when they get
    it for a disability;
    2. if you offload a social problem to medicine, if you
    medicalize a social problem, then you’ve bought yourself
    a generation or two to come up with a new plan or invade
    someone.
    Do you want riots in the streets? How much does it cost to
    prevent LA (or the city of your choice) from catching fire?
    Answer: $600/month/person, plus Medicaid. Medicalizing
    social problems has the additional benefit of rendering society
    not responsible for those social ills. If it’s a disease, it’s
    nobody’s fault. Yay empiricism.

    Those who are arguing about the cost of healthcare or think


    that poor people are lying to get benefits are completely and
    utterly missing the point of the system. It wants this in the
    hands of doctors, because it would be toxic to everyone else.
    Can you imagine your Senator deciding who gets benefits and
    who doesn’t?

    And maybe these people get some meds as well. You know
    what counts as an outcome in inner city psychiatry? Guy
    doesn’t punch his kid in the face. One less instance of
    domestic violence a month. “Well, goddam, I don’t see those
    in the DSM-V. How much is that outcome going to cost us?”
    $600/month + Abilify+ Xanax + Celexa. But you then can
    pretend it doesn’t exist.

    IVb. Who Pays for SSI?

    SSI is funded through income taxes. It does not come from


    Social Security taxes. Pause for effect. It is definitionally the
    redistribution of income.

    In theory, SSI payments to a child (hey, ADHD counts) will be


    reduced if the child receives “unearned income”— including
    child support payments. If you’ve ever wondered why
    deadbeat dads aren’t more vigorously pursued by moms, that’s
    it. (3)

    The other reason is that a deadbeat dad who himself collects


    SSI isn’t obligated to make child support payments. He’s
    disabled, after all. Phew. The kid’s the government’s problem,
    which is now not a joke.
    V. It’s not for you.

    As easy and streamlined as this process is for the inner city


    guy with no other resources, it is that much harder for anyone
    with a driveway. It isn’t for you. I know this because, by the
    way you phrased your question, do not own a gun and are not
    likely to set your town on fire when your team wins/loses. I
    realize in your case you’re filing a disability claim with an
    employer, but the idea is the same: you did work. How do you
    show you now can’t work? It would have been easier to
    “prove” you can’t work if you never worked. That’s SSI.

    The “key” to your disability claim— and your chances are not
    great but consult with your lawyer— is to show how the
    depression impairs your cognition. Lack of energy and
    suicidality may sound important, but the illness has to link
    directly to an impairment. Not being able to read a paragraph
    or perform a simple repetitive task are impairments. Wanting
    to die is not an impairment. Prove to the judge you can’t pack
    a box or stack some cans just because you want to drown
    yourself in the tub.

    “But $600/month isn’t even enough to cover the rent!” Oh,


    I’m not saying it’s a lot, I’m not judging it as a living wage,
    I’m saying that’s exactly how much it costs to keep your city
    from an infrastructure upgrade. Meanwhile, all it took to get
    stupid France to riot was raising the retirement age by two
    years. “That’s a really unsophisticated understanding of the
    issue.” Shut it. I said shut it.

    VI. No one cares what you think.

    I’m guessing that this probably upsets people, on both sides of


    an imaginary political divide that only took 40 years to perfect.
    Thanks TV! Certainly I have my own opinions, but it doesn’t
    matter what I think, what matters is what is. This is the system.
    If you think you can effect a huge social overhaul then feel
    free to vote for Hope And Change and ongoing Afghanistan
    deployments, otherwise understand how it works before you
    spew nonsense to your local Fox affiliate. “Hi, this is Bill from
    Cleveland, and I blame liberals.” Son of a bitch, why didn’t I
    think of that.

    The system not only pays poor people, it employs lots and lots
    of almost poor people. I’m not saying this is a good thing, or a
    desirable thing, I am simply stating a fact. Some of these are
    direct government jobs (e.g. staff down at the SSI office) and
    some are pretend private sector jobs. If you’re a psychiatrist at
    an inner city clinic, you may think you’re an independent
    contractor, but you’re really working for The Man (but with no
    pension.) That’s the system. Cut SSI payments and those docs
    — and nurses and etc— don’t get paid.

    “Are you saying these patients are not mentally ill?” No, many
    of them are. Too sick to work is another story, but whatever—
    sure, those people could use a psychiatrist. But there’s a fine
    line between mental illness as a result of a 13q33
    polymorphism and mental illness due to living in a house
    where roaches crawl through your hair while you sleep. What
    the hell is Abilify supposed to do for that? You’re going to
    need heroin.

    “for some reason my kid always wakes up inattentive”

    VII. This is how it works, like it or not.

    An inner city psychiatrist sees 20-40 people a day. 15 minute


    med checks, which in a city is 5 or 10 minutes. “Any major
    symptoms? Suicidality? Side effects? Here’s your refill.” You
    try and pull that off in a suburban area and the Ms. Collins will
    complain you haven’t actualized her identity or validated her
    ambivalence. But in the city (and I’m guessing rural areas)
    that’s the standard. The government allows it because someone
    has to deal with those “patients.” The government doesn’t any
    other options.

    Same with benzos (Xanax, Klonopin, Valium, etc) and


    narcotics (percocet, MS Contin etc.) Once in a while some doc
    gets publicly arrested for handing out Vicodins in Valu-Packs,
    but the amount of benzos being routinely prescribed in an
    inner city is unbelievable. Go to your suburban doc and try
    and beg for a few Xanax. Come to the inner city and you can
    get #90 Zannies on first visit. Why? Because the government
    isn’t going to mess with the eleven or so sandbags they have
    placed in each neighborhood to hold back a flood of proletariat
    rage. Patients want them (to use, to sell, whatever) and docs
    give them because if they didn’t, they wouldn’t come back,
    and if they don’t come back, what are they going to do
    instead? Get a job at Walmart? No, they’re going to burn it.

    And there’s plenty of money to be made for the


    entrepreneurial. If you want to be rich in inner city psychiatry
    (no, you don’t have to be a doc), you open a clinic and hire 1
    psychiatrist and lots of (talk) therapists, usually social
    workers. Medicaid will pay for 1 therapy visit per week
    (around $60/hr) and a 15 minute med check with the doc
    ($40/visit). The doc usually gets salaried but for illustration let
    him have it all. The therapist, however, gets very little—
    $20/hr. The rest goes to the clinic. If the clinic serves 100
    patients, the clinic can bill $24000 a month in therapy, pay
    $8000 to the therapists and pocket $16k a month, minus
    overhead and security guards. Do you know how many
    patients go to clinics? Thousands.

    Which is not at all to trivialize the role of therapy, or the


    psychiatry: it is often the only thing keeping them out of the
    abyss.

    But they have to go to therapy because the clinic requires it


    because Medicaid requires it (integrated care), and the patients
    need the clinic because that’s how they’re getting their SSI,
    not to mention the Zannies. The docs need them to come
    because that’s how they earn their living, and the government
    allows this because it needs someone to deal with American
    poverty until either we discover cold fusion or the aliens
    invade. The government doesn’t tolerate this, it doesn’t turn a
    blind eye towards it, it explicitly allows it. The only thing it
    forbids is billing for a service not performed (e.g. ghost
    patient.)

    The new move is for inner city primary care clinics to perform
    a “depression screening” (questionnaire in the waiting room)
    and bill out a psych visit along with the normal visit.

    The rise of psychiatry parallels the rise of poverty in


    industrialized societies. The reason you see psychiatry in the
    U.S. but not in the Sudan isn’t because there’s no money for it
    in the Sudan, but because there is not enough money in the US
    to make some people feel comparatively like they’re not in the
    Sudan. Hence Zoloft. It is the government’s last resort to a
    social problem it may or may not have created, whatever, but
    has absolutely no other way of dealing with. Predictably,
    world psychiatry will also be the temporary solution to world
    poverty until the aliens return to see what became of their
    6000 year experiment. So invest in Pfizer, it will only go up. It
    has to.

    I have no time to edit or rewrite this, they have already kicked


    in the door. If I don’t return, avenge my death.
    —

    1. “It doesn’t matter if he medicates you, or even believes you,


    so long as he signs the form and writes “depression.”
    Technically, you need a real diagnosis, so it would have to be
    “Major Depressive Disorder.” But to check and see if anyone
    even cares, I’ve written “depression”, “depressed”, and “very
    very sad.” The only form I’ve ever had returned to me was due
    to illegibility of my signature (so the office couldn’t transcribe
    my name into their computer.)

    2. “If you are persistent, you will get it.” Prior to about 5 years
    ago, no matter how long it took you to get it, your award
    would include retroactive payments from the date you first
    applied. So if it took you 4 years to get it, you’d get a check
    for 4 years worth of SSI (minus welfare you received during
    that time.) But they’ve changed the rules, so no more
    retroactivity.

    2. Protip: if the deadbeat Dad puts the money in a child’s


    ROTH IRA, or pays for the kid’s private school, or in some
    way puts up money for the kid that is “not available for food,
    shelter, clothes” then it’s not counted against SSI. I’ll admit
    this is an unrealistically pro protip.
    Another Man Gets Harassed
    At An Airport, This Time On
    Purpose
    November 15, 2010

    ma’am, this isn’t the elevator

    The story: man doesn’t want to be full body scanned, checks


    the San Diego airport website to make sure they don’t have
    them, they don’t, gets there and— surprise— they do. Don’t
    they update their facebook? They tell him he has to either have
    the porno shots taken or submit to a physical search of his
    “junk” (that would be penis), he refuses and asks to leave, and
    they threaten to fine/imprison him for leaving the terminal
    without getting naked.

    The other part of the story: he appears to be on the right of Tea


    Party and he had a secret video camera running, which makes
    some think that he did this all just to provoke the TSA/get
    publicity.

    After you pick a side and start yelling, take a moment and look
    at the big picture: an angry citizenry provoking a perceived
    oppressive government, manned on both sides by self-
    indulgent idiots who couldn’t care less about the big picture.
    Yikes. If San Diego bloggers are driven to this kind of
    madness, you have to wonder what the Montana Militia is up
    to. It sure ain’t blogging.

    II.

    Go back and read about how power is applied, top down, and
    protected, bottom up, and you’ll be able to see that far from
    this guy making any dent in the TSA’s monopoly on power, he
    helped them solidify it. He thinks this is civil disobedience,
    but it’s not, his actions don’t affect the workings of the
    PowersThatBe. What he doesn’t understand is that the TSA
    didn’t do this to him, a couple of guys who happen to be
    wearing TSA uniforms did it.

    Back in the day, you were supposed to subsume your personal


    identity under the larger one represented by the uniform. The
    tradeoff was that anything you did in that uniform was the
    uniform’s fault, not necessarily yours. Your superior took the
    fall; hell, he resigned immediately on principle.

    But not in 21st century Narcissist America. Personal identity


    matters more than anything, even money and certainly more
    than honor (“huh? like shoguns?”) The uniform is just
    something you add to your character sheet. “What, you think
    I’m going to let my job define me? Only TV and music gets to
    do that.”

    Well, if you’re going to play it that way the government will,


    too, so that when uniformed people do something wrong it’s
    the fault of a few bad apples, the system is otherwise ok.
    That’s why uniforms have name badges: so we can identify the
    scapegoat.

    So whether these TSA guys did everything by the book, or


    under the direction of a supervisor, or totally under the
    influence of drugs and spite, it will be a contained problem
    that will have nothing to do with the “good work” the rest of
    the TSA does every single day. Heck, give them slightly more
    power, look at the kind of nonsense they have to put up with.
    Can we just make it a federal law that you have to submit to
    full body cavity search? Not because terrorists are wiley— still
    no breast implant bombs?— but because Americans are
    annoying. You know they are, right? Thanks.

    Bonus: tighter enforcement of inconvenient laws always leads


    to an underground economy based on bribes. Thanks for the
    idea, Russia! We could really use the money.
    Advertising’s Hidden Second
    Message
    November 17, 2010

    the question isn’t why he is shown wearing a man purse, the


    question is why it takes two people to buy auto insurance

    There are others in the same format: clueless fool is missing


    on life because he’s busy with his phone.

    (Not sure I get it. Why would a Windows phone make me use
    my phone less? Oh, now I get it.)

    II. Who can we laugh at now?

    On the Ron & Fez radio show— probably the best radio show
    on the air today, and if you bring up This American Life I
    swear to Christ I’m coming over to set your cats on fire. “This
    week on This American Life, some banal idiocy, set to jazz
    breaks”—kill me— on last week’s Ron & Fez show someone
    brought up the above father/son baseball tragicomedy as an
    example of how white men, especially fathers, have become
    the accepted brunt of popular humor.

    You can take that back a few years to the popular sitcoms,
    doofus white guy married to some hottie six grades smarter
    than him, not particularly manly or strong or motivated, the
    message apparently being that what women want are men too
    apathetic to cheat.

    So it’s the same old three chords sung to different lyrics, hey,
    this song is so unique because I haven’t been alive long
    enough to have heard the same thing 8
    trillion other times, let me get a T-shirt as well. But there’s
    another
    song in the background and you have to turn up the bass to
    hear it.

    III. So why are the white guys the easy target?

    It’s not arbitrary, “hey, we did the pollacks and the indians,
    who’s next?” And no, neither is it the completely imaginary
    hope that the media is so politically correct/racially neuralgic
    that they wouldn’t dare EVER to make fun of blacks. e.g.
    when the corporate dummy drops the phone in the urinal:
    and then goes right back to using it, the corporate dummy has
    to be a white guy and the corporate black guy gets to roll his
    eyes at him.

    “Really?”

    (yeah, but the white guy fished his hog out one handed.
    ZING!)

    And when this thigh-hi wearing succubus


    tries to turn him on, his penis should have instantly become a
    Staff of Osmium and Aggravated Assault, but he just searches
    for Activia deals. Not-noticing-husband has to be cast as a late
    middle aged white guy.

    coincidence

    And when the son plays outside with his Dad and his Dad is
    more interested in ESPN than in playing with his son, such
    that the kid throws the ball at his Dad’s head on purpose—
    —and even gets away with it, that Dad will be white and that
    sport will be baseball. Or soccer:

    “…so I can actually watch my son’s game, and not be that


    guy.”

    If you agree with all that— father, husband, provider, dummies


    all, because they’re safe targets that can be shown to be
    dummies— then I can tell you something: you’re white and a
    dummy.

    Yes: all of that is just rationalization. TV programming may


    care about political correctness but advertising does not, at all,
    unless it can move product. Advertisers will airbrush a hidden
    vagina into an Absolut ad just on the chance it gets you to
    rethink sobriety/marriage, so believe me they have no problem
    putting black men in black face if it gets you to buy another
    Happy Meal. Advertisers aren’t pro-black, I’m not sure there
    even are any blacks in advertising and that part’s not a joke,
    they’re not civil rights advocates, they’re snipers from Psy
    Ops.
    can you detect the subliminal message?

    Advertisers make white guys into dummies because (they


    hope) it helps sell their product; but they’re only going to link
    their product to a message that already exists. Unfortunately,
    by piggybacking their product on that concept, they are
    making the consumer believe that the concept is already
    accepted common knowledge. Advertisers didn’t choose to live
    like this but that’s how the mutually reinforcing symbiosis
    works. Like I said, advertising isn’t our window on society, it
    is society’s window on individuals, and these white guy-as-
    dummy advertisements are telling you that the reason white
    guys are picked on is because we hate them, and we hate them
    because they have let us all down.

    Whatever your racial preference, agree that the world to this


    point was owned and operated by Whitey & Sons, Inc, and
    boy oh boy, did Sons butcher it. From the “economic crisis” to
    “unnecessary wars” to widening income gaps, global warming
    to outstandingly bad television, the world/America was
    promised there’d peace, prosperity and tube cars in 2010 and
    now it’s worse than it was under Carter. The military said they
    could protect us, Goldman Sachs said stocks would go up in
    the long run, Congress said they got this. Nope, nope, nopedy
    dope.

    The heirs of the world’s everything have dropped the ball and
    squandered their lead. I don’t know when we’ll ever have a
    black President again, but I can/could have/did tell/told/tell
    you that the one time in post-soviet history where it was a
    foregone conclusion was 2008. Even overt racists voted for
    him, how much worse could things get? It’s the same reason
    why downward spiraling Catholicism got itself a German
    Pope; why poster child for Euro bankruptcy Iceland went with
    a gay prime minister in 2009— its most popular PM ever. It’s
    not progressivism, it’s a hail mary longshot after 3.5 quarters
    of fumbles and incompletes. None of these events are
    examples of history in the making, they’re history repeating
    itself. All of this has happened before and it will happen again.

    IV. That’s not me.

    But those men in the ads are just “regular guys,” which tells
    you that the disappointment extends to anyone who had
    privilege and power: fathers, husbands, suits. It doesn’t matter
    if you think you earned every dime or it was handed to you,
    what others— including yourselves— see is that those who
    have are doing a terrible job with the present and an even
    worse job with the future.

    What kind of a husband doesn’t see that his horned up wife is


    trying to connect with him? A self absorbed man. What kind
    of a Dad doesn’t even notice he has a skull fracture? A self-
    absorbed man. So how do you expect them to find cheap
    renewable energy? That’s what society is angry about.

    Notice that these men aren’t absent— the guy got dressed in
    silk pajamas, the other guy is in a baseball uniform, “what else
    do you want from me?” — but they’re not engaged. I can cite
    a million examples of this: hovering around your kids every
    second of the day; the decade plus explosion of husbands in
    the kitchen (I’m doing something for the family but don’t
    really have to interact); “man caves” (at least I’m home and
    not at some bar) and hyper involvement in kids’ schooling but
    not their schoolwork. Fake news and fake sex over real news
    and real sex, bullying laws and bike helmets, and no kid
    outside alone, ever, too many texting drivers, serial killers and
    pedophiles (there but for the grace of God and unforgiving
    laws go I.)

    Be careful, wildpeople, if you think you’re not the hated white


    guys in these ads. It isn’t about being white or being a guy, but
    about the class of people who have inherited the earth and then
    withdrawn from it, leaving it to entropy. Those people are the
    privileged middle aged— the Dumbest Generation of
    Narcissists In The History Of The World, and society hates
    you. That’s why, in other Windows Mobile ads, these women
    are portrayed positively, as using the phone to connect:

    while these women are jerks because they’re using the phone
    to disconnect:
    Neither do hispanics get a free pass— not if they’ve
    assimilated into the middle class, taken advantage of its malls,
    and then beat a hasty retreat:

    Society is disgusted by all of you, even as you are disgusted by


    it. But look up at the ads, the ones who have to suffer for it are
    the next generation. The ones you suffocate with your physical
    presence. “We always eat dinner together as a family.” Yeah,
    well, maybe you shouldn’t.
    the balance of power in the United States for the next 25 years

    V. 99% of society’s problems are insoluble; the other 1% is


    being deliberately ignored

    The quick point is that your constant physical presence isn’t


    doing anyone any good, and as for your kids it is
    slowly/rapidly melting their soul like Red Bull on gastric
    mucosa. But the larger point is that everyone around you feels
    your apathy, it senses that you are zombies going through life,
    you would much rather be elsewhere. Like on your phone.

    If you would be honest with yourselves— which you cannot


    be, this isn’t an insult but a description of the pathology— you
    would realize that you are blowing off your kid and your wife
    and your life not to rest or relax or take a minute to yourself
    but to withdraw from reality, because in reality you are only a
    fraction of what you thought you were supposed to be by now,
    time to buy another phone and hope it connects to the Matrix.
    And you withdraw at home because the boss won’t let you do
    it at work but at home the kid has no power to stop you.
    Neither does your wife, who anyway has to work. Why does
    she have to work? Oh yeah, you let her down.

    That withdrawal from reality has not gone unnoticed— not by


    your kids or your spouse or the voters or the networks, they
    know you like programming that lets You Decide, and the
    advertisers use that to sell a phone. (The vodka sells itself.)
    Truth hurts, me hearties, or so the saying goes but in your case
    not so much, the only truth that matters is what you believe in
    and that won’t ever hurt you. And you believe Bush and the
    liberals and divorced parents and gays and blacks and the
    Christian right and fossil fuels and Xbox are all to blame,
    meanwhile you yourselves create an ad where your kid hits
    you in the head with a baseball and you don’t understand the
    message that the problem is you. It is always you. And unless
    you change that thing first, everything else will be futile. As
    the great Marshall McLuhan once said, “know thyself, mofos,
    know thy mother fucking self.”

    You may also like:

    Advertising’s Collateral Damage

    http://twitter.com/thelastpsych
    Guess What Is Unstoppable:
    Movie Review
    November 19, 2010

    i probably saw a different movie than you


    The plot of Unstoppable is deceptively simple: an unmanned
    freight train is accidentally sent running down the track,
    hurtling with all the force of an unmanned freight train
    towards a small town in Pennsylvania, where it will derail at a
    curve like an unmanned freight train and destroy the earth.
    Two men, Denzel Washington and Chris Pine, risk their lives
    to bring it to a safe stop.

    True to the title, the train is unstoppable. It defies its brakes, it


    blasts through an RV, it flips over several police cars, it flips a
    train in front of it which then explodes with the blast of the
    Manhattan Project, ignores a SWAT team shooting assault
    rifles at it (really) and not only rides right over the Automatic
    Derailers, it shoots them off the tracks where they take out
    some more police cars.
    What no one initially realizes is that not only is the train 150
    miles long and carrying AIDS, but it is also a Decepticon.

    Here’s a movie tip: whenever they apply personification to an


    object, then that object itself stands for something else that
    isn’t a person. In this case the train, like zombies, is a
    metaphor for cold, uncaring, unstoppable, raging capitalism,
    and as soon as I say that the rest of the movie makes complete
    sense, i.e. makes no sense at all. The movie then gets retitled,
    Unwatchable.

    II.

    This is what happens in the movie:

    A dumb, fat, lazy white guy— none of those are insults but
    deliberately highlighted aspects of the character— made a
    series of errors: didn’t follow protocol, didn’t listen to
    his superiors, took shortcuts, all which lead to the train taking
    off at full throttle. Fattastic’s immediate response is to chase it,
    on foot. Fail.

    It hurtles towards a small town called Stanton, PA, home of


    All That Is Good In This World. Who can save this small town
    of hard working folk from the evils of capitalism? Not middle
    aged white guys, that’s for sure, they got us into this mess. No,
    the main good guy at HQ is a young non-white woman,
    Rosario Dawson, who I’m not sure is qualified to be an actress
    let alone in charge of a railroad. But there she is, the voice of
    reason, a tough-as-nails mix of pragmatism and ethics,
    surrounded by Corporate White Guys who only care about the
    bottom line.

    This scene actually happened: a bunch of Corporate White


    Guys are sitting around a conference table trying to figure out
    how to stop the train with minimal damage to the company.
    Finally, they call the Big Boss who isn’t physically present on
    site during this disaster and can’t be bothered to show up.
    You’ll never believe where he is. A golf course. I know. The
    Suits tell him that the train has the potential to destroy reality
    as we know it, should they derail it? and because he is a
    Decider he only needs to ask one question and that question is,
    “what will the effect on the share price be?” I didn’t know that
    that was something you could get a definitive answer to? But
    I’m not white.

    After the White Guys have tried everything else— in other


    words, have made no real attempt slow Capitalism down, the
    actual job of saving the Earth falls to… wait for it… an older
    black man and a very young white man— his apprentice. They
    young white guy actually comes from a powerful family and
    they pulled strings to make him the conductor. The message is
    clear: the middle aged white guys have wrecked everything,
    the future belongs to the young white guys coming up but they
    don’t know anything because they come from privilege, i.e.
    older white guys; and the only practical knowledge left is
    possessed by the hard working black men upon whose back
    the white guys built everything. Hopefully the Denzels can
    pass their knowledge along to the Chrises quickly, because of
    course Corporate will be laying the Denzels off to replace
    them with Chrises, which, we learned, is precisely what has
    happened to Denzel. And if you think I’m exaggerating this
    point, the only other black person in the whole movie is the
    schoolteacher. Who will no doubt be laid off, just after she
    teaches all the white kids how to read and vote for Mitt
    Romney.
    III.
    No surprise: they eventually stop the train. But there’s a
    completely unnecessary scene where they explain the plan.
    The heroes/The Federal Reserve have a plan: chasing down
    Capitalism (from behind) in their engine, linking up, and then
    braking the whole thing to a halt.

    A federal regulator, who at the beginning of the movie is


    ignored and marginalized, who only accidentally happens to
    be at HQ that day, disagrees:
    INSPECTOR: I know the conventional wisdom is just
    link up and then throw the whole thing into reverse, but
    you’ll get better traction if you alternate between braking
    and full throttle.

    DENZEL: You sure about that?

    INSPECTOR: Well, it’s based on some preliminary


    calculations…

    Get it? Capitalism can be saved by interspersing braking with


    stimulus! Wow.

    IV.
    The end of the movie is right out of a Lenin comic book. The
    white guy is injured, so the black guy has to stop the train
    himself, and heroically runs from the Last Car Of The
    American Economy all the way to the front— but the last
    jump is too big. “I can’t do it,” he says.

    So it’s up to the young white guy, heir to the future but injured
    in the present, to jump from a moving pickup truck back on to
    the Engine of Capitalism and bring it under control. Which he
    does, yay. If the movie ended there it could be considered class
    warfare propaganda suitable for the Cubans.

    But then the movie takes a decidedly bizarre, American, turn.


    The final scene is a press conference— because the press
    always gets the final word about the resolution of a conflict
    and decide who’s to blame and who’s a hero. As the proletariat
    heroes answer questions for the thankful public, Denzel then
    explains to Chris how Corporate called and thanked him, and
    gave him and Chris promotions. And then… that’s it. End of
    movie. No morality lesson, no one gets punished, everybody
    back to work. Once the runaway train of Inflation And
    Catastrophe is stopped, it is returned to its Corporate owners
    and filled back up with plutonium and baby souls.
    Cut to camera 5, and pull back: to reveal that you are seeing
    this all on a TV screen, you realize that you are watching all of
    this on the news; in fact, you recall that the entire movie has
    been saturated with reporters giving exposition, TV screens
    with FOX or CNN showing us what happens. What we know
    — the facts of the train’s movements, etc, all come from the
    news:

    Which is, after all, just like real life.

    V.
    It’s a legitimate question we all first voiced in 5th grade: did
    the writer really have all that in mind when he wrote this?
    Maybe, maybe not, and I could also cop out by saying that the
    movie’s accidental theme may be what resonated with an
    exasperated public, and thus makes it popular.

    The problem with doing movie-as-social criticism is not that it


    reads too much into things but that it never goes to the
    inevitable conclusion. If that train is rampant capitalism, then
    it was human error that caused the trouble. None of this would
    have happened if it was all automated. Drawing only from the
    text, the problem isn’t that we need more ethical people, the
    problem is we need less people all together. I’m not sure that’s
    not the message they were hoping for.

    http://twitter.com/thelastpsych
    A Generational Pathology:
    Narcissism Is Not
    Grandiosity
    November 23, 2010

    something’s not right

    I like your writings about narcissism, but your description


    seems to differ from the one in the DSM and everywhere
    else I look.

    Why does that matter if indeed it was true?

    I just want to know where you came up with it.

    You mean, “I just want to make sure you didn’t make it up.”
    Because if I made it up, then it stands entirely on my back.
    Like an American, the shortcut you use for difficult issues is to
    judge their proponent as a proxy. If you don’t like some ideas,
    look for hypocrisy, discredit the speaker. Which will be easy to
    do with me, I assure you. Heavy drinking, womanizing,
    misanthropic… maybe not even a psychiatrist. There. Do you
    win?

    That’s not what I meant.

    It is what you meant, even if it isn’t what you meant. There’s


    plenty of writing on narcissism, you can start with Kohut, even
    Jung and Freud. But you’re resistant: no, psychoanalysis is
    bunk. And impossible to understand. That stuff can’t be right.

    You want science, you want something with bullet points and
    a standard deviation.

    Here are the DSM criteria for NPD, of which you must score
    at least five:

    grandiose sense of self-importance


    preoccupation with fantasies of unlimited success, power,
    brilliance, beauty, or ideal love
    belief that he or she is “special” and unique and can only
    be understood by, or should associate with, other special
    or high-status people (or institutions)
    need for excessive admiration
    sense of entitlement
    takes advantage of others to achieve his or her own ends
    lack of empathy
    envious of others or believes that others are envious of
    him or her
    arrogant, haughty behaviors or attitudes

    Much easier. Is that the narcissism you heard about? Selfish


    and grandiose. Looking at that definition, do you even come
    close to narcissism?

    Of course not, because your mind is shielding you from the


    truth. The belief that narcissism is synonymous with
    grandiosity is, itself, a narcissistic defense. You are being lied
    to, by yourself.

    What happened to the diagnosis? Why did it favor


    grandiosity?

    How do you quantify something that your mind is working to


    hide from you? How do you treat it? When psychiatry wanted
    to stop being a Jewish/Marxist/elitist worldview and become a
    real science, it needed to pretend it had medicines and
    statistics, and a whole new DSM (III).
    How do you measure the unmeasurable? Divide the
    unmeasurable into pieces, and measure the pieces. Too many
    pieces, too fine? Start with the obvious.

    We found a foot, an eyeball, and a liver. This must be a man.


    Or a triceratops. Or a… And now we come to consider that a
    man is something possessing of three attributes: footness,
    eyeballness, and liverness, with exclusion criteria of
    dinosaurization. Thanks, Aristotle, this helps a lot.

    So, too, the scales for narcissism, e.g. the Narcissistic


    Personality Inventory. While these scales are supposed to
    measure something that already exists, in postmodern fashion
    they alter your concept of what exists.

    You looked up narcissism, saw there were criteria, scales, and


    read them. And, like decimate, it was reinforced by hearing it
    in a sentence. Oh, it’s an egotistical jerk who only cares about
    himself. Got it.

    I’ve used this example before: The Hamilton scale for


    depression contains no questions about sleeping excessively or
    eating too much:
    On a 17 question scale in which a reduction of 10 points is
    outstanding, a sedating side effect can be the difference
    between $4B/yr in sales or wasted millions in R&D. Add two
    points for drugs that make you hungry:

    and that’s the whole game.

    Psychiatricians will counter that the Hamilton isn’t meant to


    be a screening tool, but in fact it’s used as a screening tool all
    the time: in clinical trials. You have to meet a certain threshold
    to be enrolled in a trial, so you can see that a person who is
    very depressed but hypersomnic and eating too much will be
    excluded.

    I just told you something that is obvious; so why isn’t Abilify


    (not sedating) testing their drug on other kinds of depressed
    people? Because they can’t. The FDA wants the HAM-D, or
    the MADRS (which is skewed the same.) Abilify would have
    to convince the FDA that their drug worked AND change the
    entire infrastructure of psychiatric drug approval. Furthermore,
    psychiatrists themselves would be suspicious, “why are you
    doing it differently?”

    If it’s not grandiosity, then what is narcissism?

    Shame over guilt; rage over anger; masturbation over sex;


    envy over greed; your future over your past but her past over
    her future…

    Imagine what you look like to another person. Now recall


    what you looked like in the mirror this morning— that’s really
    what they see. They are making instantaneous judgments
    about your personality based on that mirror image. They are
    hearing your voice like it comes form a recording, not as you
    hear from your mouth. You’re the only person who
    experiences yourself as you do.

    The narcissist feels unhappy because he thinks his life isn’t as


    it should be, or things are going wrong; but all of those
    feelings find origin in frustration, a specific frustration: the
    inability to love the other person.

    He’s a man in a glass box, unable to connect. He thinks the


    problem is people don’t like him, or not enough, so he exerts
    massive energy into the creation and maintenance of an
    identity: if they think of me as X…

    But that attempt is always futile, not because you can’t trick
    the other person— you can, for an entire lifetime, it’s quite
    easy. But even then, the man in the box is still unsatisfied, still
    frustrated, because no amount of identity maintenance will
    break that glass box.

    If the other person is also in a glass box, then you have a


    serious problem. If everyone is in their own glass box, well,
    then you have America.

    I guess Facebook is a kind of glass box?

    Facebook is a neutral tool, it’s what you do with it that


    matters. You think the “I’m better than everybody!” status
    updates are evidence of narcissism, and maybe they are, but
    the deeper pathology exists in those who derive their identities
    from that online presence while simultaneously retreating from
    the real world. Show me a man or woman who posts pictures
    of themselves in bathing suits and I shrug my shoulders. Show
    me a person who spends more than an hour a day on Facebook
    and it isn’t their job and I’ll show you a future divorce even if
    they’re not married yet. Show me a middle aged person who
    spends >1 hr a day on facebook, and I’ll show you someone
    who has been to a psychiatrist. It’s not an insult, it is a
    statement of fact. Each person tries to find ways of affirming
    themselves; but when it is done through identity and not
    behavior, it always leads to misery.

    Sure, you can convince 5000 people you’re anything. Then


    what?

    It is self-reinforcing. The type of person who withdraws into


    facebook is already stunted in their potential for happiness;
    and if you’re spending all your energy on facebook then
    you’re not spending it in ways that might actually work. The
    problem isn’t facebook, the problem is you.

    But that’s how I met my last girlfriend…

    Your last girlfriend. Narcissism has a fail-safe: since you know


    you tricked them to get them, you can’t believe them when
    they say they love you. The fact that she loves you means
    she’s not smart enough to know what love is. That’s why you
    default to measurable quantities of love: how fast did she get
    into bed with the past guys?

    Just because she thinks you’re awesome, doesn’t mean you


    can really feel her.

    I know I can love, because I love my son and daughter,


    totally and unconditionally.

    And so now I know your kids are young. No matter what you
    do to them: abuse them, yell at them, neglect them, abandon
    them, withdraw from them, they will love you unconditionally.
    But after puberty, when they start to love other people in
    different ways than you, or more than you (do you remember
    when you were 17?), even the best parent’s status drops. How
    will your ego defend against that? Sports car and drinking?
    Cybersex? “I’ve started smoking pot again, it really helps me
    unwind.”

    What can psychiatry do about this?

    Do about what? According to it there’s nothing wrong with


    you, don’t you see? You’re not grandiose. Maybe you get
    diagnosed with “depression” or a touchy-feely therapist tells
    you you have “self-esteem issues” but that’s like being told
    you have a hairy back, you make some cosmetic adjustments
    or you just don’t go to the pool, life goes on. Psychiatry has
    nothing to say about why you get so enraged when you hear
    about welfare cheats, or how your wife’s giggle at that one
    joke on TV hit you the wrong way, how everyone seems like
    shallow, phony jerks and no one is worth getting to know—
    how adamant you are that the government do X or Y, neither
    of which are feasible or even matter but to you it’s the most
    obvious thing in the world to do and the fact that they’re not
    doing it must mean they are either idiots or corrupt— and
    while you’re yelling at the TV or the monitor or in your own
    head your wife is mauling a vibrator or you don’t have a wife
    at all.

    But I never yell.

    Your rage may not score on the decibels but it is triple digits
    on the wattage. Psychiatry can’t measure that. And while this
    rage makes you miserable there’s also a societal effect: hating
    black people, hating white people, blaming Goldman Sachs,
    blaming your parents, declaring war.

    And deserving things: shouldn’t you be in a nice car?


    Nautica/Zegna/Underarmor/Polo shirts? Restaurants? The fact
    that you can’t get them is someone else’s fault; but if you get
    them, why aren’t you happier? Meanwhile there are bills to
    pay.

    And you can’t make the connection between these things at


    all. Even as I say it, you resist: it’s not that simple, you don’t
    know her, you don’t know
    them………………………………….. it can’t be all me.

    It is you, it is all you, it is always you. Isn’t it odd how


    narcissism turns everything inward, except blame?

    It’s not odd, it is by psychic design, and psychiatry has failed


    you all in this. If individual narcissism is self-defensive, one
    might presume that societal narcissism will find it’s own way
    to hide in plain sight. Narcissism became synonymous with
    grandiosity because that facilitated its measurement. But in so
    doing, the most significant social pathology in two generations
    was rendered undetectable.
    –
    You might also enjoy:

    The Other Ego Epidemic

    If This Is One Of The Sexiest Things You’ve Ever Seen, You


    May Be A Narcissist
    Fanapt Slide Deck
    November 27, 2010

    I finished the Fanapt slide deck post, now including weight


    gain/metabolic data, EPS, prolactin, and an explanation of how
    to use the affinities.
    Narcissism Out Of The DSM
    — And Into The Open
    December 1, 2010

    nothing to be said

    Jay Mohr, popular comic and actor, did a phone-in to the Opie
    & Anthony radio show and told this story (I recite from
    memory):

    So I’m shooting Hereafter, and there’s a scene where I


    walk up these flights of stairs, I fumble for my keys and
    my next door neighbor is supposed to hand me my mail,
    and it’s a letter from Matt Damon and blah blah blah.

    So all she has to do is hand me the letter and say, “here’s


    your mail.” But she’s some San Francisco wannabe
    actress, and she’s decided she’s going to get her Oscar on
    this movie. So she comes over, all dramatic, and she says,
    “so, ummmm, hi…. You want your mail?… Looks like
    you got a letter here….” And she hands it to me, but then
    she pulls it back at the last second, because she wants to
    be a cunt, and I reach for it, she pulls it out of my hand
    again. So finally I just grab it, and she says, “well, enjoy
    your mail.”

    So Clint Eastwood (the director) is down at the bottom of


    these three flights of stairs watching all this on the
    monitors, and you hear him say, “goddamn it!”— he
    doesn’t even yell cut— and he starts coming up the stairs,
    he’s like 9000 year sold, coming up, puffing, really
    slowly. Finally he gets up to the top and he looks at her
    and he says, “honey, I can’t begin to tell you how much
    this movie isn’t about you. If I could have hired just your
    goddamn arm, I would have.”

    II.

    You may have heard the news: “Narcissism is being removed


    form the DSM.”

    Narcissistic personality disorder, characterized by an


    inflated sense of self-importance and the need for
    constant attention, has been eliminated from the
    upcoming manual of mental disorders, which
    psychiatrists use to diagnose mental illness.

    That sentence is technically accurate. What’s missing,


    however, is that it would be replaced by something else, a
    more wordy, symptom cluster description of a personality
    disorder. You can still “diagnose” someone with narcissistic
    traits.

    However, on the face of it, people are understandably freaked


    out:

    One of the sharpest critics of the DSM committee on


    personality disorders is a Harvard psychiatrist, Dr. John
    Gunderson, an old lion in the field of personality
    disorders and the person who led the personality
    disorders committee for the current manual.
    Asked what he thought about the elimination of
    narcissistic personality disorder, he said it showed how
    “unenlightened” the personality disorders committee is.
    “They have little appreciation for the damage they could
    be doing.” He said the diagnosis is important in terms of
    organizing and planning treatment.
    Since he doesn’t get Pharma money, there’s no need to
    disclose his megalodon sized bias: his whole career is about
    measurement tools for narcissism.

    And so if you’re thinking that the craziness is that psychiatry


    is the doing away with the concept of narcissism you have
    fully missed the point: the issue isn’t whether narcissism exists
    or not, the issue is who gets to decide if narcissism exists or
    not.

    You break it, you bought it.

    III.

    Here’s a metaphor. When The Oscars, defying all logic and


    sanity, choose Sandra Bullock as best actress— a woman who
    Gwyneth Paltrow (Shakespeare In Love) once used as an
    example of the kind of actress she didn’t ever want to be
    (Demolition Man— anyone see the irony?) the strength of that
    choice isn’t that her performance in The Blind Side is even
    good but that I, me, a guy who watches movies, believes that
    The Oscars are nuts for choosing her: they have tricked me
    into thinking that their decision has any relevance.

    I realize it matters to the actors’ future salaries and sales and


    blah blah, but these annual terrible picks reinforce to me that
    they should have picked something else. But why should they
    have? As a reasonably educated person I recognize that people
    have individual tastes; but that there are some things that make
    a work of art better or worse; but neither of those things are
    the purview of The Oscars— they only make me think it’s
    their domain. In other words, who cares what they think? But
    while I have no problem dismissing the relevancy of the Super
    Bowl victor, it still infuriates me that the Oscar goes to X, and
    that’s because they’ve beat me. I know they don’t have any say
    about what is good. And yet I’m furious, every single year.

    IV.

    You want a historical example, here you go. No one gets


    diagnosed with obsessional neurosis anymore. People do,
    however, get called obsessional and neurotic by regular
    people.

    What happened is that a term that highly educated and


    philosophically precise people used all the time was turned
    into a vernacular label; and the power of “diagnosis”— read:
    labeling— seized by the new emperors of psychiatry with a
    different paradigm.

    The person in the chair is still recognized to have a pathology:


    but one group is dismissed by the other group as being mean,
    pejorative and unrigorous: “we don’t call it that, that has no
    construct validity, it’s better described as this.”

    Never mind that the new terms have no more validity than the
    old terms, and are equally invented. That’s not the point,
    diagnosing the patient isn’t really the point, the point is that
    the DSM is the authority. They’ve made it that the burden of
    proof of disagreement is on you, not them. They gain the
    credibility not by improving the diagnosis, but merely by
    altering it. And so you all say, “well, I think they’re wrong, but
    they must have had some scientific reason that I don’t fully
    understand…”

    And you’re stuck. You’re left suspecting that there is


    something really, really wrong, but since it’s not bipolar and
    it’s not a unicorn you’re left wondering if you’re not just a
    prejudiced ass. Worse, the only one you can turn to for
    “support” is Freud, et al, which immediately gets you labeled
    as a nut.

    Yet you can’t help but see it— so you tentatively try to dress it
    up in the least disparaging way you can, and turn to psychiatry
    for a little help, but:

    “Well, we all know there’s no such thing as hysterical


    neurosis. Allow me to offer an equally arbitrary but
    nonetheless reliable construct that puts all the power of
    labeling in our hands.”
    Wait, that’s not what I was going for…

    V.

    Let’s go back to that telling scene in Hereafter. To the extent


    one can make a judgment on a single anecdote, let’s agree that
    at that moment the actress was behaving narcissistically.
    Psychiatry, however, would not have a quick way of
    discussing this (and, truthfully, it didn’t a year ago either.) But
    by not having a useful description of it, that behavior is no
    longer psychiatry’s problem.

    Added bonus: it’s yours.


    When I Get Writer’s Block,
    You Get This
    December 3, 2010

    ART THOUGHTZ: Post-Structuralism from Hennessy


    Youngman on Vimeo.
    There may be some inconsistencies in it. But that pretty much
    depends on you.
    The Walking Dead: Not
    About Zombies
    December 9, 2010

    step 1

    The Walking Dead is a show about zombies. It’s a modern tale,


    with modern characters. They know about cell phones and
    Camaros, the CDC, and tanks. The show is also aware of its
    own artistic context, with numerous scenes
    referencing/honoring other movies.

    Mad Max knows there’s not enough time to saw the handcuff
    The “suspension of disbelief” necessary for this show is that
    zombies could exist. Once you accept that, everything else is
    America 2010. Given this, why do the characters never refer
    to the zombies as zombies? “Walkers,” “geeks,” “the walking
    dead.”

    Most modern zombie stories begin from the premise that the
    characters have “zombie” as part of their knowledge base (e.g.
    Zombieland.) But somehow these characters don’t ever call
    them zombies.

    One character, fed up with the inefficiency of his camp


    members’ zombie hunting skills, says, “you’re supposed to
    shoot them in the head. Everyone knows that.” Agreed. How
    did you learn that? So how come you don’t know what they’re
    called?

    II.

    Let’s play a game, a child’s game, and if the outcome of this


    game is a little insight that keeps you from blowing your
    brains out or helps you crawl out from under the bottle then it
    will have been worth playing. The game doesn’t have to be
    accurate to work. Interested? The rules of this game are words,
    and the name of the game is the rest of your life.

    So turn over the First Zombie Question Card: what is it called


    when something obvious to everyone else never makes it to
    your consciousness? Repression. Repressed material comes
    back distorted, sometimes unrecognizably so.

    Kind of like a zombie.

    III.

    Sigmund Freud is mostly remembered for his work on penis


    and vagina, but one of his biggest contributions to society was
    his observations about mourning, and cocaine. He went too far
    with the cocaine, and not far enough with the mourning.
    Observation 1: no one can conceive, that is, perceive, their
    own death. Allow me to vamp: the ability to do so is an
    indicator of substantial pathology, especially a terminal one.
    There’s no problem conceiving of everyone else’s death, but
    any attempt to see your own fails because it requires you— a
    first person singular perspective (“I am seeing what it is like.”)
    An interesting experiment is to try to conceive it in second
    person, e.g. looking not at your wife mourning, but as your
    wife, through her eyes. Does that make your death seem more
    sad, or less? Time to rewrite the will.

    Observation 2: All mourning is ambivalence. Ambi-valent,


    two conflicting powers: the cherishing and remembering and
    sadness part; and the guilt that perhaps maybe you wanted this
    person dead.

    Wanted him dead? You’re never too far from age 2, when your
    rage is magically powerful. At some point in your life, you
    thought it, and the unconscious never forgets even the briefest
    of hates. Sometimes the guilt over your hate has a convenient
    narrative: caring for a cancer-ridden, demented parent who
    exhausted your physical and emotional resources, and then
    finally(!) dies. That’s going to generate a phew feelings, and
    they’re going to cost you. All accounts must be settled at
    checkout.

    IV.

    It didn’t always used to be this way.

    Back in 1968, the first best zombie movie was made. How do
    you make a 60s zombie? You reanimate the dead. How they
    died doesn’t matter, because the interesting part is that
    something had the power to reanimate them. Life after death?

    Times change, and in our current time of narcissism all


    zombies appear through a new process: plague. That makes
    these zombies not so much the risen dead or the living dead as
    the incompletely dead. Life after life, life continuously— even
    in zombie films we disavow death.

    The zombie becomes the externalization of the ambivalence of


    mourning.

    Paraphrasing from memory:

    The narcissistic identification with the (loved) person


    becomes a substitute for love; the result is that even in the
    face of a conflict with the loved one, the love connection
    need not be abandoned. This substitute of identification
    instead of object-love is an important mechanism in
    narcissistic affections. This is a regression— the first
    stage of object love is identification and is expressed
    ambivalently. The ego wants to incorporate this object
    into itself (oral stage). It wants to devour it.

    Oh, I know, none of this makes sense until it happens to you.


    So turn over the second Zombie Card Question Card:

    Apart from a scene showing a zombie eating a guy, what other


    scene is in all zombie movies?

    A scene in which a main character confronts a loved one


    turned zombie. The rest of the previous zombie attacks are
    merely prelude to that one, specific, pivotal interaction. Quick,
    bolt the door, ambivalence is coming. Movies give the loved-
    one zombie a momentary flash of the old self— is it
    remembering, is it a trap, or are you seeing what you want to
    see? This is the most important scene and how the living
    negotiate that bit of mourning determines if they’ll be able to
    put the dead to rest, or are going to have be tied to them
    forever.

    In The Walking Dead, there isn’t just one such scene; the
    whole show is those scenes. Which brings us to Observation 3:

    Observation 3: zombies are uncanny. Incomprehensible, yet


    incomprehensibly familiar…

    V.

    In Episode 1, a black man and his son are hiding out in their
    house, the only two humans surrounded by zombies. They
    save the main character, Rick Grimes, who also has a kid, but
    Rick is white. Is that just a coincidence? Of course (not).
    Black is in contrast to white, which would mean—
    foreshadowing— that the black guy is going to become quite
    dark.

    But for now, why hasn’t he and his son left town? Because
    wife got turned, and husband couldn’t bring himself to re-kill
    her. And so zombie wife is still shuffling up and down the
    driveway, coming or going, staying or leaving? He’s going to
    stay until he can finally put her to rest, there’s some unfinished
    mourning to do.
    I miss you every single day. So this time I’m using a scope

    The scope won’t help. Incomplete mourning has affected his


    trigger finger, not his eyes, and so day in and day out he tries
    to (not) shoot her, repeating it over and over, working through
    it until he masters the material.

    He can spend the rest of his life repetition compulsioning if he


    wants, but time marches forward and like everything else in
    life it comes down to a binary choice: he’ll either get over her
    or get with her. It is inevitable.

    That’s why there’s no sense in putting it off, and you certainly


    can’t avoid it— it follows you around.

    That leaves the son, a small boy who isn’t afforded the luxury
    of mourning. Children are much closer to the ambivalence of
    mourning, because when they (frequently) temporarily hate
    their parent they aren’t confident of the physical limits of that
    hate, and if mom suddenly dies it’s hard not to think you didn’t
    have a wee bit to do with it. Which is why the job of proper
    mourning falls to the surviving parent— lead by example—
    and if he’s smart he’ll take advantage of the 6000 years of
    human history and allow the rituals of mourning to naturally
    lead the process, that’s how the unconscious works through its
    conflicts. Learning by doing, until it becomes second nature.
    (The first nature died with the parent.)

    And it’s never too late, if you didn’t do it right the first time
    and have been haunted ever since, you can always go back and
    perform the rituals more completely. “But I won’t respond to
    those rituals because I’m not religious.” It’s not up to you;
    you’re built for ritual. So are The Walking Dead characters,
    who completely against everyone’s and their own survival
    instincts decide not to burn(/deny) the bodies of their zombie-
    murdered friends, but bury them all in time consuming (all of
    it), backbreaking graves. “It’s a hundred degrees out here.” If
    the digging’s harder, the mourning is easier. And that’s why
    they (living and dead) are able to move on.

    Speaking of haunting, what’s one potential consequence of a


    parent’s incomplete mourning? The kid develops a strong
    belief that he can see ghosts and has ESP. If you’re not ready
    to let go, then you’ll hold on tighter; and if The Walking Dead
    scripts according to psychological flowchart, then little Walt
    will be revealed as psychic. Oh, wait, that’s not Walt…

    VII.

    In a late-r episode, Sister B gets bitten and will soon become


    Sister Z, but Sister A can’t bring herself to terminate the
    process. Instead, she sits with her sister as she lays dying, then
    undeading.

    It’s a very tense scene for us not because Sister B is going to


    die (how sad) but because we know she’s going to be pissed
    when she does. But it’s easy for us: we’re not mourning. This
    is the interesting part: we’re not mourning sister B, we’re
    angry at sister A— “shoot her, idiot!” And even when Sister Z
    reaches an undead hand towards the mourning sister’s face,
    Sister A doesn’t fight it. We are frustrated.

    She finally does discharge our anxiety right into her temple,
    and phew. But hold on: for most of the season I thought they
    were twins, I couldn’t tell them apart. Nor, given their
    character development, was it necessary to do so. Yet in one
    completely “unnecessary” scene, there’s a long dialogue about
    how Sister A went off to college and was too busy for Sister
    B, and how guilty she felt that she wasn’t there for her— yes,
    they are that much spread in age. Hmm. That would make
    Sister A the mother figure. Now it gets interesting. Where’s
    Dad?

    Oh, there he is. So now this isn’t about losing a sister but
    about losing a child. The ambivalence has taken on a different
    character. There’s no fear in this mourning, just guilt, which
    makes this scene NOT “if you can’t save them, join them” but
    rather “if you can’t save them, your punishment is to join
    them.” It’s no coincidence that Sister-A can’t shake the guilt
    and opts for punitive suicide in the season finale— only to be
    lead, at the last minute, through the final steps of mourning by
    Dad. We don’t really get a sense of his pain (it must be
    gigantic, that was his daughter, too) because the point is her
    pain, and a good Dad is beside the point. That’s what Dads
    have to be: wolfram, stoic, pulling everyone’s emotional
    weight when it’s time to do so, because if not them, then who?
    That doesn’t make their pain easier, unfortunately, but it’s
    what’s right. Does anyone remember right? Obviously not:
    that’s why there are zombies.

    VIII.

    Let’s go back to how uncanny zombies are.

    [If] every affect belonging to an emotional impulse,


    whatever its kind, is transformed, if it is repressed, into
    anxiety, then among instances of frightening things there
    must be one class in which the frightening element can be
    shown to be something repressed which recurs. This class
    of frightening things would then constitute the uncanny

    Mature people have a number of options for complicated


    bereavement. One option is to take on all that unconscious
    hostility and subsequent guilt (“I could have done more for
    him!”) and develop a pathological, obsessive guilt. (The cure
    for which, if you’re not much interested in auto-analysis, is to
    re-run the rituals, and run them right. It worked on Regan in
    The Exorcist, and she wasn’t even Christian, let alone a Greek
    Catholic. And if that doesn’t work, you run the rituals every so
    often, like memorials, keep retraining the unconscious. (And
    what about the person who doesn’t want to do the rituals?
    When something is true for a trillion people over thousands of
    years, and you are firm in your belief that it is pointless, that’s
    called resistance, and now the question changes to why you
    won’t. The young are particularly susceptible to this, they
    don’t want any part of your silly rituals and unskeptical beliefs
    because that would be to accept that they’re no different than
    the trillion who have died before them. Don’t worry ages 15-
    30, it’s natural part of ego development. But keep in the back
    of your mind that no one is bigger than history, and certainly
    no one is bigger than death or it’s consequences, and when the
    zombies come it wouldn’t kill you to remember the rules.))

    But immature people, i.e. cavemen, kids, and everyone in who


    is a main character in their own TV show (including The
    Walking Dead) have a less neurotic (so more psychotic— the
    line between ego vs. id and ego vs. reality is the true bi-polar)
    option: projection. All my conflict shifted on to the dead
    himself. And there’s enough anger there to keep them alive
    and make them come after me. Hence malevolent ghosts,
    vampires, werewolves (and oh, yes, “walkers,” or whatever
    they are, they seem familiar but I just can’t…) They are full of
    rage, not me. But a bullet to the head should solve that. Better
    them than me, after all.

    Not for nothing, projection— taking unacceptable emotions


    and attributing them as coming from the other person— is
    what TV does so well, which is why we like it so much. Now
    you know why you love it when TV says George Bush is a
    selfish jerk and Lindsey Lohan is out of control slut.

    IX.

    What’s familiar about the uncanny? The repressed material it


    represents. Are there examples?

    Seeing your own double should be uncanny, and oh boy is it


    ever. So uncanny that they tell you if you ever meet your time
    traveled double, the universe will explodonate. How’s that for
    a self-preserving narcissistic prohibition.

    Try this: adopt an expressionless face and look in the mirror.


    Don’t move, just look. That’s you. Does it look like what you
    thought it would, exactly? Now imagine that it slowly smiles
    back at you. That’s uncanny: it is the physical manifestation of
    repressed material.

    “Huh? What repressed material?”

    Is your smiling mirror-double good, or evil?


    “Oh, that repressed material.”

    Your superego is moonlighting as a projectionist.

    The double is an affront to your narcissism: “hey, wait a


    second, that’s not really me, that’s my Evil Double.” No, it’s
    you.

    Now that we can see those repressed feelings manifested as a


    double, we also understand that we don’t want to see that
    repressed material any more than we want to see a double
    smiling back at us in the mirror. The uncanny may be familiar,
    but it was supposed to stay hidden. If it doesn’t stay hidden—
    if it instead shuffles up and down the driveway— you’re going
    to freak out.

    The uncanny doesn’t defy explanation, it is obliterated by


    explanation. (Remember Lost?) In the first few episodes of the
    series, the zombies are uncanny. But the moment we see the
    scientist at the CDC watching zombie viral particles under a
    light microscope(!), the zombies are no longer uncanny. If they
    are the result of a virus then we don’t have to wonder if
    they’re the result of repressed feelings. Alternatively, if they
    are the result of repressed feelings, and those feelings are
    brought to awareness, then the zombie ceases to be uncanny
    (and exist.) Once you know the rules of mourning, zombies
    are an easy kill.

    Let’s go back to Sister A and Sister Z. Why don’t we perceive


    Sister Z as uncanny, but the zombie wife in the driveway we
    do?
    We don’t see the sisters’ interaction as uncanny, we’re
    infuriated by it— because we’re a 3rd person perspective
    reality testing the zombie narratives, and we know the steps to
    properly mourn a zombie. The point of the scene isn’t Sister Z,
    but Sister A— so not uncanny. Just like listening to someone’s
    supposedly uncanny dream. But if you consider Sister A’s
    perspective, looking from her eyes, it must be very, very
    uncanny to see her sister as a zombie. Hence, the further we
    move away from the narcissistic position— which allows us to
    recognize what’s familiar— the less uncanny it will be.

    I’ve read that the supposed crucial advancement of the zombie


    folklore is the change to running zombies. I disagree; a more
    important change was the use of humor in zombie movies.
    Humor, especially irony, represents a shift in perspective, a
    new 3rd person awareness of your first person experience.
    This decreases the personal familiarity, the uncanny-ness, and
    hence is a defense against awareness of those repressed
    feelings. A funeral is no place for jokes, there’s work to be
    done. Save those for the wake, not when they wake.

    X.

    It’s popular to say the title, “The Walking Dead,” really refers
    to the living people, not the zombies, and that the show is
    really about humans interacting with humans against the
    backdrop of a disaster. The zombies are thus “anything which
    causes society to regress to a more primitive state.”

    But those zombies aren’t just anything— they aren’t an


    earthquake, they aren’t bugs, they aren’t aliens— they are
    zombies, they are the uncanny, even if after hundreds of
    miles, deaths, and losses no one can identify them as such.
    Here we have a weakly TV serial about zombies and none of
    the characters know they are (the) zombies.

    What do you get when ego and id aren’t in conflict, in fact,


    they team up, against a common enemy— reality? A reality
    which must often be denied in order to get some id-iPal
    satisfaction? You get America. What do you get when you get
    so good at denial, that you extend it to the inevitable? You get
    American zombies: denial of death.

    The Walking Dead is a uniquely American show, about


    Americans. It depicts the unconscious processes involved in
    death and mourning with perfect articulation, because it is
    founded on denying what is obvious to everyone. “No,” it
    says, “this is different.”

    You might also enjoy:

    Unstoppable

    Near Death Of A Salesman

    When Was The Last Time You Got Your Ass Kicked?

    –-

    http://twitter.com/thelastpsych
    5 Things You Need To
    Understand About Wikileaks
    Before You Celebrate
    December 13, 2010

    this is wikileaks

    1. Wikileaks has made the MSM even more powerful.

    The most astonishing thing in those cables appears to be that


    humans often hide their true feelings; that, and the fact that we
    have nuclear weapons in the Netherlands. (Now it makes sense
    why so many Dutch donate to my site.)

    The thing to observe, however, is that I know those things not


    because I read Wikileaks, but because I read the NYT.
    Wikileaks didn’t make anything public, in the exact same way
    as releasing all the clinical trial data didn’t make anything
    public. There’s too much information, we have no strategy for
    approaching it, and what if we read something that violates our
    prejudices? Fortunately, the MSM knows what you’ll want to
    hear.
    This isn’t a trivial point. When the MSM reports on what
    Wikileaks says, we might be skeptical of the MSM but
    Wikileaks becomes the authority. If Wikileaks/MSNBC says
    “Russia Says UK Interfered, ” then it is a fact that the UK
    interfered, that’s the starting point. But perhaps Russia is
    wrong or lying; and who knows if Wikileaks isn’t lying? I’m
    supposed to trust Assange— why? Blondes are more honest?
    (NOT MY FORENSIC EXPERIENCE.)

    And once it’s out, you can’t unlearn it. Pakistani The News ran
    a story saying Wikileaked documents reveal the Indian
    government was covertly supplying Islamist militants in
    Pakistan and committing atrocities in Kashmir. Whether any of
    this is true or not I have no idea; but it’s not true that it came
    from Wikileaks. “Well, ok, maybe that didn’t come from
    Wikileaks, but it’s still true.”

    2. This statement is factually false: “Assange wants to


    expose the lies and corruption of the U.S. government; and
    the byproduct will be that diplomacy will be much more
    difficult.”

    He’s not doing it to give to uncover the lies and corruption of


    the of the U.S. Government— that’s the byproduct. That this
    will force institutions and departments to wall off and not
    communicate with one another— that’s the primary goal.
    That’s why Assange doesn’t care whether the cables are
    salacious or revealing, only that there be a lot of them, leaked
    slowly over time— to make people too nervous to work. His
    goal isn’t to tell you what’s in the truck but to stop trucking. If
    people know their secrets might be leaked, they’ll be reluctant
    to put their secrets in a truck. Eventually, they will simply stop
    trucking. When they stop trucking, they go out of business.

    Will it work? I doubt it: individual human beings (today)


    assume they are able to control when and how other people
    perceive them, which is why even though everyone has cell
    phone cameras I still see people picking their nose, stealing,
    beating suspects and masturbating in public.

    Even if government employees have the discipline to refrain


    from using their work computer for personal use (remember
    Deutch?) they still frequently use their personal
    computer/email for “light” work (“I’m leaving for Kabul next
    week, so make sure Jessica doesn’t cheat on me.”) Bonus: now
    Google (aka WikiCache) has that information.

    3. Wikileaks hasn’t made leaking documents easier, it’s


    made leaking documents popular.
    There’s always been a market for leaked documents—
    provided they are worth the risk. But what Assange has done
    with Wikileaks, complete with a logo and website and a
    famous frontman, is brand the illegality. Only the dedicated
    whistleblower will risk prison over an anonymous leak. But
    how cool is it going to be for a budding narcissist to be a
    pseudo-anyonymous leak to Wikileaks? What gets leaked
    becomes much less important than being a leaker.

    You think a hipster is going to leak to the NYT? They’re


    closer to the government than their readers, dude. That would
    be like leaking your senator’s emails to your congressman.
    How you gonna get laid doing that?

    The problem is actually Assange, not Wikileaks. It’s evident to


    me that he wanted to become famous, or martyred. This is a
    man who clings to secrecy so desperately that he has a myriad
    of cell phones at multiple undisclosed safehouses that he uses
    right after he gives an interview on CNN.

    But by making himself and his site as important a news story


    as the content of the cables, it inspires others to do the same.
    Doing what you believe in is never as compelling as doing
    what’s going to get you popular.

    Already the WikiClones are gearing up, and so it will be a


    matter of personal branding whether you leak your headshot to
    CNN via Leftyleaks or Rightyleaks. And the more such sites
    pop up, the less anyone will believe anything they “leak,” but
    who cares? Will anyone believe anything about America that
    comes from IndonesiaLeaks? Won’t matter. These become
    opportunities to offer your own opinions. No one argues about
    primary sources anymore, we argue the spin about primary
    sources. Quoting Baudrillard: “Once the sign replaces reality,
    you’re not going to need Wikileaks.”

    4. The answer to this question: Why is Assange/Wikileaks


    so popular?
    Wikileaks is a symptom of a time looking for an antihero,
    someone outside the game with enough power to smash the
    establishment.

    You don’t care about the exposed secrets; you just want to see
    the smashing.

    That’s what forms the basis of our political beliefs: hate. I


    could at least listen to communism if it was truly about equally
    distributing the bananas. But is seems much more about hating
    people with the bananas. A social policy based on hate and
    resentment is going to get you blood in the streets and then an
    emperor. A short one.

    Most of the desire to see Assange succeed is based on our own


    impotence. You can’t effect any meaningful change in the
    system, let alone in your own life— and yes, that order is
    correct— and so you’re hoping someone else punishes the
    system for being bigger than you. But meaningful change is
    done either incrementally, or in revolutions, and I am certain
    no one has the enthusiasm to riot. At all. You can’t muster up
    civil disobedience, let alone civil unrest. So you hope Assange
    has the balls to do it. NB: sex charges.

    It was the same with Obama. People expected of him, what?


    To radically alter the United States? He’s an entirely
    competent President, he’s doing a reasonable job even as I
    disagree with almost everything he is and does, but it was
    obvious to me and it should have been to everyone else that he
    wasn’t Change, but More Of The Same And Less Of
    Everything.

    Things would have been different (NB: not necessarily better)


    under McCain for the simple reason that Obama didn’t have
    the technical skills necessary to effect a vision that was
    nebulous to begin with. (Historically, the phrase “surrounds
    himself with really smart people” is followed in two years by
    “has lost his vision and is in danger of having a failed
    presidency.”) And when you’re unsure on a ship you walk
    very slowly on the quarterdeck, and soon you don’t care so
    much where it goes as long as you don’t get blamed for
    sinking it. McCain knew how to navigate a ship. Again, I
    respect that you might not have wanted him as your captain;
    but the choice was between McCain’s slow course to the
    Islands, or floating around in the Sargasso Sea for four years.
    America voted: lower the sails. So: Afghanistan, Iraq,
    Guantanamo, secrecy, extension of the tax cuts, identical
    immigration policy, government deficits, (soon to be) no
    change in healthcare…

    I’m sorry, I hadn’t noticed you were gone

    Assange is a hero to everyone who feels the system doesn’t


    care about them. But as I have indicated with references,
    graphs, and statistical models, the problem isn’t the system,
    xxx xxxxxxx xx xxx.

    Assange’s popularity among Americans should be, but isn’t, a


    prompt for self-reflection. “Why do I want this guy to succeed,
    again?”

    5. The winner is Big Business, the loser is you.

    Back to the trucking analogy. If the government can’t control


    the cargo or the trucks, it will try to control the roads. Since it
    can’t, it will get private sector industry to do so. Ten years ago
    internet regulation would have been impossible, but the
    corporations that could have stopped it— e.g. Google— now
    would love a way around the net neutrality they thought they
    wanted a decade ago. Bonus: if the government imposes the
    restrictions, Google et al can’t be blamed for making money
    on it.

    http://twitter.com/thelastpsych
    Test Of Psychopathy?
    December 17, 2010

    you failed
    Are you good at logic? Of course not; you’re American. No,
    that’s not an insult, it is a description of a process. Follow me.

    I.

    Each of the cards has a color on one side, and an alphanumeric


    symbol on the other.

    Rule: If it is blue on one side, then it is a 5 on the other


    side.

    Which cards— the fewest necessary— do you need to flip to


    check the rule?
    The answer is the blue card and the G card. We’ll come back
    to this.

    II.

    Each of the colored sides describes whether or not a sweater is


    borrowed; the other side describes whether it was returned.

    Here’s the deal: If you borrow my sweater, you must return


    it.

    Which cards— the fewest necessary— do you need to flip to


    check to see if someone broke the deal and has to face the
    wheel?

    III.

    In formal logic, this is expressed:

    (p then q) implies (not q then not p)

    Go through it:

    1.

    if p then q.
    p
    therefore q.
    2.

    if p then q.
    not q.
    therefore not p.

    Many people find formal logic difficult to understand because


    they read left to right and apply future to the right, past to the
    left. If/then statements, in language, become about what will
    happen:

    If you shoot him, then he will have a bullet hole in his body (If
    p then q).

    More generally, however, logic is operating in the other


    direction: what if there is not q?

    He does NOT have a bullet hole in his body; therefore, you did
    NOT shoot him.

    P then q also implies: without q existing first, p can never


    exist.

    In any argument if p then q, the only two things you know for
    sure are: p, therefore q; and not q, therefore not p.

    In the cards above, those are the only two cards you need to
    flip: p (the blue card); and not q (the G or the did not return
    my sweater). Flipping the 5, for example, is a waste of a flip, it
    tells you nothing: if it’s blue on the other side, then it worked;
    if it is orange, did that really tell you anything?

    IV.

    “p then q” represents the form of a proposition, but it can be


    Englished any way you want:

    Descriptions:

    If he plays baseball professionally, then he takes steroids.


    Precautions:

    If you work with HIV patients, then you must wear gloves.

    Contracts:

    If you borrow my sweater, you must return it.

    Don’t get tripped up by the words: “hey, it isn’t true that


    baseball players take steroids.” “I could borrow the sweater
    and not return it.” This is about the form. If the premise is
    accepted that “if you are a baseball players you take steroids,”
    can it be true that someone who doesn’t take steroids is still a
    baseball player? No.

    IV.

    Which brings us to human beings: we suck at formal logic,


    but, we are excellent at logic as applied to human interactions.
    Did you do better with the sweater than the numbers?

    We instinctively feel the rules of borrowing and returning; and


    the logic of what happens if “you DON’T return my sweater”
    (therefore you won’t be allowed to borrow more sweaters.)
    This doesn’t mean we don’t violate those rules, or cheat; but
    we understand the rules.

    But impersonal descriptions, abstractions (cards, ps and qs) are


    naturally very difficult for us. Unless you have committed to
    memory modus ponens and modus tollens and force yourself
    to rewrite the question in that form, you won’t score better
    than 20% (which is why it is a good idea to do so.)

    So if you take a bunch of people who are psychopaths, and


    compare them to those who are not psychopaths but of equal
    intelligence:
    You see that they do equally well/poorly on the descriptive
    questions but are comparatively terrible at precautions and
    social contracts.

    From The Economist’s summarization of this study:

    [The] test suggests that analysing social contracts and


    analysing risk are what evolutionary psychologists call
    cognitive modules—bundles of mental adaptations that
    act like bodily organs in that they are specialised to a
    particular job. This new result suggests that in
    psychopaths these modules have been switched off.

    That would be one explanation; and if it was the only one, this
    would hardly be worth reporting in the first place. But there’s
    another explanation.

    Part 2 soon.
    Test of Psychopathy 2
    December 21, 2010

    no one picks the purple


    (Part 1 here)

    Each card has a color on one side and an alphanumeric


    symbol on the other.

    Rule: If it is blue on one side, it is a 5 on the other.

    Which card(s) do you need to flip over to test the rule?

    I had said that most people don’t get this question right— the
    correct answer is p (blue) and “not q” (G).

    However, most people do get the question half right. They


    mess up the “not q.” Almost everyone picks p. And rarely does
    anyone pick “not p” (purple.)

    Enter matching bias: people pick the choices that are actually
    written in the question, i.e. “blue” and “5.” This can be
    exemplified by rewriting the question:
    If it is blue on one side, it is NOT a 5 on the other.

    Written this way, people still choose the blue and the 5,
    because those appear in the question.

    Another example:

    If it is blue…

    is logically the same as

    If it is not purple…

    But the second way increases the rates of choosing purple,


    because “purple” is a match.

    II.

    Does it overwhelm logic? No.


    TA= true antecedent (p)
    FA= false antecedent (not p)
    TC=true consequent (q)
    FC= false consequent (not q)

    In all of the above examples, the purple card (FA) is wrong.


    Though it is chosen more often when it matches the question
    (“if the card is not purple…”) it still is the least chosen card by
    far, because humans are generally good enough at logic to
    understand that to test the rule, the antecedent has to be true.

    III.

    So the situation is that people are typically bad at logic, but


    they are good enough to know that in order for the rule to be
    tested, p (the antecedent) has to be true.

    Matching bias can affect choices, but even that isn’t enough to
    extinguish p as the most commonly chosen answer. They may,
    or may not, also pick other choices (not p, q, not q, or a
    combination) but everyone picks p— especially if it matches
    the question.

    Everyone, that is, except psychopaths.


    Review: psychopaths are worse at social contract and
    precautionary logic than are normals. But what mistake did
    they make? Did they all choose q? Not choose “not q?”

    For that, we’d need access to the raw data. Fortunately, my


    writing partner, Elisa, is a female, and she was able to email
    the authors of the study to get the raw data.

    And this is what she found:

    Descriptives (did not choose p): psychopaths 42%


    normals: 34%
    Precautions (did not choose p): psychopaths 38%
    normals:13%
    Social Contract (did not choose p): psychopaths 42%
    normals: 21%

    Psychopaths are remarkably terrible at choosing what should


    be both the logical choice and the one the matching bias
    should have nudged them to choose anyway.
    You might want to give psychopaths the benefit of the doubt—
    maybe they just got overwhelmed by all of the choices?

    No; in fact, their version of the test was easier than my


    version, above. They were shown each card independently,
    with a leading question:

    It seems, well, obvious that if “Helen borrowed the car” there’s


    a chance she could violate the rule by not returning it. The
    back of that card could say “returned it” or “didn’t return it.”
    By contrast, Screen 5 “Dave did not borrow the car” is
    pointless to choose.

    But psychopaths don’t see t like that. It seems that they read
    the question as “SINCE Helen borrowed the car, she is at least
    halfway honoring the rule”— so she didn’t violate it.

    What we are coming to is not a fault in logic, per se, but a


    different understanding of what a rule is.

    Part 3 soon
    Infidelity And Other Taboos,
    Media Style
    December 22, 2010

    Freud was a punk

    The story that is making the internet and morning TV rounds:

    Two people, a man who looks suspiciously like Julian


    Assange, and a TV reporter who looks exactly like every
    MILF porn actress working today, divorce their spouses and
    get married.

    The original couples were friends, and the two met at their
    kids’ elementary school. There are five kids between them,
    and, you know, whatever.

    The twist is that they announced their marriage in the Style


    section of the New York Times, because, of course, they
    hooked up in style. The further twist is that they semi-
    shamelessly recount in the Times how they fell in love while
    they were still married to other people.

    Carol Anne Riddell and John Partilla met in 2006 in a


    pre-kindergarten classroom. They both had children
    attending the same Upper West Side school. They also
    both had spouses. … The connection was immediate, but
    platonic. In fact, as they became friends so did their
    spouses. There were dinners, Christmas parties and even
    family vacations together.

    Hardly uncommon; hardly newsworthy, but a little— brazen?


    — to reveal you were basically cheating. Why even mention
    all that about the school and the spouses? Why not simply say
    “we met and fell in love?” Or better yet, why not just say
    nothing? And why would the NYT report this?

    The story inspired the predictable controversy with the


    obvious positions:

    “The NYT’s responsibility is to report, not be the judge.”

    “There’s no infidelity— they didn’t have an affair, they


    split with their spouses before getting together.”

    “Cheat if you must, but don’t try to parade it in public as


    a love affair…”

    Whether what they did is wrong or modern is easy to answer


    (yes x 2) and not the point here. Nor is the point— a good one
    nonetheless— that by the running of the story, the New York
    Times reinforces its position as the one who decides things, in
    this case ethical things. You may be invited to offer comment,
    of course, but the best you can do is agree or disagree with the
    NYT— they become the authority. The burden of proof falls to
    you to explain why they’re wrong.

    Nor is the point that these two dummies didn’t anticipate that
    they’d be criticized. Were they really so brazen, so shameless,
    to think we’d all be “wow, that’s so Lifetime Original
    Special!” Not exactly.

    The mistake is in thinking they shouldn’t have publicized their


    story. They didn’t have any other choice.

    It’s a mantra: narcissists don’t feel guilt, only shame. Well, it’s
    not completely true, sometimes they do feel guilt, but you
    have to be hitting on a taboo to feel it.

    Even the most hardened narcissist feels some passing guilt


    when their spouse is sobbing on the kitchen floor. How do you
    get over that? (Pills won’t help, but psychiatry is happy to tell
    you they might.)

    This is how narcissism eradicates guilt: it rewrites the story, or


    as the po-mo mofos say, “offer a competing narrative.”

    [Offers Ms. Riddell] We did this because we just wanted


    one honest account of how this happened for our sakes
    and for our kids’ sakes.

    One honest account? Which were the accounts that were not
    honest? Were there any other accounts at all? Oh, yeah, reality.
    Well that account doesn’t count. This one’s better:

    it all changed two years later when Partilla invited her out
    for a drink at a local watering hole, the first time they had
    gotten together away from their spouses. “I’ve fallen in
    love with you,” Riddell recalled Partilla as saying. She
    said she beat a path out of the bar, only to return five
    minutes later to tell him, “I feel the exact same way.”

    Dress it up in the language of a story, of overcoming, of


    finding a soul mate, of mid-life romance, of self-actualization.
    These two were fortunate enough to be able to make it an
    actual story— in which they are the main characters and
    everyone else is supporting cast and the readers— you— will
    focus on the main characters. You may hate them, but that
    doesn’t matter. What matters is that they are the main
    characters. That turns guilt into shame, and if there’s no shame

    We are really proud of our family and proud of the way


    we handled the situation. There was nothing in the story
    to be ashamed of.

    They win. That’s how narcissism discharges guilt.

    You’ll notice that the exes are not mentioned by name or


    interviewed in the story; that’s not to protect their identity, it’s
    because the author of the article didn’t care/need to interview
    them, because the author, and the new couple, are focused on
    the STORY. Win.

    In other words, putting their otherwise quite shameful story in


    the NYT wasn’t dumb, poor judgment, or even damaging to
    their reputations no matter how many people end up hating
    them. It was necessary to their own emotional survival. As
    long as you hate them for it, they don’t have to hate
    themselves.

    II.

    I do not like the hypocrisy game, where you try to detect


    hypocrisy in someone as a proxy for dismissing their ideas; it
    is lazy and unhelpful, and usually done by those who
    themselves overvalue projected identity. But sometimes you
    can’t help but play. Which brings me to this nut:

    First, let’s get the preliminaries cleared out of the way. A


    week ago, Sarah Palin was never going to be president of
    the United States. Today, Sarah Palin is never going to be
    president of the United States. Once you’ve accepted that
    fact (although it’s not clear that Palin herself has), the
    political impact of this decision is minimal — the
    Republicans as a party look even a little flakier than
    before (bad for the GOP, but what else is new?)

    I don’t expect journalists or anyone else to be free of moral


    ambiguity, but it should be a postulate that if you choose to
    write those words you should not also be having sex with your
    daughter. Allegedly.

    David Epstein, HuffPo-Mo blogger and Columbia professor of


    Applied Po-Mo allegedly had a sexual relationship with his 24
    year old daughter. I’ll save you the google search: he doesn’t
    have a mustache. I was surprised as well.

    Many think his behavior is shameful. Harsh. Some think it is


    illegal, though clever people found Lawrence v. Texas on
    wikipedia and discovered “an emerging awareness that liberty
    gives substantial protection to adult persons in deciding how to
    conduct their private lives in matters pertaining to sex.” After
    a nap they figured that might apply to incest as well. And why
    not? Consenting adults? It’s a privacy issue, right?

    Oh, it’s a privacy issue, but not in the way Scalia meant. The
    goal isn’t privacy, the goal is the reverse.

    Dummy and his daughter allegedly sent text messages to each


    other, which anyone with a Nike shirt knows is what you want
    to do to get caught as quickly as possible. I’m not saying
    Epstein wanted to get caught (though I am thinking it), but
    when you break a taboo you either face the guilt Dostoyevsky
    style with a lonely nervous breakdown and a trip to
    redemptive Siberia or you get out a pen and rewrite the story.
    In Epstein’s case, we’re rewriting it for him: the mere
    discussion of this nonsense, the simple fact that any of us hate
    our fathers enough to write, “yes, but it’s a legal issue…”
    means that Id and Ego fought Superego and Id and Ego won.
    He’s taken private guilt and core dumped it to the internet for
    public judgment and the internet will always be more
    forgiving than he could ever be. As cocaine magnate Sigmund
    Freud wrote, “when the story goes live the guilt goes dead.”

    III.

    The stats on second marriages and the psychology of vampires


    and vagina predict that Riddell and Partilla will stay married.
    When you hook up in the presence of adversity it tends to
    reinforce the relationship as they steel themselves against
    Those Who Just Don’t Understand (though watch out,
    sometimes you find that that adversity was the only thing
    keeping you together). And it’s not how I’d run my life, but
    they did it and there’s no use yelling at them, they have to
    make it work for themselves and for the kids, so best of luck:
    bad start, hope you make it worth it.

    But what you need to get out of these stories is how this
    generation and forwards will deal with guilt: externalizing it,
    converting it to shame, and then taking solace in the pockets of
    support that inevitably arise. Everyone is famous to 15 people,
    and that’s just enough people to help you sleep at night.

    It is, in effect, crowdsourcing the superego, and when that


    expression catches on remember where you first heard it. Then
    remember why you heard it. And then don’t do it.

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    http://twitter.com/thelastpsych
    Taboos Are The Ways
    Christians Try To Control Us
    December 29, 2010

    if I told you the A stood for adulteress, would that turn you
    off? My husband said the same thing

    Of the many emails I received about the taboos post, only a


    handful were not of the form, “you are a right wing Rush
    Limbaugh douchebag.” Wrong at least two times. You fail.

    Here was one of the nicer ones:

    So, you’re saying to not publicize all your wrong-doings,


    because there are small pockets of people to support you,
    no matter what you’ve done. But, you seem to love
    Tucker Max (or at least his jokes?) who has basically
    done that for his ENTIRE life. What gives?

    The person who wrote that is a woman in the sciences whom


    I’ve emailed a few times, i.e. if she misunderstood the post, it
    was my fault. So:
    So, anywhere you can get support, including the NYT, by all
    means go. This isn’t about getting support, and these
    individuals aren’t getting support. They don’t care what you
    think. That’s not what they’re doing.

    You don’t need me to tell you what’s right and wrong and
    anyway I’m hardly an expert on morality. But what I am an
    expert in is the psychological tricks we play, and their
    consequences to you. You may be able to live with the
    consequences, but they exist nonetheless.

    Guilt, unlike shame, was always about You vs. Yourself. But
    what’s changed is that You— the guilty party— has found a
    loophole in the system. That loophole hurts everyone.

    I.

    What did Epstein do wrong? Incest and infidelity. He did both,


    right? What’s happened in the press? The incest’s severity has
    completely erased the infidelity. At no time does Epstein have
    to confront the internal guilt of infidelity, because he’s battling
    an incest charge. I don’t mean publicly— I mean privately, he
    never faces himself about infidelity, only incest.

    Now incest— terrible, we all agree, but should the law really
    be monitoring the sex lives of consenting adults? Of course
    not. “Incest is wrong,” I might say, “but we have no business
    policing it.” What just happened there is that “Epstein” has
    managed to get me to partially support him. I may hate him,
    but irrelevant- “he” interprets my partial support as part of a
    global judgment of him, and thus has mitigated his guilt by
    converting it to shame, and the shame is lessened because
    some people are partially supportive.

    I realize that HE didn’t do this on purpose or consciously


    (though his lawyer is), and HE does not care about my
    support. But it happened nonetheless. That’s the whole point
    of the media’s involvement, our generational solution to the
    problem of guilt. This is what we will all be doing, the internet
    as confessional and for the remission of sins. Whether we do it
    on purpose or not, once a private guilt that (should) gnaw at
    you gets exposed as a public shame, and the public/whatever
    newspaper you have at your disposal/your facebook friends/etc
    start taking sides, that internal guilt is obliterated. Epstein still
    has to deal with the shame and social and legal repercussions,
    but not guilt.

    What’s the result? The result for Epstein isn’t my interest, it’s
    his life and it’s not my right to keep his guilt alive for him. But
    now, FOR SURE, incest is no longer a taboo, it is no longer a
    matter of guilt, but of shame. Everyone is free to decide
    whether they can take the shame; everyone has become a
    Nietzschean superman, deciding for themselves if there are
    any taboos. Which, of course they were always free to do—
    but they had the good sense not to try. Now it is possible to ask
    “am I free to have consensual sex with my adult daughter?” —
    which, of course, you are free to do, and which, of course, you
    are never free to do. It’s that simple.

    Do you think it’s a coincidence that 2010 had three big adult
    incest stories, but 2009 had none? They were occurring in
    2009, but the gates of that taboo have lost their sentry: guilt.
    So now incest is a matter of shame, not guilt. If you can take
    the shame and your daughter’s hot, enjoy.

    Many in the comments accused me of being an old codger, a


    “these kids today are immoral” uptight Rush Limbaughlite. If
    you think that, you’re missing something truly important:
    these aren’t kids. These are middle aged professionals who
    have kids. I expect— want— a little Nietzsche in the 20
    somethings of the world, to fuel them to do something with
    their lives. But these are people who should know better.
    Instead, they’ve convinced themselves, after 4 decades of life,
    that they deserve to be happy, that their happiness is more
    important than anything.

    I’m not free of guilt. But the difference is that whatever guilt I
    have I don’t let infect other people. If I am incesting or
    cheating on my spouse, I would still have the human decency
    NOT to try and publicly mitigate that guilt by conversion to
    shame because I know that if I succeed then it becomes okay
    for someone else. I may have the “right” to do whatever I
    want, but do I have the right to make it okay for others? How I
    deal with guilt has an effect on how someone else will. What
    could I ever say to console my daughter if her husband cheats
    on her, when I’m in the NYT saying cheating is a matter of
    “finding a soul mate?”

    Every one of our actions has a blast radius, and there are other
    people in it. KABOOM. Count the bodies.

    II.

    Would you trust Epstein or Tucker Max to babysit your five


    year old daughter? It’s not an idle question, there will come a
    day where you will be asked to choose between X or Y and
    without any kind of architecture to guide you you will choose
    what my idiot generation has chosen, which is to choose
    nothing— “I’m not letting my child out of my sight” and
    you’ll end up like those parents at the park who use their kids
    as human shields to avoid connecting with any other parent.
    Result? Your kid doesn’t get kidnapped by the Unabomber but
    he has learned you think all people are evil. Enjoy their
    adolescence.

    “Not a fair comparison, Blackbeard, we’re talking about


    consenting adults. Who would you trust to chaperone your 24
    year old wife, Epstein or Tucker Max?” That question is a lie.
    That question really worries about who would be more
    successful with your 24 year old wife, and of course that’s not
    a comment on their trustworthiness but on your wife’s. If she
    can’t keep some alternative penis out of her vagina then the
    problem isn’t the penises.

    But to answer the question, of course I would trust Tucker


    Max more because I have a sense Max’s limits are at X point
    — has he slept with all his friends’ wives? has he cheated on
    his wife? (1) — and David Epstein’s limits are only his own
    physical limitations. Nothing but the law contains Epstein,
    which is not any kind of containment. If I’m right he does not
    feel guilt— that means anything, including eating a baby, is
    possible. “Are you saying he’d eat a baby?” No. But what’s
    stopping him?

    III.

    There are a few people commenting who doubt the relevance


    of guilt, or the need for it; who openly decry it as a tool of the
    Christians or the establishment as a means of social control. I
    haven’t tracked the IP addresses, but I’d wager big money that
    those are the same people who want to think Goldman Sachs is
    evil.

    I’d also wager gigantic money that none of these people are
    carrying around any terrible secrets. None of you supporting
    Epstein are in the market for adult incest.

    What infuriates you is the idea that anyone or anything has


    control over us. You don’t like to be told they aren’t allowed to
    do something. “As long as it doesn’t hurt anybody, I should be
    allowed…” You want complete freedom— which you will use
    to conform to very ordinary standards of living that you
    impose on yourself.

    But this isn’t a moral issue that I am describing, it is an


    architectural problem: the very thing that allows you to exist in
    a world of complete freedom is those internal controls and not
    the social controls— laws and shames— that you think bind
    you.

    Shame will never be enough— when your identity is “strong”


    enough nothing shames you, not a sex tape or a prison term,
    you’ll take that scarlet letter and put it on a tight tank top and
    wear it ironically, not to mention hotly.

    The laws will never be stronger than you. Wall Street may
    need more regulation but it won’t reduce the corruption at all.
    If they want to find a way around the law, they will. Always.
    The more laws you have, the less relevant guilt becomes. The
    laws are exactly the same mechanism as Epstein’s shaming:
    externalizing the rule affords you the opportunity to explore
    the grey areas. The only thing that will stop corruption is
    people not wanting to be corrupt.

    The new factor is our access to the media, our connectivity. No


    matter how hard you try, it is impossible to completely block
    out the judgment of others— and you won’t want to if that
    judgment is to your benefit.

    I am not trying to stop progress or technology, I’m telling you


    to be careful with your lives. Riddell and Epstein may have
    dodged huge psychological bullets, but those bullets hit the
    rest of us right in the face.

    1. Maybe this isn’t the place for a textual analysis of I Hope


    The Serve Beer In Hell, but he’s not so much disrespectful to
    women as a master of a kind of dialogue with them, one that
    both of them are completely aware of.

    “You’re a slut.”
    “No I’m not! and I’ll prove it by sleeping with you.”
    “Whatever. Let me get my coat.”

    At least within these kinds of interactions, labeling him


    “disrespectful” or “sexist” misses the woman’s active
    participation in this kind of dialogue. It’s a game, she knows
    it’s a game, she’s seen this game before, and she wants to play
    that game. Interestingly, it’s probably correct to say that your
    missing the woman’s active role in the game reveals an
    implicit assumption of male dominance in social interactions,
    i.e. you’re kind of a sexist.
    What Does The Woman Who
    Feels No Fear Feel?
    December 31, 2010

    I’m going to need another drink

    An article in Current Biology.

    A 44 year old woman named SM has a rare, autosomal


    recessive disorder that resulted in bilateral amygdalar damage
    and…

    On no occasion did SM exhibit fear, and she never


    endorsed feeling more than minimal levels of fear… SM
    repeatedly demonstrated an absence of overt fear
    manifestations and an overall impoverished experience of
    fear. Despite her lack of fear, SM is able to exhibit other
    basic emotions and experience the respective feelings.
    The findings support the conclusion that the human
    amygdala plays a pivotal role in triggering a state of
    fear and that the absence of such a state precludes the
    experience of fear itself.

    If you know anything about science, you know it loves to yell


    at people. It also loves rules, some of which are arbitrary at
    best but good luck telling anyone, ordinary folk just say, “well,
    science said so” and the ones who should know better don’t
    have time for your nonsense, they have to submit 50 page
    grant applications to a review committee comprised of a cabal
    of cronies or they won’t make full professor. /rant.

    The rule for today is amygdala= fear. So no amygdala means


    no fear.

    SM, who lacks amygdalas, was Fear Factored with snakes and
    spiders; they took her to a haunted house (though not a
    Japanese haunted house which doesn’t so much scare you as
    destroy your soul forever); they made her watch clips from
    horror movies.

    But she wasn’t scared. She exhibited, and said she felt, no fear.

    II.

    Don’t hit up a brain surgeon quite yet.

    SM not only can’t feel fear, but is impaired “in recognizing


    fear in facial expressions, and in aspects of social behavior
    thought to be mediated by emotions related to fear.” Which
    seems consistent with the expected result of amygdalar
    damage.

    But others noticed something interesting about patients with


    bilateral amygdalar damage, and by “patients” I mean the
    exact same patient as the one tested in the above article, “SM.”
    They found that she was indeed terrible at detecting fear in
    faces— but it was because she didn’t look at the eyes. When
    she was told to look at the eyes, she had no trouble detecting
    fear.
    (“SM eyes” means SM was told to look at the eyes)

    This is borne out by other studies which find that the amygdala
    is primarily involved in fear detection when you are looking at
    the person’s eyes. Body positioning and gestures, fear
    displayed by the mouth— the amygdala doesn’t seem involved
    in processing fear from those cues.

    So the incorrect interpretation is to say the amygdala is needed


    to perceive fear. A more correct interpretation is that the
    amygdala is involved in fixating and processing information
    about emotions coming from cues from specific contexts such
    as the faces’ eyes. You can see why this interpretation doesn’t
    make it to the internet.

    II.
    What’s going wrong is that one way associations are made into
    two way relationships. It is true that the amygdala is routinely
    observed to be activated during conditioned fear responses, but
    that’s not the same as saying that it is the amygdala that is
    necessary for experiencing fear.

    On top of which the terms are ambiguous. What’s fear?


    Another patient with the same disorder as SM had normal
    mood and affect, and I’ll quickly point out that this man had
    no problem experiencing fear. But guess what happened at age
    38: he developed panic attacks. Missing two amygdalas did
    not help him, but 75mg of Effexor did. Take that, anti-Pharma
    backlash.

    Wired Magazine interviewed the Current Biology study’s


    author:

    “What that suggests to us is that perhaps the amygdala is


    acting at a very instinctual, unconscious level,” says
    Feinstein.

    Well, not exactly. Another group had got hold of SM and this
    time flashed images of faces too fast to be detectable by the
    conscious mind. Normal people are able to detect fearful faces
    more easily than, say, happy faces. SM, lacking amygdalas,
    shouldn’t show any difference— but, in fact, fearful faces
    broke into her consciousness much more quickly than happy
    faces, and just as quickly as for normals. So unconscious
    perception is intact despite the absence of amygdalas.

    III.

    Though I’ve pointed out some inconsistencies in the studies of


    the amygdala— not to mention the studies of SM— the real
    “discovery” of these papers is this: all three of the “groups” I
    cited share at least one author.

    Unless we are positing these authors themselves suffer from


    some kind of brain lesion, we need a better explanation for the
    discrepancies.

    It isn’t that they are not aware of their own findings, but that
    we are not aware of them. Unless you’re motivated to look up
    everything any time you read anything, then each paper comes
    to you in a bubble. If you take it and read it and learn it, you
    will almost always get it completely wrong. It’s worse if
    you’re getting your science from the popular press, which is
    basically like reading only the 97th word in The Waste Land
    and then writing a synopsis. “It’s about canasta, I think.”

    Most real neuroscientists— not psychiatrists or even


    neurologists- understand that the common paradigm of
    structure-phenotype is overly simplistic.

    More generally, the brain doesn’t so much process information


    as apply a set of built in solutions to every single piece of
    information. It constantly learns and reorganizes, recognizes
    patterns and rebuilds.

    In the case of the amygdala, it is involved in fear


    (conditioning), but it is more generally involved in making
    decisions based on incomplete information. It helps reduce
    ambiguity through learning. How the impairment of that
    facility manifests in an individual may be very different: SM
    feels no fear, the other guy gets panic attacks. Some people
    gamble more; or take more risks; or don’t learn from
    experience. Etc. It’s not just what’s damaged; it’s what each
    individual compensates with.

    In other words, cutting out people’s amygdalas is a terrible


    idea.

    Feinstein says the new findings suggest that methods


    designed to safely and non-invasively turn off the
    amygdala might hold promise for those suffering from
    post-traumatic stress disorder (PTSD).
    Which PTSD sufferers? The ones who already have smaller
    amygdalas? Don’t hold your breath, and anyway, we already
    have something that does this: Valium.

    This isn’t to say that a specific structure isn’t important, but it


    is to say that the other structures are just as important.

    IV.

    Here’s the kind of question that should be primary, not


    secondary, to the investigation of SM: what would you expect
    her to feel instead of fear? Think about this. If the amygdala
    does fear and she doesn’t have amygdalas, what do you expect
    to happen when there’s a spider on her face?

    Probably, you’d answer nothing. You’d expect her just to sit


    there and stoic it as if it is all meaningless. “Spider. Hmm.
    Tickles.”

    But what she actually felt was wonder. And curiosity. And
    excitement.

    I could find no one else with amygdalar damage who had this
    compensatory (?) response. She had the right amount of
    emotional energy, but she experienced it as excitement. The
    spider didn’t turn into a duck, it turned into a parachute jump.
    Why?

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    Happy New Year 2011 From
    Your Friendly Neighborhood
    Pirate
    December 31, 2010

    uncovering reality a little bit at a time


    The Black Swan Movie
    Review Criminal Attorneys
    And Hollywood Don’t Want
    You To Read
    January 5, 2011

    already seen it
    I was once involved with a woman and we decided to stay in
    and watch a movie, she was a professional cheerleader who
    was interested in dancing, travel and working out, and the
    movie I chose was Pi.

    45 minutes into one of the best movies I had ever seen she
    says, “I have absolutely no idea what’s going on in this movie.
    All I see is a paranoid fucker living in a world of madness.”

    II.
    As I was leaving the White Trash Monday (matinee) showing
    of Black Swan, exactly what I predicted to myself would
    happen happened: a woman turns to her boyfriend and
    mentions how beautiful the Swan Lake ballet’s music was, and
    how she’d like to get it from itunes.

    Is it beautiful? I’m no expert on beauty, pornography is more


    my thing, but I’ll go with yes. But I do know that that woman
    is in for a surprise, what she heard in the movie wasn’t the
    music of Swan Lake but the same 4 measures of Swan Lake
    Act 2 looped over and over and over and over again, like it’s
    being played by a wind up music box, which half of the time it
    was.

    Those of you musically inclined will observe that I erased the


    F clef and edited out the first measure (four beat rest) to
    generate the above graphic, which is analogous to what the
    movie does: exerts considerable effort to spoon/force feed you
    the necessary elements, when letting them happen naturally,
    which would have been easier and more rewarding.

    That’s just the music. Now imagine what it does with the
    psychosis.

    III.

    Are there any new stories in the world? A high school


    girlfriend told me the universe was made of them. I’m ok with
    remakes, but you have to take the story somewhere different,
    right?

    Here’s the story: Nina is a dancer and wants, then gets, the top
    spot in Swan Lake. The previous prima ballerina got old. Nina
    is an innocent, childlike waif. The director knows she’ll be
    great as the white swan, but can she tap into the dark side to
    play the black swan? In so doing, she goes crazy, has anorexia,
    eats a cake, has bulimia, skin picks, kills herself, maybe kills
    someone else, has sex with Mila Kunis, punches her mom,
    takes ecstasy, never once mentions the existence of a father,
    and turns into a bird. I’ll leave you to sort out the order.

    In parallel: Natalie Portman (the actress) loses a ton of weight,


    many times thought she would die, thinks what will get men to
    want to see an Aranofsky film is a lesbian scene, and marries
    her costar. No, the other guy.

    Sort of parallel: Mila Kunis (the actress) denies getting drunk


    before the sex scene, and ends a 9 year relationship with the
    kid from Home Alone. (So that’s what happened to him.)

    We get to see her crazy ex-ballerina mom infantilize and


    control her, and her French director try to seduce and mature
    her. There’s the psychological tug-of-war: the mother wants to
    keep her as a child, the director wants her to become a woman,
    Nina can’t choose so she District 9s into a bird.

    The problem with this interplay is twofold.

    First, the porn— doing the most obvious to generate the


    desired emotion. The mom isn’t just Carrie crazy, she is
    exactly Carrie crazy. The French director isn’t just smarmy, he
    is exactly “French director” smarmy. Example: he grabs her
    crotch and whispers, “respond to my touch. Respond to it.”

    As advertised, there’s a lesbian scene in the movie, it’s


    supposed to depict the psychosexual component to Natalie’s
    obsessiveness. Mila Kunis and Natalie Portman get naked, and
    Mila lustily gives Natalie
    oral, and I’m thinking to myself, what’s the matter with me
    that this terribly unsexy? Am I too old? Too much porn?
    The literary answer, the subtext answer, the one that is never
    touched, is that perhaps Nina’s relationship with her mother is
    not just controlling but incestuous, a ha!, which explains why
    Nina would dare to have her first lesbian experience at home,
    in her princess bed, with her Carrie mom banging outside the
    door; Mila Kunis becomes a projection of mother who brings a
    guilt ridden Nina to orgasm. The only way she can orgasm is
    with mom; and the only way she can orgasm is to pretend it’s
    not mom. And when Nina is masturbating on her princess bed,
    at the moment she should have an orgasm she (thinks she) sees
    her mom asleep in the chair. Sex without mom is impossible;
    sex with mom has made all other sex impossible.

    That’s one answer. The other answer is that I’ve already seen
    this scene, this exact scene, a dozen times. No attempt is made
    to make it different, unique to this story, important to this
    story. Hence, it is gratuitous; and I certainly have no problem
    with girl on girl gratuity but when it’s done boringly even I
    will be bored.

    Secondly, it’s wrong. When those two forces pull, they pull at
    angles with a resultant vector, they are not exact opposites—
    you don’t get torn apart. If you go with the psychoanalysts, the
    schizophrenogenic mother causes psychosis through certain
    interactions, but explicitly NOT because there’s another force
    in your life opposing the mother’s. The alternate force,
    however bad it was, since it opposed mom would be reality
    grounding, and while you can still get every kind of
    personality disorder and a lifetime of messed up relationships,
    having that opposing force prevents psychosis, not enhances it.

    Natalie Portman adeptly plays lots of different pathologies:


    anorexia, psychosis, OCPD, etc— but these things don’t all
    manifest in the same person and certainly not because of
    events in your life— this thing made me OCD and this thing
    made me hallucinate and this thing…

    It is also the kind of crazy defendants fake when they want to


    pretend they’re crazy. Not understanding real psychosis, nor
    the specifics of the legal term “insanity” often means
    defendants endorse or exhibit every symptom I throw at them.
    They pull a Nina, thinking I’ll be impressed. (A very common
    one: cross modal hallucinations, e.g. seeing and hearing a
    demon talk to you, are rare in schizophrenia and if they
    actually happen are usually the result of drugs or other organic
    illness.)

    Of course, anything is possible and blah blah, but since this


    depiction is not novel and not accurate, what is it, and why is it
    at least partially effective? The answer is that it’s a genre
    piece. The genre isn’t ballet, the genre is paranoid fucker
    living in a world of madness. Nina’s craziness is the (male)
    audience’s fantasy of crazy, it is a template for the kind of
    crazy a 20something wants to pretend he has to impress girls.
    The crazy part is a signal to girls: I’m passionate, creative,
    driven. (FYI: It almost always signals a lack of commitment.)

    The movie is very much what an outsider assumes happens in


    a world he doesn’t inhabit. Crazy overbearing ballet mom?
    Seems plausible. But doesn’t exist— not at the professional
    level. That’s grade and high school stuff. A person who needs
    to work hard at a profession would have abandoned such a
    mother (fathers are different) long ago because it interfered
    with her own progress. Crazy soccer mom? Check. Crazy
    Olympic soccer moms? No. Where you would see such an
    enmeshed mother-adult daughter relationship, with the mom
    living through the daughter, is when there is no technical skill
    necessary, e.g. living through their daughter’s beauty, youth,
    relationships. I don’t expect pathological enmeshment between
    Natalie Portman and her mom; it wouldn’t surprise me in Kim
    Kardashian.

    IV.

    None of this is to detract from Natalie Portman’s Christian


    Baling the role or Aranofsky’s tremendous directing and
    emotional impact (Ron Bennington: “Aranofsky’s movies
    make you hate the human body.”) But the story doesn’t do
    anything but repeat scenes from other movies which were
    better in their originals. This is why Natalie Portman could
    probably get an Oscar for Best Actress, but the movie isn’t a
    contender for Best Picture. Nine years married to Rachel
    Weisz, he’s going to be predisposed to melodrama.

    Unfortunately, where I see Hollywood headed isn’t more


    sequels or more remakes, but more copying, more cheating.
    When a movie copies a scene from another movie, that used to
    represent an allusion; it now represents a cheat sheet to the
    audience: remember how you felt about the dance scene in
    Jacob’s Ladder, the fear, sexuality, confusion? Just apply all
    that here, it saves me the work of exposition.

    Here’s an example: the preview before Black Swan was for a


    super cool movie that I really want to see right up to the part
    that it turns out to be a Transformer.

    But listen to the music. At the big reveal, the music they play
    is the Lost crescendo; and at 1:45, the way they signal we’re
    not in Kansas and things are not what they seem is to play the
    Inception theme.

    And on and on. The Adjustment Bureau is a Matt Damon


    movie about fate. So when you want to quickly create a
    backstory, just put the Fringe guys in anachronistic 1940s
    clothing and Dark City yourself a spiral staircase
    and we’ll take it from there. It is in all ways identical to the
    shortcuts and cheat sheets we employ for ourselves—
    branding— to generate a backstory without having to put in
    the work. “See this hat? It means I like to think about the
    things I heard on NPR.”

    I’ll still go see these movies, of course, but I find myself


    wishing someone would do something original or at least in an
    original way. By all means, make it 3D.

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    Wakefield And The Autism
    Fraud— The Other Part Of
    The Story
    January 7, 2011

    get it?

    Does the MMR vaccine cause autism? Merely writing those


    words guarantees the google crawler is going to summon the
    trolls. But it’s a legitimate question, not legitimate in that it is
    true but legitimate in that since someone says it does, we
    should all be interested in finding out one way or another.

    Short version: a paper in 1998 with more authors than test


    subjects observes that previously normal kids developed
    autism after the MMR vaccine. Back and forth, the science is
    questioned, 10 of the authors renounce the study and Lancet
    ultimately retracts the study.

    However, a new analysis finds that Wakefield wasn’t just


    wrong, but he probably faked the study.

    From AP:
    The analysis [by Deer] found that despite the claim in
    Wakefield’s paper that the 12 children studied were
    normal until they had the MMR shot, five had previously
    documented developmental problems. Deer also found
    that all the cases were somehow misrepresented when he
    compared data from medical records and the children’s
    parents.

    The obvious outrage is how this guy frauded all of us, and may
    have inadvertently/on purpose caused thousands of kids to not
    get the MMR vaccine.

    But there are two other problems that should also generate
    outrage, or at least bafflement.

    First, it’s 2011. The paper was written in 1998. How long does
    it take to look over the primary source data?

    Which brings us to the next, larger problem: the people who


    finally reviewed Wakefield’s paper, scrutinized the primary
    sources, and went and talked to the parents was not a team of
    neurologists or 3 new peer reviewers, but a journalist.

    That’s who we have fact checking our science.

    This journalist did what all of medicine did not do for a


    decade: email 12 people.

    II.

    Hold on: as we now already knew for years, Wakefield wrote


    this paper in order to support a lawsuit against the vaccine
    manufacturers. In 1998. There were several other Illness v.
    Vaccine civil cases as well.

    No?

    Let me spell it out for you: in these gigantic cases with


    millions of dollars at stake and every possible resource
    imaginable— Wakefield himself got $500k— no one in the
    legal community thought to verify the science either. They just
    trusted the expert witnesses, who, of course, never read a
    primary source on anything— always review articles and
    books. All that money hinging on, essentially, the word of
    Wakefield, and no one bothered to check his work.

    Think about this when you meet with your public defender.

    III.

    I get it: Wakefield’s evil. A Big Legal shill who faked the data
    to enhance his testimony and own profits. He probably thought
    — and this is in fact what happened— that it would be a small
    enough study that no doctor would care about it, but he could
    use it in court to say “there is evidence to support the notion
    that…” And, indeed, no one read that paper until 2 years later,
    when Wakefield pressed his luck by writing more articles
    citing that study.

    We should “extradite him to Britain to face fraud charges,”


    said some article somewhere.

    Whatever. If you want to be cattle and moo with the herd, fine:
    blame Wakefield. But Wakefield didn’t do this, Wakefield is a
    product of this. It’s like blaming Bernie Madoff for the
    banking crisis. He’s guilty, but he isn’t the cause of the
    problem, he’s the result of the problem.

    You scientists have created a system that trusts, implicitly, the


    word of every scientist— except if he is getting paid by
    Pharma, of course (as everyone knows, NIH and university
    funds do not influence results.) If he says the patient had a -7
    on a scale, then it was -7, end of story. “Well, we have to trust
    the researcher a little bit, otherwise the whole architecture falls
    apart.” Exactly. Why then do you not trust bankers that way? If
    a banker lies he goes to jail. Are there any penalties for
    making up a study? Do you seriously believe that scientists
    have less reason to nudge the numbers than bankers do?

    Then, you’ll engage in serious academic disputes about


    whether MMRM is better than LOCF for analyzing a double
    blind study— you’ll assert that double blind trials are the gold
    standard!- when you all know that 75% of the time we can tell
    if it’s placebo or drug. When you title the paper, “A Double
    Blind, Placebo Controlled Trial of–” you are lying.

    And why wouldn’t you? The system is set up for you to lie.

    Why, in the internet age, is the primary data not part of the
    paper?

    Peer Review is a joke— why do you call it that? They’re not


    my peers, they’re my close friends or my mortal enemies
    depending on my/my department’s relationship with the editor;
    and they’re not reviewing it, they’re writing asinine, self-
    important comments that will never be noted after publication.

    Why doesn’t it change? The answer is precisely in what


    Wakefield did: he wrote a tiny paper that he hoped would not
    be scrutinized (or even read.) He just wanted to be able to say
    he wrote it, he wrote it not for science but for himself. Now
    pick up any journal. How many articles within are not for
    clinicians to act on, they’re to put on a CV, get a promotion,
    get a grant, establish a name. That’s why we have ten million
    journals, none of which anyone reads, ever.

    Fortunately enough good science gets done, loudly,


    powerfully, that medicine moves forward. But the amazement
    shouldn’t be that Wakefield’s study was a fraud, the
    amazement should be why we haven’t discovered hundreds of
    studies that are frauds.

    I’ll save you the meta-analysis: it’s because we don’t have


    enough journalists.

    –-

    From 2009:

    MMR Vaccine Finally Cleared Of Assault


    Autism And The MMR Vaccine: Bait And Switch, For Profit
    The Suicide Of Bill Zeller
    January 11, 2011

    with respect: he was wrong

    I.

    I’m writing this for the other Bill Zellers.

    II.

    Bill Zeller, Princeton grad student and Metafilter regular,


    committed suicide last week, leaving behind a long suicide
    note that explained: “My first memories as a child are of being
    raped, repeatedly.” The note describes growing up in a cold
    fundamentalist Christian household; being repeatedly molested
    by someone; and the parents, or at least the father, either not
    caring or not stopping or the molester. It’s possible that the
    father did not condemn the molester because he had already
    been identified as “saved.” I don’t know how any mortal
    would know that about another mortal but I’ll admit I don’t
    fully understand “saved.” I guess it means the rape charge
    doesn’t stick.

    I’ll also admit that my first, reflexive, thought was that he


    hadn’t been raped. That he made it up. The story seemed too
    vague, especially for a note that whose supposed purpose was
    to make things clearer. The language reminded me of other
    similar fabrications, e.g. “my first memories as a child are of
    being raped.” First? There were no specifics mentioned; and
    while there was plenty of rage, there was no trace of the guilt
    that accompanies so many admissions of childhood abuse.

    In traditional therapy these suspicions are initially irrelevant


    because the point is present feelings, and whether their origins
    are real or invented doesn’t change the veracity of those
    feelings. But ultimately it does matter; a fabrication of
    molestation may signify that this is the only way they know
    how to verbal language storyboard the kind of pain they are
    feeling— “unless I invent a trauma backstory, no one would
    appreciate how desperately sad I am.” Or, the fabrication
    could signal not a pain but an undeservingness of love; the
    only way they think they can merit love is to be pitied,
    damaged. “The only time they held me lovingly is when I fell
    down and hurt myself.” Different people will connect with
    either of those; you know who you are, and so I may as well
    say: this process is not unusual, and you are not Alone.

    But looking at the comments on Metafilter, Gizmodo and other


    places, I was stunned at how many people I “knew”— regulars
    on those sites— admitted to being molested themselves. That
    guy?? That girl???? Him, too? All these people?? I began to
    wonder if true binary of the world wasn’t men/women or
    rich/poor but people who had been molested and no one cared
    or stopped it/ people who had never been molested or someone
    cared and had stopped it. Even Freud’s idea of the oedipal
    fantasy was a backpedaling: it couldn’t be that all these people
    were actually molested, right?

    But it’s hard to argue with the numbers, and the numbers were
    overwhelming. Then came my inbox, and it was the same. I
    had, as a personal prejudice, not appreciated its prevalence.
    Ok. But when even the news reports blindly accepted the
    abuse story, I had to ask: how come no one wondered if Bill
    hadn’t made the whole thing up?

    III.
    If rape was the clear motivation for his suicide, Christian
    Fundamentalism was the clear motivation for the rape. George
    Zeller, his father, is about as hard core fundamentalist as you
    can get, dissecting the atomic structure of something called
    Christian Sonship in droning recordings and labyrinthine
    essays, and if this man is only the assistant to the Pastor then
    there exists a man on this planet that I am frightened of. I
    don’t know anything about fundamentalism, but if you pause
    and look at George’s writings not as a religion but as an
    activity, what you see is George reworking and reworking the
    ideas over and over and repeating and repeating, nuance after
    nuance after microscopic nuance, until he gets them “right.”
    But there is no right; there is only the identification of wrong.
    It is an obsessiveness with sterility and removing dirt that
    doesn’t have room for outsiders— hence his minuscule
    disagreements with other thinkers blown into theological
    catastrophes. He must always be in conflict with another’s
    thoughts not because they’re wrong but because their very
    presence contaminates the lattice he uses to lock down the
    Anxiety, yes, in the same way watching someone disturb one
    piece of your hoard means you have to redo the whole pile.
    He’s hoarding religious minutiae.

    George was an easy target, and if the fact of Bill’s growing up


    in a fundamentalist home was brought up by a commenter, it
    was always brought up as evidence that Bill was raised by an
    insane man, maybe even evil.

    But again, almost no one doubted he was raped. More than


    that: many people automatically assumed he was truthful
    because his parents were Christian fundamentalists, i.e. “I’m
    not saying all fundamentalists are child molesters but it’s damn
    sure pretty near all of them.”

    And then I could see that my doubt of the rape was actually a
    reaction to their assumption it was true. I was reacting to their
    reaction. They had their prejudices, I had mine, and Bill Zeller
    was the excuse for an ideological battle we had already chosen
    sides about long before he killed himself. Ugh.
    IV.

    Suicide notes are unreliable; they don’t convey information,


    they convey mood. And if you have ever been on the other
    wrong end of a suicide note you’ve probably lost part of your
    soul trying to decide if they were right, so let me help you: as a
    rule, they weren’t. What they said isn’t the point, it’s how they
    said it. “I am so angry at _____.” The direct object is a red
    herring, the subject-verb is the whole truth.

    You might say it doesn’t matter, ultimately, if the causes of his


    pain were true, only that he was in pain, and I agree; but the
    counter is that Bill is dead and his parents are not and now
    they have to live not only with the death of their son but the
    popular belief that they caused it. My son is dead, and he
    thinks I hated him.

    I don’t know what being molested is like; but the empty,


    wretched, backwardsness of your child’s death, and the
    subsequent relentless reminder of the wrongness of reality and
    the impossibility of ever fixing it; the incessant scrutiny of
    memories, was I nice enough to him? Did I tell him I loved
    him? When he wanted that balloon and we were in a hurry,
    shouldn’t I just have—

    — all that is not something anyone should have to experience.


    And yet that unique, infinite, unfathomable limbo is being
    experienced by thousands of parents a year, forever. George
    Zeller didn’t believe in purgatory, and now he’s in it, waiting
    for the end to come. There isn’t anything else to wait for.

    And I’ll say something I almost dread saying: what if it is


    true? What if George himself raped his son repeatedly, when
    he was 6? Does that mean that George has lost the right to be
    devastated by this loss?
    now what

    It doesn’t much matter whether he has the right or not,


    whether he should or not. If he did rape his son, there’s a
    Calvinist hell awaiting him no matter how saved he thinks he
    is. But if he didn’t, and we blame him anyway because it
    matches our prejudices, then that hell is waiting for us.

    V.

    I’d also like to address my family, if you can call them


    that. I despise everything they stand for and I truly hate
    them, in a non-emotional, dispassionate and what I
    believe is a healthy way. The world will be a better place
    when they’re dead—one with less hatred and intolerance.

    Maybe that’s the key to the whole note, maybe he made up the
    rape to bring shame to his parents for abandoning him. To
    punish them.

    Maybe. It’s obvious he was sad in an unfixable way, not


    unfixable because there’s no fix but because his depression
    had fiendishly protected itself from fixing, like a bacteria
    developing antibiotic resistance. He says he stopped drinking
    to make this decision with a clear head; but that drinking was a
    kind of solace, and stopping it was a punishment, you can’t
    even enjoy that. It was the Depression tricking Bill into
    thinking that since he wasn’t drinking therefore he had a clear
    mind.

    And though he had gone to several doctors, he told no one of


    his pain— I don’t even mean the molestation, but the
    emptiness. And he had devised a workable rationalization: if
    you tell the doctor, then they will betray your secrets. But that,
    as a Metafilter poster named pastabagel observed, is the secret
    protecting itself; it prefers pain to the unknown. But what are
    you afraid of? That they’ll learn your secret, or learn you don’t
    have any secrets that would explain so much misery?

    It’s different for everyone.

    He could have been helped; I don’t know how, I just know yes.
    Maybe he needed to be told that nothing in the past defines
    you. “Ever since, I haven’t been able to ___.” The horrible
    truth is that you probably still can. You won’t— this isn’t a
    criticism and I don’t blame you— but you can.

    Or maybe you are helped to figure out the concrete steps that
    would lessen the rage, from punishing the molester to
    punishing the ones who turned a blind eye to not punishing
    yourself. Or maybe you take it all in and make it part of you,
    reaction formation that pain into something better. There are a
    million possibilities, but he didn’t try them. The Depression
    doesn’t want them to work; it doesn’t even want you to think
    you and it are separable. It convinced Bill.

    VI.

    People say suicide is selfish. I think it’s selfish to ask


    people to continue living painful and miserable lives, just
    so you possibly won’t feel sad for a week or two. Suicide
    may be a permanent solution to a temporary problem, but
    it’s also a permanent solution to a ~23 year-old problem
    that grows more intense and overwhelming every day.
    He’s wrong, it’s a mind trick, but I can see the seductiveness
    of this thinking. Only heroes and suicides get to choose the
    time, and the manner, of their death, a power none of the rest
    of us will ever possess, of and for that reason they deserve a
    silent respect. Rest in peace.

    http://twitter.com/thelastpsych
    Are Chinese Mothers
    Superior To American
    Mothers?
    January 13, 2011

    oops… a simple oversight, I’m sure

    “A lot of people,” writes Professor Amy Chua of Yale, in the


    Wall Street Journal,

    wonder how Chinese parents raise such stereotypically


    successful kids. Well, I can tell them, because I’ve done
    it. Here are some things my daughters, Sophia and
    Louisa, were never allowed to do:

    • attend a sleepover
    • have a playdate
    • be in a school play
    • complain about not being in a school play
    • watch TV or play computer games
    • choose their own extracurricular activities
    • get any grade less than an A
    • not be the No. 1 student in every subject except gym
    and drama
    • play any instrument other than the piano or violin
    • not play the piano or violin.

    It’s hard to argue with success— one of her daughters is


    pictured playing piano at Carnegie Hall— and the kids seem at
    least ISO 400 happy. So is making them practice 3 hours a
    day, etc, so terrible?

    If you’re trying to figure out if her method works or if it is


    harmful some other way, you’re missing the real disease in her
    thinking. She’s not unique. the disease is powerful and
    prevalent, it is American, but a disease nonetheless. (No, this
    time it’s not narcissism.)

    I’ll explain what’s wrong with her thinking by asking you one
    simple question, and when I ask it you will know the answer
    immediately. Then, if you are a parent, in the very next instant
    your mind will rebel against this answer, it will defend itself
    against it— “well, no, it’s not so simple—” but I want to you
    to ignore this counterattack and focus on how readily,
    reflexively, instinctively you knew the answer to my question.
    Are you ready to test your soul? Here’s the question: what is
    the point of all this? Making the kids play violin, of being an
    A student, all the discipline, all of this? Why is she working
    her kids so hard? You know the answer: college.

    She is raising future college students.

    Oh, I know that these things will make them better people in
    the long run, but silently agree that her singular purpose is to
    get the kids into college. Afterwards she’ll want other things
    for them, sure, but for 18 years she has exactly one goal for
    them: early decision.

    Before you argue the merits of that goal, let’s ask ourselves
    why that is the pivot point in America? I don’t know any
    parents who are desperate to raise better parents or better
    spouses or even better software engineers, we don’t think like
    that. The few times someone thinks out of the box— “I want
    my kid to be a basketball star” “I want my kid to be a Senator”
    the parent is identified as an unrealistic nut. And while a stated
    goal might be to raise a future doctor, in truth that’s really only
    an abstract promise— the 18 year goal is explicitly college.
    You don’t teach your 6 year old to assess acute abdominal
    pain, do you? Nowhere to put that on an application. No, you
    teach him piano.

    I certainly am not saying forcing them to learn piano is bad, or


    bad for the kid, or that despite the disease that has infected you
    it won’t benefit the child— I’m not saying Chua isn’t right in
    her techniques. I am saying that what Chua is advocating is
    ultimately pointless because it is for a meaningless endeavor.
    The piano isn’t for itself, it’s for the “right” college, and for
    99% of America the precise college you went to is as
    irrelevant as the beer you used to lose your virginity. Was it
    Bud Light or Stella Artois? Same bank account.

    I feel you resisting my thesis, but no moment in time, at that


    moment, seems as important as getting into college, both to the
    parents and the kids. No one anymore celebrates getting a job
    even though that really represents your future lifestyle,
    limitations, experiences, everything.

    You want your kid to go to a good college, of course I get it.


    But that monomania for college has to occur at the expense of
    something else. How much better/worse off are you that you
    went to your college and not your friend’s college? In this
    hypothetical you don’t play football.

    And is that average class at an Ivy really better than the


    average class at a state school? I’ve taught at both: no. NB that
    in my example both the state students and the Ivy students had
    the same teacher— me. I know there are differences between
    schools, I’m not naive, but most of those are
    social/political/sexual and not educational. An Ivy is “better”
    because its brand is better, like a car. No I don’t mean “hey,
    they all get you there” I mean that the engine of a Toyota and a
    Lexus is the same, the difference is the leather seats. You want
    to pay for brand, go ahead; but the people in the know aren’t
    fooled by your fancy car and windshield sticker and the people
    who aren’t in the know can only praise or envy you, but
    they’re in no position to help you attain your goals.

    Don’t think I’ve forgotten how important college is to a high


    school kid. I remember that despite terrible grades I was,
    inexplicably, put on the wait list to the University of Chicago.
    And all I could think was, “I’m going to be Phaedrus!” I didn’t
    give a damn about the education, I was hoping/believing that
    that college was going to define me, make me into someone I
    was not. I should have been drafted into an infantry battalion
    just for that.

    II.

    “Get back to the piano now,” I ordered.


    “You can’t make me.”
    “Oh yes, I can.”
    Back at the piano, Lulu made me pay. She punched,
    thrashed and kicked. She grabbed the music score and
    tore it to shreds. I taped the score back together and
    encased it in a plastic shield so that it could never be
    destroyed again. Then I hauled Lulu’s dollhouse to the
    car and told her I’d donate it to the Salvation Army piece
    by piece if she didn’t have [the piece] perfect by the next
    day. When Lulu said, “I thought you were going to the
    Salvation Army, why are you still here?” I threatened her
    with no lunch, no dinner… no birthday parties for two,
    three, four years. When she still kept playing it wrong, I
    told her she was purposely working herself into a frenzy
    because she was secretly afraid she couldn’t do it. I told
    her to stop being lazy, cowardly, self-indulgent and
    pathetic.
    Take a step outside the article. This is a woman explaining
    why Chinese mothers are superior. The thing is, I don’t know
    any Chinese mothers who would ever talk about their families
    this way, publicly, describe their parenting, brag about it.
    Never. And then you see it: Amy Chua isn’t a Chinese mother,
    she’s an American mother. She had a Chinese mother, but now
    she’s a first generation American, which means she has more
    in common with Natalie Portman than she does with any
    recent Chinese immigrant. As an American, she was raised by
    the same forces: MTV, Reagan, Clinton, John Hughes movies.
    She may have reacted differently to those, but they were her
    experiences.

    And what do Americans do? They brand themselves. I have no


    idea if Amy Chua cares about Viking stoves or Lexus
    automobiles but clearly her brand is SuperSinoMom and her
    bling are her kids. When Jay-Z wants to front he makes a
    video, and when Amy Chua represents she writes a WSJ
    article. Because that’s her demo, you feel me?

    Which means this self-serving piece has nothing to do with


    “how Chinese mothers are superior” but is really a summary
    of her episode of MTV Cribs. “Welcome to my home, yo, let
    me show you my gold toilet. It’s for peeing and flushing the
    coke down when the heat comes in the back way.”

    III.

    She meant this next passage to be self-congratulatory, let me


    know if she succeeded:

    “You just don’t believe in her [the daughter],” I accused.


    “That’s ridiculous,” Jed said scornfully. “Of course I do.”
    “Sophia could play the piece when she was this age.”
    “But Lulu and Sophia are different people,” Jed pointed
    out.
    “Oh no, not this,” I said, rolling my eyes. “Everyone is
    special in their special own way,” I mimicked
    sarcastically. “Even losers are special in their own special
    way. Well don’t worry, you don’t have to lift a finger. I’m
    willing to put in as long as it takes, and I’m happy to be
    the one hated. And you can be the one they adore because
    you make them pancakes and take them to Yankees
    games.”

    Who talks like this? This isn’t a 3rd person account, it’s her
    autobiography, these are her words, she chose these words,
    these are how she saw it all go down: “accused,” “scornfully”,
    “rolling my eyes,” “sarcastically.” That’s her impression of the
    world. She’s writing this about her husband.

    She can’t resist getting in a few jabs at her husband. I cringe


    when I hear a spouse criticising another spouse in public.
    Lesson 1: you should never, ever, ever, demean your spouse in
    front of a commoner, and that’s a much more powerful lesson
    to teach your kids than a decade and a half of Minuet in G.

    (sotto voce): my husband is a piece of crap my husband needs


    his face bitch slapped

    And while we’re on the subject of her husband, when I Google


    Earth this guy “Jed” what Chinese province is he going to be
    from? Oh, Jed isn’t Chinese, he’s a Jewish American Yale law
    professor. Now I can’t tell if this woman is a racist or insane.
    Its ommission can only be deliberate, right? It’s almost as if
    she is trying too hard to convince us not that she’s a good
    mother or a successful woman but Chinese, that’s the focus for
    her, so important is this that she needed to make it public—
    which makes me want to bet ten million dollars that her
    children are being raised Jewish. Is she publicly broadcasting
    that she’s the Chinese mother stereotype to make up for the
    SinoSems she’s created?

    You/she’ll say that the Chinese discipline is what makes the


    kids successful, but that’s silly. Given that her husband is a
    Jewish American equivalent to her Chinese Americanness,
    why isn’t their daughters’ successes the result of Jewish
    fathering? Chua would say that she’s the one who made her
    practice, but she’s at work all day just like he is, right? I get
    that she yells more, ok, mission accomplished, but as a
    technical matter she’s not there all the time, the kids have to be
    self-motivated, and that self-motivation came not just from the
    mother, but from growing up in with those parents. Unless
    she’s arguing that the father is pretty much irrelevant? Oh, that
    is what she’s arguing. Sigh.

    What Chua believes has made her kids succeed isn’t just that
    she makes them work hard, but that she is allowed to yell at
    them.

    As an adult, I once did the same to Sophia, calling her


    garbage in English when she acted extremely
    disrespectfully toward me. When I mentioned that I had
    done this at a dinner party, I was immediately ostracized.
    One guest named Marcy got so upset she broke down in
    tears and had to leave early. My friend Susan, the host,
    tried to rehabilitate me with the remaining guests.

    Look, I totally get how sometimes a parent will threaten their


    kid with piranhas or downed electrical wires, but why on earth
    would you brag about it? Seriously, think about this woman’s
    mind. Either she is totally oblivious to what people would find
    appalling, or else she actually thinks that she is going to
    convince an entire room of what I assume are also baby
    making professionals that what she is doing isn’t crazy, but
    awesome.

    IV.

    Amy Chua wants us to believe she is a “Chinese mother,” and


    my contention is she’s not. I’m not saying she’s a bad mother
    at all, only that what she thinks is and what she actually is
    aren’t the same.

    What defines a “Chinese mother”— and any steretoypical


    immigrant parent situation— is the sacrifice. “We sacrifice
    everything to give you better opportunity!!” they shriek at
    dinner. Look up at her opening list: those are the sacrifices her
    kids make, but what sacrifices does she make? Again, I don’t
    mean she’s a bad mother, but where is the sacrifice of her own
    personal happiness, clothing, hopes and dreams? Note
    carefully that she may in fact be sacrificing, but in her essay
    she does not describe those as important (or at all) to the
    success. What’s important to her is the yelling and the
    discipline, which she believes is a Chinese technique.

    The curse of the second generation, in which they do worse


    then their parents, isn’t about lazy kids but self-absorbed
    parents. When you immigrate to America to open a dry
    cleaning business you don’t make it your identity— it’s all for
    the kids (and boy of boy do the parents never let you forget it.)
    Then your kids grow up to become, oh, lawyers, and that does
    become their identity— so when these lawyers have kids of
    their own the lawyering isn’t all for their kids, a lot of it is still
    for the lawyers. It’s not a criticism, it’s a comment on the 24
    hour day: two lawyer parents aren’t home as much as their
    wife of a dry cleaner mom was, so there’s less time for the
    kids. There’s nothing you can do about that.

    Except there is, and what Amy Chua isn’t telling you, the real
    secret of her brand of “Chinese” (read: affluent American)
    mothering, is that there’s likely a brigade of tutors running
    through the house. Now it appears on screen that Chua can be
    both successful and devote all this time to calling her kids
    fatties, but behind the scenes she has help. Hey, God bless
    anyone who can get it/afford it/convince your spouse it isn’t
    because you want college girls around, but if you want to
    prove that something is associated with success, you have to
    control for the external variables.

    V.

    You will observe that she is writing this nonsense not in a peer
    reviewed journal that could take her to task, e.g. McCall’s, but
    in the WSJ. Why would the WSJ want to support “the Chinese
    mother?” Because if you’re reading it, it’s for you.

    The WSJ doesn’t care a lick about her, as evidenced by the


    fact that they actually published this embarrassment. What the
    WSJ does care about is defining “good kids” in the same (but
    opposite) way The New Yorker wants to be the one to define
    it. For the WSJ, good = will generate a positive ROI.

    Let’s go back to her crazy list of why her parenting is better.


    #9: violin or piano, no other instruments. If Chua is so
    Chinese, and has full executive control over her kids, why
    does she— and the real Chinese parents out there— make their
    kids play violin, play Bach and not Chinese music? They’d be
    happy to educate you on the beauty of Chinese music, I’m
    sure, but they don’t make their kids learn that. Why not?

    She wants them learning this because the Western culture


    deems classical music as high culture, and therefore anyone
    who can play it is cultured. Someone said Beethoven is great
    music so they learn that. There is no sense of understanding, it
    is purely a technical accomplishment. Why Beethoven and not
    Beethoven’s contemporaries? The parents have no idea. Can
    her kids write new music? Do they want to write music? It’s
    all mechanics. This isn’t a slander on Asian musicianship, it is
    an observation that the parents who push their kids into these
    instruments are doing it for its significance to other people
    (e.g. colleges) and not for itself. Why not guitar? Why not
    painting? Because it doesn’t impress admissions counselors.
    What if the kid shows some interest in drama? Well, then the
    kid can go live with his white friends and see how far he gets
    in life.

    That’s why it’s in the WSJ. The Journal has no place for,
    “How a Fender Strat Changed My Life.” It wants piano and
    violin, it wants Chua’s college-resume worldview. Sometimes
    it has no choice but to confront a Mark Zuckerberg but they
    quickly reframe the story into the corporate narrative. “The
    Google boys were on to something, but to make it profitable
    they had to bring in Eric Schmidt…” The WSJ is operating
    well within the establishment, right wing, artists-are-gay and
    corporations-are-not context. It wants kids who will conform,
    who will plug into the machine (albeit at the higher levels), it
    wants the kind of kids who want the approval of the kinds of
    people who read the WSJ.

    Amy Chua thinks she wrote an essay and published it. Wrong.
    The WSJ wanted this kind of an article and they chose one
    from the thousands available. They chose hers— a woman’s—
    because if this same article had been written by a man it would
    have been immediately revealed as an angry, abusive,
    patriarchal example of capitalism.

    Which is where this comes full circle. Amy Chua thinks she’s
    raising her kids the Chinese way, but she is really raising them
    to be what the WSJ considers China to be: a pool of highly
    skilled labor that someone else will profit from. On second
    thought, that is the Chinese way.

    –-

    You might also like:

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    The Dumbest Generation Is Only The Second Dumbest

    –-
    http://twitter.com/thelastpsych
    This Time It’s ESP
    January 17, 2011

    I knew this was going to happen

    Let me clarify one point about the MMR/Wakefield


    controversy. The fact that Wakefield faked his data does not
    prove there’s no link. Right? I don’t think there’s a link, of
    course, but what do I know? I’m a pirate.

    There’s a controversy about a paper published in the Journal


    of Personality and Social Psychology, a highly reputable
    academic journal. The paper is about ESP, which is the
    controversy.

    Either (NYT):

    Journal’s Paper On ESP Expected to Prompt Outrage

    One of psychology’s most respected journals has agreed


    to publish a paper presenting what its author describes as
    strong evidence for extrasensory perception… The
    decision may delight believers in so-called paranormal
    events, but it is already mortifying scientists.
    Or (NPR):

    Could It Be? Spooky Experiments That See The Future

    One of the most respected, senior and widely published


    professors of psychology, Daryl Bem of Cornell, has just
    published an article that suggests that people — ordinary
    people — can be altered by experiences they haven’t had
    yet. Time, he suggests, is leaking. The Future has slipped,
    unannounced, into the Present. And he thinks he can
    prove it.

    All depends on whether you think “scientists don’t know


    everything, man!” or “scientists are fraudsters, man!”

    II.

    The experiments are of the type: two groups take a test; one
    group is then shown the answers, the other group isn’t. The
    ones who see the answers after the test did better on the test.
    Weird, right?

    The paper describes nine unusual lab experiments…


    testing the ability of college students to accurately sense
    random events, like whether a computer program will
    flash a photograph on the left or right side of its screen.
    The studies include more than 1,000 subjects. Some
    scientists say the report deserves to be published, in the
    name of open inquiry; others insist that its acceptance
    only accentuates fundamental flaws in the evaluation and
    peer review of research in the social sciences.

    “It’s craziness, pure craziness. I can’t believe a major


    journal is allowing this work in,” Ray Hyman, an
    emeritus professor of psychology at the University
    Oregon and longtime critic of ESP research, said. “I think
    it’s just an embarrassment for the entire field.”

    Hyman is right but for the wrong reasons, for self-serving


    reasons, which makes him wrong. And the NYT assertion that
    this “accentuates fundamental flaws in the peer review of
    research in the social sciences” is also wrong, wrong, wrong,
    wrong.

    There’s a subtlety to the experiments that is indeed explicit in


    the articles but is easily overlooked, so I’ll quote from the
    study:

    From the participants’ point of view, this procedure


    appears to test for clairvoyance. That is, they were told
    that a picture was hidden behind one of the curtains and
    their challenge was to guess correctly which curtain
    concealed the picture. In fact, however, neither the
    picture itself nor its left/right position was determined
    until after the participant recorded his or her guess,
    making the procedure a test of detecting a future event,
    that is, a test of precognition.

    This is the part that’s important. If it was a study of


    clairvoyance, well, could there be a possible physical
    explanation? Perhaps. But time travel?

    Which is why anyone who says this study “doesn’t belong in a


    scientific journal” is wrong. It doesn’t belong in a psychology
    journal: this is an experiment about the laws of physics, not
    the laws of psychology.

    And so to say that it is a failure of peer review— like they did


    with Wakefield— also misses the point. Bem’s peers are in
    absolutely no position to review this. This study is better
    reviewed by physicists. Bem himself makes an explicit case
    for quantum entanglement! So notwithstanding my own rants
    about peer review,
    “Four reviewers made comments on the manuscript,”
    [said the journal’s editor] “and these are very trusted
    people.”

    Trusted though they may be, they are not experts in the field
    being studied.

    All four decided that the paper met the journal’s editorial
    standards, [the editor] added, even though “there was no
    mechanism by which we could understand the results.”

    Exactly. So you should have sent it to the physicists. You


    know, the ones who work a building over in the same
    university that you do. That was the whole reason for
    universities, right?

    No, I’m a dummy. The purpose of universities is to suck up


    Stafford loan money. And the purpose of journals is to mark
    territory, more money in that, like a corporation that spins off a
    subsidiary. NO CROSS SCIENTIFIC DISCUSSION
    ALLOWED IN SCIENCE, EVER, EXCEPT IN SCIENCE,
    NATURE, AND THE POPULAR PRESS.

    II.

    So I’ll be explicit: peer review may have problems, but the


    entire way we evaluate science is territorial and stuck in the
    19th century, which, ironically, was a time when scientists
    were much less territorial and practiced multiple disciplines.

    With a data feed to select articles on “psychiatry,” what do I


    need a psychiatry journal for? If you wanted to be brain
    scientists, why do you have separate journals form other brain
    scientists?

    How awesome would it be to have an astrophysics grad


    student or a PhD economist or a dancer or anyone of the
    mofos from metafilter to come look at a psychiatric clinical
    trial and discuss it? You wouldn’t have to pay them, they
    would think it was fun— what, you think I’m blogging
    because of the millions of dollars in donations I get from
    Denmark and now the pacific northwest (6x in a month— did
    you guys find a work around for Cybernanny?)

    And no, not just the paper data; why not video the whole
    process and upload it? I have a phone that shoots HD 720p;
    good enough for the optical demands of amateur porn, why not
    good enough for science?

    If researchers published their paper along with all of the


    primary source data on a web page, and let the public
    wikipedia it up, we might discover that a study was crap but
    we might also learn something about how studies become
    crap, the biases or hidden pitfalls, etc. (No, “available upon
    request” does not cut it.)

    Instead, we have a near idiotic controversy occurring in self-


    imposed darkness. “It’s a big butt!” “No, it’s a big leg!” “No,
    it’s a weird snaky-thing!” “Well whatever it is, don’t turn on
    the light, let’s just keep guessing— this way we can all get
    publications out of it.”
    Are Law Schools Lying To
    Their Applicants?
    January 25, 2011

    Fordham’s post-graduate employment data

    Almost at the same time no one was asking why the WSJ was
    publishing excerpts from Amy Chua’s, How To Make A
    College Student, no one was also asking why the NYT was
    interested in whether law schools weren’t a scam. I respect
    that this is an unwieldy first sentence, but it’s late and I’m
    drunk. That’s how I start my essays.

    I.

    The New York Times asks, Is Law School A Losing Game?

    The piece has two main points. The second one is that students
    incur a huge amount of debt with little ability to pay it back,
    and, if the law jobs don’t materialize, won’t ever pay it back.
    This second point is presented first, indeed, in the first
    sentence:
    If there is ever a class in how to remain calm while
    trapped beneath $250,000 in loans, Michael Wallerstein
    ought to teach it….

    Mr. Wallerstein, who can’t afford to pay down interest


    and thus watches the outstanding loan balance grow, is in
    roughly the same financial hell as people who bought
    more home than they could afford during the real estate
    boom. But creditors can’t foreclose on him because he
    didn’t spend the money on a house.
    He spent it on a law degree. And from every angle, this
    now looks like a catastrophic investment.

    Which brings us to the first point, the main point: law schools
    are lying. Despite the fact that “JDs face the grimmest job
    market in decades” the schools are somehow reporting to
    prosepctive applicants that, e.g., “93% of grads are working”
    and “the median starting salary of graduates in the private
    sector is $160,000.”

    How do they do this? “Enron-type accounting


    standards…“says a law professor. “Every time I look at this
    data, I feel dirty.”

    A law grad, for instance, counts as “employed after nine


    months” even if he or she has a job that doesn’t require a
    law degree. Waiting tables at Applebee’s? You’re
    employed.

    The schools do this because the schools are extremely


    profitable businesses: high cost, low margin.

    “If you’re a law school and you add 25 kids to your class,
    that’s a million dollars, and you don’t even have to hire
    another teacher,” [said an ABA commissioner.]

    II.
    Why do law schools bother to fake this data? If it was “80%
    employed” vs. “90% employed,” who would notice?

    They fake it because that pointless data gets handed over to the
    illusionists at US News along with other pointless data
    (expenditure per student, library facilities, max bench press) to
    generate a single overall ranking, which is just the kind of
    simplistic, pseudoscience objectivity that students, parents,
    and schools demand.

    A quick word on the US News rankings. 25% of the ranking


    comes from a “peer quality assessment” in which schools rate
    each other. So, say you are Clemson Law School. What should
    you do? “Rate all other programs below average.” And, of
    course, do what University of Wisconsin did: give the highest
    score only to itself and one other school that you’re not really
    competing against. You can also bring up that “alumni
    donations” factor by calling alumni and asking them to donate
    $5, and whoever doesn’t donate label as deceased.

    A ranking, like the “percent employed”, is an example of


    information bias. You think you know something, but you
    don’t. If Fordham is #21, is that different than saying it is #29?
    Or saying it is in the second decile? It’s a deliberately
    obfuscated precision that you can’t act on. That level of
    “certainty” does not inform your decisions.

    By the way, the ranking doesn’t have to be inaccurate for it to


    be information bias. A ranking can be deadly accurate and still
    be ridiculous. Back in college and yesterday, me and my boys
    used to rate women to the tenth decimal place, “yo, yo, yo,
    check this out, I just got maced by this 8.9!” and while our
    scale had confirmed 100% inter-rater reliability, what were we
    going to do with this information? Was our audition going to
    be any different with a 8.4 vs. a 9.7? “Hi, I’m here for the part
    of sketchy boyfriend, here’s my headshot, references… Light
    my head on fire? No problem.”
    this is a billion

    See? Grade inflation. We already know about the problem of


    grade inflation in colleges; the LSAT was supposed to help
    offset this by offering a standardization. Now the ABA wants
    to do away with the LSAT requirement. Fine. But the result of
    all this is you can’t really be sure how you compare to other
    applicants, so instead you demand objectivity in the schools’
    rankings as a proxy to guess where you might belong. “I think
    I belong in a top tier school…” How do you know? The
    analogy is you have no idea what kind of a man you are and
    thus what kind of a woman would be right for you, so you just
    harass the girls that other people think are the best. Then if
    you don’t get her you’re angry at the girl (“these bitches just
    want jocks and legacy applicants”); and if you get her you’re
    surprised to find that three years with her has left you
    unfulfilled.

    And once they’re in law school, there is more grade inflation


    and even retroactive adding of .333 to everybody’s GPA. And
    now law school graduates are surprised to find they’re
    unemployed. Law students had no real measure of their status
    as an applicant; no reliable descriptor of what kind of a school
    they went to (short of branding); and no reliable measure of
    their performance there. “What do you mean I can’t get
    hired?” They think to themselves, “amn’t I bright? Hard
    working? Fluent in legal theory?” And the employers respond,
    “how the hell would we know that?”
    III.

    That’s Mr. Wallerstein, I assume clutching a yellow legal pad.

    The structure of the NYT article is to offer a profile of an


    unemployed graduate and use it to explore the law school
    system. In the vein of its analysis of the unemployed college
    grad, it exposes him as intelligent but entitled douchebag.

    Here’s an example. Though his massive debt is in the first


    sentence, it isn’t until page 4 that you learn why he’s in debt:

    WHEN Mr. Wallerstein started at Thomas Jefferson, he


    was in no mood for austerity. He borrowed so much that
    before the start of his first semester he nearly put a down
    payment on a $350,000 two-bedroom, two-bath condo,
    figuring that the investment would earn a profit by the
    time he graduated. …Mr. Wallerstein rented a spacious
    apartment. He also spent a month studying in the South of
    France and a month in Prague — all on borrowed money.
    There were cost-of-living loans, and tuition of about
    $33,000 a year. Later came a $15,000 loan to cover
    months of studying for the bar.

    He lives with his fiancee who is “unperturbed by his dizzying


    collection of i.o.u.‘s.” She doesn’t want him to get a corporate
    law job because (take a sip first): “we like hanging out
    together.” Carly, another unemployed law graduate explains,
    “I guess I kind of assumed that someone would hook me up
    with something.” I’m sure she felt she deserved it.
    Do you hate law grads yet? Hold on, here’s how the article
    ends:

    MR. WALLERSTEIN, for his part, is not complaining.


    Once you throw in the intangibles of having a J.D., he
    says, he is one of law schools’ satisfied customers.
    “It’s a prestige thing,” he says. “I’m an attorney. All of
    my friends see me as a person they look up to. They
    understand I’m in a lot of debt, but I’ve done something
    they feel they could never do and the respect and
    admiration is important.” [my edit: he isn’t actually
    practicing law.]
    …And he’s a quarter-million dollars in the hole.
    Unless, somehow, the debt just goes away. Another of
    Mr. Wallerstein’s techniques for remaining cool in a
    serious financial pickle: believe that the pickle might
    somehow disappear.
    “Bank bailouts, company bailouts — I don’t know, we’re
    the generation of bailouts,” he says in a hallway during a
    break from his Peak Discovery job. “And like, this debt
    of mine is just sort of, it’s a little illusory. I feel like at
    some point, I’ll negotiate it away, or they won’t collect
    it.”
    He gives a slight shrug and a smile as he heads back to
    work. “It could be worse,” he says. “It’s not like they can
    put me jail.”

    Haters: this guy is asking for it.

    IV.

    Let’s take all this at face value. Is he entitled? Delusional?

    I don’t doubt for a moment he sincerely believes he is a


    lawyer, because lawyer for him isn’t a profession or even a
    job, it’s a label, a code word for a kind of intellectualism he
    wants for himself. As long as “all of my friends see me as…”
    it was well worth the cost. He didn’t study to become an
    attorney, he bought a back-up identity.

    It’s worth asking why Wallerstein chose a JD as a back-up


    identity, and not an MD or a PhD. Can we agree it was easier?
    Why not an MBA? Because an MBA is for something else; a
    law degree is a brand in itself. You can get an MBA and still
    be nothing unless you find a job. Get a law degree, you’re
    always a lawyer.

    It’s probably the same reason he didn’t try some other hail
    mary like, say, borrow $200k and just open up a coffeeshop or
    become a daytrader. You could fail at those. Graduate from
    law school— and everybody does— and you can’t possibly
    fail. (Surprise.)

    I go through this to show you that law school, while it attracts


    people wanting to practice law, also attracts college kids who
    are bright but emotionally adrift. They don’t know what they
    want— besides a mental image of a lifestyle— and they don’t
    know who they are— besides a mental image of an identity. A
    three year law program is a great way to postpone reality and
    still have something to show for yourself.

    This is as good a place as any to point out that a huge portion


    of this failure to mature is the fault of the undergraduate
    college that gave him up for adoption. If four years of
    mandatory intellectual exploration not to mention electives in
    acid and penetration can’t guide you to self-awareness then
    you probably paid too much for the experience. Smart students
    will always tell you that most of what they learned in college
    they learned on their own, which is true but opposite to the
    purpose of college. Demand a refund.

    Law schools are magnet for those kinds of people, because to


    people not in law school it sounds like it’s three years of
    elevated debate, philosophy, history, thought, with a feudal ka-
    ching at the end for joining the club; in other words, it sounds
    like what college should have been.
    In actuality, law school is utterly useless. The only thing that
    was useful was the writing class, which basically taught you
    how to argue thoroughly but efficiently on paper. Law school
    is also the first place that many people are confronted with
    someone who tells them their conclusions are stupid, so I
    suppose there’s benefit in that.

    IV.

    Please remember that as I quote the Times‘ description of Mr.


    Wallerstein, I have no idea if it’s true, I only know that the
    NYT wants me to believe it’s true, which makes me more
    suspicious than 6 clear vesicles on both labia. The one thing I
    know for sure is that the New York Times— throw in The New
    Yorker and The Atlantic, too— hates its readers. It wants them,
    of course, but see them only as organ donors. The Times is
    accused of being a leftist/socialist paper, but that’s not true,
    their collectivist perspective comes from assuming all of you
    people are free range cattle. It thus feels it has an ethical
    obligation to construct stories that will get you to believe their
    message, even if the facts of those stories have nothing to do
    with the message they’re interested in. If you follow this, you
    then discover that Mr Wallerstein is an unemployed law grad
    —let alone an entitled douchebag— but a straw man.

    While it looks like this is a story about law schools, it is in fact


    a story about debt— and who’s to blame. By debt I’m talking
    American style debt, the kind that Greece and Iceland scooped
    up like a Komatsu front loader only to discover they couldn’t
    print money like we can.

    So now we have a rewrite: You’re promised the American


    dream. You borrowed against that dream, but now the dream is
    gone and the debt remains. Someone’s to blame. That’s the
    story of housing in Florida.

    Put that way, of course it’s the law schools’/mortgage brokers’


    fault. How could a kid— or a hispanic— be smart enough to
    ever consider that they were too much in debt when the people
    in charge were saying it was okay to leverage because it
    would all work out? Predatory lending.

    Now, no one would dare propose taking that money away—


    we want everyone in big homes— but something has to be
    done, right? What would be an effective solution to the high
    cost of law school?

    Steven Greenberger of DePaul recommends a mandatory


    warning — a bit like the labels on cigarette packs — that
    every student taking the LSAT, the prelaw standardized
    test, must read. “Something like ‘Law school tuition is
    expensive and here is what the actual cost will be, the job
    market is uncertain and you should carefully consider
    whether you want to pursue this degree,’ ” he says. “And
    it should be made absolutely clear to students, that if they
    sign up for X amount of debt, their monthly nut will be X
    in three years.”

    That is exactly the kind of solution I’d expect from a lawyer:


    completely ineffectual and CYA.

    Solving the J.D. overabundance problem, according to


    Professor Henderson, will have to involve one very
    drastic measure: a bunch of lower-tier law schools will
    need to close. But nobody inside of the legal
    establishment, he predicts, has the stomach for that.
    “Ultimately,” he says, “some public authority will have to
    step in because law schools and lawyers are incapable of
    policing themselves.”

    And again, the lawyer answer: we need more regulation.

    If you want one single sentence that summarizes precisely


    what is wrong with the interpretation of what is wrong with
    law schools, it’s this one:
    Today, American law schools are like factories that no
    force has the power to slow down — not even the
    timeless dictates of supply and demand.

    If something is immune to the laws of supply and demand, it’s


    usually because someone deliberately set it up to circumvent
    those rules.

    Supply and demand should have caused these lower tier


    schools to lower their costs to entice students away from the
    better but more expensive schools. But they don’t need to,
    because all law schools are free. Read it again. All law schools
    are free.

    Not after you graduate, of course, but right now. Law schools
    can charge anything they want because everyone has enough
    money to pay for it- today. As long as there are guaranteed
    government loans available for this, there is no economic
    incentive to lower the costs. And as long as the price is zero,
    demand will always be infinity.

    If it was true supply and demand, #1 ranked Harvard and #100


    ranked Hofstra wouldn’t have the same tuition. But they do,
    the same as stupid Washington University, which is so stupid
    it’s in Missouri. “It’s underrated.” Bite me. Are we saying that
    Hofstra’s worth the same money as Harvard? That people
    would pay anything to go to Hofstra? No, they don’t have to
    pay anything to go to Hofstra. That’s the point.

    You cannot, on the one hand, say you want to lower the
    number of students while on the other hand incentivizing them
    to go. But you’re not incentivizing the students, are you? It’s a
    wealth transfer to universities. That’s why you want to directly
    limit the number of schools while keeping the payments to the
    rest of them intact. More for you. And if you have to throw
    Mr. Wallerstein under the bus to hide this truth, well, sacrifices
    have to be made.
    –

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    Vanderbilt University: The Goal Is To Keep Them In Puberty


    Ohio Mom In Jail For
    Sending Kids To The Wrong
    School
    January 28, 2011

    collateral damage
    A (black) woman pretends to live in another school district to
    be able to send her kids to that better school. She gets caught,
    and is sentenced to jail.

    The question on everyone’s mind is if/how this is unfair, but


    the real money is in another question: why now?

    We can all agree: if they wanted to handle this quietly, they


    could have. Prosecutors could have easily turned this into a
    misdemeanor, let her plea bargain.

    Instead:

    The district hired a private investigator, who shot video


    showing Williams-Bolar driving her children into the
    district. The school officials asked her to pay $30,000 in
    back tuition. Williams-Bolar refused and was indicted
    and convicted of falsifying her residency records.

    Re-read those three sentences, but put the word “Then” in


    front of the second and third. Oh, so that’s how it is.

    The wrong way to understand this story is to think it is racial


    (which it probably is), or that she deliberately manipulated two
    systems— public housing in Akron and schooling in Copley-
    Fairlawn (she did.)

    The important points not in the news: she had been pursued by
    the school district for years about this, as had other parents
    gaming the system. So the question is why they indicted her in
    November 2009. Not why her; why then.

    II.

    Here’s the first hint that this “news story” has nothing to do
    with conveying information to you. Look who gets a quote:
    prosecutors, superintendents, judges. Look whose name is
    completely absent: her lawyer’s. In fact, that she even had a
    lawyer is not mentioned once. I’m sure she had one, but what
    he had to say isn’t important to the story… is it?

    The missing part of the story is that in November 2009, the


    district was about to lose $467087 due to Ohio’s inability to
    balance their budget. On August 3, 2010, the Copley-Fairlawn
    district was the only one of 7 districts that managed to pass a
    school tax hike of 23%.

    The board chose to pursue this woman— apparently, the first


    one so prosecuted in the state’s history— for the specific
    reason that it can. It is a display of power, a show of force: we
    will protect your interests. If you’re asking why her, you’re
    missing the point, it could have been her for a million tiny
    reasons: race, she had been antagonistic with the board in the
    past, she was left handed, who knows? This wasn’t an
    assassination, it was a bomb blast. She just happened to be in
    the building.

    Why are you hearing about this story, in this way: “oh my god,
    those bastards won’t even cut a break to a poor black
    woman?” Because that story simultaneously delivers the
    government’s message: “we don’t squander taxpayer
    resources; we’ll fight to protect every dime we can get.” The
    symbiosis between media and politics: the media gets their
    readers, and the government gets their message relayed to the
    public. There’s no news here, this is propaganda.

    “But why would the school district want to portray themselves


    as racist meanies?” Do you think they care what you think of
    them? Dolla dolla bill, y’all. They owe their allegiance to the
    voters of Copley-Fairlawn.

    “But what’s wrong with the Board protecting taxpayer


    money?” That’s just the point, they’re not protecting it, they
    are pretending to protect it. $30k for two years and two kids?
    If you think the cost of public education in Akron is $7500 a
    year, you are completely and utterly insane and need to be
    disintegrated with acid. The University of Akron, which is
    only slightly worse than any high school in Akron, charges
    $8k. Granted, their teachers have PhDs but,… wait a second…

    $30 million budget? For what? As long as you assume they’re


    racists, as long as you think they are way too strict in their
    pursuit of fraudsters, then never will it occur to you to ask
    what exactly you’re getting for your money. That’s what the
    media is for. Oh, look, Idol is on tonight.

    Anyone on the outside should be able to see this for what it is:
    a mafia style protection racket. Pay us. If you pay us, we will
    protect you from those who… don’t pay us.

    http://twitter.com/thelastpsych
    Tech Sunday: Will.I.Am Gets
    A Job At Intel
    January 30, 2011

    taking it to a whole new level


    From the press release:

    Intel Teams with will.i.am, Black Eyed Peas Front


    Man

    NEWS HIGHLIGHTS

    * will.i.am joins Intel as “director of creative innovation.”


    * Unique collaboration entails the development of new
    technologies, music and tech advocacy.
    * Intel and will.i.am “share a strong interest in innovation
    around music, art and lifestyle.”

    For those of you who don’t know, Intel is a company that


    manufactures atomic-scale thinking machines that are the
    pinnacle of human civilization. I can’t hate on a guy who
    writes songs that make people happy, but his only substantial
    contribution outside of the world of pop music is punching
    Perez Hilton in the face. Is that enough on the resume to get a
    job at Intel?

    So why is Intel hiring an idiot to be Creative Director?


    Because outside of its engineering departments, Intel is staffed
    and run by idiots. Same goes for nearly every tech company.

    The closer you look at the strategic plans of companies like


    Intel, Microsoft, HP and others, you come to the conclusion
    that the CEOs of these companies must all be heavy investors
    in Apple, because none of them do anything that is remotely
    threatening to Apple. I would like to know how much Apple
    stock is owned by the guys who run Apple’s competitors. It
    wouldn’t be hard to extinguish Apple from the marketplace,
    Apple’s products aren’t really that good. Yes, a lot of people
    buy Apple products. But a lot of people also read The Secret
    and watch Glee. I wouldn’t put a lot of stock in what the
    masses think.

    Apple is successful not because their products are “insanely


    great.” No matter how good they are, their products are
    obnoxious and way overpriced. $499 for an device with a
    1024x768 screen, no ports, no accessible filesystem, graphics
    from the first Bush Administration, and a 1GHz CPU? That’s
    not overpriced? Yes, yes, we all enjoy the pinching and
    zooming on the iPad, that multi-touch return-of-the repressed
    masturbatory ritual that only crudely and temporarily
    substitutes for real satisfaction. But the thing is so crippled by
    design you can do nothing with it but consume. Oh, look
    streaming episodes of Glee. Wicked.

    I’m using an iPad last night, and it comes to pass that I need
    SSH in order to—and I apologize for being technical here—
    transfer and organize “terabytes” of “warez” and “illegally
    downloaded Hollywood movies in high definition” among the
    horrific array of computers on my MPAA-disapproved home
    network.

    SSH is one of maybe a thousand free command line tools that


    are part of the entirely free Linux operating system. The
    source code is freely available. All it does is let you log into
    another machine and get the command line on that machine.
    So naturally I assume someone has put up SSH for free on the
    app store, because duh.

    I look at the offerings on the App Store. SSH costs $10. Or $1.
    Or $5. There are about ten different SSHs for sale on the App
    Store. None of them are free. Most of them have a three-star
    rating. How the hell does the command line get a three star
    rating? What is the criticism? “Pfft. This sucks because I can’t
    use Helvetica.” Hit the bricks, Hipster, and take your overused
    homogenized Velveetica with you. It’s remote access, you
    either logged in to the other system or you didn’t. It’s a binary
    proposition.

    At best, I still have to pay $1. Actually, $1.09 because of sales


    tax. That’s right. Listen up all you 1337 hax0r5 and script
    kiddies, if you want SSH on the iPad you’re going to pay the
    State for the privilege. How does that sit with your
    “information wants to be free” ethos?

    I think it’s unacceptable. It is 2011. I was promised tricorders,


    Skynet, and flying cars, not sales tax on the bastard child of
    telnet so that Pixar could crank out movie after movie about
    baby toys doing baby crap in a way that oddly follows the plot
    of The Magnificent Seven.

    You would think that a competitor would step into this breach
    to offer a tablet or phone computing device that was, well, a
    computer. Nope. Oh, I know what you’re thinking. You’re
    thinking, “But Android has all the unix tools blah blah blah.”
    You’re thinking that because you are a stupid Android
    consumer who is stupid. Android devices aren’t computers
    either. The flagship Android phone, the Droid X, has about
    thirty-seven cores running at 1.21 jiggawatts. (Jay-Z is
    Android’s Creative Director). With all that hardware, have you
    ever tried to run one of those real-time audio apps like they
    have on the iPhone? You can’t. Do you know why? Because
    Android has exactly the same round-trip audio latency as DOS
    2.1. Yes. I looked it up. To do real-time audio, you need under
    10ms. Meanwhile, the Droid-What is 350ms in version 2.2 and
    45ms in an “optional” package in 2.3. (According to the Davos
    Summit, “Optional” is an industry term for “Unavailable”.)
    So, despite the fact that it runs on military-spec hardware,
    Android can’t do the fun multimedia stuff that the iPhone can
    do (provided that you pay and pay and pay for it (plus sales
    tax.))

    And now Blackberry wants to sell a tablet too. Oh joy. The


    Blackberry is basically a corporate house-arrest ankle bracelet
    that prevents you from thinking about anything other than your
    job no matter where you are in the world. I can’t wait for that
    soul-sucking experience in 9-inch high-definition. With
    multitouch.

    This is not competition. This is copying. Charging users a


    premium for a locked down OS which in turn nickel-and-
    dimes the user for single function apps that are freely (and
    legally) available in much more advanced configurations on
    normal PCs is not innovation. It’s asinine. Which brings me
    back to the beginning: I’m convinced the CEOs of these other
    companies secretly hoard Apple stock. How else can you
    explain this total unwillingness to do the obvious: to bring to
    the tablet space the computing platform that relegated Apple to
    a niche player in PCs?

    You know what costs $499 and can do real-time audio, SSH,
    PDFs, Flash, 1080p and
    everything else you’d ever what to do for no additional cost?
    A crappy laptop
    from Tiger Direct.

    So why don’t any of these companies just sell you that laptop,
    minus the keyboard, with a touchscreen? I would buy that.
    Today. But no one sells it. Why? Because corporations are
    amalgamations of people operating in lowest-common-
    denominator cover-your-ass protected mode. Some corporate
    sperm donor at Intel or Microsoft or HP wearing khaki pants
    and a blue dress shirt sees Apple’s success with the App Store
    and decides to copy it in his company. Khaki Blueshirt, VP of
    Entrenched Thinking, then gets labeled internally as an
    innovative guy, because in corporate America, innovation
    means copying Apple without also copying all the artsy
    designy stuff that is “gay.”

    Attention corporate America: you don’t want to copy Apple.


    Apple sucks. Yes, they make money. Two-and-a-Half-Men
    also makes money. Apple makes money for the same reason
    Moleskine makes money selling $0.99 cent notebooks for
    $7.00—because they don’t teach checkbook balancing in high
    school.

    I don’t need Intel to sell me a quad-core CPU designed by


    Will.i.Am with two dedicated “urban” cores providing
    hardware-accelerated Photoshop graffiti tags. I don’t need a
    “krunk” instruction set that invites me to “get retarded.”

    I need Windows (or Linux, real Linux) in a tablet form so I


    can download Firefox, Flash 10.1, Greasemonkey, VLC,
    utorrent, SSH, and a life-goals management app called
    “Inception 2010 BRRip 1080p x264 AAC - honchorella
    (Kingdom Release)”. That’s what I need.

    Listen up, Khaki Blueshirt. Just because you upgraded the star
    wipe in Powerpoint doesn’t make you a creative guy. You’re a
    drone. You sell commodity hardware and a lots of it. You want
    to beat Apple, stick to what you know. Sell tablets that allow
    users to do more than fingerpaint and view advertising at the
    same time (yes, there’s an App for that.) The hundreds of
    millions of us that have not bought iPads want tablets that let
    us do on them what we do on our regular computers—
    spreadsheets, Powerpoint, movie piracy, and porn. Don’t get
    fancy.

    — pastabagel

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    Upgrading Movable Type
    Are All Drug Reps Hot?
    February 4, 2011

    brought to you by Reaganomics

    (This is only peripherally about drug reps.)

    Someone was arguing with me about why all drug reps are
    hot. I told him they weren’t, and I would know. I’ve seen a lot
    of reps, I even used to train them, fly out to their HQs and give
    them a two hour lecture on the pharmacology of their and the
    other drugs.

    “Then why does everyone say they are?” He told me that a


    friend of his in the medical field also noticed they were all hot.
    And didn’t CNN or some blog say they hire college
    cheerleaders and sorority girls?

    Of course, he isn’t asking me because he wants a date. The


    point he is making, the point everyone always makes when
    they bring this up, is that this is a strategic plan of Big
    Pharma’s: hiring eye candy to influence prescribing.
    How would that work, exactly? Pfizer tells HR to screen
    applicants by cup size? You know HR is run by women, right?

    I shouldn’t have to explain that a company can’t have an


    employment strategy that discriminates against a protected
    class. Saying that your hiring practices are a necessary part of
    a marketing strategy does not get you out of this.

    There are some jobs where appearance is a bona fide


    occupational qualification (BFOQ— see, there’s even an
    acronym for it) and if you have to ask if your job is one of
    those, it isn’t. Elite Modeling can hire based on looks, but
    Abercrombie & Fitch can’t. I leaave you to tease out the
    details.

    Surprisingly, ugly people are not a protected class, and phew.


    But while Pfizer can hire attractive women, it cannot be a
    hiring strategy. Could a manager choose the prettiest out of all
    the candidates and get away with it? Sure. But he couldn’t
    hold out for only attractive ones. So if they did want their
    salesforce to be all attractive females, it would have to be, in
    effect, a conspiracy: everyone knowing the deal, and everyone
    playing along. Do you know how hard it is to get a conspiracy
    going in this country? It’s impossible.

    But most people have never met a drug rep. And people who
    have seen one in a doctor’s office are sure they’re hot— “I saw
    her!” But the assumption is wrong, and your eyes are lying to
    you. You are all making the same mistake.

    II.

    When you hear that all drug reps are hot, you can be confident
    that the person speaking is a middle aged man and/or someone
    with… limited sexual power. These people are prone to two
    errors. A psychological one: fetishization; and a biological
    one: mistaking for beauty what is merely youth.

    This is supported by the reverse complaint among young male


    residents, young male reps, and guys who’ve been around the
    block: where are all the hot reps? This company blows.

    These women aren’t hot, they are polished, hair and nails, new
    shoes, clothes, time at the gym and plenty of sleep. (Sigh, that
    was me— never.) What would you expect of a single woman
    with a lot of disposable income magnified 10x by credit? If
    you saw them in a bar you might not even notice them, but in a
    doctor’s office their appearance is jarring, out of place, no one
    else has such attention to their appearance. No one else is as
    young. No one else walks with such confidence.

    III.

    I’m not saying reps aren’t trying to influence doctors; I am


    only saying that the looks aren’t part of corporate strategy, and
    it asinine to the point of insanity to believe that the 25 year old
    female rep put on an Ann Taylor suit and Nine West pumps to
    look good for you, so you’ll prescribe Zyprexa.

    If you found an actual hot rep, and asked her if she thought she
    looked hot in that suit, she would say, “oh God, in work
    clothes?”

    But it’s those clothes, that job, that make her sexy. Take a 25
    year old and put her in a bar, she’s a girl. Put her in the clothes
    and she’s a woman— so for a 40 year old, there’s much less
    guilt about seeing her as a sex object, because she isn’t a sex
    object, she’s a professional.

    “Sex for scripts” is not a derivative of prostitution. It is sexy


    because it is not prostitution. If it were strictly transactional, it
    would lose its sex appeal— no one fantasizes about having sex
    with prostitutes, they have fantasies of paying for sex, and the
    fantasy isn’t that she does it even though she doesn’t want to,
    the fantasy is that she wants it so much she’ll do it for so little.
    What makes it sexy is the fantasy that the woman doesn’t
    mind it at all; for her, sex is easy, comfortable, immediate.
    She’ll have sex with a man simply out of curiosity: “I just
    wanted to see if he was any good.”
    They don’t have to have sex with you, of course, but their
    threshold for doing it is much lower. The image of a woman
    offering her sexuality to obtain a non-sexual reward— in this
    case scripts, but it’s no different from the idea of the woman
    who blows the bouncer to get into a club, or sleeps with the
    band’s frontman even though she thinks he’s kind of weird
    looking, just for the story— is comforting. It offers an
    explanation for why her sex seems so easy with other men and
    so out of reach for you: she’s doing it for some reason that is
    not sex. So you make it porn— she has the ability to enjoy sex
    even with people she doesn’t actually like— and now you
    ladies know why your boyfriend doesn’t care a lick about the
    three years you spent with your ex, but goes all quiet when
    you bring up a drunken one night stand. Say this: “he was
    cute, I guess, but I don’t actually remember his name,” and
    strap in for the best sex he can deliver (or a beating.)

    If I say “drug rep,” you think she’s hot. If I say, “she blew the
    bouncer to get into the club,” again, you think hot. If I say
    she’s a “nurse” then she’s hot. But if I say she’s a surgical
    nurse, or a nurse practitioner, then she’s not hot. The more
    specific you get, the older you imagine her to be, and the
    specifics crowd out the fantasy.

    That makes being a drug rep a fetish, in which the job— not
    the woman— is attributed with sexual power that it does not
    have, but we all act as if it does. That same girl in a
    supermarket might be ordinary; but call her a drug rep and
    give her the uniform, and it’s boner time. That uniform is just
    as important as her actual appearance. Uniforms de-humanize
    (that’s the point of them.) The uniform tells you to think of this
    person not as an individual but as whatever that uniform
    represents. But if that uniform represents sex (as do nursing
    uniforms, etc) then the woman can’t help but being thought of
    as sex. So you have to abandon the uniform.

    IV.

    Instead of wondering why Pfizer hires only young women to


    be reps, you should ask why young people are lured into
    Pharma.

    And why not? Money is great out of college; it’s a purely


    white collar job, not much experience is necessary. While it’s
    not a physically taxing job, who else wants to enter a career
    where they have to work three nights a week until 10p? I know
    it’s at a restaurant, but these young women you expect to be
    hot have enough money to go on their own, with people they
    like, not a 50 something “I was an obstetrician in my country”
    or a table of know-nothing residents who all think they’re
    going to Vasco da Gama the buried data of the presentation.

    But the hidden danger is that for most of these reps, there is no
    future in Pharma. Pharma cut more jobs than any other private
    sector industry, about 100k since 2009.

    Whatever else you might think about reps, they represent the
    goal of the nation: young, motivated, college educated workers
    who want to 401k their future, have families, watch the Super
    Bowls and not get involved with nonsense. The problem with
    the nation is that it didn’t have any jobs to offer them except
    Pharma (and similar) jobs. Those jobs don’t exist now, and
    there aren’t any other jobs for them. It’s one thing to say the
    poor/uneducated can’t find work, it’s another thing to say the
    explicitly desired outcome of this country’s social and
    educational system can’t find work. The supply is there; but
    there’s no demand. And there’s no demand because there’s not
    enough people who create stuff creating stuff which would
    justify the other jobs.

    When this occurs, a country has two options. It can support


    those young people through social services, healthcare,
    housing and food subsidies, etc— with steady GDP growth of
    about 5%; or it can create jobs. The first one is called Egypt.

    Let’s stick with the Pharma example, though it applies


    everywhere. If Pharma was creating new drugs, it could justify
    all these jobs. Now they aren’t, so jobs are cut. Create new
    drugs and everyone’s back in business. Ok— but wrong.
    They never were creating new drugs, they were only creating
    new markets. I realize Zoloft and Lexapro are nominally
    different drugs, but they are really the same drug, packaged
    differently: markets were created to sustain both Lexapro and
    Zoloft; not one market with two products, but a doubling of
    the market. In a perfect world, Lexapro wouldn’t have been
    invented, they would have worked on something else. But
    since they knew they could create a market for “another
    Zoloft,” they took the easy route. And they hired a salesforce,
    accordingly.

    While that was good for Lexapro, it’s terrible for the country.
    Temporarily— and ten years is temporary— hiring all these
    people to essentially duplicate efforts cannibalizes resources
    from other industries. All of those reps might have done
    something else, back when they were young enough to do
    something else. You might say it’s not for me to judge whether
    being a rep is more valuable to society than being, say, an
    engineer. I agree, that is not my place to judge, the market can
    do that; but it is the responsibility of the nation’s
    administrators to decide that what they want for their 18 year
    investment. And if they want more engineers, entrepreneurs,
    creators, they have to incentivize that, and de-incentivize other
    choices. And if Pharma is offering $60k + benefits, the
    country’s got to come up with something better.

    Here’s an example: Pharma offers 401k with matching


    benefits. The government, if it wants to use stimulus money
    the right way, could offer college grads who go into jobs the
    country wants (e.g. engineering) a matching pension. In 2009,
    $50B worth of school loans were in default. If you spent only
    $10B a year on grants to pay for e.g., engineering, you could
    get 200k engineers through college. Etc. And many people
    who are already employed would love a way to fund side
    projects, in essence doubling the output of a single person.

    The chief predictor (actually, the only predictor) of suicide is


    hopelessness. A person can withstand all manner of attacks
    and traumas, but if you take away hope all bets are off. When
    the hopelessness becomes endemic, it looks like this:

    –-

    You might also like:

    Diana Chiafair Is Hot, But Is She Illegal?


    Or, You Could Just Nuke
    The Bitch
    February 7, 2011

    no, i was just giving him a boost

    This is how it happened.

    She’s zippering the coat of her 6 year old son after soccer
    practice. Two other mothers are talking nearby, one of them
    animatedly, about how some bastard kid punched her son. “No
    one hits my son. If I find that mother, I’m going to let her have
    it.”

    She finishes zippering, gets up, and they walk to the door, but
    she hears Angry Mom yell to her. “Hey!” she says, coming
    towards them. “I want to talk to you.”

    “Me?”

    “Yeah, you. Your son punched my son.” She is very angry.


    And loud.
    “He did?”

    The background noise in the gym goes down as all the mothers
    stare openly at the confrontation.

    “Yes, “says Angry Mom, “he did. Scratched him right in the
    face.”

    She looks down at her own son. “Is this true?”

    He looks up at her. “No, I didn’t hit him.”

    She looks back at Angry Mom, tentatively. “I’m sorry, there


    must be some kind of mistake, are you sure it was him? He
    doesn’t hit people, he’s not that kind of a person.”

    “Are you calling me a liar?”

    “No! no, I’m just saying that—”

    Angry Mom calls over her shoulder to her own son. “Did this
    boy punch you? Don’t be afraid, you tell me.”

    “Ummm, yes.”

    “I’m very sorry if he did,” and then turns to her son, “are you
    telling me the truth? Are sure you didn’t hit him?”

    “No, really, I didn’t.”

    “I’m sorry, I don’t know what else to do, he says he didn’t do


    it and I know him, he’s not that kind of boy.”

    Angry Mom cuts her off. “The coaches are going to hear about
    this. I won’t tolerate violence.”

    “I’m sorry—”

    END SCENE.
    The mom walks away shaken, for two days she can’t get past
    it. That kind of emotional hysteresis happens to all of us, and
    if the reason for it isn’t actual guilt then it’s repeatedly trying
    to force an incorrect interpretation onto a situation. For the
    right one, you have to look at it from the outside.

    Re-imagine this as a scene in a movie. What is the setting,


    why is it there and not, e.g., over the phone or in a private
    meeting with the coaches? Who is (singular, not plural) the
    main character? Who are the supporting cast? Who are extras,
    and what are they for?

    Dialogue like this is exposition. What does it tell us about the


    characters?

    II.

    It may seem that Angry Mom is angry because her kid got
    punched, but she was actually Angry before that. Allow me to
    explain.

    In this scene, she’s yelling at the mom for two reasons, both of
    them bad.

    First, because in America you NEVER yell at another person’s


    kid— or praise them, or hug them, or ask them what their
    favorite Harry Potter movie is; every adult-child interaction is
    immediately interpreted on a continuum of pedophilia or
    abuse. (Why are we so worried about child abuse nowadays?
    Because the truth is deliberately obfuscated. CNN will tell you
    how many pedophile priests there are, but not emphasize that
    they molested 20+ years ago, and that the incidence of priest-
    abusers now is tiny. Nor do they let on that they know that the
    person who molested you almost certainly has the same last
    name as you, BORING, here’s a modified narrative about a
    girl we’ll call Elizabeth Smart. See? It was a crazy person, and
    they’re everywhere. The state encourages the media promotion
    of boogeymen— in the 1970s serial killers, today pedophiles
    and etc— because it makes the populace demand increased
    state control in their private lives, which is the precisely the
    natural single goal of any state. The state and the media effect
    this encouragement by pretending not to know of the
    boogeyman’s nonexistence. Says a Congressman: “you mean
    there’s an epidemic of baby rapers out there? Wait— did you
    say rapers or rappers? The hell you say! Elect me, I’ll make
    sure we buy thousands of cameras from my supporters at
    Nikon to monitor our streets, we’re going to need tech support
    so let’s bring in Google….” None of this is consciously
    planned in advance, it doesn’t have to be, it is in the nature of
    things: individual selfishness always finds a way, and that way
    leads to indoor recess for all of us.)

    But she really doesn’t want to yell at the kid, the point is to
    yell at the mom, that’s the whole reason for this exchange. The
    kid isn’t a person, he’s an extension of the mom, in the exact
    same way that Sarah Palin isn’t a Republican but an extension
    of the Republican Party, which is the only reason you’re
    yelling at her.

    Second, she’s conveying to the audience that she’s the kind of


    mom who defends her kid, who is tough, who will stand up to
    anyone. That’s the reason she was telling the other mom about
    it and why the confrontation is so public. Does this exchange
    say, “don’t mess with her kid?” No. It says, “don’t mess with
    her.”

    III.

    What about the puncher’s mom? Surely she is not at fault?

    Well… her mistake, a crucial one, is she allowed herself to get


    blindsided by the Angry Mom’s Cognitive Kill Switch—
    hijacking a discussion and making it a criticism of the person’s
    identity instead of the actual issue. Rather than repeated I’m
    sorrys and he’s not that kind of boy what she should have said
    is, “why are you yelling at me? I didn’t punch your kid.”

    That changes the whole movie, now we have a different main


    character. Now Angry Mom is put on notice: back off and let’s
    talk rationally, or confirm to me you are a nut and face the
    consequences.

    But her reflex— a product of the generational forces to which


    she was exposed— was to square off and get defensive: my
    kid wouldn’t do that, my kid wouldn’t lie. She accepted Angry
    Mom’s premise— the premise of Gen N— that the kid is only
    her, and so she took the Angry Mom’s attack as an attack on
    her directly, which it was, because that’s the premise. If the kid
    is truly an individual, he has to answer for his own behaviors;
    and not just explicitly, but implicitly: if the mom’s reflex is
    defensiveness then the reflex isn’t towards individuality.

    This is a kid who has a brain and does stuff, yes, a lot of it
    involving boogers and punching but still he is the one doing it.
    But the two moms are treating it like a fender bender: you lost
    control of your kid and drove him into my kid because you
    were too busy texting, and that makes you a bad person.

    IV.

    But why isn’t this just a case of a mom reacting angrily to her
    son getting hurt? Why can’t it just be that she wants to protect
    her son? Because the prepositional phrase is absent: protecting
    him from what?

    I said this was a scene manufactured by Angry Mom to display


    her identity, and as incorrect as that analysis might initially
    feel you should consider it very seriously. If the purpose of the
    confrontation is to prevent her kid from getting punched, it
    failed. Will it prevent another kid from punching him? Will it
    prevent even that boy from punching him some other day?

    It is completely impossible to expect that boys are never going


    to come into violent contact with each other. It is simply
    unnatural. I’m not talking about bullying, but any two kids
    who are otherwise friendly are eventually going to punch each
    other in the nuts. And then go right back to playing Madden.
    God made them that way. Sure, break it up, sure, reprimand
    them, but if kid A hits kid B, then the situation is kid A hit kid
    B, not “I don’t allow violence in my home.” Zero tolerance is
    impossible and counter to the education of children: it teaches
    that violence is the sole privilege of the state and the people
    who run it.

    V.

    Does it seem like we are hypersensitive to kid on kid crime?

    Call it PTSD By Proxy: a bully of your kid is a flashback to


    being bullied yourself, and what you wish you could have
    done had you been bigger and more powerful and, hey, wait a
    second, you are bigger and more powerful. But as much as
    you’d like to travel back in time 30 years and be an adult kid
    again so you could punch your son’s bully in the face, you
    can’t because he wasn’t alive then and he didn’t bully you, he
    bullied your son, and he’s a kid and you’re not. So all you can
    do with that rage in a Tardis is yell at the other parent, or bully
    the bullies using the weapons you have, like laws and rules
    and social norms, and if you cross the line I am going to make
    you regret it. And if that logic seems highly convoluted, well,
    Seroquel isn’t a blockbuster for nothing.

    VI.

    So if a crazy parent rolls up on you, what can you do without


    resorting to a tire jack or 20oz Dunkin Donuts stun grenade?

    You don’t let it be about you.

    The first step is to make the other person feel important, that
    she has been heard. She’s upset, so you assure her that you’re
    going to take on her level of intensity to handle the situation,
    you will make it as much of a priority for you as it obviously
    is for her: “Listen: I’m going to get to the bottom of this. If my
    kid actually did this, then don’t worry, I will go old school on
    him, and he’ll come in tomorrow with an apology and an
    offering of Junior Mints.” You don’t have to accept any blame,
    but you can’t just deny it and trivialize the other person’s
    complaint. No parent wants to feel stonewalled. Even crazy
    people want justice.

    Simultaneously, you have to declare the limits of your


    deference, that the only reason you are not going Defcon 2 on
    her is that you are reasonable. “…but, if it turns out that he
    didn’t do anything, well, we’re just going to have to let that be
    the end of it. Right?”

    Finally, in every conflict, the ones you can win and the ones
    you can’t, unless you really want to fight you must always
    give the other person a saving-face way to back down. No one,
    especially nowadays, wants to walk away in shame, they’d
    rather die, or kill you. Angry Mom stupidly made this public,
    and so she has no way to back down unless you, as the more
    powerful person, the one with understanding, give her one.

    You take the conflict out of the interpersonal and move it to


    the realm of fairness and justice promising to abide by
    whatever comes about.

    And yes, I am talking about Iran. Bet you didn’t see that
    coming.

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    that would be a gross misrepresentation of the facts

    Imagine you are the editor of New York Magazine. You want a
    story that will generate buzz but no one wants to hear how
    hard it is to be a parent in Manhattan— so porn it is. How
    about an article about how porn is making real sex less
    interesting to men? Conventional wisdom at $3 an issue. Nice.

    Gotta have pics. You can’t show porn only because the
    advertisers don’t like it. So how about some “photographs of
    men watching online pornography, taken January 25”?

    Sweet. Let’s get five random guys and set them in front of the
    Pornotron:
    An observation. The top guy looks like Dexter, which is good
    because they are all obviously serial killers. What’s the
    message here? That porn leads to meth?

    II.

    You’ve read the same thesis before: too much porn leads to too
    much masturbation and there’s no cum left for the ladies,
    resulting in sadness and gnashing of teeth.

    The article is written by Davy Rothbart, and is a mixture of


    personal anecdotes, interviews, and expert commentary from a
    key celebrity, in this case John Mayer.

    It’s not like there’s anything in the article to dispute, it


    happened to him, he’s spelling it all out for you in graphic
    detail. Too much porn made it impossible for him to perform
    with women. Here he is able to bone up but unable to hose
    down.

    Had I just given up, things might have played out the way
    they often did, with shades of confused disappointment
    and inadequacy on the part of the woman and mumbled
    apologies and awkward shame from me. But that night,
    ingenuity struck—unable to actually get off, I found
    myself flying a fresh route: I faked it.

    That’s right, he faked an orgasm during a one night stand


    because porn ruined it for him.

    And here he quotes some guy named Perry:

    “I used to race home to have sex with my wife,” says


    Perry, a 41-year-old lawyer. “Now I leave work a half-
    hour early so I can get home before she does and
    masturbate to porn.” Throughout the course of our
    conversation, Perry insists that he’s still attracted to his
    wife of twelve years. Still, he says, she can’t quite
    measure up to the porn stars he views online. “Not to be
    mean, but they’re younger, hotter, and wilder in the sack
    than my wife,” he says.

    It is a narrative that is impossible to argue with: too much porn


    leads to trouble, as Perry and Davy will tell you. And they did
    tell you, so you’re on notice.
    And so we are back to first principles: what does the author
    want to be true?

    III.

    I won’t argue with the hypothesis that gently annoying your


    penis for two hours, boringly, while you surf the tubes is going
    to lead to some desensitization. You have to approach porn
    like a bank heist: get in, get out, you got 15 minutes and
    someone tripped the silent alarm. Leave nothing behind.

    That’s not this guy’s problem.

    I realize regular readers are anticipating my punch line, but


    that doesn’t make it less true. The reason he’s semi-impotent
    has nothing to do with how he views porn, it has to do with
    how he views himself, i.e. completely oblivious to reality.
    Observe that this guy wrote an article, under his own name,
    about how he can’t get an erection with women because he
    watches too much pornography. Take a minute. He thinks this
    is such a universal problem that far from feeling any shame, he
    should be applauded for exposing the dark secret of American
    men.

    Run through it: does he want it to be true that he’s impotent?


    No. He wants to be true that the reason he has sexual problems
    is the porn, in the same way that I have no doubt he believes
    the reason he can’t find a job is Sarah Palin.

    It is for this reason that I can make the following prediction


    with 100% certainty: if he never looks at porn again, if he
    never masturbates again, ever— he will still have chronic
    sexual dysfunction. Pornography is a scapegoat.

    IV.
    This isn’t a judgment on Rothbart, it is an indictment of all of
    you who want it to be true that something is destroying your
    lives but that something cannot possibly be yourself.

    Here’s the first paragraph of the article, in full:

    I met the woman at a Broadway show, but the night’s best


    piece of acting, I’d say, came from me, back at her East
    Village apartment, after we’d been having sex for about
    25 minutes, with Neil Young wailing the song “Comes a
    Time” from the laptop on her bedside table. The dried-out
    condom had a full-bodied choke hold on me, but I’d
    already stopped twice to put on a fresh one, and I knew,
    as I kept earnestly pumping away, that one more condom
    wouldn’t make the necessary difference. Had I just given
    up, things might have played out the way they often did,
    with shades of confused disappointment and inadequacy
    on the part of the woman and mumbled apologies and
    awkward shame from me. But that night, ingenuity struck
    —unable to actually get off, I found myself flying a fresh
    route: I faked it.

    I don’t need anything other than that paragraph to tell me that


    his problem isn’t porn. Do you know anything, anything about
    the woman? Forget her life choices; what color hair does she
    have? Hell, even characterize her as just a sex-object, a bimbo,
    tell me she’s got big boobs, degrade her, anything, but put her
    in the movie! How would you cast her? “Well, it’s not really
    important who plays her.” Got it.

    But I know too much about him, none of it important, all of it


    branding: Broadway show, East Village, Neil Young, two
    condoms in 25 minutes. You could counter that perhaps the
    story is just made up to illustrate his point, but that only
    reinforces my point: this is what he imagines to be important
    to a story about sex.

    The article proceeds to offer examples in support of the


    premise that too much porn leads to an inability to connect
    with a real woman:

    Then there’s Stefan, a 43-year-old composer, who has no


    problem getting aroused when he has sex with his wife.
    “In order to come, though, I’ve got to resort to playing
    scenes in my head that I’ve seen while viewing porn.
    Something is lost there. I’m no longer with my wife; I’m
    inside my own head.”

    Just like with Perry, above, you’re supposed to interpret that as


    he has to fantasize that he’s with a hot chick, but that’s not
    what he’s doing. He’s masturbating, but instead of his hand he
    just happens to be using a climaxing vagina attached to a
    woman some other guy would be happy to penetrate, which is
    weird because that’s what he’s imagining anyway.

    V.

    Ron says that for the past couple of years, he’s had
    weekly “dates” with his favorite porn stars, which he
    looks forward to all day and even showers and shaves for,
    as though preparing for a live-action rendezvous.
    “Mondays are for Gia Jordan,” he says. “Tuesdays for
    Sasha Grey.” Wednesdays he has a reprieve—a
    Portuguese night class. “I always look forward to
    Thursdays the most—Kasey Kox,” he says. “Then, on the
    weekends, I hang out with my girlfriend.”

    So, Ron is insane. I don’t think there’s any point in debating


    that. Any women who finds his obsessiveness charming and
    are interested in auditioning for the Wednesday slot should
    check the casting notice:
    Are you right for the part?

    But the point it makes is clear: Ron has an ideal woman image
    in his head, and only porn can give it to him. Real women
    don’t measure up. We can debate the impact on women, that it
    forces women into gender specific stereotypes and presents
    women with impossible expectations of their sexuality and
    availability. Or something.

    But feminists and Ron are reading this the wrong way. Porn is
    not causing him to be disconnected from women, he is already
    disconnected from them, and the only person that will have
    him is online. He’s not retreating into porn because real
    women don’t measure up, he’s retreating into it because he
    doesn’t measure up. He’s not porn material. He doesn’t expect
    or want that women will naturally act like porn stars in bed, he
    expects that he will be able to turn them into porn stars in bed,
    with his massive dong packing her into a creaming pliancy. It
    is his failure to be able to do this that drives him back to porn.

    Narcissism is about the need to self-identify and to broadcast


    that identity to others. Online porn doesn’t help you do this
    because it robs you of your pants, but you can run it as
    defense: online porn prevents other people from finding out
    you aren’t as good as you think you are. Everyone imagines
    they are good in bed, but when you hit 30, 40, 50, and you
    slow down, now you’re no longer as good as even you once
    were. And so you will give up sex, actual sex, something you
    would have previously stabbed a harp seal to get, just so you
    and she don’t have to realize just how mediocre you are. “No,
    you’re wrong, I simply don’t have the energy.” But you can
    stay up till 2am spinning the Wheel of Anal?

    Add to that his own self-image. When you masturbate to porn,


    as with all fetishes, you are able to focus on a single piece of
    something as a proxy for all sexuality. It is super easy to look
    down at, say, your own penis manipulated to its max and see it
    as gigantic, see it as a proxy for the stud that you imagine you
    could be given the right script, lighting and production. But
    the moment the director yells, “action!” the self-consciousness
    kicks in. You see your flabby gut through her eyes and
    imagine she can’t possibly be aroused by it. You don’t feel
    sexy, so you are not interested in sex. Do I need to point out
    that this is what women used to say about themselves? Dude,
    you’re acting like a girl.

    You don’t need to drive more than three paragraphs down to


    find evidence of this. Here’s what one tool said about being a
    tool:

    “I’ve always thought it’s really hot when women in porn


    movies say dirty stuff,” he says. “Usually, they’re just
    literally narrating the shit that’s happening, giving the
    play-by-play: ‘You’re fucking me! Your dick’s in my ass!
    I’m sucking your cock right now!’ For whatever reason,
    that’s what does it for me. But recently a woman I was
    with started saying all that stuff, and it just kind of
    spooked me. She seemed slightly nuts.”

    And

    Women, noticing a decline in their partners’ libidos, try to


    reenact the kinds of scenes that men watch on their
    computer screens. Men, as a result, get really freaked out.
    They don’t want their real women and their fantasy
    women to inhabit the same body.
    They’re not freaked out, he has assessed them incorrectly.
    Remember Sartre’s “look?” This is an anti-look. This is where,
    as she’s looking over her shoulder at you and screaming out
    the expletives she’s learned men like, you catch a glimpse of
    her eyes and see behind them, into her soul, and you see that
    she’s pretending, this is just an act, this is fake, this sex is even
    less real than the stuff on the internet.

    VI.

    Let me be clear: it’s not masturbation that we’re talking about,


    neither is it a critique of porn in general, but specifically
    online porn video clips— the way Davy and Ron and pretty
    much the rest of America views it. What makes it so bad, and
    how can we stop it?

    This is the approach that fails us with social issues, “what can
    be done about it?” Nothing, you can’t do anything about the
    porn, the porn is a fact of reality. You may as well uselessly
    ask what can be done about giraffes or misplaced modifiers.
    Porn is here, ubiquitous, and until the government finds a way
    to kill you over the internet there’s nothing stopping you from
    blowing out your retinas. We can Thomas Aquinas this issue
    for another decade, and maybe it is a moral issue I have no
    idea, but I do know that it won’t change reality. You can only
    change yourself, and if you can’t change yourself you had no
    realistic possibility of changing the world anyway. Stop
    rationalizing.

    We’re looking at the porn “problem” the wrong way. Because


    there are vaginas in it, we think it has something to do with
    sex or libido or even power, but strip porn down to its
    functionality and you’ll see it’s something else. Do a rundown:
    it’s not illegal. For the most part, it isn’t even shameful, you
    say Brazzers and every guy in American will be happy to tell
    you about it. “How did you know that?” “Wikileaks.” It’s easy
    to access. It’s not terribly damaging. It sucks up a lot of time
    that you always regret afterwards, Davy and Ron may light
    candles and dim the lights in preparation for their “date” with
    but three seconds into the ejaculation they’re already planning
    how to kill themselves. That’s right, mo, that’s two hours you
    could have spent learning to Ricky Jay a deck of cards or
    dictionary attack your ex-GF’s facebook account. “Hey,
    what’d you do last night?” “Hung out.” “Me too. I’m
    exhausted.”

    And: no one climaxes unexpectedly from watching online


    porn. You decide you’re done. The first 10 minutes are
    thrilling but after that you’re not holding back from
    orgasming; in fact, you’re trying to remind your penis to stay
    hard until you find whatever it is you think you’re looking for,
    because you think you’re going to want to suddenly come
    when you find it, whatever it is will be so awesome you won’t
    be able to hold back— but it’s never so spontaneous. You have
    to decide the time has run out. This is why online porn is so
    problematic: there’s no natural end in sight.

    And for most, the biggest problem is the drive: you don’t do it
    because you’re horny, you do it because you’re bored. With
    porn that available, you never get to really horny anyway in
    the same way Americans never get to really hungry.

    You’re training your penis to resist physical stimulation and


    key off your mind, which sounds good in theory but you see
    the results with poor Davy— you’re training yourself to have
    sex in your head. So it’s not that real women aren’t porn-like;
    even porn, after twenty minutes, isn’t porn-like anymore.
    What you need to finish is some time afterwards to create a
    masturbation scenario, and with some real woman squirming
    underneath you playing her own movie, “give it to me,
    Julian!” it’s hard to concentrate.

    In other words, online porn isn’t a drug, it isn’t an addiction, it


    isn’t a sign of deviancy or a trigger for disease: porn is junk
    food. It is a bag of potato chips you eat when you aren’t even
    hungry, and once you start and the initial “mmmm!” passes
    you’re all in, may as well finish the bag, you’ve ruined your
    diet/night already, start over clean tomorrow.
    After a while potato chips just figure into your routine, there’s
    a passing thought that perhaps you shouldn’t but since there
    aren’t any obvious and immediate consequences… And now
    it’s part of who you are.

    But no one would ever say that “other foods don’t measure
    up”, no one says that potato chips taste better than steak not
    because they don’t but because no sane person makes those
    kinds of comparisons. If you did, if you played it all out in
    your head and now deliberately avoid eating a steak in order to
    get to potato chips— then you have a problem that is deeper
    than steak or potato chips.

    Junk food is stripped of the essentials of real food, leaving just


    the vulgar, the simple, the obvious of taste: sugar, salt, fat,
    repeat. It is the pornographization of food. The mistake people
    make is that they think it is delicious, but it’s really just easy,
    comforting, reliable, satisfying. And that’s where we are now:
    online porn is the pornographization of porn.

    VII.

    When you characterize porn as an addiction it tells you that it


    is hard to break free, that it is a struggle, that relapse is
    inevitable— all things that have nothing to do with porn. But
    when you characterize online porn as junk food, the solution is
    obvious: don’t eat it.

    Easier said than done, I know, but the thing I find helps most
    people is to understand that you can’t refrain from doing
    something you like. You can, however, change the person you
    are into the kind of person who doesn’t even like that stuff.
    Sugar Smacks still taste the same as they did under Carter, but
    I don’t know anybody who still eats them. Do the same for
    soda.

    In medical school a lot of the guys (who went into ortho) went
    to the gym and would discuss with euphoria how much canned
    tuna they ate. “There’s 15g of protein and zero fat!” they’d
    whisper to each other, and they’d sooner eat salamander eyes
    than lick a Dorito. That was the kind of guys they were.

    This may not be a reassuring solution to some, but I can


    promise you that it is the only solution: you have to decide
    you’re not the kind of person who wastes time on that.
    Condemning it, banning it, hiding from it— all will lead to
    failure. Lust isn’t the trigger, boredom is, idle hands are
    something or other, so the sooner you get a default activity, the
    better. When your wife walks in on you in the midst of an
    overhand tug and she moans, “you are pathetic!” she’s really a
    vowel off, apathetic is more accurate and considerably more
    amenable to improvement.

    VIII.

    Davy believes porn messed up his relationships with women. I


    don’t expect him to understand that he gravitates to porn
    because of who he is.

    Like any through researcher, I decided to investigate a


    theory. I had heard about something called the National
    Day of Unplugging, sponsored by the New York-based
    Jewish group Reboot, which encourages people to take a
    one-day vacation from their tech. But I chose to unplug in
    my own way: by refusing to visit the usual series of
    tawdry websites I frequent before bedtime.

    If you can get past the branding, you can see that Copernicus’s
    porn usage isn’t an addiction but a routine. Routines are part
    of your identity, like it or not, with the unfortunate
    consequence that you’ll reflexively defend it even if it is
    foolish. Here is the very next sentence:
    Now, I’m certainly not trying to indict porn, or to
    conclude that it has no place in men’s lives, whether they
    are alone or in company. And I’ll concede that some
    couples still find it to be something of a turn-on. But
    realigning one’s relationship to it might just improve
    one’s actual relationships—especially if you’re often
    finding yourself in the bedroom, staring into the eyes of a
    very confused partner.

    “Just don’t do it” is going to be hard for him, the porn is part
    of who he is, but— and this is the part you should focus on—
    if he decides to be a different person he can stop that routine,
    and if he stops that routine he will become a different person.
    But he doesn’t want to change, he just wants things to change.

    I went without porn for a day. Then I tried it for two.


    Then three. On the fourth day, I had the fortune of having
    sex with a woman. And nothing was faked, although I
    can only speak for myself.

    The next 40 years of this guy’s life are going to be drudgery,


    and for anyone else he drags with him. So if that’s you, for the
    sake of everyone around you, stop eating junk food.

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    –

    http://twitter.com/thelastpsych
    Not A Good Month For
    Blonde Reporters
    February 18, 2011

    and not a good generation for everyone else

    Honest up, wildpeople, when you heard a TV reporter named


    Lara Logan got sexually assaulted by a gang of hooligans, how
    much did you want to see what she looked like? Lara sounds
    hot. And how certain were you that to find out, all you’d have
    to do was click the link?

    Is rape a crime of sex or a crime of violence? Better to ask:


    how good is your psychic filter that you can find sexiness in
    pretty much anything? You didn’t picture her bloodied and
    crying, you imagined her reluctant. How easy was it for your
    mind to turn “gang rape” into gang bang”? You don’t have to
    answer; I live in the same country you do.

    The story seems to be that she was raped by a bunch of


    hooligans, but that story is long gone in favor of the louder
    one, the one that’s everywhere: did her looks have anything to
    do with it?

    Years of cognitive retraining have finally taught us not to ask


    that question, though only because we’re now in general
    agreement that looks have everything to do with it. Oh, I
    know, not all rapes— just the ones you’re going to hear about
    in the media.

    Media producers, my pet name for the Chthulu, have


    pretended to be appalled by the public’s wonder if Logan’s
    blonde hotness had anything to do with her rape, but it’s
    hardly the public’s fault— they made her hotness the story. I
    knew she’d be Victoria Secret hot the moment I heard the
    story, partly because I assume they only hire hot reporters but
    also because I know they wouldn’t bother screaming the story
    at me if she wasn’t. Do they ordinarily reveal the faces of rape
    victims in other cases? Well, here’s one so you don’t have to
    google it.

    But they’re not telling you she’s blonde to suggest that’s why
    she was raped, they’re telling it to you to read the story. And
    when they tell you that you are a misogynist jerk for thinking
    that her swimsuit model body had anything to do with her
    attack, I hope you can see that they are telling you that so that
    they have an excuse to mention that she had a swimsuit
    model’s body. Like Arthur challenges Saito, “don’t think about
    elephants. What are you thinking about?” Son of a gun,
    inception works.

    Are there any among you who read the story but didn’t wonder
    if she was good looking? Ladies, no one’s looking, you can be
    honest.

    So don’t let the media tell you her looks aren’t an issue, I have
    no idea whether they weren’t an issue in the rape but they are
    most certainly an issue in the story, which is all they care
    about, and which becomes your entire data set of the world.

    II.

    You know what I don’t know about Lara Logan? Who raped
    her. Pro-Mubarak or anti-? Too bad, that’s what I want to
    know, so I know whether to write the country off for the next
    decade or the next five decades.

    Oh, refreshingly, the media has refrained from the reflex racial
    apologistics that follow American crimes, “not all Egyptians
    are rapists” and “this isn’t indicative of all Egyptians,” but the
    media has to hold off because we don’t know who did it, the
    media isn’t sure which way they want to go. Once we know
    for sure, you won’t have to fire one synapse to figure out if
    this is indicative of all Egyptians or not, they’ll Matrix it out
    for you in news reports, TV shows, and commercials. Stay
    tuned, the next generation of foreign policy axioms brought to
    you by the producers at CBS.

    III.

    It isn’t a good month for blonde reporters on location. Some


    other swimsuit model tried to get the words out right, tripped
    over the first, and then like dominos all the words went down,
    down, down, and there’s only one valid interpretation: her
    brain misfired.

    The story is that she maybe had a stroke; but the story of the
    story is that the media want to get out from the shadows and
    become the story, and any chance they can get it— and at
    anyone’s expense— they will take it. No one wants their
    reporters to have strokes or get gang raped, but no one should
    let a good crisis go to waste, either, it’s an opportunity to do
    important things that you would otherwise avoid, thank you
    very much Mayor Emanuel. Maybe we had a good reason to
    avoid certain things? I will point out that the entire pubic
    discourse on these reporters does not ever mention the content
    of the original story— what was Logan about to report? What
    words was Branson trying to get out? Oh, that’s not important.
    Then why did we have her out there in the first place?

    oh, now I see

    It’s hard to summarize the extent of the damage that the news
    media inflict on each individual’s psyche because it all seems
    so appropriate: shouldn’t we want more information, not less?
    That way we can pick and choose what’s important to us? It
    makes some sense, yet it still takes me weeks to pick a
    computer that is identical to all my other choices though none
    of which are really appropriate to my needs. Information bias
    is a steel death trap, once you’re in you do not want to come
    out. But there are only 24 hours in a day, and with sleep and
    porn and driving and drinking, what you know about the world
    comes in brief soundbites, and the minutes you spend knowing
    about Branson and Logan are minutes you don’t know
    something else, and worse, you think you can extrapolate from
    these pop culture images to a sophisticated understanding of
    finance and politics. You can’t, there’s no time left for
    thinking. I know you think you’re above pop culture and stick
    to news, but all of this is pop culture and you’re eyeballs deep
    in it and there is no where else to turn. I guess I’m guilty too,
    having just spent hours writing about this, but I justify it by
    saying someone has to make this explicit, someone has to let
    you know that these maneuvers and seductions aren’t
    incidental but wholly the purpose, sure they know it’s
    dumbing and wrong but that’s the game, everyone’s gots to get
    paid, you may not be interested in pop culture but pop culture
    is interested in you.

    http://twitter.com/thelastpsych
    The Decline Effect Is Stupid
    February 22, 2011

    we were surprised to find the data fit well within the two axes.
    Further research is needed

    Is there something wrong with the scientific method? asks


    Jonah Lehrer in The New Yorker.

    The premise of the article is a well known phenomenon called


    the Decline Effect. As described in the story, that’s when
    exciting new results, initially robust, seem not to pan out over
    time. Today a series of studies shows X, next year studies
    shows less than X, and in ten years it’s no better than nothing.

    To be clear, this is what the Decline Effect is not: the finding


    of better data that shows your initial findings were wrong. The
    initial findings are right— they happened— but they happen
    less and less each time you repeat the experiments. The
    Decline Effect is a problem with replication.

    An example is ESP: the article describes a study in which a


    guy showed remarkable ability to “guess which card I’m
    holding.” He was right 50% of the time. That happened. But in
    subsequent experiments, he could do it less. And less. And
    then, not at all.

    Many critics of Lehrer’s article read this and say, a ha! the real
    explanation is regression to the mean. Flip a coin and get
    heads nine times in a row: it could happen, but if we flip that
    coin enough times we will see that it is ultimately 50/50.

    But that explanation is incorrect, the article explicitly states


    that the Decline Effect is not regression to the mean.

    The most likely explanation for the decline is an obvious


    one: regression to the mean. As the experiment is
    repeated, that is, an early statistical fluke gets canceled
    out… And yet Schooler has noticed that many of the data
    sets that end up declining seem statistically solid—that is,
    they contain enough data that any regression to the mean
    shouldn’t be dramatic. “These are the results that pass all
    the tests,” he says. “The odds of them being random are
    typically quite remote, like one in a million. This means
    that the decline effect should almost never happen. But it
    happens all the time!…”

    And this is why Schooler believes that the decline effect


    deserves more attention: its ubiquity seems to violate the
    laws of statistics.

    Lehrer believes that the Decline Effect is an inexplicable


    byproduct of the scientific method itself.

    So? What gives?

    By now, many scientists have weighed in on this article,


    offering the usual list of explanations— publication bias,
    selection bias, regression to the mean. But while these are real
    problems in the pursuit of science, the real explanation of the
    Decline Effect goes unmentioned.
    A hint of “what gives” is contained in the rest of Schooler’s
    quote, above:

    …This means that the decline effect should almost never


    happen. But it happens all the time! Hell, it’s happened
    to me multiple times.”

    The true explanation for the Decline Effect is one no one cites
    because the place you would cite it is the cause itself. I am not
    exaggerating when I say that the cause of the Decline Effect is
    The New Yorker.

    II.

    The Decline Effect is a phenomenon not of the scientific


    method but of statistics, so right there you know we are out of
    the realm of logic and into the realm of “well, this sort of
    looks like a plausible graph, what should we do with it?”
    Here’s the article’s money quote:

    But now all sorts of well-established, multiply confirmed


    findings have started to look increasingly uncertain. It’s
    as if our facts were losing their truth: claims that have
    been enshrined in textbooks are suddenly unprovable.
    This phenomenon doesn’t yet have an official name, but
    it’s occurring across a wide range of fields, from
    psychology to ecology.

    A wide range of fields from the almost entirely made-up to the


    slightly less made-up are losing their “truth?” This
    phenomenon isn’t occurring in physics. You could (and people
    did) build a Saturn V launch platform on the unscarred edifice
    of Maxwell’s equations, and then 40 years later build an
    iPhone on top of that same edifice. It’s amazing what you can
    do with the black magic of electromagnetic theory.
    Psychology, e.g., is different, because it attempts to model the
    particular minds of some humans at this particular time in this
    particular culture, and those models may apply 3 or 3000 years
    from now, or they might not. Ecology attempts to form a static
    model of the dynamic relationship of constantly evolving
    organisms to each other and their environment which we are
    wrenching to and fro in real-time. But there is no static
    “reality” in these fields to observe. In these soft sciences, the
    observation of reality doesn’t just change the results,
    sometimes the observation actually changes the reality almost
    completely.

    In these regression sciences, we throw a ton of data into


    Visicalc and see what curves we can fit to them. And then,
    with a wink and a nod, we issue extremely broad press
    releases and don’t correct the journalists or students when they
    confuse correlation with causation. We save that piercing
    insight for the cushy expert witness gigs.

    The problem isn’t that the Decline Effect happens in science;


    the problem is that we think psychology and ecology and
    economics are sciences. They can be approached scientifically,
    but their conclusions can not be considered valid outside of
    their immediate context. The truth, to the extent there is any, is
    that these fields of study are models, and every model has its
    error value, it’s epsilon that we arbitrarily set to be the
    difference between the model and observed reality.
    Quantitative monetary theory predicts that given this money
    supply and this interest rate, inflation should be 2%, but
    inflation is actually 0.4%. Then let’s just set epsilon to -1.6%
    and presto! Economics is a Science.

    III.

    To make its point about the Decline Effect— and


    unintentionally making mine about science— the article
    predictably focuses on the psych drugs that we hate to love to
    take, that keep the McMansions heated and the au pairs
    blondily Russian. “They were found, scientifically, to be great,
    and now we know, scientifically, that they’re not!” Medicine is
    not a science, and despite the white coats and antisocial
    demeanor doctors are not scientists. Docs and patients both
    need to get that into their heads and plan accordingly. That
    why we say doctors practice medicine. If medicine was a hard
    science, doctors would not have been surprised and puzzled by
    the effects of some of these drugs. You can show me
    Powerpoint slides of depression rating scales for as long as the
    waitress keeps refilling my drink, but none of that “science”
    explains why imipramine doubles the mania rate, Depakote
    does nothing to it, and Zoloft lowers it, with apparent
    disregard for their scientific classifications.

    The problem isn’t the Decline Effect, the problem is you


    believed the data had the force of F=ma. No one should be
    surprised when medical “truths” turn out to be wrong— they
    were never true to begin with. And if you made sweeping
    policy proclamations based on them, well, you got what you
    paid for.

    IV.

    But for all this imprecision, the criticism— by folks like Jonah
    Lehrer— directed at the “social” sciences is even worse.
    Eggheads are collecting data in routine and predictable ways.
    They are at least consistently using statistical analysis to
    analyze that data. It isn’t art history by postdocs with warez
    Photoshop.

    So when I read this, I have to manually push in my temporal


    artery:

    Many researchers began to argue that the expensive


    pharmaceuticals weren’t any better than first-generation
    antipsychotics, which have been in use since the fifties.
    “In fact, sometimes they now look even worse,” John
    Davis, a professor of psychiatry at the University of
    Illinois at Chicago, told me.
    Shiver me timbers. Okay, Professor Davis, now that your
    conclusion about the inferiority of the expensive drugs has
    been read by an audience twenty-five times larger than that of
    any study you’ve ever read, let alone written, can you please
    show us that data that supports your conclusion that atypicals
    are less efficacious? Oh, that’s not what you meant. I’m
    confused, what do you mean by “worse?” Wait, were you
    talking about depression or schizophrenia? OCD? I’m lost,
    let’s back up. And while you’re at it, please define for
    us/Jonah Lehrer the other technical terms: “sometimes,”
    “they,” “now,” “look,” and “even,” because I have no idea
    what they hell they mean in this context, and, big money
    down, you don’t either.

    This is where the “scientific method” is breaking down. Not in


    the lab or at the clinical trial. It’s breaking down in the
    sloppiness of the critics. If any researchers want to argue about
    the efficacy of new drugs over the old ones, there are ways and
    places to do that. The New Yorker is not among them, because
    it lets scienticians get away with sloppy soundbites, and leaves
    anywhere from nine to 3M layman readers with the impression
    that scientists “know” “the newer meds” are “worse.”

    And the moment you talk to The New Yorker, your


    misinterpreted statistical association becomes truth. Certainly
    for the layman’s mind, but also in the mind of the Professor.
    I’m going to bring up Depakote again until I get a public
    apology— do you know how many times a day I have to
    correct psychiatrists that Depakote does not have “a lot of
    studies” supporting its efficacy in maintenance bipolar— let
    alone an actual indication?

    Left alone in his office and a stack of contradictory papers, he


    probably wouldn’t be so flippant about it all. It’s slow,
    excruciating, unexciting work that is the pursuit of science.

    But that won’t get you any grant money, let alone quoted in
    The New Yorker.

    V.
    An example:

    What Møller discovered is that female barn swallows


    were far more likely to mate with male birds that had
    long, symmetrical feathers. This suggested that the picky
    females were using symmetry as a proxy for the quality
    of male genes. Møller’s paper, which was published in
    Nature, set off a frenzy of research. Here was an easily
    measured, widely applicable indicator of genetic quality,
    and females could be shown to gravitate toward it.
    Aesthetics was really about genetics….In the three years
    following, there were ten independent tests of the role of
    fluctuating asymmetry in sexual selection, and nine of
    them found a relationship between symmetry and male
    reproductive success. It didn’t matter if scientists were
    looking at the hairs on fruit flies or replicating the
    swallow studies—females seemed to prefer males with
    mirrored halves.

    That’s what Lehrer wrote. I know you didn’t read it all. Here’s
    what you read:

    ”Females seem to prefer symmetric males.”

    The actual study suggested nothing about what the picky


    females were doing. Lehrer inferred it. By the time we get to
    the end of the paragraph all the reader remembers is that
    women prefer to have sex with symmetric guys, which is
    simply, undeniably, not true. But none of the studies in that
    paragraph every concluded that. They each made specific
    conclusions about the specific creature they were studying.
    And if you think I’m splitting hairs, then you are the reason for
    the “Decline Effect.”

    Scientifically detected associations, in specific situations and


    contexts, are then generalized by the popular press— or at
    least by the profession’s internal pop culture— and those
    generalizations are used as working knowledge. Those
    generalizations, which were never true, are the starting point
    for the future decline in effect that Lehrer is worried about.

    When the article then goes on to describe the breakdown of


    this sweeping generalization in studies after 1994 (on other
    species), it attributes that to the Decline Effect. It’s not. When
    you look at the studies together, what you should have inferred
    is “symmetry is an associated factor in mate selection by
    females in only some species and not others and more research
    is need to explain why.” Instead, the article attributes its
    inability to summarize the variety and complexity of nature in
    a 140 character Twitter message to an underlying failure in the
    500-year-old guiding principle of science.

    Worse, as the article points out, sometimes journals want to


    publish only confirmatory findings, which set the stage for the
    discovery of a Decline Effect later on. But the article doesn’t
    go far enough: they’re not looking for confirmation of a
    previous study, they are looking for confirmation of a
    sweeping generalization. Not: “Zyprexa is more efficacious on
    the PANSS than Haldol for schizophrenia,” but “Don’t we
    already know atypicals are better than typicals?” And then
    those same journals, in the future, will only want negative data
    because their new sweeping generalization will be popular at
    Harvard via a grant from NIMH, all the Pharma guys moved
    on to Ohio. That’s not the Decline Effect: it’s a pendulum
    swinging wildly from one extreme to the other, over a pit, in
    which is tied a guy. You’re the guy.

    V.

    Here’s an example of how sloppy science becomes enshrined


    as “truth” by popular press outlets like The New Yorker.

    In 2001, Michael Jennions, a biologist at the Australian


    National University, set out to analyze “temporal trends”
    across a wide range of subjects in ecology and
    evolutionary biology. He looked at hundreds of papers
    and forty-four meta-analyses (that is, statistical syntheses
    of related studies), and discovered a consistent decline
    effect over time, as many of the theories seemed to fade
    into irrelevance.

    Look at that sentence, inadvertently hitting on the truth: the


    decline effect happened as the theories became irrelevant—
    not the other way around. The question isn’t what does science
    say is true; the question is, what does the author want to be
    true?

    But how can the author will a meta-analysis to show what he


    wants it to show? Maybe he could manipulate an individual
    study, wouldn’t a “study of studies” be immune to his dark
    sorcery?

    Imagine a study of Prozac vs. placebo in 10000 patients, and


    Prozac is awesome. Imagine two more studies, each with 6
    patients, and Prozac doesn’t beat placebo in those. I now have
    three studies. My meta-analysis concludes: “Prozac was found
    to be superior to placebo in only a third of studies.” Boom—
    Associate Professor.

    When meta-analyses look at only a few studies (e.g. N=4), if


    even one of them is a poorly designed study you can
    overwhelm— or purposely extinguish— what might actually
    be a real effect.

    In theory, researchers are supposed to be vigilant about the


    kinds of studies they lump together, making sure they are all
    similarly designed, etc. In practice, researchers are not, on
    purpose. Researchers all know what they want to find, and
    maliciously or unconsciously the studies to be included are
    selected, and, surprise, the researcher’s hypothesis is
    supported. I have a blog full of examples, but conduct your
    own experiment: take any meta-analysis, look only at the
    author’s name, find out where he works— and guess
    everything else.
    While you’re wasting your time with that, that author of that
    meta-analysis is talking to The New Yorker and changing
    reality, “well, studies have shown that…”

    V.

    This is going to get worse as the internet allows for popular


    discussion but not for access to the primary data. I am
    contacted all the time by the media, “hey, what do you think
    about the new study that finds that women are hotter when
    they’re ovulating?” I try to drop some knowledge in a media
    friendly way, but at least a third of the time the reporter just
    wants me to a agree with that atrocious study and speculate
    wildly. “Do you think it’s because their boobs get bigger?”
    Let’s find out.

    It’s easy to go through Lehrer’s examples and identify the


    culprits of the supposed Decline Effect, but the best example
    of why “science” goes bad is, not surprisingly, offered by
    Lehrer himself. In (brace yourself) Wired, Jonah Lehrer
    answers some questions about his New Yorker article. Recap:
    his premise is that the Decline Effect is real, occurs in all
    sciences, may be a function of the scientific method itself, and
    eats away at even the most robust findings.

    Question 1: Does this mean I don’t have to believe in


    climate change?

    Me: I’m afraid not. One of the sad ironies of scientific


    denialism is that we tend to be skeptical of precisely the
    wrong kind of scientific claims.

    Get that?

    Instead of wasting public debate on creationism or the


    rhetoric of Senator Inhofe [critic of climate change], I
    wish we’d spend more time considering the value of
    spinal fusion surgery, or second generation
    antipsychotics, or the verity of the latest gene association
    study.

    Jonah Lehrer is the Decline Effect. I think he is a good and


    earnest person, and I know he was previously a scientist
    himself, but he ultimately grades the science he’s not
    knowledgeable about based on value judgments. Which is
    fine, it’s his life, though I wonder if deep down he believes it.
    If he goes psychotic, will he actually want me to give him
    Haldol over Abilify?

    The trouble for the Earth is… he writes for The New Yorker.
    And Wired. Which means that his value judgments carry more
    weight than the science itself.

    If they didn’t, I, and those who are real scientists, wouldn’t


    have to explain why the Decline Effect doesn’t exist, I
    wouldn’t have to waste time rebutting his article.

    But I do. That’s the problem.

    –
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    The Trouble With Charlie
    Sheen
    March 3, 2011

    crazy like a fox

    You want me to confirm he’s bipolar? An addict? A narcissist?


    You don’t need me for any of those things.

    You can judge a man by what he says or by what he done, and


    this is what he’s done: taken Scarface levels of drugs and slept
    with lots of pornstars, gotten rich, kept his hair, and not gotten
    fat, skinny, or AIDS. Not bad for a Wikipedia page. Mine just
    says, “horny/scurvy.”

    And he’s held down a job, well, up to now anyway, and


    produced products that reveal absolutely no hint whatsoever of
    his personal behaviors. I’ll give you a thousand bucks if you
    can find the scene in Navy Seals that looks like he was doing 7
    gram rocks. (Ok, ok, the whole movie looks like…)

    Of course, as fun as all that sounds— and I admit it sounds


    wicked awesome— he’s also having legal, employment, and
    diagnostic issues, and if you put your ear up to the TV you can
    hear America breathing a collective sigh of relief, thank God
    he’s falling apart, because if he wasn’t crazy and there’s no
    God then what rationalization could you possibly have for not
    following his lead? We want our celebrities sexy and wild but
    the narrative has to include a built in reason why we can’t
    imitate them, something like divorces and cops and rehabs but
    definitely not genetics, lack of commitment and social
    retardation. Your life sucks, but at least you have your health.
    Enjoy your five ounces of wine a day.

    II.

    “Why do you sleep with pornstars?” asks the marionette from


    20/20 after weeks of texting him and visiting his home.
    Seriously? What answer is she waiting for? I’m not saying it’s
    for everyone, but the question answers itself, right? It’s a
    tautology.

    The question her producers are getting her to ask in this po-mo
    way is, “what’s it like to be able to sleep with pornstars? Got
    any footage?” I wish they would simply have asked it that
    way, but she doesn’t want to appear salacious, she wants to
    appear concerned, indignant, superior.

    In a particularly enlightening exchange, she recalls a radio


    interview he had done and proclaims, “one message you put
    out there that didn’t sit well with people was that using crack
    socially was ok as long as you can manage it.” Sheen’s
    insanity suddenly disappears and he laughs in her face. “Was
    that a joke?” she asks indignatiousnessly. “Come on,” Sheen
    says shaking his head, “you’re a smart [sic] lady [sic], what do
    you think? Of course it was a joke, because it was so
    absurd…” Sheen may have a highly evolved brain but there
    was a better answer: “I do crack, and you all think it’s
    hilarious. I say I do crack, and you all get self-righteous. I
    sleep with pornstars, you all want details. I say that I sleep
    with pornstars, and you all judge me. I may be crazy, but you
    — you, you manipulative harpies, are just terrible,
    manipulative, harpies. Interview over. I’m going on break.”

    III.

    An observation: Sheen went publicly insane early last week. It


    wasn’t until this Tuesday night, after Extra and Today started
    showing the goddesses, that the court ordered an extraction
    team to medivac his kids. He’s had a week of full on insanity,
    20/20 had an entire crew in his house last Saturday, Radar was
    in there all day and no one felt obligated to rescue the children,
    but go on TV and publicly say you like multiple vaginas and
    they put your name on a database. No more interstate travel
    for you.

    IV.

    Is Charlie Sheen bipolar?

    The only thing you’re never supposed to do in psychiatry is


    offer an opinion without conducting a full psychiatric
    examination, they’re very emphatic about this, which is weird
    because half your grade on the psychiatric board exam comes
    from diagnosing a guy in a 10 minute video clip from 1977.
    (Academic dishonesty spoiler alert: he has OCD.) Thus, I will
    reveal here that I conducted a brief examination of Charlie
    Sheen, online, from my car.

    I know mania when I see it, but I also know that there are a
    dozen reasons for mania that I can’t see from the outside. The
    pressured grandiosity is pretty characteristic, the cause of it
    isn’t.

    But there’s a much bigger story about Charlie Sheen’s illness


    you won’t see anywhere, way more important than his actual
    diagnosis.
    Lunatic or not, Sheen makes one very solid point: CBS is not
    doing right by him. I don’t care what he’s done, Charlie Sheen
    is a big time actor from a Hollywood royalty pedigree, CBS
    made a fortune and a half on him, and now when he needs
    somebody in his life with a little power to step in and help him
    make some better decisions, they abandon him.

    Forget CBS, I’ll go further and say that all of Hollywood


    abandoned him, as they do all of their “employees.” Ok, so he
    fires his publicist and goes on several different interview
    shows talking about his time as the Air Force. You know what
    each and every one of those shows should have done? Refused
    to let him on. Not aired the segments. Whatever happened to
    taking care of your own? SAG, and all that? Viacom should
    have declared a media blackout immediately, so the public
    wouldn’t even know he was going nuts, or at the very least not
    display it on purpose. There’s something very cannibalistic
    about Hollywood, we’re not surprised when they drool over an
    exposed breast or turn on a President, but am I the only one
    who finds it weird that they eat each other after years of
    relationships and profit? Is there any species other than soccer
    players that think it’s ok to eat one of their own when they get
    ill?

    Sheen made money from, and for, Hollywood, and when they
    couldn’t make any more money off him that way they let him
    on Piers Morgan and made money off him that way. Is his
    breakdown so important 20/20 devoted an hour to it? Is it
    news? Doesn’t this distract us from $100 oil and the fact that
    Egypt’s Facebook Revolution is being run by the military, or is
    that the whole point after all?

    This is CBS, this isn’t some half-assed intervention by the five


    other waiters at the TGIFridays, CBS has limitless resources,
    they could spend a million dollars to hire a battalion of
    psychiatrists or extraordinary rendition him to Paraguay and
    not only not miss the money, but make a profit when he comes
    back fluent in Spanish. Dos y Media Hombres! Even the
    Federal Government takes better care of its battle fatigued, and
    that’s saying a lot, because they suck at it.

    Whether Sheen did this to himself is irrelevant, and didn’t you


    tell us mental illness was “no one’s fault?” You don’t abandon
    a guy when he needs you most even when he’s fighting you,
    especially when he’s fighting you. He didn’t hurt you, he
    didn’t attack you, all he did was go bananas. You don’t drag
    him out into the open and tie a honey sandwich around his
    neck and let bears eat him. “Well, we tried to help him before.”
    You keep trying, that’s your job as his “friends” or his
    coworkers or whatever you said you were to him a month ago,
    and for damn sure you don’t videotape it to trade for Camel
    Cash or whatever currency CBS uses nowadays.

    zark off

    It’s the old psychiatric argument, genetics or environmental? I


    can’t comment on Sheen’s genetics, but his environment
    blows. And yes, that’s a professional opinion.

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    3 Media Narratives About
    The Middle East You Should
    Defend Against
    March 7, 2011

    if you’re watching it, it’s for you


    (that’s why the signs are in English)

    1. Youth In Revolt
    Ha! That’s hilarious. Wait— you’re serious? You know Jay-Z
    is 40, right?

    According to Time, these are the guys who toppled Mubarak.


    That one guy in the back punched him and the girl poked him
    in the eyes. The guy in the back right ate the body.

    The New Revolutionaries: a liberal, pro-democracy group of


    consumerists concerned equally with global warming and
    expressing themselves, discreetly lip-synching the words to
    Lose Yourself as they march on Freedom Square.

    You’ll have to excuse my cynicism: I’ve seen this exact same


    movie a lot of times, admittedly to a CCR soundtrack.
    Of course the young(er) are looking for social changes and a
    better life. And I don’t doubt that they at least believe
    themselves to be earnest. But the media narrative that it is they
    who are the force behind the acute changes is both wrong and
    manipulative.

    It’s manipulative because it is easy. We can understand that


    kids might not like the world as it is, and the youth certainly
    appear to have enough energy drink to march for a week
    straight or yell anti-Bush obscenities, so it is logical that
    they’re the ones to focus on. It gets Time, et al, out of the hard
    work of trying to figure out why the revolution happened,
    happened now, and if it’s a good thing or a bad thing. Even
    Obama’s not sure how this plays out, so the more we hear
    about youthful idealism on the march, the less we have to
    worry that Israel doesn’t first strike Iran, just in case.

    Also, it’s self-aggrandizing. This is the folks at Time saying,


    “hey, man, we get this hip generation.” It makes them think
    they’re young and in touch, (“they even figured out how to use
    the internet for something other than porn!”) and I’d bet 10
    piastres every guy working at Time thinks the girl in the
    bottom right would find them interesting.

    The narrative is wrong, or at least woefully inadequate,


    because— in the simplest terms possible— the guys in the
    picture aren’t the ones changing the world. I’m sure they’d
    have thought voting for Obama was going to bring change,
    too, but they’d have been way wrong about that as well.

    Here are some sobering statistics for the Time readers. There
    are 80M people in Egypt, 10% unemployment and 40% in
    poverty, as defined as less than $2/day. About a third don’t
    know how to read. None of those people are in the picture.
    None of those people want the same things as those in the
    picture. None of them will ever listen to those in the picture.

    There may have been 100k students in that Square, but if their
    50 year olds are anything like our 50 year olds, then their 50
    year olds might actually find those students infuriatingly
    arrogant regardless of what side they’re on.

    The sad truth is revolutions start with the disenfranchised, get


    attributed to the idealism of “students” and “the youth,” and
    are ultimately resolved by thugs or corporations. Sideways
    Glasses Guy is in for a jarring quarter-life lesson in economic
    history, and I’m guessing he’s not going to pass.

    1b. The Young Are Mad As Hell, And They’re Not Going
    To Take It Anymore. Sorta.

    In the next issue of Time after that one, I found this picture of
    the Wisconsin union protests (click to enlarge):

    Some observations:

    1. Look at the crowd in the background. They’re all older


    people. But Time has put the young ones front and center.

    2. They do not appear to be members of the teacher’s union.


    Or particularly fond of teachers.

    3. They are smiling.

    They’re not angry, they’re not outraged, they’re… socially


    conscious? I’d bet a lot of money those kids aren’t there to
    support the unions, that’s not exactly their fight, but that fight
    happens to have a common enemy (feel free to speculate who
    that common enemy might be.) This explains precisely what is
    wrong with so many fights and positions and ideals: they are
    not for something, but against something else.

    “What’s wrong with coming out in support?” Well, go ahead


    and ask Time: “what’s wrong with putting them front and
    center?” Because if I was agnostic about unions, and interested
    in really deciding who I supported in this fight, one look at
    that picture guarantees I side with whoever they’re yelling at.
    If you want to know exactly what is wrong with the “political
    discourse in America today,” it’s that we are trained to pick a
    side against something we hate.

    So choose your “face of the revolution” carefully because if


    it’s an emotional response you are trying to evoke, there may
    be some unintended consequences. That’s what happened in
    the 60s, too— Woodstock the revolution and you landslide in
    Richard Nixon with a victory margin 3 times higher than
    Obama’s. Guess music can’t change the world after all.

    2. The Mad Dictator That Has To Go

    Oh, he may be a nutjob, but once he’s out— what, exactly?


    He’s not a lone nutjob. There was an entire government in
    place there and while they don’t all have voluptuous nurses
    you can be damn sure they want voluptuous nurses, and if they
    can’t get that they’ll settle for all your money and your
    obedience.

    It’s a narrative that existed long before the nights of Saddam,


    get rid of the dictator and things will get better. Sometimes it
    works, sometimes it doesn’t, and if your country has oil in it it
    usually doesn’t.

    yes, Mr. President, I’m going to get a haircut and try and ride
    this one out

    Imagine you replaced George Bush with Obama, but kept


    Cheney and Rumsfeld, Wolfowitz, Pearle, Rice… Imagine you
    get rid of all the Congressmen, but kept all the lobbyists, all
    the civil service employees, intelligence services, all the guys
    previously on the take— and the media infrastructure. “The
    media supports the people!” Oh, yes, that has long been my
    experience with media.

    It’s so easy to get distracted by the Evil Despot that we aren’t


    horrified that Egypt’s chaperons of future democracy are the
    military. Really? “They didn’t turn on their own people!”
    Wow, that’s your metric? Do you think they’re just going to
    step aside when the kids show up to sell off the tanks to pay
    for education?

    I am certainly in no position to decide whether you Paul


    Bremer everybody in a uniform or keep specific people on the
    payroll, but I can at least tell you this “new” government isn’t
    going to have any room for the likes of Sideways Glasses Guy.

    The best thing that can happen to him, is a long, boring,


    bureaucratic shuffle towards elections, because if you do them
    in anything less than a year the old entrenched powers will
    win. Or the Muslim Brotherhood, who are going to win
    anyway (my prediction.)

    If the kid in Time wants to participate in government, he needs


    at least a year to get his act together, not to mention money
    from the U.S. (You didn’t think we were going to stay out of
    it, did you?)

    The media likes the Mad Despot narrative because, again, it’s
    easy, but, again, it’s wrong and manipulative. And it backfires.
    When George Bush pulled the Mad Despot card, the media
    reacted against it— but that was itself a manipulation, because
    they wanted the Mad Despot to be Bush himself. Offered no
    other choices than “one of these guys is utterly, completely,
    evil,” America was forced to choose who they thought was
    actually the Mad Despot; and— tip for the media— most
    Americans will think it’s the foreign guy.

    3. The Power Of Social Media

    The intended subtext of this myth isn’t that facebook and


    twitter aided people in their revolution; but that those were
    somehow the cause of the revolution. That the technologies
    themselves “need” freedom, they force freedom, they cause
    freedom, by their very existence.

    This is a letter to Time:


    Re: Why It’s Different This Time” What we have on our
    hands today is not only a revolution in Egypt but also the
    beginning of an era when a new medium finally proves to
    the world its equal and comparable importance to that of
    the printing press. Social media are no longer just how we
    stalk ex-girlfriends or update the world about where we
    bought coffee. It fuels revolutions…

    In my short time on earth, I’ve lived through: papyrus, morse


    code, radio, yelling, mobile phones, and I have only just
    recovered from TV. All of these “disruptive technologies”
    share two commonalities. First, they empowered the people to
    communicate, congregate, and share ideas. Second, and more
    importantly, all of them were eventually co-opted by the
    government and business to manipulate those people, who
    didn’t mind one bit as long as the ads were under 30 seconds.

    It’s fairly obvious why media companies would push the idea
    that the media itself is responsible for puppies and Reese’s
    Pieces cookies, but when the medium becomes the message,
    there’s no message.

    II. So What Are The Lessons Of History?

    From The Economist:

    In Tunisia Zine el-Abidine Ben Ali met peaceful crowds


    with concessions. In Egypt Hosni Mubarak tried to ride
    out the protests by mixing concessions with force. In
    Bahrain King Hamad bin Isa al-Khalifa resorted to
    violence, but did not have the stomach for the fight. In
    Libya Mr Qaddafi seems to crave blood. Screaming
    ghastly defiance in an hour-long tirade on February 22nd,
    he vowed to “cleanse Libya house by house”. If he
    prevails, dictators the world over will know which course
    to follow.
    Or: every time history repeats itself, the price goes up.
    Partial Objects
    March 11, 2011

    I’ve started a new site, Partial Objects, which is a short form,


    high post frequency version of TLP, and I’m going to use TLP
    for longer posts.

    I get so many links from readers that time and alcoholism


    prevent me from writing up with a full post; and so I’m hoping
    this is a place where I can put down some basic ideas, offer a
    perspective, and let people comment with their interpretation.

    I’m aiming to do 3-4 posts a day on Partial Objects.

    I’m also opening it up to anyone who wants to post, the main


    requirement is that you try to tell the reader something. If
    you’re linking an article, don’t let that article speak for itself—
    tell us something that perhaps we wouldn’t have seen on our
    own. Questions are also welcome— I get a lot of “what should
    I do about X?” that are worth repeating for other people. I will
    always try to respond to them.

    I hope people find it worthwhile.


    When Is It Okay To Rape A
    Woman?
    March 15, 2011

    no one’s gonna hear nothing

    I think I’m supposed to put up a *PTSD triggers* warning, so


    consider yourself warned.

    I.

    On the Ron and Fez show, an male intern asked: if you could
    rape a girl, but then give her this magic drug that left her with
    no memory of the rape, would you do it?

    Such hypotheticals are often argued over beers and best settled
    over rum, but the real learning isn’t in the answer but in the
    asking of the question.

    His argument was that since there’s no evidence that it


    happened and she can’t remember it, then she can’t possibly
    suffer the consequences of it. So, no harm done. And the
    response to this is that there’s a reality outside of perception,
    and whether she suffers or remembers doesn’t much excuse
    the act. Rape is rape. End of story.
    But it’s right about there that the question gets more
    interesting.

    II.

    Without even answering the question, it’s important to


    understand what the intern did: he assumed that most of the
    (male) population would (want to) do the same. He didn’t
    think men would all rush out and do it— and he was protected
    from finding out because such a magic pill doesn’t exist— he
    believed that in men’s hearts, when they consider the world of
    fantasy and what they wish they could get away with, men
    would want to get away with this. We all wish we could just
    bang that girl and then erase her memory.

    A caller incorrectly identified this as the consensus fallacy. A


    consensus fallacy is the assumption that since lots of people
    believe it, it must be true. But in our case the intern’s mistake
    was in assuming that lots of people agree, which is false. The
    actual fallacy is called the false consensus bias, in which one
    assumes others share the same beliefs as you do.

    I make this distinction explicit because it should be evident


    that two different kinds of people will be prone to either error.
    Some will hold, as their premise, what many already believe;
    and others will PROJECT what they believe onto others.

    Importantly, no amount of data or solid evidence will convince


    the latter— the false consensus bias guy— that he is wrong.
    That’s because it’s not a belief, it is a maneuver, it is an act to
    protect the self, an act that they will take as far as they need to.
    “No, they’re lying, they’re just not willing to admit it.” When
    you hear that— “I speak for others who are too frightened”—
    run; because if they had a gun, they would speak for you.

    III.

    In physics, you typically solve an equation by getting it into


    the form of a different equation that’s already been solved. So
    the Rape question is of the form “if a tree falls in the forest,
    and no one is around to hear it, does it still make a sound?”
    Solve for x: duh.

    Not so fast, Sir Charles, technically, the answer is no. The


    question doesn’t ask if the tree fell or not, but if it made a
    sound. The felled tree generates (real) air pressure waves that
    we call sound waves, and these pressure waves hit the ear
    machine and are interpreted as sound. The tree doesn’t make a
    sound, we interpret what it makes as sound. A creature with no
    ears might experience these waves differently, Beethovening
    them as vibrations on it’s body.

    So now our rape question is, if a penis goes inside a vagina,


    but no one’s around to remember it, is it still rape?

    The intern says that as long as she never finds out, she can’t
    judge it as rape. He’s arguing that moral questions (“this is
    rape/ this isn’t rape”) are different than technical questions (“I
    penetrated her/ I didn’t penetrate her.”) There’s no such thing
    as objective morality, society merely agrees on some rules—
    and since she can’t remember, she can’t judge it.

    Fine; but he is a person, and he remembers it, and he was


    there. So it is still rape. He might try and rationalize that he
    doesn’t think it’s rape, but then he’d be lying: the question he
    asked used the word rape.

    One of the biggest mistakes we make when arguing with


    dummies is that we don’t take their own words at face value—
    we allow them pretend that their initial move was meaningless
    in comparison to the revisions, like a bank robber who says to
    the police, “yeah, but I’m giving it back right now.” The initial
    volley is always the most relevant: everything afterwards is
    defense.

    IV.

    But there are some of you who will agree with the intern.
    Some of you will wish you could— not that you’d ever do it,
    but boy oh boy wouldn’t it be great. It’s to them I’m writing.
    The intern, and you, don’t even need to have performed this
    rape; simply by answering the question in the affirmative, your
    lives have veered sharply to the left, you have made
    connecting with another person substantially more difficult.
    By which I mean impossible.

    V.

    If you could rape a girl, and then give her a magic drug that
    would leave her with no memory of the rape, would you do it?

    In responding to the intern, Ron (the host) made an obvious


    point, and before I make it I want you to clear your mind and
    imagine yourself acting out this scenario. You’re a man, on top
    of the woman, finishing, pulling out, and then giving her the
    drug. She blinks, looks at you like she forgot what she was
    going to say, and goes back to ringing up your order.

    Got that image? She doesn’t remember anything. She’s


    perfectly happy, no harm done at all. The point Ron made was,
    “so if a couple of my boys from the west village rape you in
    the ass, and inject you with the drug, that’s ok?” He used the
    word “fucking” to modify every noun in that sentence, but I’m
    paraphrasing.

    Some of you are right now experiencing a weird


    disconnection. Like the intern, that obvious thought simply
    hadn’t occurred to you. And it wakes you up to the reality of
    the rape, of course this rape is wrong. Forcing you to imagine
    yourself as the victim makes the scenario more real, more
    vivid.

    But why it didn’t occur to you? Are you a bad person?


    Selfish? Homophobic? Why is imaging yourself as the victim
    more real than imagining yourself as the raper, even though
    that was the intended fantasy?

    Because picturing yourself exerting power is fantasy;


    imagining yourself as victim is easy. Which is why you
    brought this all up. You spend a lot of your waking life
    creating elaborate fantasies of power that contain their own
    self-justifying logic, and those fantasies are so numerous that
    added together they actually take up a real portion of your day.
    A portion you’re not spending on something else. If I saw a
    Tardis, then I would know how to pilot it. If such a drug
    existed, then my sexual problems would all disappear.

    What you don’t see is that this logic isn’t even self-justifying,
    it is self-destructing. Not “since I have sexual problems, I wish
    I had the drug”; but, “since I wish I had the drug, I have sexual
    problems.” Since I wish I had the drug, two hours have already
    gone by. I’m staying in tonight.

    VI.

    How could you live with yourself? Guilt without shame, that’s
    how. Guilt without shame, for you, is no guilt, because what
    you did isn’t who you are. You’re a good person. How do I
    know? You told me yourself.

    You can imagine yourself getting raped by the West Village


    guys, and that’s really vividly bad. Imagining what she must
    feel when you do it to her— that’s really vaguely good. How
    easy is it to empathize? Easy. How easy is it to sympathize?
    Not so easy.

    VII.

    No one can hear us. So level with me: just because it’s wrong,
    doesn’t mean you wouldn’t still do it. Right?

    The intern, in a pseudo-devotion to his premise, said that the


    west village ass raping scenario is a go under his logic. Maybe,
    maybe not, but what he was really thinking was, “I know it’s
    wrong, I don’t want it happening to me, but if I could do it to
    someone else, I might still take the chance.” Stealing is wrong
    but if the leprechaun is off dancing a jig you’re going to
    shimmy down indigo and make off with his Lucky Charms.
    In your defense, violating a rule is much healthier than
    thinking the rules don’t exist. So you’re not lost, you can still
    change your life. But it’s lonely. There’s no one else in it.

    VIII.

    “If a tree falls in the forest, and there’s no one around to hear it
    fall, does it make a sound?”

    The question itself is explicitly a question about sound, but we


    wield it to make a point about objective reality. We want it to
    be about reality, fine, but that’s because the objective reality
    question seems open to debate while the scientific one is not,
    and so we alter the question’s intent to get to where we want to
    go.

    So the way we choose to hear the question says a lot about


    what we believe to be true or important, even without
    answering the question.

    Let’s re-run the scenario. On her, in her, out of her, drug her.
    She blinks her eyes, smiles, and goes back to cheerleading
    practice none the wiser. End scene. That about right? Okay,
    question: was she crying?

    The scenario is about a magic drug that makes her forget. But
    how on earth do you plan on getting your penis inside her
    before that? How are you going to get an erection strong
    enough to penetrate a woman who is crying in terror, not to
    mention resisting? The reason you’re even imagining this is
    because you feel like you can’t get her through seduction, so
    you still have the mechanical problem to contend with.
    I agree that a dangerous minority want this fantasy to be about
    violent rape, and I agree that it’s easy to spot those guys
    because they all have mustaches. BUT the majority are
    imagining… come on, think hard, get into the scene, you are
    imagining that she likes it. Maybe you imagine her partially
    drugged (though that wasn’t part of the premise, was it?) but
    by the end of it, she’s into it.

    That’s what makes this premise so bizarre and so revealing. If


    she enjoyed it, you wouldn’t bother with the forgetting drug.
    What he is imagining is that she’ll want to have sex with him
    and then forget; but what he said— what we’ve run through
    for several paragraphs— is that he wants a drug to make her
    forget.

    Squirm, wildman, squirm. “No, what I meant was…” And it


    starts, the minor adjustments to the original question, e.g.
    “well, the drug could be for the times when you know you
    could totally bang your wife’s sister but who needs all the
    drama later?” Fine, but admit you just made that up now. That
    wasn’t what you were imagining.

    And so on, a million of these amendments and appendments


    and defendments to the original question that you say are
    clarifications, but they’re all defensive, they are post hoc
    rationalizations, they are diversions. The true form of the
    question you are asking is, “does the ability to give a girl a
    forgetting pill afterwards give you the courage to try and hook
    up with her?” Which simplifies to: “can you live with
    rejection?” Solve for x: duh.

    IX.

    The argument here is that you would rape her as long as she
    wouldn’t remember it or suffer, but it reveals how little you are
    able to perceive the complete existence of others that you
    would even consider using them as a prop. I can confidently
    predict a gargantuan amount of rage in you, which you will
    assume is completely unrelated. You’d be wrong. They are the
    same force.

    The interesting thing about where you have found yourself is


    that it is easy to fix, but as usual the focus has been backwards,
    on you and not on what you do. While the question reveals a
    lot about you, it also causes you to think and behave a certain
    way. Though it’s a fantasy that a pill can solve your problems,
    your mind includes it in weighing your next real moves. You
    are less likely to approach that girl at the DMV because your
    mind has found a safer way (for you) to handle it. That “less
    likely” may only be a dyne of force, but it is not nothing.

    Now think about how many fantasies and scenarios you’re


    actively running every day about a million things, and think
    about how many of those things you’re actually attempting in
    real life. I know the popsicleogists will say you’re running the
    scenarios to make yourself feel better, but they are what’s
    holding you back. Those thoughts, in the absence of any
    action, have defined you. Just because no one else can see it,
    doesn’t mean it didn’t happen.

    You might also like:

    Did The NPR Chief Have A Liberal Bias?


    Ready To Go, Even For Nonconsensual Sex?
    March 13 Week on Partial
    Objects
    March 19, 2011

    The Adjustment Bureau


    All The News That’s Fit To Compartmentalize
    Physics Envy Can Be Hazardous To Your Health
    Amy Bishop Didn’t Snap
    Simulating The Simulated Experience. With Gum

    Looking for others to post their own deconstructions!


    Bad At Math
    March 23, 2011

    how much is this worth


    The following story is fiction. Any similarity to people living or
    dead is purely coincidental.

    The doctor was at work doing the usual, which means patients,
    and a 20 year old hispanic man bursts through the door and
    right away the doctor knew he was in big, big trouble.

    The man wore sunglasses, the kind of one solid plastic band
    around the eyes that you don’t wear unless you’re insane. He
    locks the door behind him and shouts, “if you give me any
    shit, I’m going to fucking kill you.” That was his opening line,
    the next few lines were derivatives of the same.

    He was yelling in English, but at about three threats in he says,


    “I want a translator—” so he opens the door and the secretary
    (hispanic) that had come to the door to see what the yelling
    was about steps in, no, he pulls her in, locks the door again,
    and goes back to yelling. “You’re fucking dead, do you hear
    me? Fucking dead!”
    One other thing: he has a gun.

    Putting it together later, yes, there will be a later, the doctor


    had seen that man, Juan, once before. He had demanded
    Xanax max dose three times a day, and in the subsequent
    negotiations it was agreed that as long as the guy could
    provide clean urines he could get one Xanax half dose a day,
    along with the other medications. Deal? Deal. So he got a
    script for 14 days, “come back then and we’ll see how things
    are.”

    Somehow Juan had taken the 14 tablets as a personal insult, he


    expected 90, even though it was clear that it was only for two
    weeks, and however he figured it in his brain the doctor was
    screwing him. So he came back— three months later—
    looking to show the doctor he messed with the wrong guy.
    “You think you’re going to play me?”

    The room they were in was the size of a large closet, about 8x8
    square. The door opened inwards, then there’s a desk, and then
    the doctor— so the desk is in between the doctor and the door.
    The waiting room is full and it’s right outside that door, so
    everyone can hear the yelling, but no one can see the gun. Not
    yet, anyway.

    The problem, logistically, was that even if the doctor wanted


    to jump him, he couldn’t— Juan is blocking the door, and the
    desk is between them. If he comes over to hit him, then they’re
    close, but with that desk in between, the doctor was
    completely at his mercy.

    The other problem, the GIGANTIC problem, is now there’s a


    woman in there with them, and she can’t get out because she
    would have to open the door into herself (she’d end up behind
    the open door) and then move towards him to get out.

    Patients yelling at the doctor to give them Xanax is nothing


    new— they threaten, they yell, they posture, and it’s all part of
    the game. The doctor had always played the game respectfully,
    cool, calm, no anger, and he let them, nonverbally, understand
    that he respected the power that they had— if they wanted to,
    they could kill him— but that the job is the job, nothing
    personal, you’re not getting Xanax not because I hate you but
    simply because I don’t think it’s right. And he let them know
    that he’d do whatever else he could for them. Sure some
    people left angry, but they left.

    And when they yelled he let them, let them go on for so that
    they felt like they had delivered their message, and eventually
    cut them off; ultimately they just need to feel that they chose
    to let him go, not that they were turned away or rejected but
    that it was their choice to move on, and when they left that
    would be the end. It happened about once a week to him and
    all the other doctors, it’s just the nature of the business and
    there’s no billing code for “pissed off xanax seeking guy.”

    But this guy was different, this guy wasn’t looking to get
    something. This guy came with the specific intention of killing
    him, he wasn’t looking for more xanax or anything else.

    And he wasn’t psychotic, he was logical, specific— just very


    threatening. “You think I’m playing?” “I’m going to tell you
    what’s what.” “You think you know me?” Every gangbanger
    movie cliche, as if he was reading from a script, but if that guy
    stayed true to his character then this was going to end very
    badly.

    So Juan locks them all in, and she’s scared, and the doctor is
    scared. Because now, with her there, he was completely sure
    he meant to kill them. Before she came in, it was between him
    and Juan only, and he might be able to talk him down, but
    when Juan brought her in it was clear he wasn’t worried about
    being caught or identified or collateral damage, he just wanted
    to kill.

    So he yells for about 30 seconds (it felt like an hour) and then
    the doctor tells him that perhaps he can get him some
    Klonopin, which is a lot like Xanax. The Klonopin was
    incidental to the argument, but he figured that if he could get
    this maniac to focus on something concrete, turn it into a
    treatment or at the very least a transaction, in which he could
    be “given” something, the guy might back down just enough
    to not kill everyone.

    But the problem was the woman. She was scared but also…
    irrational. Would she try and run? Would she try something
    stupid? Was he going to kill her, too? He had to get her out.

    So the doctor turns to Juan and says, “but I need your


    insurance card to make sure I can give you Klonopin.” That
    was a lie, but it was a distraction, turn the focus to something
    else. Juan gets his wallet out muttering, “he wants my card
    now, my card, this fucking (something) wants my card.” And
    he gives it to the doctor, and the doctor hands it right to the
    woman and says, “I need a copy of this immediately.
    Immediately.” She hesitates, she’s unsure, she moves towards
    the door slowly but Juan lets her pass. Thank God, he thinks.
    It’s going to be okay.

    Wrong. As soon as Juan closes the door behind him, he goes


    ballistic. It was like he remembered what he was there for.
    “You fucking [this], I’m going to fucking [that]!” and etc.
    Whereas before he was waving the gun around, now he kept
    his arm locked, gun pointing towards the floor. He’s still
    yelling, cursing, threatening. The gun is there and it’s pointing
    down and it’s simply waiting for him to decide to raise it.

    Again, even if the doctor could disarm him, he can’t because


    of the desk. He can’t throw anything, there’s nothing else on
    the desk. He can’t run. If he stands up, he’ll get shot in the
    chest. If he ducks down, it forces Juan to lean over the desk,
    which means he’ll get shot in the back of the head or the spine.

    This was the plan: turn to the side and let him shoot him in the
    shoulder or arm.

    What did he think about? He thought about his kids, how sad
    they’d be that their father was dead. They would cry. He
    thought about how this nut would eventually get caught and
    the kids would have to face the man who did it and listen to
    his words and the words of everyone else. The kids would
    have to look around at an insane world that tried to explain
    everything with lies. And then they’d have to go home and
    grow up. “That’s life,” someone would tell them, because it’s
    true and that helps.

    He also thought about how stupid this guy was, how terrible
    he was at valuing things, he had decided that his life was
    worth throwing away over… what? He wasn’t stealing his car,
    there wasn’t anything of value at stake. Xanax? He could have
    gotten it anywhere else, easily, anytime. Revenge? It wasn’t
    like the doctor had raped his sister, he had just not given him
    something. But somehow in his calculus this grudge was
    worth carrying for three months, worth killing someone over,
    worth 25 years in jail. This wasn’t psychosis, this was a man
    who was bad at math.

    The plan is to give him the shoulder, take it in the shoulder,


    and not turn, not go down.

    Then the woman comes BACK. What caused this woman to


    come back is unknowable, but she opens the door and it bumps
    him because he’s in front of it. So he turns around to see who’s
    coming in and he grabs the paper out of her hand and he sort
    of flings it at the doctor.

    But everything is different now, because the door is wide open,


    and everyone in the waiting room can see them.

    So the doctor, as calmly and with as much authority as he can


    muster, looks at the paper and says “ok, I can give you 30
    tablets of Klonopin with this.” He tried to make it sound like
    that was what they had been talking about the whole time, a
    treatment, a transaction. It wasn’t about the doctor, it was
    about the pills.

    Juan reflexively says, “no, Xanax,” and the doctor responds,


    “no, all I can give you without a urine (drug test) is Klonopin,”
    and Jaun says, “I want 90 of them.” And the doctor says, “only
    after the urine.”
    Whatever calm exterior he displayed was not mirrored on the
    inside, and while he was trying to show steady penmanship he
    made a mistake- and he wrote Xanax instead of Klonopin. It
    just came out. So now Juan sees the doctor writing that, and
    the doctor has to decide if he was going to give it to him that
    way or not. But if the reason he was still alive was that he had
    turned it from something personal into a treatment, then
    handing him the Xanax was an admission that it was, after all,
    not a treatment but a stick up. And maybe that would remind
    Juan that the doctor had screwed him the first time. So the
    doctor says, out loud, “dammit,” tears up the script and
    rewrites it. Doing the job correctly.

    Juan took it, made a few more threats, and left. 20 minutes
    after that the police finally came, and while they were there he
    called the clinic and said he was coming back to kill the doctor
    because he only got 30 tablets. A man who is terrible at math.

    When the doctor went back to see the patients who stuck
    around, all of them, men and women, told him the same thing:
    “Yo, man, I had your back, if anything happened, I was going
    to bust in here.” Of course they would have.

    What’s unsettling, however, is that Juan had been in the


    waiting room for an hour before the doctor even got there,
    muttering to other people that he was going to “fuck him up.”
    But no one said anything.

    There’s not much more to the story, except that the doctor
    went home, felt a little shaken, had a drink or three, debriefed
    with some people and not with others, and eventually 3am
    came and he went to bed. And when he woke up it was gone,
    merely a memory, it all felt like it happened a decade ago.
    That’s life.
    The Fall And Rise Of
    Rebecca Black
    March 24, 2011

    agreed: bomb Libya


    For those of you without an internet connection, Rebecca
    Black is the 13 year old nobody pretending to be a 17 year old
    nobody who wrote a song and made a video that everyone
    hated almost instantly. But haters gonna hate, yo.

    Even Autotune couldn’t repair her nasally, off key voice. But,
    and but, is it the worst song ever? Is it worth 30M hits of
    venom and disgust?

    Break it down by parts and look at them. Music? Off the rack
    pop music, indistinguishable from anything else. Lyrics?
    Probably below average, but no worse than “la la la la la la la”
    which is Kylie or Dannii Minogue, depending on the decade
    you last ejaculated. Singing? Again, below average but worse
    than Ke$ha or the entire Colbie Caillat portfolio? Shut your
    mouth.

    Video? Standard illogical mandness, why is a 13 year old girl


    going to a party like she’s been doing it for years? Is she an
    emancipated minor? No one can say, but does it make any less
    sense than the Black Eyed Peas having a dance off to a song
    they didn’t write and have no business sampling? Unlike that
    video, when I watched “Friday” it never crossed my mind how
    urgently the video needed a speeding box truck and an oil
    slick.

    No. None of the parts adequately explain the level of hate.


    And that’s because the hate isn’t directed at any of the parts, or
    at the video, or even at her, but at what she represents: another
    spoiled rich white girl that has a video made for her, and
    releases it like she’s as good as her Daddy’s money pretends
    she is.

    II.

    No, no judgmental statements from me, not yet, I am merely


    giving substance to that hatred so you can understand the rest.

    No one hates Rebecca Black for her music, you hate her
    because she’s spoiled, because she has opportunities in excess
    of her talent and the ability to create what superior artists will
    never be able to simply because they lack the economic
    resources or maybe even the free time that Rebecca has plenty
    o’. It’s hard to get to the studio when you’ve got an 8am down
    at the main office. Welcome to America, no one said it would
    be fair, in fact, no one said a damn thing at all, they just
    showed you the pictures on the TV commercials and we
    inferred the rest. Meanwhile, no one’s yet recognized your
    talent. Rebecca’s Dad forced us to recognize hers, and she
    wins even by losing, but he’s one guy. Are you so angry at this
    one guy who gamed the system?

    If it was just another battle in the Class War, so be it, another


    perfect proxy for our fury is sure to get upmoded on Reddit so
    save some energy for later.

    But then something happened: Rebecca announced on


    Tuesday’s Tonight Show that she was giving the proceeds from
    the video to charity, to Japan relief funds. Well, you might say,
    she may suck and she may be spoiled but at least she thinks
    about things bigger than herself and for a 13 yo that’s not bad.
    And just like that, the tide turned, the haters slowly became
    challenged by the respecters? defenders? enablers? and
    comment after comment, blog after blog, article after article,
    her selflessness overshadowed her posited lack of talent and
    now…

    Slow down.

    The problem with that narrative is it doesn’t match the


    calendar or the numbers. Even as of now, haters trump
    respecters 10 to 1, though admittedly it’s changing. And the
    support for her predates the Tonight Show appearance— e.g.
    Lady Gaga calling her a genius, Alan Colmes stating “she has
    a wonderful voice.”

    The tide didn’t turn because she gave the money to charity, the
    tide turned because it hit critical mass where it was no longer
    cool, no longer original, no longer branding, to hate her; it was
    cooler to like her. None of that has anything to do with
    Rebecca Black— did she remaster the audio? get implants?—
    it has to do with how we form opinions in the age where
    instantency matters more than consistency, let alone logic.
    That’s right, I invent words.

    That’s America, that’s how debate is done in America, that’s


    how we decide all of our questions from who blows as a singer
    to which blathering dictator we should oppose/depose/impose.
    We don’t have beliefs, we don’t have positions, we have
    reactions to other people’s beliefs, to other people’s positions.
    As long as you can be shown to be a free thinker opposing the
    tyranny of the majority’s insightlessness then you can look like
    a hero, and if you have to pull a 180 in a week or so to do it,
    party on. No one will care/remember what you did last party.
    Just remember the rule of opinion, of media: speak early, and
    often, and if you have to drag a 13 year old down or
    dramatically alter foreign policy for the next quarter century to
    lift yourself up, hey, it’s all good.
    The Lululemon Whydunnit
    March 28, 2011

    bad gamblers play not to lose


    AP:

    An employee at an upscale Maryland yoga clothing shop


    is accused of killing a co-worker who found suspected
    stolen merchandise in her bag, then trying to conceal the
    crime by tying herself up and blaming the attack on two
    masked men.

    [Prosecutor] McCarthy said Brittany Norwood, 28, spun


    an elaborate ruse to convince authorities that she and the
    dead woman, Jayna Murray, had been attacked inside the
    Lululemon Athletica shop in Bethesda where they
    worked.

    Terrible and tragic and etc, but at least intelligible, a linear


    internal logic. Norwood is stealing, gets caught by coworker
    and now has to make a decision: fold and lose everything, or
    go all in on one last hand and maybe get out of this.

    That’s the gamble: is it worth a life, is it worth going to jail


    forever, to get out of a retail theft charge? It is if it works, I
    guess.

    II.

    When you read enough news reports, you get to understand the
    code words. [Murder AND “upscale neighborhood”] always
    means domestic homicide (usually murder-suicide) or “non-
    white.” Google it if you don’t believe me.

    The codes aren’t conscious attempts to communicate


    unspeakable info to the reader, they are unconscious
    manifestations of the retinas of the writers. It’s how they see
    the world, and after a while, you can tell how they see it by
    how they describe it.

    “Make a left at the traffic light.” “Make a left at the strip bar.”
    Two different people.

    So unless the two women were dating, this upscale


    neighborhood killing means one of them is going to be black
    or Asian. I leave the rest as an exercise for the reader.

    III.

    When Norwood was found the morning of March 12


    inside the shop, she told police that she and Murray, 30,
    had been sexually assaulted by two masked men who
    came in the previous night after closing time. Norwood
    was found with minor scratches and other wounds, her
    hands and feet bound.

    Trouble is, when they examine the women, there are no signs
    of rape. A week later they figure out it was Norwood.

    [Prosecutor] McCarthy offered new details about what


    happened before Murray died, saying she had been asked
    by a store manager to check Norwood’s bag for stolen
    merchandise. Murray called the manager that night to say
    she believed Norwood had been stealing.

    That same night, after the store had closed, Norwood told
    Murray she needed to get back into the store because she
    left her wallet. When the two returned, they argued over
    the suspected theft, McCarthy said.
    Norwood then picked up some sort of weapon inside the
    store and used it to beat Murray for as long as 20 minutes
    throughout the shop, McCarthy said. He said Murray
    sustained a severed spinal cord and blows “too numerous
    to count.”

    Oh, ok, it’s this movie plot. Norwood didn’t kill Murray to
    prevent her identity from being exposed, because Murray had
    already turned her in to the manager. Norwood killed her later
    that night. Now it becomes a revenge story. Still terrible, but at
    least it makes sense. Revenge taken as murder, and then
    Norwood stages the scene and concocts a story about masked
    men to trick everyone. So she’s no longer going for four aces,
    she’s trying to bluff. It’s a longshot, but no one would wonder
    why you tried it.

    IV.

    Except–––—

    When Norwood was found the morning of March 12


    inside the shop…

    ––-except rather than leaving the store, rather than staging it as


    a robbery/murder and then getting the hell out of there so that
    no one would even think about her, Norwood stayed behind
    and pretended to have been a victim, too. She stayed there all
    night until the manager came to open the store the next
    morning.
    That’s not the behavior of someone trying to get away with
    something, that’s the behavior of someone who wants to
    pretend to be someone else: I’m a victim. She thinks she can
    win, as long as she can trick you into going easy on her.

    That’s called a hustle, trying to convince seasoned players that


    you’re someone that you’re not. And when it fails, you get in a
    lot more trouble than if you just folded early and come back to
    play another day. Trouble is, hustlers don’t hustle to win, they
    hustle because they don’t know any other way to live.
    Observations Afterwards
    April 1, 2011

    the real test of your soul’s strength is whether you are trying
    not to see it

    As most know, I was the “victim” of a hold up of sorts, a


    “patient” came in with a gun and etc, long story short is I’m
    still here.

    But I made some observations which are worth telling.

    1. Despite spending almost 20 very personal minutes in the


    room with him, I cannot remember what he looks like. I know
    he’s a male, I have a sense that he’s about 6′1″, and that he has
    dark hair, but… that’s it. If he came up to me in the street and
    offered me a sandwich, I’d take it. I know the hair was dark,
    but I can’t remember if it was buzz cut, or short, or…

    I can’t remember what he was wearing. Blue and white shirt?


    Can’t remember.

    I do, however, remember his sunglasses, I can even remember


    a hair on one lens. The glasses were so prominent and unusual
    that they took my attention away from everything else, and, I
    reconstructed the physical appearance of this guy around his
    glasses. I believe that if he was not wearing those glasses I’d
    have remembered his face or his clothes better— thought it’s
    possible my attention would have been focused on the gun.
    Now I know why they rob banks wearing Nixon masks.

    2. As further evidence: I had his chart. I studied it after he was


    gone, and for sure I knew his name— until Monday, when I
    discovered I had, for the entire last week, remembered his last
    name incorrectly. Not misspelled it— completely a different
    last name. And when someone recently corrected me, I didn’t
    realize I had made a mistake— I was genuinely shocked to see
    I had memorized it wrong. I thought they were wrong.

    There’s been 20 years of good research on the (un)reliability


    of eyewitness testimony— generally warning against the
    transference and distraction effect, and the universally terrible
    idea of offering a witness one suspect and saying, “is this your
    guy?”
    Most have seen the gorilla walking through the basketball
    game video, but watch it again:

    The problem is that our attention is weaker than our memory,


    and selective attention to one thing is at the expense of others.
    And no, it doesn’t help that the girls are pretty.
    Practice can mitigate this, but not extinguish it. And even
    someone like me who prides himself on his cool and his 133t
    perception skillz still gets tripped up. I’ll repeat something
    important: I didn’t forget his name, I really believed it was
    something else. I would have vigorously defended that belief.
    “Are you guys insane? You think I’d forget his name?”

    3. I had wondered if, involuntarily, I’d be nervous to go back


    to that same office. Would I be hypervigilant? Would I have
    involuntary physical responses to the area? Would I dream
    about it?

    No, none of those. When I awoke the next morning, it felt like
    it happened a decade ago. I went back like nothing had ever
    happened. I’ve really tried to understand why this is so I could
    propose it as a solution to other people who want to get past it,
    and what it feels like to me is that I was acting in a play a long
    time ago, playing the part of the doctor-victim, and now I’m
    onto a new role.
    Reinforcing this is my feeling towards the guy with the gun:
    that if I saw him again, I wouldn’t be afraid of him or even
    angry at him, but like he was an actor in a new role. Why
    would I not be afraid of him?
    I’ve tried to parse this out, what allowed me to get over that so
    quickly, and I think I have the answer. Maybe this will help
    someone else.

    4. What’s my pivot point? What’s the thing I keep coming


    back to, over and over?

    If I run the fantasy version in my head, where I can imagine


    myself doing anything I want, the thing I do differently is I get
    the door open sooner. Whether I yell at him and he does it or
    he forgets to close it or someone comes in, the focus is that the
    door gets and stays opened. When the door was open, I felt
    like I was no longer under his control. That was the difference
    between having power and being powerless.
    And so when I commanded the woman to get a copy of the
    insurance— i.e. to open the door and leave— and it worked, I
    had (perhaps the illusion of) power. He wanted her there, but I
    told her to leave, and he didn’t stop her. I won that mini-battle.
    And even though it closed again and he remembered he was
    insane, when I run this over I am “proud” of myself for being
    able to control the situation and get her to leave.
    So what it comes down to, at least for me, is finding the one
    specific moment where I exerted some power, where I was not
    powerless, and it made up for everything else.

    Which explains the lack of hypervigilance or worry about


    going back: since I had some power the last time, I’ll probably
    have some again. All of this may be an illusion or a psychic
    defense, but reorienting myself away from my powerlessness
    towards a single instance of power completely changed the
    emotional memory of it.

    Results may vary.


    After You Shoot Three
    Women, Who Should You
    Call?
    April 7, 2011

    dressing the part


    The rule in media is that if they mention your middle name
    you killed someone, so Thomas Franklin May is nominally
    guilty.
    His ex-wife put out a restraining order against him, so he
    drove out to where she was and shot her in her car. She was
    36. He also shot a nearby 63 year old woman and a 94 year old
    woman, I assume so they wouldn’t turn into Agents.
    It’s hard not to judge a book by its cover when the book is
    wearing a big America # 1 t-shirt and a Harley Davidson cap
    even if that is the mandatory uniform of Alabama and he
    drives a Jeep. Why is this idiot in sneakers?

    Police did not release a motive. “We really don’t know


    what’s in a person’s mind when they do something like
    this.”

    Yes we do, same thing every time: “It doesn’t matter what
    anyone else thinks.”

    About three hours later, when city officers already had


    left campus, a man driving a white Jeep Liberty with the
    same tag number police had released as the suspect’s
    pulled into the parking lot where the shootings occurred.
    Photographer Todd van Emst, who was taking photos of
    the scene for The Associated Press, said the man asked to
    use his cell phone. Van Emst said the man gestured and
    said he “did all this.”

    Uh oh, someone broke the fourth wall. It’s hard to believe that
    a man with a white Jeep Liberty needs to drive back to the
    scene of the crime to make a call; and anytime anyone asks to
    borrow your cell phone you should assume they’re running a
    short con, duck. No, Thomas Franklin May chose to go to the
    media. Did he think they’d be sympathetic? Doubtful. They’d
    let him go? No. He loves the liberal media? It’s Alabama. He
    went because he figured they’d do what he needed them to do:
    soft ball the bad guy and publish his side of the story.
    The media will drop a blonde in a war zone without a
    moment’s hesitation, but what they don’t like is a gunman out
    of context, and this guy was way the hell out of context. So
    rather than sitting him down to figure how this can be Bush’s
    fault, they called the cops.
    And then this happened:
    After members of the media called 911, police arrived
    within minutes, knocked the man to the ground and
    handcuffed him, van Emst said.

    If it takes you minutes to drive to somewhere to knock


    someone down, you probably didn’t need to knock him down.
    Not that May didn’t deserve it, but in truth knocking him
    down was van Emst’s right, not the police’s. Read that again.
    The police have a partial monopoly on power because they
    promise us to use it judiciously, when necessary— but we
    often forget that we humans retain a special right for
    scenarios, like the scenario of a homicidal maniac in a white
    car (protip: if not female or Asian = INSANE) coming up to
    ask to borrow your cell phone. That guy you’re allowed to hit,
    if you can.
    The point here is not that the photographer should have
    tackled him. The point is the more police get to use our right
    of force, the more we become afraid, or even forget, to use it
    ourselves. The result is that the tenuous duopoly of force
    becomes a monopoly. Rates will go up.

    II.

    But as much as May’s outfit reveals a lot about his thinking, it


    also affects his thinking, or do women not feel any change in
    personality when they wear Louboutins? Well, while you
    ponder that link exchange take a look at the Navy Seal
    arresting May— that’s standard police attire. What the hell
    kind of town is Opelika that the cops wear sneakers because
    they expect to be doing a lot of running? That guy came
    dressed for Two Men Enter One Man Leaves, and goddam if
    he’s not going to get a front incisor as a souvenir for his kid.
    This is the full, uncut banner picture at the top of the website
    of the Alabama Department of Public Safety Highway Patrol
    Division:
    Where’s the highway? Is this steganography?
    Note that this banner is for the state police’s website, i.e. this is
    their idea of public relations. I don’t fault them for preparing
    for Red Dawn, but why tell us this is who they are? If this is
    who they want us to think they are, how will their actions
    mirror this desire? Not to mention recruit the kind of people
    who think 24 is a training video which it was, until season 4,
    then it kind of got weak.
    Listen, I’ve been to Mobile about a thousand times, and every
    time I’ve wanted air support. Parts of it are tough, I get it, and
    off topic I will mention that if you’re married in Mobile it is
    100% certain one of you is cheating. But all that paramilitary
    gear is after the crime stuff—it helps them catch the bad guys
    but does not Protect & Serve you from the bad guys. (Note
    that this guy already had a protection order against him.)
    Where your head is at, how you carry yourself, who you think
    you are all affect your behaviors, and vice versa (vee-kah ver-
    sah.) Get dressed.
    I get the police’s position. There’s such a huge anti-police,
    anti-government philosophy that cops don’t know if a guy is
    going to squirt them with a bottle of HIV just on principle, so
    if there’s a homicide suspect who is still standing you make
    him not be standing, and then you can explain he has the right
    to a totally ineffectual public defender.
    Thomas Stupid May is going to get what’s coming to him,
    because this is, after all, Alabama. But May was in uniform.
    What would they have done if he was wearing an America Is
    #965868 t-shirt?
    –

    More on the Alabama shooter


    The iPad and The Death Of Techno-fetishism
    The Abusive Boyfriend
    April 8, 2011

    not pictured
    He doesn’t hit you, he’s not that kind of abusive.

    And he’s not mean, or controlling, not like that. No, not really.

    But he’s careful to make sure you don’t notice that a certain
    movie is on tonight, and he’s deftly avoided ballroom dancing
    lessons with you. And he walks you the other way if he spots
    one of your friends, or any billboard with Gabriel Aubry on it.

    He’s not jealous, he just doesn’t want you… distracted.

    He has no problem admitting that other men are attractive


    (“I’m no Tom Cruise”), but never the men that you yourself
    find attractive.

    He’s never mean or disrespectful to your friends when you’re


    out together (he goes reluctantly, but for you), but later he
    reminds you of how you’re better than they are, and when they
    do things “like that” it’s silly/wrong/beneath you. He never
    says you can’t go out with them, but there’s always a
    coincidental reason for you not to. “Oh…..
    well………………… I had a special night planned for just the
    two of us…”

    How sweet he is, once a month he buys you a new CD,


    classical music, with a flower, though now you don’t really
    listen much to the music you used to like.

    He is always with you, always in contact with you. Even when


    he’s not there you hear him in your head like a voice over.
    You’ve even said to him, “sometimes I’m about to do
    something that I would have done before I met you, and then I
    hear your voice and I think, “well, Tom would say XYZ” and I
    realize that I shouldn’t do it after all, and I feel so much
    happier having that part of you with me” and he nods
    knowingly, yes, he says silently, you’re learning to be a better
    person.

    No one else who knows you understands why you’re with him.

    But you’re not unhappy. When you’re with him, alone, things
    are usually great. And he loves you, there’s no question.
    Maybe you think he’s worried you don’t love him? But you
    do, how can you express that to him, so he believes it, so he
    doesn’t have to feel threatened by anyone else?

    Save your breath, that’s not what he’s worried about. He has a
    different class of dread, because he is, after all, really smart,
    and perceptive. He has, deep down, that feeling that you’re not
    really compatible, and he may even know he’s not good for
    you— he may suspect he’s actively clipping your wings so
    you don’t get away.

    He tells himself that he’s keeping bad influences away from


    you, protecting you from “your old self.” But he doesn’t
    completely believe that— he is,after all, perceptive— he
    secretly knows these “bad” things are better for you, they are
    more you. He knows you’d be happier with them. But then
    there’d be no room left for him.

    What’s he sure about is that this is the best there is. Other
    things, different things, may make you temporarily happier;
    more money, a trip, more freedom, a bigger dick, laughs with
    friends, but in terms of your life, your soul, this is as far as you
    need to go.

    He will help you pursue any goal, any happiness, as long as it


    does not compromise your relationship with him. He will give
    you everything and allow you to do anything, as long as
    nothing makes you wonder if he isn’t manipulating you, as
    long as nothing makes you wonder if another kind of life is
    possible. Not a better life, just a different life. He’ll take a
    bullet for you on instinct, but if another man innocuously tells
    you he’s also interested in art history or compliments your
    hair, then you’ll relentlessly over months be presented with
    subtle reasons why art history is a fraud and you need a
    haircut. Attacking the man would be too transparent.

    But why so much energy controlling the world? Why not just
    let things be and see what happens? Is he so afraid things will
    get worse?

    No. He’s afraid things will get worse or they will get better.
    He is afraid of change, any change, not just because the
    relationship may change but because if it changes then he
    would have to change. Into what? How? With what resources?
    With what net? Once change has happened, doesn’t that mean
    other possibilities were obliterated? It is his possibilities he is
    trying to beat down with your sclerosed dreams.

    All that matters is keeping the relationship intact. Even if you


    both end up miserable, better misery and stability with him
    than the tachycardia of something else, something unknown,
    something he can’t control or defend against.

    Do you know this guy? You think you do.

    This is what you need to know: the boyfriend I’m describing


    isn’t Tom, the hipster who’s number one on your speed dial.
    And no, I’m not directing this at you, man-boy, I’m not saying
    you are doing this to your woman, though you may be. At any
    moment there is only one person in the room no matter how
    many people are in the room, and that one person, you, is
    lugging around the same man you’ve lived with for years. The
    abusive boyfriend I’m describing is your unconscious, and
    Tom has nothing on him, though Tom has, through the
    hypertrophied intuition of damaged men, figured out how it all
    works.

    The unconscious doesn’t care about happiness, or sadness, or


    gifts, or bullets. It has one single goal, protect the ego, protect
    status quo. Do not change and you will not die. It will allow
    you to go to college across the country to escape your parents,
    but turn up the volume of their pre-recorded soundbites when
    you get there. It will trick you into thinking you’re making a
    huge life change, moving to this new city or marrying that
    great guy, even as everyone else around you can see what you
    can’t, that Boulder is exactly like Oakland and he is just like
    the last guys. And all the missed opportunities— maybe I
    shouldn’t, and isn’t that high? and he probably already has a
    girlfriend, and I can’t change careers at 44, and 3 months for
    the first 3/4 and going on ten years for the last fourth, and do I
    really deserve this?— all of that is maintenance of the status
    quo, the ego.

    You think you’re with Tom by accident? You were set up.

    And when all else fails, it will beat you down with apathy. Or
    the Monday night lineup. Or pot. Or––––––-

    The men, or women, aren’t lying to you, and you’re not even
    lying to yourself. You are being lied to, by yourself.
    J Crew Ad Promotes
    Something That Some Call
    “Transgenderism”
    April 12, 2011

    I love how natural she looks


    The kid is Beckett, the son of the woman in the photo. Look,
    he’s wearing pink.

    Media commentator Erin Brown of the Media Research


    Center also had strong views, calling it ‘blatant
    propaganda celebrating transgendered children.

    ‘J Crew, known for its tasteful and modest clothing,


    apparently does not mind exploiting Beckett behind the
    facade of liberal, transgendered identity politics.’
    Before you jump in with your own ideas, ask yourself a
    question with a very obvious answer: do you think that photo
    is real?

    People are arguing over it like it’s hidden camera footage of


    this woman’s house. Do you think this scene wasn’t staged?
    How many takes did it require?

    Look at the ad carefully. What is it selling?

    You probably think it’s the shirt, but there are two products
    there: the shirt and the nail polish.

    Look carefully at that nail polish, neon pink. It doesn’t exist,


    not in that exact color, anyway. The color’s name is “Short
    Shorts,” and thanks to the magic of Photoshop it doesn’t have
    to look like this:

    Look at those crayons. Those are artificially enhanced colors.

    This isn’t to say it isn’t trying to promote transgenderism, or it


    is; but as an ad it’s telling you something about you vs. the
    products so we may as well listen.

    II.

    It’s Saturday, you don’t have to dress up for work. Yay! Hold
    on, that doesn’t mean you’re allowed not to dress up. No
    sweatpants for you.

    The woman in the ad is attractive but not in a vulgar, sexual


    way. Supremely comfortable with herself, her life. It seems
    effortless. And she’s the president of J Crew. And she has her
    son with her. She’s the product. The image. You don’t like the
    polish, fine, J Crew has other stuff to make you into her. In
    other words, she is you, the aspirational you. The kind of you
    that can say this:

    She doesn’t put her kids in front of the TV so she can get a
    minute to poop. She doesn’t have to.

    She’s the product, all those things around her are accessories.
    The polish is an accessory, and its color has been enhanced to
    better broadcast the message. The kid is an accessory, and he’s
    been enhanced to broadcast the message. Clean, vibrant,
    simple, alive, happy, fun.

    What’s going on in the ad? Now it’s 11:30 (Beckett sleeps in


    on the weekends, of course) and the art project is done and the
    coffee (french press) is so good it doesn’t need milk or sugar.
    Giggle. Lighthearted fun ensues, and the boy gets his toenails
    painted. Now, obviously, he’s a boy and he’s not the kind of
    boy to get his nails painted pink, it was all in spontaneous fun.
    But it’s not like anyone’s watching, it’s in a safe environment,
    where you can do whatever you want and no one makes
    assumptions. Dad’s not there. She can just throw her hair in a
    bun and be the kind of beautiful women like. “I love Anne
    Hathaway.” Me, too.

    How much you wanna bet her nails aren’t painted neon?

    Of course not, that’s not her style. She’s not the kind of
    successful and stylish mom who would wear neon pink, either,
    but sometimes it’s fun to play. HA! That is fun. So why even
    buy the neon and the orange behind it if you’re not going to
    wear it out? Oh, because it’s fun, frivolous, like the crayons.
    The nail polish is crayons. And because, precisely, if you wear
    it, it doesn’t mean anything.

    III.

    “But surely J Crew must have known this photo would be


    controversial?” Ummm, duh.

    And controversy is publicity and blah blah, marketing 101.


    But the controversy serves to establish who you are not. First,
    if you’re offended, you’re probably not a woman. Do you see
    any men in the ad? It depicts a safe, comforting place for
    women. He’s not home.
    Or you’re not an attractive woman. Erin Brown of the Media
    Research Center might be a supermodel but she sounds ugly,
    doesn’t she? Or old. Yuck. Nothing clean, simple, or vibrant
    about that. Her Saturday’s probably involved planned
    defecations. That’s not you, the J Crew consumer.

    “But don’t you always say “if you’re watching it, it’s for you.”
    Why is Erin Brown watching it? Because the ad gives her a
    way of defining herself. Everybody wins.

    “But now there’s a possibility the kid may become gay, or


    transgendered.” The word you focused on is transgendered,
    the word J Crew wants you to focus on is possibilities. The kid
    with the painted nails is young, doing something out of the
    norm. He embodies possibilities, so J Crew embodies
    possibilities.

    If there is anything “bad” about this ad, it isn’t the


    transgenderism, but the Desire. You are different from her, but
    you desire to be her.

    The problem is that your desire doesn’t know the difference


    between real you and the aspirational you, and it relentlessly
    pursues the Symbolic. Desire is never satisfied, it is never
    fulfilled.

    That’s what J Crew is banking on.


    What Is A Real Man?
    April 15, 2011

    nope
    “Real Men Don’t Buy Girls” pretends to be a PSA against
    child sex slavery. What it really is an effort in rebranding.

    In this clip, you see Ashton Kutcher. If you had to find 300M
    Americans to be on a list of “Real Men,” and every person in
    America except for Ashton Kutcher had been eaten by a giant
    squid, Ashton Kutcher would still not make that list, ever. This
    isn’t to say he’s a bad person— he stuck with Demi
    (admittedly, not hard to do) and seems to have done right by
    the Willis kids— but he’s not in Jung’s Psychological Types.

    In the clip he’s disheveled, unshaven, he’s wearing a knit cap,


    he has dirty socks— real men don’t care about their
    appearance. But he can’t even fake it; his stubble is carefully
    maintained, and I don’t know any guy in the world who has an
    extra pack of socks available “just in case.” No guy buys socks
    unless they need them right now; if you see a guy picking up a
    pack, he stepped in a river. You see a guy buying underwear,
    he’s going to put them on in the car.

    Real Men, as defined in these ads, means 35+yo men acting


    like 10th graders. All of the men in the PSAs— Justin
    Timberlake, Jaime Foxx, Bradley Cooper— are unmarried.
    Kutcher is technically married, but in the PSA he “isn’t.” Yes,
    he’s wearing a ring, but the room is obviously only for him.
    There are no decorations; the only visible book is “Travel As a
    Political Act” which they give you free at high school
    graduation. There’s a crumpled shirt in the corner, waiting for
    Saturday when he can take it to his mom’s.

    Here’s Bradley Cooper reprising his Hangover look, and you


    can tell he’s a Real Man because he eats breakfast cereal.
    Meanwhile, he eats it out on a deck that no guy has and
    crosses his legs the way no man ever does.
    I know Jaime Foxx is a real man because I saw him in a Kanye
    West video pretending to be Ray Charles singing about
    bitches. Also, he drinks beer because that’s what real men do;
    never mind he puts the beer to his lips like he’s a bulimic
    actress fumbling her way through a Doritos commercial.

    All of these “real men” are pretending to be what they think a


    “real man” is. But it’s clear that they have no idea what that
    means— so they go for image.

    The end of the ads puts each actor’s face in a picture, and then
    cuts to other real men— Die Hard Bruce Willis, Cowboy Tom
    Selleck, Han Solo Harrison Ford. Those are all fictional
    portrayals of real men. But by putting Jaime, Bradley and
    Ashton next to them, they inherit the branding.

    All of this is conscious, purposeful emulation of images. If I


    don’t shave; if I act like John McClain; if I am single— then I
    am a real man. It doesn’t work. The ads grossly reveal how
    obviously they are faking it— even though they actually are
    real men. What makes them not real men is precisely the
    conscious pretending to be a real man.

    That last part is the important piece. Here’s an example: the


    one thing Ashton Kutcher has done in his life which is
    indisputably evidence of being a real man is that stayed with
    Demi and helped raise and support her kids. Say whatever else
    you want about this egomaniac, that is a real behavior that is
    of real consequence, that is the essence of “real man.” But
    Ashton himself doesn’t see that— he even tries to hide it.
    None of these people do. Maybe because they’re actors,
    maybe because they are part of The Dumbest Generation of
    Narcissists In The History Of The World— they cannot help
    but put appearances over behavior.

    Note also that at the end, it is a woman, a super hot It-Girl like
    Jessica Biel or Eva Longoria, who judges what a real man is.
    That gives them considerable power. We the viewers
    understand that it is their sexiness that lets them be the judges
    of men, but did anyone notice that they also become the ones
    to judge who is a real woman? Hence their endorsement of
    Arianna Huffington and Randi Zuckerberg(?!) And in that
    endorsement, the It-Girl brands herself as not just a pretty face
    — smart by association— after all, she was smart enough to
    choose Randi Zuckerberg and not some dumb model. It’s
    transparent and patronizing, and a lie. Does she actually
    believe she can convince men that Randi Zuckerberg is a “real
    woman” just because she said so? The answer is yes, she
    believes it. Since she can judge men, she can also judge
    women.

    So what have we learned from these ads? Real men are image;
    real women are hot, or liberals.

    See also Does The “Real Men” ad work?


    Why Do Autistics Score
    Poorly On The Eyes Test?
    April 24, 2011

    “I think she wants me.” Wrong.


    Asking what’s lacking in an autistic kid is like asking what’s
    lacking in a car. Fuel efficiency? Horns? A duck?

    There’s no consistency in diagnosis, even though the diagnosis


    is immensely reliable. That means that ten doctors will all
    agree a person has “ASD,” but that person may look nothing
    like the other people all who have reliably been diagnosed.
    This makes offering them treatment even more difficult.

    So we have choices: try to refine the diagnostic criteria, or


    create separable categories, or dig backwards in time to find
    the “neurodevelopmental deficits” that existed in common.

    Trouble is, even an identical, genetically determined, structural


    pathology— e.g. “larger cerebellum”— may result in different
    phenotypes as each kid will learn different strategies to cope.
    How, without the eye of God, am I supposed to tell if someone
    has it?

    II.

    “Reading the Mind in the Eyes” Test was devised by Simon


    Baron-Cohen, and revised in 2001 to improve sensitivity. The
    test is widely employed and widely criticized, but it’s useful to
    understand his logic first.
    The test is 36 pictures of eyes like the one above. The
    woman’s eyes, above, have choices:

    a) decisive
    b) amused
    c) aghast
    d) bored

    The test is here— but DON’T TAKE IT until you read this
    whole post first. A similar version for children is here, using
    the same eyes but different words:

    a) made up her mind


    b) joking
    c) surprised
    d) bored

    Here is a distribution of scores generated with normals:

    In this particular study, the “high functioning autism” group


    scored 21.9 +/- 6.6.

    What does Baron-Cohen think this test tests? One starts from
    the assumption that ASD is a neurodevelopmental disorder—
    i.e. a “static encephalopathy.” Something happened early, and
    though it may not be progressing, it is a physical limitation.

    The point of this test is to be able to detect, even in a person


    who appears normal, whether they have this “static
    encephalopathy.” Do they have true deficits in social cognition
    that occurred early but have been masked by learning?

    Hence the Eyes test. The test is NOT testing the ability of the
    person to read faces or interpret their emotions, that’s exactly
    the opposite of the point of it. People can have learned
    adaptive strategies to get at the right answer. This test is
    supposed to be immune to those tricks.

    This test was conceived of as a test of how well the


    participant can put themselves into the mind of the other
    person, and “tune in” to their mental state.

    Importantly, this requires that the person understand their own


    emotions and have language to articulate it, which is what
    Baron-Cohen and others believe is the core deficiency of
    ASD: the “absent self.” So to do well on the Eyes test, they
    must not be alexithymic. You can’t interpret the eyes as
    “judgmental” (lacking the “hints” that come from the mouth,
    forehead, context, etc) unless you understand that emotion in
    yourself. The relationship between alexithymia and low Eyes
    Test scores has been directly measured.

    For example: do psychopaths have difficulty “tuning into” the


    mental state of others, or can they do it just fine but don’t
    care? I’ve always felt the latter, and so I’d predict psychopaths
    do fine on the Eyes Test. They do. (Which, BTW, speaks to the
    legal question of sanity.)

    III.

    Is the test flawed, i.e., does it really detect these pre-learning


    deficits? Lots of ASD people do well on it, especially women,
    so the test may not be very sensitive after all. Can we at least
    say that those who score poorly do have the deficits in social
    cognition? That the test isn’t particularly sensitive, but it is
    specific?

    I have very little experience with ASD patients, but I had


    occasion over this holiday break to cover an ASD unit. An
    occupational therapist was explaining this test to me, and we
    showed some of the eyes to a 6 year old boy with ASD who
    was hospitalized (his second) for behavioral dyscontrol. The
    kid got several wrong, for example this one:

    Baron-Cohen’s theory of autism is predicated on a reduced


    ability to imagine the thoughts and feelings of the other person
    substantially because they cannot recognize them in
    themselves.

    So I took the ones he got wrong, and three others that he had
    gotten right, and asked him to guess again, but this time I told
    him to imitate the eyes himself. Doing it this way, he got them
    all right. All of them.

    Obviously, this surprised me. Admittedly, it was a slow


    process, but of interest was why it was slow. I watched him
    “get into character”— it took five or so seconds to sculpt his
    eye muscles, individually, into the proper configuration, but
    once he had done this the answer came easily.

    Which tells me that this kid has the ability not to “learn
    adaptive strategies” or “fake it till you make it,” but truly
    access his own inner state and then apply it to others, i.e. to
    truly empathize. What he seemed to be lacking is… practice?

    So now I ask you to take the test yourself; when you click
    “Get Score” it will show you the ones you got wrong. Cover
    the words, look at the numbers, and then go back and try to
    imitate the eyes for the ones you got wrong. Did it help?

    You might also enjoy:

    Are You Good At Reading Faces?


    Hop, With Russell Brand: A
    Life Lesson For 4 Year Olds
    April 25, 2011

    “Hop? I’m not watching that.” Well, your kids might, so


    you’ll want to know what narrative America is using to raise
    them. You may not be interested in pop culture, but pop
    culture is interested in you them.
    The Easter Bunny runs a huge candy factory, staffed by little
    chicks, and they make easter baskets and deliver them on
    Easter morning. It’s the family business, in operation for “four
    thousand years,” and he wants his son, EB, to take over
    (“someday, son, you will be crowned king of the Easter
    Factory!”)
    But the boy, EB, played by Russell Brand, is a slacker—
    running a business isn’t his bag, man. So he sneaks out one
    night and heads to— where else— Hollywood.
    The set up is basic enough but remember this is 2011. Kids
    don’t set off on adventure anymore, especially those who stand
    to inherit the motherlode. And what’s up with that? How do
    you make a 2011 American audience accept the existence of a
    corporate monarchy? How do you make transferring an
    enormously important institution to the oldest son okay with
    the 9% unemployment crowd, angry at corporate perks?
    There’s other trouble, too: while the bunnies have been at it for
    4000 years, so have the chicks. Generation after generation,
    they’ve been working in the factory with no investment in the
    company, no chance for advancement.
    So how do you make feudalism palatable to Americans?
    Answer: make the bunnies British, and it simply won’t occur
    to the audience that there is anything odd about the
    arrangement. So the Easter Bunny is British. Never mind he’s
    a German creation brought to us by the Amish.
    They put Santa Claus at the North Pole. Where should they put
    the Easter Bunny’s headquarters? Remember— he’s British.
    No guess? Easter Island. They access the massive
    underground candy factories by entering a secret door in the
    base of the statues.
    Now, you can be forgiven for thinking it’s just a clever/lazy
    use of the name, but they didn’t put Christmas on Christmas
    Island and make Santa’s tagline, “Crickey!” So is there
    anything else we should know about Easter Island?
    Well, the folklore of the land has it that there were originally
    two groups of people on Easter Island: dark skinned
    Polynesians, called Short Ears; and early white
    settlers/enslavers called Long Ears. You can take it from there.

    II.
    Over in America a parallel story is unfolding, but instead of
    feudalism it’s more late stage capitalism. Successful Dad has a
    successful adult daughter, and the rule in movies is if you want
    to depict a woman as successful, you make her super hot but
    put her in glasses or a suit jacket. “I just got a promotion!” she
    announces at the dinner table as the buttons on her blouse
    strain to contain her success. But Dad also has a slacker son,
    Fred, who’s 30 and has no valuable skills. But unlike EB, Fred
    has no legacy to inherit, and he doesn’t want to leave home.
    Wait a second, who’s that other kid sitting there next to the
    daughter?

    There’s an extra daughter there. She’s Chinese (=successful), I


    put her at 8. Why is she there? If the son is 30, figure that they
    adopted her around his college graduation. Hmmm. You
    almost think they adopted her because Fred was such a
    disappointment, and you think this partly because the only
    thing she says at the dinner table is, “sometimes I think you
    adopted me because Fred was such a disappointment.” Hush,
    child, “that is a very hurtful statement!” To Fred. Crickey. It’s
    a scene that would cringe you into tetanus if you weren’t
    distracted by the blonde with the successes. Phew, scene
    saved.
    Personal note: it’s a kids’ movie, so they have to sterilize
    everything. So we have a table with four adults eating a
    sumptuous meal, drinking from goblets, but not one person is
    drinking alcohol. Are there families in America that simply
    don’t drink? I don’t trust anyone not on probation who doesn’t
    have wine at their table; and, while we’re at it, I don’t trust any
    man who drinks milk. Keep your hands where I can see them
    and no, I am not letting my kids come over.
    So while creepy Dad drinks iced tea with lemon, he gives
    some advice to Fred. Guess what the advice is: settle. “Forget
    about ‘great’, just settle for a job that’s good.” Where have I
    heard that before?
    Mom agrees: “settling is fine,” she says wistfully. And she
    looks away dreamily. This may seem like a throwaway line
    except that delivered by an attractive middle aged woman it’s
    drowning in innuendo. America isn’t the land of hopes and
    dreams, it’s the land of no prospects and settling. Remember
    this, we’ll come back to it.

    III.

    We have to think about the dichotomy between the two


    families. The Easter business is serious business. It’s a family
    business, sure, but a huge one, employing innumerable chicks.
    But “someday, son, you will be crowned king of the Easter
    Factory” is the kind of thing Huffington Post puts as a
    headline to make you hate white people.
    Any chance we might inadvertently identify with the chicks?
    They’re basically indentured servants. Minimum wage, no
    benefits. Don’t Americans resent dynasties, nepotism? One
    chick— the foreman of the factory— wants to be the next
    Easter Bunny and retool the factory to make some chick-
    friendly treats. He tries to impress the boss with his skills, his
    ability to run the business. He works very hard, he even hops
    and wears bunny ears to show how serious he is.
    Meanwhile, EB, the true heir, couldn’t care less about the
    business, he squanders his advantages and turns up the music.
    So the chick gets resentful of EB and you can’t blame him:
    “enjoy your life of privilege,” he mutters under his breath.
    So even though post-Crash Americans might naturally identify
    with the chicks over the rabbits, in the movie the rabbits have
    to be the good guys and the chicks are the bad guys. So what
    do the chicks have to do to earn our hatred?
    I wish I was making this up: they’re Marxists. The main
    conflict comes when the chick leads a worker’s revolt against
    the Easter Bunny and take over the means of production, so
    right away you have the worst kind of bad guys. Now make
    that hatred visceral, make that chick different from us, make it
    natural to hate him. Making him a black chick would have
    been way too obvious and racist, so they went with the next
    best thing: they made him Hispanic.
    That’s right, the bad guy in this movie is Carlos, complete with
    Hank Azaria’s Dr. Nick Riviera Mexican accent, the face of
    organized labor. That’s what we call a bad guy.
    IV.
    Let’s turn to page 60 in the script like any good studio exec
    would. What’s the pivot, the script’s sell?
    Fred and EB have interrupted Fred’s Chinese sister’s school
    play. She’s Peter Cottontail, and sings, terribly, the bunny
    song. That would be a cheap Chinese copy of the original. It
    irritates EB, who stops the show and starts a duet with Fred
    that culminates in a full audience sing along of “I Want
    Candy.” It’s great, it’s American, and everyone’s thrilled. Well,
    maybe the little girl would be sad that she was interrupted and
    upstaged? They don’t show that. My mistake— they feature it.

    I can accept a talking bunny, but I can’t envision a scenario in


    which a grown man interrupts a school play, hurting the
    feelings of a little girl, that does not result in his being stabbed
    in the neck. But everyone in this movie thinks it’s great.
    She may be dressed like a bunny but she’s a chick, a stand in.
    Remember, she’s not the star of the family, is she? She was
    just there to keep the family afloat until he got his act together,
    and now that Fred’s stock is on the rise we don’t much need
    for her services. She is, after all, Chinese. And cut.

    V.

    EB gets his big chance to play drums on David Hasselhoff’s


    TV variety show. He’s in his dressing room, and a production
    assistant opens the door to tell him he’s on next. The
    production assistant is (human) Russell Brand. EB says under
    his breath, “hello, who’s this gorgeous devil?” Get it? Yes, we
    get it. But take it at face value: why would EB find a human
    male gorgeous?
    Remember, EB’s arc requires him to escape his legacy and do
    what he wants (drumming); and Fred’s arc requires him to find
    a career in a land where there aren’t any. So, in the final
    resolution of the movie, Fred decides he wants to be the Easter
    Bunny. That’s what he’s going to do with the rest of his life.
    NB this is a hereditary monarchy and he’s not a bunny. Also
    NB the actual Easter Bunny and his son are still alive. So?
    So EB and Fred form a partnership, hmm, an odd sort of
    partnership, officiated by his father who says this:
    “Place your fingers on the Wand of Destiny. By the power
    vested in me, I pronounce EB and Fred O’Hare… co-Easter
    Bunnies!” And everyone cheers.
    Where have you ever heard the words, “by the power vested in
    me?” That’s right, it’s a domestic partnership, a marriage of
    sorts, and rather than try and un-pc figure out which one’s the
    girl and which one’s the boy simply observe that person B
    finds actualization by completely subsuming his own identity
    into the business of person A, who in turn gets the leisure time
    to pursue other interests (like drumming.) That, my fellow 4
    year olds, is an American fairy tale.

    (reposted/edited from partialobjects)


    What Should Really Be Done
    For Autistic Children?
    April 28, 2011

    if only he had been diagnosed earlier

    Though not my field, my recent experience (N=1) lead me to


    ask myself, and now you, a terrible question.

    There are numerous modalitlies and medications and theories


    that are used to help autistic children. You try to find a
    treatment program that suits the child and the family, and you
    begin; then ordinary life intrudes: missed appointments,
    effective medications aren’t well tolerated; unforeseen
    consequences, etc.

    So I wondered: given unlimited resources, unlimited access,


    the best “clinicians” available in the world— what could be
    done? I don’t just mean rich parents; I mean someone like the
    president of the United States, with enough clout to be able to
    command the attention of anybody he wanted. What’s the best
    possible outcome? It seems like we should know what that is
    before we move to a general approach.

    For ease of discussion, let’s just take the simple(r) case of a


    high functioning Asperger’s boy. Bill, age 6, has social delay,
    speech and language delay, motor coordination problems but
    most major milestones hit appropriately, and no intellectual
    deficits. Struggles with empathy, with articulating emotions,
    acts out when frustrated. Fails the Eyes Test.

    Is there a theoretical maximum to improvement? I can predict


    remission, “cure,” in depression. Is it possible to take Bill and
    make him into an adult who would not be detected as ASD on
    objective testing? (Let’s leave aside whether other people can
    tell there’s “something about him.”)

    If the answer is yes— that using the best of the best of all of
    the world’s resources a child can eventually “lose the
    diagnosis”— then the terrible question I asked is, does the
    treatment itself cause even worse damage?

    Here are some of the structural problems of the treatment:

    0. The diagnosis will make the parents want to try and help
    the child. This is axiomatic. No parent with access to services
    will be told their kid has a diagnosis of “PDD” or Asperger’s
    and say, “not interested, let’s wait a few years and see how this
    goes.” Once a diagnosis is made, the psychiatric juggernaut is
    activated.

    1. The race against puberty. That’s how long you have to


    teach meaningful coping strategies before the gigantic burden
    of sexuality and adolescence hits you in the face. So let’s agree
    that the majority of the work has to be done in childhood;
    parents won’t wait.

    2. Do you tell the school? Remember, these parents do not


    need the school to access services, they can get them on their
    own. Should they tell the school anyway? We talk about
    stigma, but the more dangerous and pernicious force is the
    contextualization of all behavior. Even if we predict
    “remission” by age 18, the existent diagnosis of ASD alters
    how they see him. If the kid fights another kid at recess, it
    could just be a fight, but it will be impossible for the school to
    see it as anything other than a manifestation of autism. The y
    may not treat it differently this time, but the kid is always
    going to be operating from a defensive position.

    3. The treatment harms self-esteem. Sending a 6 year old to


    psychiatry and etc is fine, but as the kid gets older and
    understands the social interpretation of psychiatry, it is likely
    to be a blow to his self-esteem. (True?) And as the kids get
    older, they may make fun, or just treat him differently. Does
    treating autism lead to marginalization, poor self image, and…
    depression?

    4. The treatment is necessarily ab-normalizing. The best


    treatment probably includes different things, e.g. play therapy,
    social skills group, horseback riding— again, I am positing
    access to the “dream” treatment plan. All of those things take
    up time. When does the kid get to watch Secret Of The Kells
    and play Legos instead of “you only have time for one, we
    have to get to Dr. Miller’s by 4”? At some inflection point the
    treatments are taking time, energy and interest away from
    ordinary activities. Does he lose by not having them?

    5. Other parents. Posit again that this treatment works, it


    makes the kid completely “normal” by age 16— as defined as
    undetectable on objective testing. He has, however, been long
    identified as in intensive treatment. When the kid is 16, what
    parents are going to allow their daughter to go out with “the
    autistic kid?” I wonder if parents would much sooner let their
    daughters out with the “odd” kid (who never got treatment)
    then the perfectly normal kid with a diagnosis.

    Etc. Certainly at the low end of functioning services become


    more valuable, but at some higher end of the spectrum… does
    intervention cause (un)forseen consequences?
    Neither is this a question about “too much of a good thing.”
    The question is: is the mere activation of the psychiatric
    infrastructure more harmful than helpful? If Bill Gates had
    been diagnosed… then what?
    Osama Bin Laden Has Been
    Killed
    May 5, 2011

    but he says…
    Early Monday morning I heard the news: “Navy Seals have
    killed Obama.” Ha. I knew what they meant.

    The view from my chair: my very first thought was that this
    was a scam. How convenient. Any pictures? No. Video? No.
    Body? No, that was dumped in the sea. Sea? What sea?
    Pakistan has a sea?

    The more I watched the various news anchors gloat about


    Obama and the Special Forces and “the turning point in the
    war” the more I became convinced I was being lied to. I’ve
    seen Fog Of War, Network, Three Days Of The Condor and
    Independence Day and I know a long con when I see it. Unless
    I could see the imprint of the bullets, and put my finger into
    the wounds, I wasn’t going to believe it.

    But something nagged at me. Why was I so suspicious? Why


    did I need to see the body for myself? What was it that made
    me think there was something deeply wrong with the story I
    was being told?

    And then the answer hit me: I drink too much. Rum. And I
    don’t sleep. I’m also not a very good person.

    Did I really need to see the body to believe he was dead? It


    was information bias supercharged with arrogance: I’m going
    to be able to tell it’s him? Me? Really? Forget about CGI and
    make up and look alikes— they could show me a picture of a
    female puma and say it was bin Laden and my only
    contribution would be, “damn, dialysis is hard on a mofo.”

    II.

    The first step in recovery is admitting you have a problem. Ok,


    I have a problem, but it’s not all my fault.

    It’s impossible to hear the news about his death and not feel
    some sense of payback; but it’s also impossible not to hear the
    news reporting and not want to punch something electronic.

    None of them reported the story. I don’t just mean how much
    they got wrong, I mean every one of them used it as an
    opportunity to explain how awesome they were.

    Some examples, not too many, you need your strength:

    Start with the media outlets and politicians that were fooled by
    the fake bin Laden death photo. I’m not concerned that they
    were duped, fine, female puma, but I am very concerned that
    they didn’t google the photo to see if it was a fake?

    Congressman Scott Brown said, “Let me assure you that he is


    dead, that bin Laden is dead — I have seen the photos.”

    Ok, so he was fooled, fine, the guy doesn’t work for Adobe.
    But why did he then say about the photos, “If it’s to sell
    newspapers or just have a news cycle story, no, I don’t think
    they should be released.” What? How did he see them, remote
    viewing? He saw the photo on the internet just like everyone
    else— or does he think he has a secret internet? Actually, yes:
    he saw them on his Blackberry, which is totally different.
    What this shows you is that there’s an airhead gap between
    politicians and journalists and the rest of humanity. They have
    not yet connected the world of the internet with their own
    world; yes, they’re aware their internet is the same as ours, but
    they think they’re seeing something we can’t see by virtue of
    who they are. They’re privileged. And they’re going to remind
    you of that special privilege every chance they get, which is
    why you see so many news reports about news reporters.

    I’m exaggerating? This is what Scott Brown then said, out


    loud, to people with microphones:

    [President Obama] made the ultimate decision and he


    made a bold decision. I have a handwritten note to him to
    that effect.

    That’s where his head is at. Bin Laden is dead, and he is


    bragging to the press about a note that he wrote.

    The myopia isn’t exclusively self-aggrandizing; sometimes it’s


    just ignorant. This morning, Senator Schumer was interviewed
    on CNBC “live at the WTC site.” As he’s crowing about “yes,
    we have increased electronic surveillance but there hasn’t been
    another attack,” he adds, “remember, right after the attack we
    were all worried this area would become a ghost town. Now
    look at it… young people are moving into high rises.” Do you
    see? He thinks the young people are finally over their fear. But
    those young people were in high school when 9/11 happened.
    They’re don’t remember it as “yesterday,” it was two lifetimes
    ago, and right or wrong they’re not afraid of “another attack”
    in the way a 40 year old is. Do you expect a person who has
    no intuition about “young people” to be able to think long
    term, for the benefit of three generations out? If you show him
    the digits “2097” he gets vertigo and falls down.

    III.

    Over at basic cable the Mayan Calendar was coming to an end.


    CNN jumped at the chance to offer breaking news— about
    which they had no actual information, much like its reporting
    on 9/11. But you have to fill the time; so they ran a seven page
    story, only three sentences of which had anything to do with
    bin Laden’s death. CNN did, however, make up for it by
    running a poll:

    Do you think bin Laden is in Hell, or don’t you think so?

    a) in Hell
    b) not in Hell
    c) don’t believe in Hell
    d) not sure

    It’s been a long time since I infiltrated IVCF to penetrate a


    girl, but isn’t publicly answering this question in the
    affirmative 1 Cor 4:5 proof that you lack God’s grace? I’ll
    save you the look up: yes.

    Fox News was in a full blown existential crisis: “yay he’s


    dead! Whoa— son of a bitch, Obama gets the credit?” It was
    as like a man thrilled that he finally got his hot wife to have an
    orgasm, but unfortunately it was by letting a black man have
    sex with her. That’s right, Fox News is a cuckold. They
    dutifully gave Obama credit for “giving the order” but
    reminded everyone that it was Bush era policies (and later
    waterboarding) that gave us the intel. See how I said intel?
    That makes me sound smart.

    Jon Stewart isn’t a news guy. I know this because he keeps


    telling me he’s not a news guy, yet 1.6M people get their news
    from him and there’s is no detectable difference between him
    and Keith Obamaman. Here’s what Jon Stewart said:

    Last night was a good night, for me, and not just for New
    York or D.C. or America, but for human people. The—

    Stop the tape. Nobody move, stop, have a drink, I insist you
    really meditate on the enormity of this man’s monologue. Why
    is it such a good night? It has to be duh, right?

    The face of the Arab world in America’s eyes for too long
    has been bin Laden, and now it is not. Now the face is
    only the young people in Egypt and Tunisia and all the
    Middle Eastern countries around the world where
    freedom rises up. Al Qaeda’s opportunity is gone.

    Ad hominem is not my style, but here it can’t be helped: this


    man is an idiot. This is what he wants us to believe he
    believes? Right before he closes his eyes at night he says to no
    God, “phew, now Americans can look at Arabs more
    realistically?” Never mind that who he thinks “the young
    people in Egypt and Tunisia” are bears no resemblance to
    actual young people in Egypt or Tunisia or anywhere on the
    planet except his audience, none of whom are in Tunisia, and
    none of whom will every rise in revolution to fight for
    freedom, ever. Not unless Steve Jobs tells them to.

    The whole thing, from the politics to the news reporting, is set
    up not for the conveyance of information or truth but of image
    and feeling.

    IV.

    In this content vacuum, in this total avoidance of substance in


    order to project personal image, how can anyone be faulted for
    not reflexively distrusting everything they hear?

    It doesn’t help that the government and media want me to


    believe it’s not staged, that they wouldn’t stage it, even as they
    stage stupid things that don’t need to be staged. When you
    watch the President give a speech, you’re watching him give a
    speech. When you see a photo of him giving a speech, you are
    seeing a photo of him re-enacting the speech he gave— just
    for the still cameras.
    “No, you’re misunderstanding. It’s not a great system, but the
    cameras are too loud to use during the actual speech. There’s
    no other way to get the photo.” No, you’re misunderstanding:
    no one cares about the photo. Do you really believe we want a
    fake photo of an event you couldn’t attend? Oh.

    V.
    And then there were the slips of the tongue:

    “Obama has been killed in Pakistan.”

    “President Obama is dead.”

    It happened enough times for it to be significant, and, as usual,


    significant in a way that the media missed.

    What everyone wanted it to be was evidence of a Freudian


    slip: an unconscious desire pushing itself into verbal
    expression.

    But that’s not what a Freudian slip is, really. A Freudian slip
    serves the purpose of discharging energy, either anxiety or
    desire, whose origin is unconscious. If Blake Lively is nude
    and says, “would you mind helping me get dressed?” and the
    guy responds, “oh, sure, I would love to bone you!” that’s not
    an unconscious desire, that’s a perfectly conscious desire that
    he accidentally said out loud. If he says it, the unconscious slip
    isn’t that he wants to bone her, but that he wants to tell her he
    wants to bone her. In other words, he’s scared of her; the slip
    discharges that anxiety.

    Substituting “Obama” for “Osama bin Laden” is straight up


    cognitive psych, yo. Substituting a less common word for a
    more common one is a Freudian slip; a more common word
    for a less common one is a problem choosing what word to
    choose for a linguistic unit. Not

    “<man> is dead.”

    but

    “<word for arch-nemesis or bad guy> is <word for expired>.”

    In the Mad Lib that is his brain, “Obama” is more accessible


    for “bad guy” than “bin Laden.” I’ll let you work out the
    implications.

    VI.

    What’s going on that people are so suspicious— or so sure—


    just because it happened during Obama’s Presidency? Grant
    me that you stick Bush in there, and everyone switches sides.

    “People have good reason to be suspicious, the government


    has a track record of lying to us.” Agreed. And I don’t need to
    be reminded that Afghanistan has a trillion dollars worth of
    precious resources like lithium and adamantium that we’ll
    need for future facebook phones. They can’t tell us they want
    that, so they pretend it’s for something else. Right?

    But the practical problem is that when we are forced to divine


    the “real” motivations for politics that changes the behavior of
    the politicians in unexpected ways: it doesn’t make them less
    likely to wage war for oil and say it’s for democracy; it makes
    them more likely to do it in secret. Hence your new CIA
    Director, supporting mercantilism one special op at a time.

    This is the pattern of abuse. Your father is manifest superego,


    if he tricks you or hurts you enough and you don’t trust him
    anymore, then you can’t trust anything. So you either find a
    proxy for a superego— a boyfriend, a religion, political
    ideology, Dianetics— or you recede into the comfort of
    narcissism. You surround yourself with image and images, you
    create narratives that pretend to explain reality but really
    protect your individuality (“I see what they’re up to, man!”)
    And you rot from the inside out, which is exactly the state of
    affairs in America. No outside force can touch us, but they
    don’t need to. They just need to wait it out.

    “Then they should just release the photos so we can trust


    they’re telling us the truth!” Slow down, Thomas, that won’t
    help your faith, which is the real problem here. “It’s a start.”
    You’re not listening. Not releasing the photos is getting you in
    the habit of not expecting photos to be released. Having
    terrible information mangled by the news media is getting you
    used to having terrible information mangled by the media.

    Of course I think bin Laden’s dead, because I haven’t yet lost


    all faith in “the system,” though a lot of people can be excused
    for being suspicious of a government that cries wolf.

    But when you repeatedly elect a government that cries wolf,


    the problem isn’t the government, the problem is you.
    The C Team
    May 14, 2011

    back in the day

    Monday was the 8-11 girls’ soccer (“you know, it’s really
    called football”) tryouts for the A and B teams.

    Her father had watched the practices. She was good, but was
    she A team good? It depended on the day. Precise and
    aggressive one day, distracted and chatty the next day. Some
    days she owned the ball. Other days she had to pee. And she
    was picking her fingers a lot.

    He had given her some helpful advice: dribble up the right


    sideline because those right footed girls will have a harder
    time getting the ball away from you. Also when you kick on
    goal kick knee height, force the goalie to have to bend down.

    He also told her that Hannah Montana (“Dad, that’s not her
    name”) was the evidently the dominant player on the other
    team, and when it looked like Hannah was going to go after
    the ball her teammates would hang back and out of her way,
    but that meant the ball was unguarded. That was a good time
    to go after it.
    It was the kind of advice he wished someone had given him
    back when it was his turn.

    II.

    Ok. There were four obvious A teamers, leaving seven spots.


    Call it 6. If Jane and Sue made A team, she’d definitely make
    it. Kathy and Claire were older and if they got picked because
    of seniority then there’d be only two or three open spots left.
    Tight.

    The Dad said this: whatever team you make, you have to earn
    it everyday. You make A but don’t keep up, they’ll send you
    down to B. Make B but work hard, and they’ll move you to A.
    (That’s life, he thought. That’s what this is all about anyway.)

    Besides, they’re not going to let someone too good be on B for


    very long because they’d dominate the game. The coaches
    want everyone to get a chance to play. (Sophistry in the
    service of the ego. That’s life, too, but it’s not a lesson he
    wanted her to have to learn.)

    III.

    Tuesday: no call. But Kathy heard: A team. Wednesday came:


    no call. Claire got A team. Wednesday night: Hannah Montana
    found out she was B. That made no sense. Other mothers
    checked in, they heard A team was filled. “I guess she made
    B,” they apologized in advance.

    Then there was the news: there were too many girls. Or plenty
    of girls. So the coaches created a C team. Uh oh.

    Thursday came.

    Then Friday.

    Then Saturday.
    Then Sunday.

    Then Monday.

    She went into school: everyone else had heard. “What’d you
    get?” Claire asked.

    “I don’t know.”

    “Oh. My. God. That means you got C team!”

    She picked her fingers a lot that day. If she made at least B,
    she promised herself she wouldn’t buy a soft pretzel with the
    milk money and wouldn’t throw out more than five of her
    grape unless… unless she finished all her carrots. And she
    would stop trying to control everything.

    When she got home her Dad was already coping with the
    news. “I’m so sorry. They said you made the C team.”

    She started not to cry. “That’s okay,” she said. It wasn’t.

    IV.

    This is another one of those times you make it as a parent or


    you move out because your presence is a biotoxin to everyone
    in the family. So: as terrible as it was, he could use it to make
    her into a better person. First the obvious lesson: failure
    happens, nothing is guaranteed. Life is competition. Parents
    and the government can’t bail you out of everything.

    Ok— facing her classmates and having to tell them that she
    was C while still maintaining her dignity— without hiding
    behind “we’re all special in our own way”– there was value in
    that. “What should I tell everybody at school?” she asked.
    “(Can I lie?)” No. “Just tell them: ‘I made C team. I don’t
    know how it happened, I feel pretty awful about it, but I’m
    going to make the most of it.’ Whenever you talk, be straight.”

    And of course she could get better. Let’s face it, she hadn’t
    worked that hard. It’s not like she drilled every day in her
    yard. Getting on A with only Saturday practice could easily
    make you think you’re better than you are, more deserving
    than you are, and when the inevitable failure comes from boys
    or grades or lotteries it crushes you right through your paper
    foundation. Next thing you know you’re 15 and one of your
    friends has an older brother who knows where to get some pot
    and how to have sex without getting pregnant.

    Starting from C and and getting to A is the biggest


    accomplishment, it’s what makes you a man. Or woman in a
    man’s world.

    V.

    “You have lots of potential. Nothing is set in stone. You’re still


    young. Practice, practice, practice. You can be anything you
    want.” He had plenty of advice, quite practical. Keep it
    coming. In this way he might avoid the thought: this is another
    thing at which she will not be exceptional. The thought came
    anyway.

    He had never wanted to be a soccer star, he hadn’t even played


    very much, but at 50 it was inevitable that he would never
    become a soccer star. Now his daughter wasn’t going to be a
    soccer star either which meant that he had failed at soccer
    twice. Another closed door just got boarded up.

    One by one his daughter failed or lost interest in the things he


    had never done. There was no time left for him to be
    exceptional at anything though his daughter represented a
    wide open future with millions of open doors. But she spent
    the first years of her life closing them. “How would vous like
    to go to un Francais immersion camp?” he had once asked.
    “French?” she had replied, reaching for a door, “I don’t
    know…” Slam.

    The only thing left for him was to become father of. “My
    daughter is a soccer star, ” he wouldn’t have to say, everyone
    would just know it about them. And he’d sit at the practices
    and give her advice and then afterwards a quick snack and off
    to violin, because she had the potential to get to Julliard if she
    practiced, and, crazy passing daydream, one day People would
    do a story about him.

    But it wasn’t going like he had imagined it would. Somewhere


    in his brain he had thought that maybe his daughter’s success
    would keep him from getting old. He had never been able to
    get off C Team, and the last thing left that he might be excel at,
    fatherhood, he was proving to be as mediocre as in everything
    else.

    When you are a narcissist, children, even the good ones, are a
    narcissistic injury. That story almost never has a happy ending,
    but it does end.

    VI.

    There is no redemption for him because the point isn’t his


    redemption, it’s hers, and you either get that or you don’t.
    Most people don’t, which is why there’s a C team at all.

    When she said, “that’s okay,” of course it wasn’t, and


    something in his brain shorted and he was able to resist all of
    his best impulses and instead just hugged her and said, “there’s
    not much I can say to make this better, but I love you all the
    time, all the time. So there’s this.” And he opened a bag and
    pulled out the next Harry Potter movie which she had been
    begging for every day, (“please please PLEASE!”) but at those
    times he had pretended to be the Dad that People would one
    day profile, “you have to finish the book first because I want
    you to learn that the books are always better.” Shut it, old man.

    Sometimes when a little girl is sad you just… fix it. And this
    time it made her smile so much and for so many reasons and
    after dinner they sat down together and watched it. That was
    all. It was about a boy who didn’t have a mom or a dad, and he
    had to make it all by himself, and he did.
    Soccer wasn’t going anywhere. But she was.
    How To Write A College
    Application Essay Or
    Personal Statement
    May 16, 2011

    Sometimes you know something but the full significance


    never makes it to consciousness, because your very soul rebels
    against the implications: we’ve been doing it wrong all this
    time?

    NYMag: You’ve Got Mail: Inside a top college’s admissions


    room. That college is Sarah Lawrence. Ring a bell? Some of
    you silly people will remember that Blair on Gossip Girl got
    rejected from there, but anyone over 30 will no doubt
    remember The Simpsons:

    Mr. Thai [Thai restaurant owner] to Bart: Put flyers


    on doorknobs. Then I get more business. Send daughters
    to small liberal arts college. Swarthmore. Maybe Sarah
    Lawrence. Call professors by first name. Dynamite!

    Bart later tosses them in the dumpster, and when the


    restaurant owner finds out:
    Mr. Thai: You a quitta! Quitta boy! Now restaurant fail.
    Children go to state college. Serious students powerless
    against drunken jockocracy. Baseball hats everywhere.

    Sarah Lawrence evaluates a student’s performance in three


    spheres: academics, writing, and “personal”, defined as
    extracurriculars and “other background.” I’ll leave the merits
    of “other background” to The Weekly Standard. The issue for
    us here is the college essay.

    Read this:

    Standardized tests are supposed to correct for the ways


    high-school grading systems vary, so to make up for that,
    Sarah Lawrence’s committee uses a sample essay graded
    by a high-school teacher to determine the curriculum’s
    rigor. But the samples also tell something about the
    readers. “I had one essay that said how awful Twilight
    was”—the essay was about damaging themes of female
    submissiveness in the series—“and I was like, ‘Admit
    her!’ ” says Melissa Faulner, a 2006 grad on the
    committee. Whereas what the readers wryly call TCML
    essays—“theater changed my life”—are looked at more
    skeptically.

    No doubt, NO DOUBT, critics of higher education and


    multiculturalism will jump on the implication that the
    committee leans left, way left, and will favor those applicants
    with similar predilections.
    WRONGINGONTHEFLOORLAUGHINGMYASSOFF. Read
    it again, you’ve missed something crucial.

    ‘Admit her!’ ” says Melissa Faulner, a 2006 grad on the


    committee.
    Still don’t see it? There’s a very good chance that the only
    person who will ever read your college essay is 25 years old.

    II.

    In every college admissions website, they are referred to as


    “Admissions Officers.” While I didn’t assume they were in the
    military, I suppose I did assume they were… old. er.

    And some are, I guess, there’s got to be an Admissions Dean


    in the building somewhere. But the average applicant is
    writing an essay that he thinks an adult with a suit and three
    kids would want to read. Instead, it’s probably being read by
    someone who can’t wait for the new iphone and still bites their
    nails. Ten grand says they think Jon Stewart is “a freakin’
    political genius.”

    But surely there are some adults on the committee? The article
    focuses on Tom Marlitt, director of West Coast Admissions.
    They don’t give his age, they give a physical description.
    Media— and The New Yorker is probably the wost offender of
    this— offers a physical description of their subject as a code
    about their character in exactly the way the media would never
    allow a regular person to do. If they profiled me it woudl start,
    “Wearing a disheveled undershirt clutching a rock…” and
    leave it to you to make an objective assessment (=“drunkard,
    likely unbalanced.”) What they say about Marlitt is: “a spiky-
    haired man in all beige.” That’s media code 50 year old acting
    like a 25 year old.

    Look, nobody likes 25 year olds more than me, especially ones
    that are too pretty to get into Sarah Lawrence. And there’s
    little sense in arguing the merits of college admissions being
    determined by a 25 year old vs. a 50 year old when the whole
    college game is a carny act that works only because we agree
    to pretend it does, runs FIFO, and is subsidized by the
    government. It is what it is.

    But if 85% of the applicants have already been weeded out


    before it gets to the committee, and they have been weeded out
    by a 25 year old, or a 50 year old who thinks he’s a 25 year
    old, it would make more sense to write an essay for a 25 year
    old. Not for a 50 year old, which is what most people do,
    employing the maxim, “What essay would make my Dad
    happy?” So you get: quote from some uncontroversial famous
    person; affirmation of one’s heritage/parents; generic
    sycophantic praise of the school; vague promises of changing
    the world.

    Admit him!
    Before you write your essay, profile your Admissions
    committee members. They, not “the school”, are the ones
    accepting you, and writing an essay for a theoretical
    “Admissions Officer” is like having sex with a theoretical
    “vagina.” Yes, it means you’ll be submitting different essays to
    different places, but this kind of information may save you
    from describing how much you admire Kissinger’s foreign
    policy:

    If you’re targeting a(n actual) 25 year old, i.e. someone who


    through no fault of their own has been conditioned to prefer
    brevity, appeals to emotion, and branding, here are the words
    you want to include in your essay: “sex” (as self-expression,
    not conquest), individuality, curiosity, hypocrisy, naked. 25
    year olds have hypertrophied BS detectors, so nothing
    contrived. Bonus if you can include some dialogue in your
    essay, everyone loves a supporting cast. Triple points if it can
    be read ironically, or if it is funny, especially in a self-
    deprecating way.
    Second Life Is A Second
    Chance, Which Is Why It
    Fails
    May 25, 2011

    my avatar

    A man makes a documentary about Second Life, the online


    immersive experience, as a way of commenting on the larger
    issues of internet addiction and escaping from reality. Is the
    movie good? No idea. Are you about to be lied to? Oh yes,
    bring a sandwich.
    This is what The New Yorker wrote:

    Ingenious… suggests the porous boundaries between the


    fictive and the concrete, the power of role-playing in
    defining real identities, and the risky self-discoveries that
    may result.
    Which, like everything else in The New Yorker, means Bush
    invaded Iraq under false pretenses. And Variety:

    A peerless study… every thread here raises a provocative


    question about the ethics of online interactivity, and
    serves to demonstrate the Web’s ability to both facilitate
    and destroy human relationships… a chilling window into
    the psychology of the internet-obsessed.

    There is something presumptuous, not to mention deluded,


    about a print magazine that no one reads claiming that a movie
    no one will see is a peerless window into something anyone
    can access anytime they want.

    II.
    Ponder that flippant run-on sentence for its hidden truth. Who
    judges whom? What are the criteria for becoming a judge? It’s
    not popularity; nor the sophistication of the staff and writers;
    or the insight of a director. In the hierarchy of authenticity and
    truth, which one is at the top? Why can Variety call someone
    “internet obsessed” but no one can call Variety a “comic book”
    which, as I am about to show, it is?
    There’s plenty to be said about the people obsessed with the
    internet. But Variety cannot— not will not, but is physically
    unable— to discuss it, because— well, let’s not get ahead of
    ourselves.
    This movie doesn’t represent a “window into internet
    addiction.” It represents the narrative, the way other people
    who are not internet addicted are going to think about those
    who are addicted.
    So here’s the obvious one, the typical narrative of the
    “normals”: on Second Life she’s a Fahrenheit 500, in Real Life
    she’s a fat chick.
    Dramatic music, and scene.
    The script, the editing, the music, all indicate that this is the
    message, to “normals”: “hey you guys, be careful when you
    log on to the World Wide Web, people aren’t honest.” Catfish,
    another documentary style movie about facebook, was also
    presented in this way. By normals, for normals.
    If you saw Catfish, you cannot help but be struck by the
    obvious: that normal guy is complete douchebag. But he can
    define himself as normal in comparison to someone else; and
    the bigger the scale of this comparison (e.g. a movie) the more
    true it is. So, phew, he’s not a loser for falling in love with a
    facebook profile, let alone driving to Canada or wherever she
    lived without telling her first, no, she’s a loser for lying to him
    about her appearance. Oh, that makes sense.
    he photoshopped her into his naked pic to show how real he is

    But since he made the movie, it’s his version that is the
    default. Yes, you can disagree with him, but the burden’s on
    you. Suck it. So, too, this movie: the message throughout is:
    “normal people are not like these people.”
    I accept it’s not their responsibility to be fair and objective to
    Second Lifers. But don’t for a second think you’re
    understanding anything about SL users. All you’re seeing is
    the filmmaker’s bias in HD: there’s real life, and fake life, and
    these people are pretending to be something they’re not. On
    the internet, no one knows you’re a dog.
    The thing is, no one on the internet cares if you’re a dog,
    unless they are interested in bringing that world into this one,
    which they are not. I run a quasi-anonymous blog, and for the
    most part no one cares who I am because it isn’t relevant to
    their reading of this blog; and my ego isn’t wrapped up in
    having people know it, so we’re all cool. This movie, much
    less Variety, cannot comprehend this state of affairs at all.

    III.

    The film shows a man and a woman finally meeting in real life
    after a long time together on SL. They are almost normal
    because they want to bring the relationship into the real world.
    So the man says to the camera, “it’s a relief that when we
    finally meet, she is who she says she is.” What could he mean
    by that? Of course, duh: she generally resembles her avatar,
    i.e. she’s hot.
    I think we’ve all been on the receiving end of a westbound
    Aeroflot flight praying Katya looks like her profile pic, so I
    don’t necessarily begrudge this guy his relief that she weighs
    less than he does. That’s not what makes him insane. This is:
    Second Life is completely fake, yet what attracted him to her
    in the first place was her sexy avatar. If her avatar was of a fat
    chick, he never would have connected with her on Second
    Life.
    That’s the thinking of someone who isn’t “addicted to the
    internet” who still thinks it somehow reflects reality. Those SL
    clothes are fake; that SL hair is fake. The way she SL kisses is
    pure game programming, not some derivative of her emotional
    experiences. Yet somehow he thinks it’s telling him something
    about the real her. Does he think that’s air he’s breathing?
    People who escape from reality into SL have a set of
    problems, obvious problems. But the people who want it to
    mirror this one because this one hasn’t given them what they
    “want” are truly nuts. Why are you reproducing this reality in
    that one? The black woman above says her in-game job is to
    create houses. Why? There’s no point. Your avatar doesn’t
    sleep, doesn’t shower, doesn’t anything. I may think it’s a
    waste of time, but the only reasonable thing to do on SL is to
    walk around and meet other people, create fantastical spaces,
    experiment. Using Second Life to shop at an American
    Apparel is like dropping acid in order to defecate.

    IV.
    Everything wrong with Second Life and other online
    diversions can be summarized by this picture:
    On Second Life, you spend a lot of time looking at yourself.

    V.

    But give the director his platform, let the subtext become raw
    text: What the hell is wrong with these people? What could
    possibly make them want to give up their real lives in favor of
    nothing?

    I wish they had just asked that explicitly, but then the movie
    would have to be redone with the cameras pointing in the
    opposite direction.

    When your wife withdraws into 8 hr/d of Second Life, are you
    completely blameless? Is there no human marriage she could
    have been in that wouldn’t have resulted in her making the
    jump to cyberspace? Louis CK: “When someone says, ‘I’m
    getting divorced,’ don’t ‘awwwww’ them, because it’s a good
    thing. No good marriage in the history of the world has ended
    in divorce.” Or in immersion in Second Life. Or constant
    facebook. Or porn. Or etc.

    Don’t confuse longevity with good. A marriage can last


    forever as long as the two fleshbots don’t have to interact long
    enough to hate each other.

    “Our real life partners don’t know what we’re up to,” some
    man says as his avatar makes out with some other avatar by a
    pretty lake. “As far as they’re concerned, it’s just some kind of
    game that we play.”

    I don’t need 3D glasses to see what’s going on in this guy’s


    life. He may be a tool, but that’s not why his wife doesn’t take
    the game seriously. His real life wife doesn’t take it seriously
    because she doesn’t take her marriage seriously. She doesn’t
    notice he’s on the computer all night and distant all day? Or
    doesn’t she mind, because she’s too busy with her own self-
    absorbed lifestyle, her void filled with [insert junk food here]?
    Look, if you’re going to make a movie about something you
    should at least make sure someone hasn’t already written the
    book, twice. The conceit of this movie is straight out of
    Baudrillard, but the director apparently doesn’t know it.
    Second Life is fake, but it’s fakeness is overt. While we shoot
    spitballs at the users of SL like jocks at a 9th grader in a 14ft
    scarf, the true purpose of SL, for us, for those who don’t use it,
    is to make us think that the real world is, indeed, real. That
    we’re cool. It disguises the fact that the world outside of
    Second Life is equally fake and manipulated, but in 3D. The
    real world marriage is fake, the words they say to each other
    are fake, the politeness is fake, the ideology is fake, and don’t
    get me started on the shoes. Nothing about it is real.
    I know, I know, when “Gallifrey84” kisses
    “ChasteForJondalar”, it’s just SL’s software simulating a real
    kiss; but back in the 3D world when that guy kisses his wife,
    that’s even more simulated. It isn’t even acting, which would
    at least arouse someone watching it. This “real” kiss is an
    instinctive, rehearsed simulation of what they saw on TV or
    used to do in the past. And no one would get turned on
    watching it. “But at least the lips are touching in real life.” So
    what? Your lips are real, you aren’t. So?

    VI.
    Second Life, as an immersive experience, fails because it isn’t
    immersive, it’s only two out of the seven senses (penis and
    vagina). So it is certainly a poor representation of real life. But
    FF three or four generations, maybe we get some holodecks or
    a fully functional Matrix. Now what? Are they running
    towards something cool or running away from something
    that’s not? You can’t get the answer without evaluating the
    thing behind them.

    The reality of it all is simple, which makes it very difficult to


    fix. These aren’t sick individuals, it’s a sick society. People are
    being squeezed like silly putty by the fist of branding. We see
    the “losers” oozing out of “reality” through the fingers— some
    of these losers go to Second life, some to porn; but there’s the
    others who are squeezed more into “reality,” into branded
    clonocity, their existence depends on no one looking at them
    from the outside and noticing that they aren’t actually
    individuals. “Huh? What does that mean? What? Speak
    English!”
    i.e. for example: most hot chicks, in order to be hot, copy
    something a celebrity wears; remember the Rachel-do? No
    problem, they look hot in it; but their delusion is that they are
    referencing Jennifer Aniston and not the millions of other
    women with the exact same haircut, i.e. that they draw their
    identity only from the celebrity’s identity— “This look really
    says me!” Yet sit along the wall of the bar and the conclusion
    is inevitable: yes, you’re hot, but you don’t look like Rachel,
    you look like the other hot chick right next to you. And,
    bafflingly, you did it on purpose.
    If she looks at you with sudden realization; or if she says, “I
    know, but I still like it,” she is free. If she looks at you like you
    don’t get it, like you’re insane, get out, you’re in the wrong
    bar, neither of you will ever be happy.
    3 Important Things About
    The New Wikileaks
    Controversy
    May 31, 2011

    um, yeah, this is the best picture from 2007 we could find for
    today’s Guardian

    Last week, Frontline did a documentary on Wikileaks which


    blew my mind. In it I learned Bradley Manning is gay. And
    short. And nothing else. No wait, about ten minutes in I
    learned I hate Frontline.
    enemies of the state

    I didn’t think anything could make me an Assange supporter,


    but it turns out that the enemy of my enemy is my friend.
    That’s right, I’m Alone.

    I.
    Assange wanted to leak to the NYT, Der Spiegel, and the
    Guardian. However, he wanted the NYT to publish first to
    avoid the U.S. charge that he was leaking info to foreigners,
    i.e. take advantage of the 1st Amendment. But the NYT
    wanted Wikileaks to publish first, so then it could simply
    report on what was leaked, rather than be a leak.
    These are probably legitimate concerns except for the fact that
    Wikileaks and the NYT are having this discussion explicitly.
    I’m not a lawyer but isn’t that racketeering? It is like a bunch
    of mob guys discussing who should be the one to do the hit
    based on their parole status. Assange:

    There was collaboration from beginning to end in terms


    of timetabling, researching stories, talking about how to
    understand data, etc., etc., embargo dates, the works.
    [NYT editor] Keller has tried to say we were just the
    source; they were a passive recipient… in order to protect
    themselves from the Espionage Act they needed to be
    completely passive, or be presented as completely
    passive.
    One man’s collaboration is another man’s conspiracy. So
    any collaboration between a journalist and a source,
    between one media organization and another media
    organization, can be viewed, the Attorney General Justice
    [sic] [Eric] Holder says, as a conspiracy that flows
    through.

    Assange is diabolically clever, I wouldn’t expect anything less


    from the self-aggrandizing Cobra Commander. He’s made this
    “collaboration” the point. Since they collaborated, the NYT
    can’t pretend they were passive recipients, so they must
    therefore defend the legitimacy of such collaborations in
    general.
    He’s holding the press to task: your job is to keep the
    government accountable.
    But they’re terrible at it, as evidenced by the fact that while
    they were “collaborating,” while they had all this juicy info
    sitting in front of them, the story the Times chose to run was
    one about… Bradley Manning.
    The New York Times must stand up, and it must hold the line of
    the traditional form of journalism, because if it is not
    protected, it will be the end of holding the national security
    sector to account!!!

    II.
    Remember Climategate? Sarah Palin had a public orgasm and
    4092 commenters blew up like Scanners. Climategate was the
    set of leaked emails that appeared to show climate scientists
    hiding data against global warming to suppress the critics; a
    global warming conspiracy.

    “Climategate is an interesting case [says the Frontline


    interviewer]. What’s the intent that you had when you
    leaked the Climategate e-mails?”
    The truth needs no policy position, so there does not need
    to be an intent. We have a framework, and the framework
    has an intent.

    This is exchange is so powerful it takes days to understand it.


    First, Assange didn’t leak the Climategate emails, which
    makes one of these two people a fibber and the other a fool.
    Assange did, later, host the data after the initial leak; and since
    it doesn’t affect the next point, let’s just move on.

    III.
    “Climategate is an interesting case [says the interviewer].
    What’s the intent that you had when you leaked the
    Climategate e-mails?”
    The truth needs no policy position, so there does not need
    to be an intent. We have a framework, and the framework
    has an intent.

    Assange believes that truth needs no intent, which is obviously


    false. Without a context, the truth can mislead. Excluding the
    context on purpose, when you know that it will be
    misunderstood, is often as good as lying. This has always been
    my/everyone’s concern about Wikileaks.
    But note the interviewer’s question: “what’s the intent you
    had?” That sentence is everything that’s wrong with the press.
    Here are the assumptions the interviewer has made:

    1. He assumes Assange believes in “global warming.” Why


    would he assume this? Because Assange is anti-U.S.
    government. So to the reporter, anti- U.S. government
    and belief in global warming go together.
    2. If Assange believes in global warming, the interviewer
    assumes Assange wouldn’t want to release those
    documents because it would hurt the cause. Even though
    Assange has repeatedly said how he wants “everything”
    public, the reporter assumes that Assange would only
    want to release things which complement his own
    personal biases. In other words, he assumes Assange is
    going to be like him.

    Which is why his incredulous follow-up question is

    But if you believed that we had a climate problem, that


    man was contributing to rising greenhouse gases — I
    don’t know, do you believe that’s a reality?
    He’s stumped, exasperated. Why would you hurt your own
    case? I mean.. you don’t doubt global warming, do you??????
    That’s the difference between Wikileaks and the regular press.
    For the reporter, climate change is not a scientific question, or
    else it wouldn’t matter what cables get released. It’s a political
    one, in which competing narratives are bolstered by
    circumstantial evidence and appeals to authority and control of
    the debate.
    Assange picks up on this and replies:

    I do not think anyone working outside of climate science


    understands whether that is true or not, because people
    simply do not understand all the complexities. Rather,
    instead we look to see who is the most critical voice.
    What are the motivations behind those people?

    Assange just dropped a truth bomb about science, evolution,


    psychiatry, energy policy, economics, etc: since most people
    have, at best, a college level understanding of the science but
    not nearly enough to appraise it themselves, the debate about
    science is really a political debate— no, a religious debate—
    adorned with the trappings of “measurements” and “data.”
    I would have preferred we try to “elevate the debate” and talk
    about primary sources; but he seems to think that won’t work
    on the public. So Assange will use intent as a proxy for truth,
    the closest approximation in the absence of really
    understanding what’s going on.
    The reporter thinks that intent is the only thing that matters.

    So you publish the truth regardless of what effect it’s


    going to have on the debate? Fair?

    Read that quote again. And again. And again. This man
    represents the Fourth Estate that decides what truth you’re
    allowed to read.

    IV.
    How can an organization go about doing things it shouldn’t
    do, but wants to?

    …we got hold of Guantanamo Bay’s main manuals, we


    discovered that there were sections outlining how to keep
    information from the Red Cross and how to falsify
    records in relation to Red Cross visits to detainees. And
    this really surprised me… who would be foolish enough
    to put in a military manual that that sort of deliberate
    fabrication…?
    But I came to understand why: that if you have a center
    that is devising policy, the center of a military [or a]
    commercial organization, and it wants to have that policy
    widely implemented, including by grunts, then it needs to
    go down in writing, because otherwise you just have
    Chinese whispers occurring, and the grunts can’t work
    out what it is precisely that they are meant to be
    implementing.
    Instead, [the grunts will] conduct behavior that is purely
    in their own interests, and the central policy gets
    distorted.

    That’s what the Cobra Commander thought, too, which is why


    he structured it like a traditional military operation. Regardless
    of whether your orders are good or bad, the only way to have
    them reliably executed is to make them official.

    So that’s a rather interesting understanding of how


    organizations really only have two choices to deal with
    transparency. The first choice is they can simply stop
    doing things that embarrass the public, so instead of
    committing an unjust act, commit a just act.

    Pass. What else you got?

    The other choice is that they can spend more on their


    security… they can take things off-record, speak orally
    and continue with this course of unjust action. But if they
    do that, they will become inefficient compared to other
    organizations, and they will shrink in their power and
    scale. And that’s also great because unjust organizations
    are in economic and political equilibrium and competition
    with just organizations.

    It is very easy, very easy, to decide whether what Wikileaks is


    doing is right or wrong. I don’t mean you’ll decide correctly, I
    just mean it only takes you a second to decide. Just like it took
    you with WMD and climate change.
    The hard question to answer is what happens now that
    Wikileaks is a reality. The wholesale release of secret
    documents is now part of our cultural foundation, like porn,
    coffee, cohabitation, English, pants, driving, football. These
    things will be with us for generations. Assange thinks that this
    reality itself— not the documents themselves, but the ability to
    access secrets, reduces the size and power of governments. Is
    he right?
    If online porn can be seen as the wholesale leaking of sexual
    secrets, then its effect on traditional sexuality— good and bad
    — may serve as an analogy worth pondering.

    The WSJ wants Assange indicted for competition


    An Education
    June 8, 2011

    Thanks, Jenny, you made it all possible


    This is the movie poster for An Education:

    If this looks terribly adorable, then there are spoilers below. If


    not, then there are no spoilers below. Take a minute and think
    it over.
    The movie is about a 16 year old girl in 1961 Britain, in her
    final year of “gymnasium” or A-Levels or sixth form or
    whatever they call it over there, wanting to “read English at
    Oxford.”

    Her father, an unsophisticated, stuffy, and concrete man, wants


    her to go to Oxford. Period. Not learn Latin or study
    mathematics or play the cello— which he insists she do— but
    do those things solely because they will get her into Oxford.
    He relaxes in a suit and tie and drinks only on Christmas. In
    other words, he’s an American parent. Yes, just like Amy
    Chua, which is why your reactions to them are identical.

    She wants to go to Oxford, too, but is perplexed and resistant


    to the purposeless of her life so far. Is the only point of cello
    just to impress the Oxford interviewer? She wants to live, read
    books and listen to jazz, go to Paris and Rome, eat good food
    in restaurants. That’s a quote.

    It helps that a) she is extremely pretty with not one single hint
    of threatening sexuality— so that women in the audience can
    identify with her; and b) super-intelligent and witty, so that the
    same women can assume that because of a), they are also b.) It
    also give the male audience a comfort zone— since she’s not
    sexy, there’s nothing creepy about me liking her. The absence
    of sexiness is vital to the misunderstanding of the movie, and
    to its appeal. We’ll come back to this.
    This is a movie about teenage rebellion, in the past. Whenever
    teen rebellion is depicted in present day, it’s teen becoming
    worse. When teen rebellion is depicted in the past, it’s teen
    trying to be better. NB: movies are made by adults who have
    kids.

    So our mythic hero receives The Call to Adventure. I’m going


    to try to describe it in the most neutral language possible, so as
    not to influence you, but I’m going to fail. Sorry in advance.

    As she’s standing in the rain one day, a man, about 35, in a


    purple sportscar drives up and offers her a ride home.

    At first it’s platonic, but gradually they fall for each other. He
    is sophisticated, worldly, eventually takes her to Paris, loves
    the Pre-Raphaelites, likes both jazz and classical, is the perfect
    gentleman. He has two equally worldly friends, a couple, and
    the three of them introduce her into a world full of life. The
    one she longs for.

    But at the midpoint the plot twist comes: he’s a thief. And a
    slum lord. And married. And now we get to see that she’s been
    tricked into throwing her future away for something that isn’t
    real.

    The question for you reading this right now is whether this is a
    “plot twist,” or is this “duh”? The movie makes his duplicity
    be the reason the relationship fails. But the relationship was
    doomed immediately, duplicitous or not, from the moment this
    psychopath pulled up in a sportscar and asked a 16 year old to
    get in. Of course I understand why she’d fall for it, but that
    doesn’t mean the audience is supposed to fall for it. In my
    imagination, the audience is looking at each other like wtf?
    seriously? But if the internet is any guide, people reacted to
    this as if it was a puppy rescue on CNN.

    “So what, if I see a 16 year old standing in the rain in my


    suburban neighborhood, I can’t give her a ride home?” It’s
    very simple: if you’re nervous about it, for her sake let her
    catch a death of cold. Just because bin Laden was married to a
    16 year old doesn’t mean it’s okay for you.

    I’ve watched the movie twice to be sure I’m not insane,


    though admittedly this is not a valid test. Yes, they slowly drop
    small hints that he’s not who he seems, but I am certain that in
    the beginning, the viewer is not supposed to detect anything
    wrong with their relationship. The only reason I assumed that
    the three of these sophisticates must also be cannibals is
    because I, me, can’t believe that three adults who lure a 16
    year old girl into their fold wouldn’t obviously be cannibals.
    My personal bias.

    The point I am making here is that this is decidedly not the


    bias of the filmmakers, and that is very, very, very creepy. And
    lazy. Didn’t they see Twilight before they shot a remake of it?
    II.

    If David’s arrival on screen is creepy, the father’s presence is


    nothing short of preposterously offensive.

    The movie wants you to see that he only cares about


    appearances, not her soul. He is the worst, utterly the worst,
    thing a Hollywood director can imagine: he is bourgeois.
    Here’s a media protip: the words “bourgeois” and “American”
    are always completely interchangeable.

    In being this, he is blind to his daughter’s true nature and an


    accessory to child rape. He grills and insults some poor teen
    who asks her out, but because David is a higher class person,
    he doesn’t try to find out anything about him, doesn’t ask if
    he’s on a list, lets him take Jenny out late and on overnight
    trips. He practically shaves her vagina for him. The father
    never even asks David’s last name. In fact, his only reservation
    about David is that he is… wait for it… Jewish. Oh, no matter,
    David charms the anti-semitism right out of him. Yes, it was
    that easy.

    Naturally, when it is discovered that David is married, her dad


    gets angry. He wants a confrontation, so he mans up: “right, if
    you won’t do it, I will. I’m still your father.”

    “Oh, you’re my father again, are you?” she says in the only
    line that makes sense in the whole movie. “What were you
    when you were encouraging me to throw my life away? Silly
    schoolgirls are always being seduced by glamorous older men,
    but what about you?”

    That’s your life lesson. The unique problem of raising kids is


    that not only will they hate you for not letting them do stuff,
    they will hate you for letting them do stuff they later regret.
    Choose accordingly.

    III.
    I don’t blame 16 year old Jenny for falling for the charismatic
    and sophisticated older man, of course I get it. And, to a point,
    I am not even surprised that the parents fell for him either;
    they wanted “the best” for their daughter, and he looked like
    the best. I can’t do anything about misreading a stranger.

    But what is their fault is that they misread Jenny. They never
    listened to Jenny’s words. They may be good or bad people,
    but they failed as parents in this specific way.

    Every time she explains why she loves David, or why she
    wants to marry him, or leave school, she says something like
    this:

    “I want to read books, and listen to jazz, and go to Paris and


    Rome, and eat good food in restaurants.”

    None of those things are descriptions of David. She may think


    she loves him, but to anyone who listens to her words it’s clear
    she loves the world he offers. That’s not a reason to love
    anyone, in fact, it is proof you do not love him. However much
    the parents want her to “marry well,” they should have heard
    these words and realized that she didn’t love him and that it
    inevitably wouldn’t last. That was their responsibility. David,
    if he was any kind of man, should have noticed and let her go.
    And any intelligent women seduced by the prospect of a man’s
    new world should describe her happiness in three sentences
    and count how many times his name comes up, and then return
    the ring.

    IV.

    The movie pulls off a clever trick: even after you learn David
    is a cad and a liar, you don’t really ever hate him. And that’s
    because you all Anglos have forgotten how to hate. You think
    your lack of hate is a evidence of your own sophistication and
    maturity; just as Jenny doesn’t hate him, she goes beyond him,
    you do, too. But you’re not being honest.

    Imagine the exact same movie, everything the same, but


    filmed entirely from his perspective. He sees a girl in the rain,
    and makes his move. Now you easily hate him, now you see
    him as a bad person. So why the change of heart?

    Similarly, if Jenny had been portrayed as superintelligent and


    witty but also as extremely hot— that single change and no
    other, e.g. played by Megan Fox, you would have immediately
    detected the corruption at the center of the movie and stoned
    David and his purple car.

    So the reason you don’t hate him in An Education is because


    you are deliberately not seeing reality objectively, you are
    choosing to see it entirely from her eyes, or have so identified
    with her that they are your eyes, which makes David merely a
    supporting character. That inability to value people as
    individuals, good or bad, to appraise their worth independent
    of yourself, is a characteristic which is excusable in a 16 year
    old girl, and inexcusable in anyone else.

    V.

    It’s evident to me that the filmmakers did not understand the


    true meaning of the tale they were telling, and I soon
    discovered why: they were telling a tale that had already been
    told by someone else. Lynn Barber, a writer for the Observer,
    wrote the original story about her own experience as a 16 yo
    Oxford wannabe falling for an empty Tiffany’s box. The
    stories are very similar, except for their final lines. This is how
    the movie ends:

    So I went [to Oxford], and I probably looked as wide


    eyed, fresh and artless as any other student. But I wasn’t.
    One of the boys I went out with— and they really were
    just boys— asked me to go to Paris with him. And I told
    him I’d love to see Paris. As if I’d never been.

    You can imagine her winking at a knowing audience.


    Here’s how Barber’s story ends:

    What did I get from Simon? An education… My


    experience with Simon entirely cured my craving for
    sophistication. By the time I got to Oxford, I wanted
    nothing more than to meet kind, decent, straightforward
    boys my own age, no matter if they were gauche or
    virgins. I would marry one eventually and stay married
    all my life and for that, I suppose, I have Simon to thank.

    Barber grew up. Jenny didn’t. But the movie thinks she did.
    The movie is called “An Education”, but Jenny didn’t get one.
    She is like so many other women who have deceived
    themselves into thinking they are wise. She’s still in her
    movie, ready for a sequel, same as the original. Jenny won’t
    ever be happy; fortunately for her, she’s not real.
    Are Antipsychotics
    Overprescribed To Kids?
    June 16, 2011

    does this make me look like I’m keeping an eye on waste?


    10 year study of inpatient kids: 44% got antipsychotics. Is that
    a lot? Yes. It’s a lot.

    And most of the time, not even for psychosis. 44% of the
    PTSD and ADHD kids got antipsychotics.
    You can wrack your brain trying to figure this out or blame the
    usual suspects, but the answer is right there in the article:

    Variables associated with antipsychotic use [included]


    male gender, age 12 years and under, being nonwhite, and
    a length of stay 13 days or longer.

    You’ll observe that none of those words is “diagnosis” or


    “severity.”
    The cause of these high levels of medications is so simple
    you’ll recoil from the truth of it, but pour yourself a drink and
    take it like a man: the kids showed up. That’s it. The kid is in
    front of you and you have to do something, now, that results in
    an acute change. Not better grades 4 years out, or less sadness
    over the teen years; change the sleep tonight, make the kid less
    hyper now, and when it “stops working” you can up the dose
    or change the med.
    It doesn’t matter what the diagnosis is or what the symptoms
    are, really, whether he ate his dog or got a C on a test he’s
    going to be getting something at qd and hs because that’s what
    you get when you put psychiatry as the cornerstone of a
    Multidisciplinary Treatment Team.
    When a kid is presented to a psychiatrist, the psychiatrist is
    pressured, obligated, to do something pharmacological. If a
    psychiatrist looked a single parent a joint away from a nap
    right in the eye and said, “nope, he’s acting out because of X,
    Y, Z, and medications aren’t going to fix this” that doctor will
    get his head handed to him by parent or by lawyer. Justice will
    be done, you negligent elitist.
    And the simple reason why the kids showed up is that the
    parents and the schools and the cops and the courts were told
    that’s where you go when a kid punches another kid or
    becomes hispanic. That’s why outside the oakwood offices of
    the private docs the shingle says “Practice of Psychiatry” in
    Palatino Linotype, but get within fifty blocks of a black kid
    and the whole thing is labeled “Behavioral Health” in what I
    think is Erasermate.
    This is why reducing antipsychotic prescription is a Chuck
    Grassley political diversion, if the kids don’t get
    antipsychotics they won’t get nothing. The problem is the
    overprescription of prescriptions.
    I get that when a 15 year old starts up with cocaine it is a bad
    thing. But is it automatically true he has ADHD or BPD and
    needs medications? Check the map:
    There’s a very large system in place for not doing what’s best
    for people, it is expedient and simple and the law but
    nevertheless ineffective and counterproductive in the long run.
    The trouble is, this system screws it up for people who
    actually need it. Just because a 10 minute med check is perfect
    for the vast majority of patients who don’t have any
    psychiatric illness, doesn’t mean it’ll work on the kid with
    prodromal schizophrenia and the crying parents who look at
    you like, wtf? Are you kidding me with this?

    An Epidemic of Mental Illness


    If this blog were a book you
    would give to someone else,
    what posts would you want
    in it?
    June 18, 2011

    I’d like to take some of these posts and compile them into a
    book.

    The posts would be reworked, sent to an editor, etc.

    What I’m looking for aren’t necessarily people’s favorite


    posts, or posts that hold up best over time. I’m looking for
    those posts you wish you could send to someone else, except
    that they don’t read blogs.

    Submit your suggestions any way you’d like (twitter, fb,


    comments here, email).

    Thanks for helping me with this.


    Louis CK on being a dad—
    the hidden piece of his
    happiness
    June 20, 2011

    It’s no secret I love Louis CK. He’s funny but insightful in a


    way only comics can be.

    And certainly sacrificing yourself, subsuming your own


    “dreams” and focusing on the dreams of your children is a
    thesis entirely consistent with this blog.

    So I write this with that love declared upfront.

    Here’s the missing piece of his PSA about being a father.

    A while after his leg fell asleep on the toilet, and before he had
    that epiphany to flush down his own personal dreams and
    devote himself to his kids…he had a divorce and moved out.
    I have no doubt he is a great father. But— and this is a big but
    — it is much easier to go all in with parenting when the courts
    obligate you to give the kids to someone else every night.
    Don’t yell at me, divorced parents, I’m not criticizing you, I
    realize you have other burdens. But if he hadn’t had the
    divorce, I doubt he would have made this PSA.

    So this isn’t a judgment on him at all. Maybe he’s able to


    focus so well on his kids because there’s no reason to try and
    steal moments away. He knows he will have a blocks of time
    that are free of the greatest killer of creative work:
    interruptions.

    And maybe modern married creative couples need to create a


    system or regular “breaks,” I have no idea. What I do know is
    that it is much easier to be two kinds of people at different
    times, then be two kinds of people at the same time.
    Is The Cult Of Self-Esteem
    Ruining Our Kids?
    June 27, 2011

    what does the author want to be true?

    The article is called How To Land Your Kid in Therapy, it’s in


    The Atlantic, and this is how it dares to start:

    If there’s one thing I learned in graduate school, it’s that


    the poet Philip Larkin was right. (“They fuck you up,
    your mum and dad, / They may not mean to, but they
    do.”)

    Get the rum, we’re going to need it. No, all of it.

    I.
    Lori Gottlieb is a writer for the various outlets that pose as
    intelligent— Slate, NPR, Salon, whose demo is people who
    use the word “inappropriate” and know there are no wrong
    answers. She also wrote a book called, Marry Him: The Case
    For Settling For Mr. Good Enough which roughly coincided
    with her never marrying anybody.
    Other than submit articles to The Atlantic, she did something
    else that a lot of confused, directionless people do: she became
    a therapist. Easy, everybody, hold that thought for a minute,
    we’ll come back to it.

    But soon I met a patient I’ll call Lizzie. Imagine a bright,


    attractive 20-something woman with strong friendships, a
    close family, and a deep sense of emptiness. She had
    come in, she told me, because she was “just not happy.”
    And what was so upsetting, she continued, was that she
    felt she had nothing to be unhappy about. She reported
    that she had “awesome” parents, two fabulous siblings,
    supportive friends, an excellent education, a cool job,
    good health, and a nice apartment… So why did she have
    trouble sleeping at night? Why was she so indecisive,
    afraid of making a mistake, unable to trust her instincts
    and stick to her choices? Why did she feel “less amazing”
    than her parents had always told her she was? Why did
    she feel “like there’s this hole inside” her? Why did she
    describe herself as feeling “adrift”?

    I was stumped.

    I’m not surprised. None of those variables have anything to do


    with happiness. Any way Lizzie has of identifying herself
    based on something she’s done rather than something she has
    or is? Any of those characteristics a verb? No? (1— read the
    footnotes later.)
    So I’m not surprised Lizzie is unhappy, the question is whether
    Lori, as her therapist, should have been surprised.
    Maybe she was, maybe she wasn’t but she spends 4 pages
    explaining that kids today are coddled, given everything,
    protected from harm/hurt/failure and squeezed into bike
    helmets, and this has the terrible effect of creating wandering,
    unfulfilled, depressed adults. Too-perfect parenting has made
    the kids soft.
    That may be the thesis of article, and it may be factually
    accurate, but boy oh boy is it not at all the reason she wrote it,
    or why it’s the cover story for The Atlantic.

    II.
    real cause of the ruin of children, what makes them into
    “narcissists” (her word), you have to look carefully at why this
    story is in The Atlantic. I don’t think even the lifetime
    subscribers in Westchester, NY turn to The Atlantic for the
    current scientific data in psychology, and no one turns to
    Gottlieb for parenting advice. They’re coming because they
    already know the answer they want to be true but want it
    stated more eloquently. What does it say better than its readers
    could, that confirms their own beliefs?
    Let’s go through it. When confronted with Lizzie’s
    unhappiness, what is the first thing Gottlieb considers?

    Where was the distracted father? The critical mother?


    Where were the abandoning, devaluing, or chaotic
    caregivers in her life?

    Bad parenting, ok, fair guess. But, as the title of the article
    reveals, it’s actually good parenting, overparenting, coddling.
    Do we all agree? Please observe that while this may be the
    opposite problem, it is in fact the exact same psychic solution:
    unhappiness is not your fault, it’s caused by someone else. Jot
    that down, we’ll come back to it later.

    Consider a toddler who’s running in the park and trips on


    a rock… some parents swoop in immediately, pick up the
    toddler, and comfort her in that moment of shock, before
    she even starts crying….
    “Well-intentioned parents have been metabolizing [the
    kids’] anxiety for them their entire childhoods,”
    [psychologist] Mogel said of these kids, “so they don’t
    know how to deal with it when they grow up.”

    The above consonants and vowels completely correspond with


    the preferred logic of Atlantic readers, but I’d like you to
    consider, for a moment, the kind of atrociously malignant
    parent that does not rush to comfort their toddler “even before
    she starts crying.” Are you raising a ninja? “I just let her feel
    the burn, get used to the sight of blood. Builds character.” Pass
    me that hammer, I want to build your character.

    No one who doesn’t eat human flesh would let their kid cry
    and do nothing. So what is the purpose of this logic if it
    actually defies reality?

    Take a second and consider the likely offenders of this style of


    “too-perfect,” rush to protect overparenting. Do they have
    mullets? No. Live in Daytona? No. Do they read Sports
    Illustrated? Guns & Ammo? No, they read The Atlantic.

    So the purpose of this article can’t be to suggest to its readers


    they are terrible parents, and anyway they already suspect
    they’re overparenting and that it is bad. They’re turning to
    Gottlieb and The Atlantic for therapy, to be told that they are
    indeed overparenting but it’s understandable… you have good
    intentions.

    III.

    And there’s an awesome, unintentional subtext: parents are


    overinvolved with their kids because they want what’s best for
    them, but this has the perverse effect of harming them, and
    so……….. it’s ok not to be. Why don’t you get a facial?
    It is certainly ok/infinitely preferable not to spend so much
    time with your kids. But saying you’re doing it because it’s
    good for the kids is like saying you’re getting an Asian
    massage because it’s good for Asians.

    IV.

    They didn’t rush because the kid can’t handle pain, but
    because they can’t tolerate the kid’s pain. They rushed to the
    kid’s side because it protects the kid, yes,, but primarily
    because they can’t handle the anxiety of it all. What’s my role
    as a parent? What do I do?

    I go through this because Gottlieb wants it to be true that the


    cult of self-esteem is ruining our kids, but the cult of self-
    esteem has already ruined the kids who are now adults. It
    produced her and her peers. And now they are raising new
    kids, well or badly I have no idea, but their main
    preoccupation isn’t with raising better kids but with self-
    justification. This fact is completely lost on her.

    As a parent, I’m all too familiar with this [entitled kids


    with too many options.] I never said to my son, “Here’s
    your grilled-cheese sandwich.” I’d say, “Do you want the
    grilled cheese or the fish sticks?”… He’d come to expect
    unlimited choice.

    Guess what six words she says next.

    When I was my son’s age, I didn’t routinely get to choose


    my menu, or where to go on weekends—and the friends I
    asked say they didn’t, either. There was some negotiation,
    but not a lot, and we were content with that. We didn’t
    expect so much choice, so it didn’t bother us not to have
    it until we were older, when we were ready to handle the
    responsibility it requires.
    This is laughable coming from anybody, but is she unaware
    that she’s written several books describing her own childhood
    psychiatric visits and teen anorexia? And serial dating
    culminating in nothing? If I were a therapist, I’d label this as
    “poor insight.”
    The kid’s problem isn’t that he is offered too many choices at
    all. The kid’s problem is that his mom believes these choices
    are the thing that will ruin him, that’s where she sees danger,
    not TV or Xbox or learning violence is always wrong, but in
    choice.
    There’s no insight about the dynamic effects of a mother who
    feels compelled to offer him meaningless choices— that she is
    discharging the anxiety of her own indecisiveness onto her
    kid. Fish sticks and grilled cheese may not seem like heavy
    decisions but there are consequences nonetheless, and if she
    doesn’t have to bear them, she’d just as soon pass them on to a
    four year old.
    I wasn’t there, but I will bet ten thousand dollars that every
    guy she has ever dated has had the following interaction with
    her:

    Guy: What do you want to do tonight?


    Her: I don’t know, what do you want to do tonight?

    and:

    Guy: I’m at Blockbuster, what movie do you want to rent?


    Her: I don’t know, what movie do you want to rent?

    Jesus Christ, just say Officer And A Gentleman and let me get
    out of this death spiral.
    Since she chose to go with doctor supervised immaculate
    conception, the kid now gets the job of sounding board for
    dinner choices. You know what choice she’ll never offer him?
    The choice to fight back on the playground or disagree with
    her. Being given the illusion of free choice when all of the
    choices are meaningless or terrible has a name, and they used
    to think it caused schizophrenia, so grant me that it probably
    drives some kids to therapy.
    A similar phenomenon is the parent who “has” to quit
    smoking, or drinking, or cursing, or whoring, or whatever,
    “now that I have kids.” So noble. Nothing better than making
    the kid a living replacement for your own hysterectomized
    superego. There is absolutely no chance, none at all, that your
    resentment of him will ever come through in your interactions.
    ESPECIALLY not when your kid one day tries these things
    himself. Impossible. Your parenting is rock solid.

    V.
    Along with the article, The Atlantic includes a video clip of
    Gottlieb interviewing another therapist. They did this because
    they are trying to kill me. If you want your head to ignite, fast
    forward the video to 1:05 and watch the next nine seconds,
    then call Universal Studios and tell them you’re the next Ghost
    Rider.

    It’s worth watching the video, but here’s what happens: brown
    haired Gottlieb introduces a smiling white hair and glasses Dr.
    Mogel, who responds:

    Mogel: Hi, Lori.


    (cut to Gottlieb)
    Gottlieb: I just wanted to start off and say, it seems like
    this idea of ordinary is so–-
    (cut to Mogel)
    The moment Gottlieb gets to the word “ordinary,” Mogel nods
    her head vigorously in agreement and then starts writing
    something down. WTF is she writing?? a) it’s an interview, b)
    Gottlieb hasn’t even said anything yet, and c) Mogel’s the one
    being interviewed!
    So obviously it’s a nervous thing, a reflexive gesture, sure, I
    get it, but what you and she don’t get is that every time a
    therapist writes something down it’s a nervous thing. They
    write to discharge their anxiety of too long looking into a
    person’s eyes and it not leading to either “I love you” or “I’m
    going to kill you.” I know this is going to run me afoul of
    every comfy-chair therapist in America, but there is no reason
    to write anything down, ever. You’re not a detective, you’re
    not looking for coded messages or lost time, the patient is
    there for answers and the structure of your relationship is itself
    the answers. Why does she like me? Why does she get
    bored/angry/expansive when I do this? Why did she continue
    with a therapist who is so uncomfortable around other people
    that they need a yellow pad as an emotional shield? Seriously,
    that’s not an accident at all, answer that question and the
    therapy is done, the patient is cured.

    We can discuss good and bad technique later; the point here is
    to establish that these two people are creating “environments”
    that are safe for themselves. It may also be safe for the patient,
    it may be labeled as “for the patient” but I hope it is evident
    that the real impetus is the comfort of the therapist. With me
    so far? Ok: that’s also how they parent.

    “Many of us went through psychoanalysis, and we


    learned the minutiae of despising our parents and all the
    horrible mistakes they made.”

    What kind of psychoanalysis did this woman pretend she went


    through? Only a two year old, a 16 year old or a narcissist
    hates their parents because of the less than perfect things that
    they did, and that anger, not the effects of the parenting, is
    where the focus of the therapy should have been. And yet:
    Let your kids hate you sometimes, it’s good for them.
    You don’t have to always have them agree with you or
    have them always like you.

    Note the phrasing— this is good for the kids, which is actual
    kids, not the adults-that-were-once-kids. Adults’ anger gets to
    remain justified.
    And it’s a lie anyway. Sure, it is good for the kids, but is there
    anyone who can’t see that the primary reassurance is for the
    parents who can’t handle being hated by their kids?

    VI.
    That Lori Gottlieb has had a life marked by free agency,
    drifting around from interest to interest, job to job, relationship
    to relationship; and having the unique luxury, first by parents,
    then by writing talent, of being able to afford such wandering;
    and that it all leads to therapy, not just as a patient but
    ultimately as a therapist— is not at all an accident.
    The old adage that shrinks go into shrinkage to figure
    themselves out sounds awesomely correct except that it’s
    incorrect and inawesome. They go into it so they don’t have to
    figure themselves out. Best way to avoid judgment is to
    become the judge. Overruled. I said overruled.
    The therapist has a sanction to create narratives, and there’s
    nothing better than being able to create a narrative that also
    defends your ego from all manner of attack. Actually, there is
    one thing better: be a therapist and a writer for The Atlantic.
    Now not only do you get to create the narrative, you get to
    make it the accepted wisdom. “I don’t fall for it, I don’t read
    The Atlantic.” It doesn’t matter if you read it, if anyone reads
    it, an article’s publication in it makes it the default intellectual
    position of middlebrow America, and so if you want to
    disagree the burden of proof is on you, eat it. She wrote
    500000 words justifying her depression as her parents’ fault
    but her overparenting the result of “wanting what’s best for
    my child” and now no one else has to, because it passes into
    conventional wisdom. “Oh, smart people are spending less
    time with their kids to watch Weeds.”

    It’s the same way that an advertisement for a TV show you’ll


    never watch can change the way you think about sex, because
    you think it is how everyone else thinks about sex, and now
    suddenly it is how everyone thinks about sex. The commercial
    — not the show— made it true.
    Gottlieb wants it to be true that overparenting and artificial
    self-esteem is causing kids to become narcissists, but that’s all
    defense. Overparenting doesn’t cause narcissism, narcissism
    causes narcissism.(2)

    Here’s what a therapist should say: “too perfect” parents who


    coddle and overprotect their kids aren’t doing it for their kids,
    they are doing it for themselves, in defense of their own ego;
    and that, not the bike helmets, is why their kids end up adrift
    and confused. The problem isn’t that kids are too wussy to go
    out and play, but that their parents do not trust themselves,
    their generation (“if I graduated Wellesley and I’m this
    stressed out, that other mom must be a pedophile”), their
    impulses and instincts, so kids must be dandelions made of
    cotton candy in a rainstorm made of lava, which makes no
    sense yet it makes perfect sense: paranoia. Ego vs. reality, and
    you can’t appraise either. And then one day your kid is
    punched by some bully raised by Nascar fans or baby
    mommas and you shut down the school because you think the
    problem is the bully. The problem is you. The bully may have
    punched your Edward in the belly but you mobilized a school
    district to DEFCON 2, who has more power? Who is the
    biggest bully?(3)
    The problem is you are in therapy not to become better parents
    or to do better work but to… to what? Do you have any idea?
    More than likely kids overcome all this, everybody finds their
    own way, but to those who feel stuck the only solution is to
    forsake all attempts at figuring out who you are, conveying
    who you are— because you aren’t anybody yet— and just
    accomplish stuff, yet be ready to discover in 50 years that the
    sum total of your life’s real accomplishments may be very
    different than what you expected, and it must be enough. In
    the irreplaceable words of Marshall McLuhan: “there’s
    nothing God hates more than some mofo with a cable
    subscription running out the clock.”
    That’ll be $250. You can pay at the window.

    You may also like:


    Marry Him! Or Don’t

    ––––––––––––––––
    – Footnotes:

    1. I’ve made this point before, but worth repeating: chronic,


    non-medical insomnia is a similar symptom of a lack of
    completion, accomplishment. All the usual suggestions
    (read a book, light exercise) are temporary
    accomplishments, which is why they work; and the other
    maneuvers (surfing the web, watching TV, drinking) are
    searches for something accomplishable. And nothing says
    accomplished like a Pornotron orgasm. Night night.
    2. A technical correction: the typical premise, articulated by
    Twenge (top of page) is that artificially elevating kids’
    self-esteem makes them narcissistic, grandiose. But
    narcissism is not synonymous with grandiosity, not even
    close, and anyway high self-esteem should make them
    happier, not more anxious. More accurately, the
    unhappiness comes not from thinking they are better than
    they are, and not even from the inevitable future failures,
    but from not being sure how good they are, if they are
    good at all. They are not sure what is supposed to define
    them. “How can you know what kind of a man you are if
    you’ve never been in a fight?” The important thing
    wasn’t to win. The reflex defense of existential anxiety is
    to define yourself against something, not “I am this,” but
    “I am not that.” And where this is most harmful is the
    avoidance of guilt. “Yes I did this, but I am not the kind
    of person who does that, you don’t know the whole
    story…”
    3. Before you remember/reinvent how it was back in “the
    old days”, here’s the “sad” truth we just need to accept:
    we’re never going back to the old way. There was a time
    you could slap your bitch or paddle your kids, and right
    or wrong you can’t do that now and you will never be
    able to again. It doesn’t matter if a little ass pinch at the
    office does improve productivity and morale, or treat
    zoster or prevent communism, it is never coming back.

    And the moment the nerds responded to a couple of


    wedgies with overwhelming firepower, the moment they
    made the bullying “this shit just got real” real for
    everyone else— right or wrong, sissy or not, bullying was
    done forever. If you’re 11 and you punch a fat kid, let
    alone a gay fat kid, it’s game over for you, they cancel
    your subscription to Weekly Reader and set you up for
    home schooling. Unless you’re in an inner-city school, of
    course, and then you get wrap-around services, 6 years of
    Adderall and extra time on tests. We can spend the next
    60 terabytes arguing whether this is progress or regress or
    whether America is soft or turgid, or we can stop wasting
    time comparing today to the day and just get on with the
    regular business of ordinary life.
    Jezebel Proves Scott Adams
    Is Right
    July 1, 2011

    (note to lawyers: I made this, not Scott Adams, and falls under
    parody, so bite me.)
    Scott Adams, Dilbert creator, sparked a feminist controversy
    of sorts, and then he asked for feedback from:

    Judge

    Psychologist (professional)

    Logic Professor

    Scientist

    etc, by which he meant: men.

    And he got a lot of feedback

    If you already know the controversy, skip right to III.


    II.

    Now consider human males… Powerful men have been


    behaving badly, e.g. tweeting, raping, cheating… The
    current view of such things is that the men are to blame
    for their own bad behavior. That seems right. Obviously
    we shouldn’t blame the victims….
    The part that interests me is that society is organized in
    such a way that the natural instincts of men are shameful
    and criminal while the natural instincts of women are
    mostly legal and acceptable… Whose fault is that? Do
    you blame the baby who didn’t ask to be born male? Or
    do you blame the society that brought him into the world,
    all round-pegged and turgid, and said, “Here’s your
    square hole”?

    That’s Scott Adams, writing the not original “men are


    oppressed in a female controlled society” argument. Men
    would naturally be raping and pillaging and wearing horn
    helmets, but the world’s not set up that way anymore, and its
    not set up that way by women. They have all the power, and
    they have restricted men from acting on their penile instincts.
    Here’s is the prototypical “feminist” response/censorship
    petition, from Change.org:

    Scott Adams, has written a blog insinuating that the act of


    a man raping a woman is a natural instinct and that
    society is to blame for these things, not the man who
    committed the rape.

    Which isn’t what he said, but, whatever.

    III.

    Let’s start with Jezebel, who, despite having the moral high
    ground and being staffed by people who are paid to practice
    writing about this sort of thing, completely botch it. If you
    want to increase understanding or bring people together, do
    not do anything close to what Jezebel does here.
    Jezebel’s response is typical of the way Americans argue
    politics and social theory: straw man and appeal to authority.
    It’s obvious the writer finds Adams’s blog offensive, and I will
    accept that she wants the world to be a better place, but no
    where does she make even an attempt to articulate why she
    finds it offensive. After she quotes Adams, she writes:

    Wow. Trying to make it sound like your argument falls


    under the category of “gender theory” while saying that
    “boys” are pretty much designed to be rapists and we’d
    better get used to it is…I don’t even know what it is
    anymore.

    And nothing else. There are other words, sure, but just like the
    above none of them refute his point, they’re just ad hominem
    padding, “he’s a jerk for thinking it.” I’m sure your regular
    readers agree, but for the dummies among us, can you perhaps
    explain why?

    Which leads me to suspect that she doesn’t actually know why


    it’s wrong, only that it is wrong. And to escape detection, she
    offers deliberate misreadings like “he’s justifying rape” so that
    she can follow it with “‘Nuff said.”

    Here’s the very practical problem: Adams is not alone in


    thinking that women are running the culture and men are being
    emasculated. If Jezebel’s goal is simply to insult him, fine, but
    tremendously boring. But if their goal was also to promote a
    vision of social equality, they’ve done the opposite. All they
    did was bully and insult him. “You’re a jerk, accept it! I said
    accept it!” But that power is precisely what he’s complaining
    about. So not only does it not convince Adams (or anyone
    else) what he’s saying is wrong, it confirms for him he is right
    about them.

    IV.
    Salon pretended to offer a reasoned response. Three
    paragraphs of fluff, then in the fourth paragraph she begins:

    There are two important rebuttals to be made here.

    Ok, finally, please proceed:

    First and foremost: thanks for all the gags about casual
    Friday, but Scott Adams sounds like he’s lost his freaking
    marbles.

    Hmm, interesting and unexpected point. And second?

    Second, as a colleague pointed out recently, remember


    the old sexist argument that women weren’t qualified for
    positions of power because their lady hormones would
    make them act all crazy and emotional?…You don’t hear
    that one so much anymore, do you?
    Adams, in contrast, represents a different extreme — and
    extremely lunkheaded — version of an alternate line of
    sexist thought. And in his own clumsy way, he articulates
    something many of us have heard repeatedly over the
    course of our lives, an argument that boils down to boys
    being boys. Left to their own devices, men apparently
    would just go about raping and pillaging all the livelong
    day, with occasional breaks for grilling and watching
    ESPN. They’re just being men, and doggone it if this
    pesky thing called civilization keeps getting in the way.

    That’s not a rebuttal, that’s unfunny sophistry. She’s basically


    saying, “not all men are rapists.” Again, no one disagrees with
    that; but the more nuanced reworking of Adams’s arguments is
    whether civilization is the only factor that prevents humans
    from falling into violent anarchy. After the fallout settles,
    should we should expect more rapes and murders, or the same
    number? That’s a very interesting question, one that goes to
    the heart of the justice system vs. poverty.

    But rather than have that discussion, Salon merely states, as


    self-evident, that Adams is a lunatic.

    That, in a backwards and poorly articulated way, is Adams’s


    point. Why is he required to justify and clarify and hedge and
    explain, yet Jezebel and Salon can make it axiomatic that he’s
    wrong? Because they control society?

    ( made by me, not Scott Adams)

    Jezebel and Salon have utterly failed to convince anyone who


    was not already convinced that Adams is wrong; and have
    reinforced to Adams, et al, that women are running the culture.
    If you want to swing back at me that it’s not Jezebel and
    Salon’s job to change people’s thinking, fine, but then what the
    hell are people doing reading Jezebel and Salon?

    It’s probably unnecessary but still completely worth pointing


    out that the only reason anyone is offended by Scott Adams is
    that he is Scott Adams the famous cartoonist, and not Scott
    Adams the retail manager at Best Buy.

    IV.

    So what is wrong with what Adams said? What argument


    might convince him that he is wrong, or at least help him
    release some of that anger?

    Adams seems to be believe that men are naturally sexually


    aggressive, and women/society put limits on their natural
    impulses. This is what Jezebel got wrong: he doesn’t believe
    this. He wishes this.
    And when he says society is a “prison” for men’s natural urges
    to penetrate random women like in caveman days, he is not
    really complaining about this prison. That’s what he wants. He
    wants it to be true that society is cockblocking him.
    Because if that is true, then it isn’t his own inability to score
    chicks that’s limiting him. “I’d love to just walk up to some
    hot chick in a bar and just take her home and bang her,” he
    might think, “but society doesn’t let me.” Really? Dude, you
    need to switch bars.
    Not being able to easily and fluidly pick up women is
    maddeningly destructive to many men, not tempered by other
    successes in their lives. We hear the refrain that media images
    create unrealistic expectations of women to be hot, etc, but the
    flip side is that some men can’t understand why everyone else
    seems to be able to hook up easily, freely, fun-ly, while they’re
    in the corner all boiling rage. Confronted with this, they have
    two choices: I’m inadequate, or the Matrix is against me. Men
    who don’t want to kill themselves choose b.
    Notice carefully and repeatedly that I didn’t say “have sex
    with.” The point isn’t the having of sex, the point is the
    convincing of someone to have sex with you. That, and not the
    sex itself, is a measure of your value as a man. The value has
    to be determined by someone else. If she thinks you’re worth
    it and she doesn’t know you, then you must be. The sex part is
    fun and best done standing up, but irrelevant.
    There are men who sleep with three dozen women and still
    think they can’t pick up girls, because they have an
    explanation for why each one didn’t count: she was drunk, she
    was on the rebound, she was slumming it, she was trying to
    make her boyfriend jealous…
    Note that Adams is a world famous cartoonist… and it is still
    not enough. Neither is the fact that he’s convinced at least one
    woman (wife) to sleep with him (“that doesn’t count, she loves
    me.”) Why? Because he hasn’t allowed those legitimate
    successes to define him (“that’s not who I am”— which is also
    why he is reinventing himself as a blogger), and so he’s
    trapped in the mind of a pre-cartoonist nerd, finding a scale for
    his self-worth in people who don’t know him’s eyes.
    What Adams doesn’t realize is that this world controlled by
    women, who prevent his fulfillment and happiness, does not
    exist; and that he thinks it does drives women, and at least a
    few men, bananas. But it is absolutely necessary to his
    survival that he believes it exists, or else all is lost.
    I’ll bet he has little cartoons taped to his office wall. He should
    replace one of those cartoons with a little yellow post-it note
    upon which he should write, with a Sharpie, seven words: you
    are being lied to, by yourself.

    –-

    Why is Tracy Morgan in trouble a second time? It isn’t what


    he said.
    When A Culture Is This
    Invested In The Lie, The
    Culture Is Finished
    July 6, 2011

    what does the author all of us want to be true?


    The title of the article is called, How To Spot A Narcissist, and
    it is similar to thousands of such articles about narcissism by
    being exactly the same thing.

    Here are some sentences from the article, taken entirely at


    random, see if you can detect the theme:

    Narcissists will be thrilled to hear that as a group they are


    rated as more attractive and likable than everyone else at
    first appearance…

    Tucker Max and his ilk stoke our attention and our ire —
    sometimes in equal measure. They are a decidedly mixed
    bag; therein lies one of the many paradoxes of
    narcissism…

    Women who score high on tests of narcissism


    consistently dress more provocatively than their more
    modest counterparts; male narcissists resort to displays of
    wit and braggadocio…

    A cross section of the narcissist’s ego will reveal high


    levels of self-esteem, grandiosity, self-focus, and self-
    importance…

    Erica Carlson and her colleagues found that college


    students scoring high in narcissism rated themselves more
    intelligent, physically attractive, likable, and funny than
    others, as well as more power-oriented, impulsive,
    arrogant, and prone to exaggerate their abilities!

    How can narcissists maintain their inflated self-image


    even though they know how they are perceived by
    others?

    In the sexual realm, promiscuity is a key strategy that


    allows narcissists to maintain control…

    And it closes with an offer to self-test using the Narcissistic


    Personality Inventory. Go ahead, take it. Let me guess: you
    scored low.

    Of course you did.

    II.

    Whether the article is technically accurate is besides the point,


    the point is why it exists, why they all exist.

    Read the article: who is a narcissist? The narcissist is the other,


    the unattainable other. It opens with Tucker Max, who has had
    lots of sex with beautiful women. Since you chose not to be
    able to have lots of sex with beautiful women, you aren’t a
    narcissist, which is some sort of consolation prize, I guess.
    Enjoy your Netflix queue.

    All of the photographs, except one, are of super hot, super


    sexy women.

    Are you a super hot, super sexy woman? No, you’re pretty, but
    you’re not so obsessed with your looks. And you’re obviously
    smarter than her. Phew. You’re not a narcissist. You can go
    back to torturing your boyfriend’s soul.

    Narcissists thrive in big, anonymous cities,


    entertainment-related fields (think reality TV), and
    leadership situations where they can dazzle and dominate
    others without having to cooperate or suffer the
    consequences of a bad reputation.
    Not you? You should stop wearing deodorant, it masks the
    delicious empathy.

    There is one picture is of a man:

    and it seems abstractly arty enough to be a reasonable


    depiction of narcissism, except this is the title of that photo:
    man looking at his reflection in a broken mirror. Oh, so it’s the
    mirror’s fault. If only this shirtless Effexor success story could
    get a quality mirror, then he could see himself the right way.
    (Who wants to go po-mo?: note that the hot chick has a
    perfectly good mirror.)

    There is one other photo of a man and a woman, both looking


    at themselves in hand mirrors. Get it? That’s not you, right?
    The photo is a deliberate lie of their/your unconscious. If you
    want that to be technically and psychologically accurate, if
    you want to rock your ego, the proper depiction would be each
    one looking at the other person’s reflection in the mirror.
    Because a real narcissist doesn’t see himself, he sees himself
    reflected back by the other person. Is this chick correct enough
    to be the kind of woman that the kind of man I want everyone
    to think I am would be with? “What?” I know it’s hard, but
    you have to do the work.

    III.

    The article, like the thousands of others, offers explanations as


    to why we’re often attracted to narcissists. (NB: that must
    mean you’re not a narcissist.)

    They’re “attractive,” “extroverted,” “talented,” “dominant”….


    and maybe these things are true and maybe they are not but the
    reason they are mentioned is the same reason there are always
    obligatory references to evolutionary psychology, so that you
    can say: you were tricked, you were seduced, you were
    manipulated, as if you had no responsibility in the matter.

    You think you chose your partner for the good qualities and
    the bad ones are baggage; but you chose them both because
    they fit your needs. That the relationship later failed didn’t
    mean you were getting something from it. “Blaming the
    victim!” I’m not blaming the victim, I am observing a
    universal rule: the common denominator in all of your failed
    relationships is you.

    I’ve written well over a hundred words about who is or isn’t a


    narcissist, not to out them but to force you into the condition of
    self-reflection, to force you to ask, “do I do this to other
    people?” Is this me?”

    My next sentence was going to be, “spotting a narcissist won’t


    do you any good,” but even that statement is a hedge. The
    spotting is a deliberate defensive maneuver. “That guy, and
    thus not me!”

    Spotting a narcissist will get you nowhere because the problem


    isn’t the narcissist, the problem is you.

    Read this: A Generational Pathology


    My name is NotMichaelBay,
    and I just fucked your
    girlfriend
    July 15, 2011

    objet petit a my ass


    The article below is a fake interview intended as parody. I did
    not actually interview Michael Bay. The article is written
    entirely by me in the spirit of humor without any malice or ill-
    will towards any of the people or institutions named within. In
    particular, in no way do the statements in the article below
    reflect the thoughts, opinions, beliefs or statements of the real
    Michael Bay. This is a work of fiction and any resemblance to
    actual persons living, dead, robotic, or vermiform is purely
    coincidental. It’s a joke, people.

    I’m here with NotMichaelBay, (not the) director of


    Transformers: Dark Of The Moon. Thank you for sitting
    down with me.
    Yeah.
    I’d like to begin by reading the opening sentence of one
    critic’s review: “Michael Bay’s “Transformers: Dark of the
    Moon” is a visually ugly film with an incoherent plot,
    wooden characters and inane dialog. It provided me with one
    of the more unpleasant experiences I’ve had at the movies.”
    How do you respond?
    By making a fourth movie. This guy sounds like a dick.
    But it certainly can’t be the first time you’ve heard similar
    criticisms.
    Come on, you think anyone who said “the movie isn’t shabby
    or painful, but romantic and wonderfully entertaining” about
    An Education can be trusted to review my movies?(1)
    So you knew this was Roger Ebert? You memorize movie
    reviews?
    I know everything. My game is tight. I’m the guy who sees
    you and your girlfriend at a bar, and I roll up and say, “Hi, I’m
    going to fuck your girlfriend” and you guys just giggle
    because you’re too much of a pussy to tell me to fuck off. I
    buy you guys some drinks, tell a few jokes, next thing you
    know you’re waiting up and I’m inside your girlfriend.
    Everybody wins. I give you what you want, I take what I want,
    and everyone hates me because it all seems so easy, which is
    what they want.
    So they hate on me, as if they could be me but choose not to.
    Come on. Haters gonna hate, and haters’ girlfriends gonna
    cheat.
    But audiences have come to expect, well, perhaps not a Les
    Mistons or even a Rashomon, but at least a film which
    doesn’t simply reuse existing footage from older movies
    and add in a new robot.
    Isn’t that just a sign of artistic indolence?
    I’m not reuising shit. It’s called ‘sampling.’ Like a rapper.
    Fuck you.
    Sampling? But sampling requires you to take an existing
    work of art and reinterpret it for a new audience, infuse it
    with a new meaning. Is that your claim?
    I claim I sampled the Inception soundtrack for T3.
    What did you mean in doing that?
    That Chris Nolan’s my bitch. Fuck him and his arbitrary
    MacGuffins.
    And there is the ubiquitous complaint that your movies are
    made for “15 year old boys.” For example, your first shot
    of Carly [played by Rosie Huntington-Whiteley] has her
    clad in only a white men’s shirt, and you offer a long, 3D
    tracking shot of her climbing the stairs— on her toes, no
    less, and it appears you’ve placed the camera on the floor
    and are shooting upwards. Some have claimed this is
    merely pornographic pandering to a post-pubescent
    demographic.(2) How do you respond?
    I need to respond to that? Seriously? I put her half naked in a
    movie, and you want justification?
    Look, Rosie was a Victoria Secret model, right? So I set up the
    shot the same way she’s shown in a Victoria Secret
    commercial, because she is a Victoria Secret model.(3)
    Ah, you’ve deliberately made explicit Carly-the-
    character’s semiotic connection to Rosie-the-actress,
    making the film’s world draw on the real world. Carly the
    beautiful girlfriend is “in reality” Rosie, who is known to
    be a Victoria Secret model, which is itself another signifier,
    another character, and so on ad infinitum; there is no
    terminal woman-in-herself. Thus ‘woman’ is merely an
    image, to attract the Lacanian gaze; yet because she cannot
    be represented in any other way except as such an image
    she a priori eludes the gaze.
    Exactly. And she’s got a great rack.
    So in doing this, you’ve uncovered Carly , i.e. “woman”, as
    a partial object, the objet petit a. Women can only exist as
    fantasy, the cause of desire.
    Her only fucking job before she met me was to get people to
    look at her; so I gave her that exact same job but wearing more
    clothes, and people are acting like I’m some sort of pervert.
    But the difference is that her partial nudity is appropriate
    in the context of a commercial to sell lingerie. In a film, it’s
    merely gratuitous.
    She’s not selling any fucking lingerie, she’s selling herself and
    the brand and the lingerie is tagging along for the ride. What, I
    got to draw you a fucking picture?
    Let’s turn to the story. Numerous critics have decried the
    meaninglessness of much of the film’s action. Why does the
    copier attack the office staff? What is the purpose of the
    giant Decepticon worm? There are plot holes and
    inconsistencies—
    Woah! Slow down, wildman, those were on purpose. Look,
    we’re all being raised by TV. Do you think as 4 year olds we
    really understood what the hell was going on on Batman or
    Scooby-Doo? You think your kids can really follow the plot of
    anything by Pixar? Since we’ve been able to enjoy movies
    anyway, without following the story, there’s no incentive to
    follow it anymore. And since we have no incentive, we don’t
    get no practice— and now we can’t follow a story, story gets
    distracting. Just like a porno. Fucking the most confusing
    movie ever made was voted to be… Vanilla Sky. WTF, you’re
    confused by Vanilla fucking Sky? These lunatics aren’t
    confused just by B plot, they’re confused by B roll. So we cut
    that shit right out and replace it with something on fire.
    You deliberately reduce story integrity while
    simultaneously enhancing the viso-auditory immediacy of
    the experience? Isn’t that ultimately self-negating, even
    Dadaist?
    Explosition, not exposition. That’s how we do.
    That seems—
    In real life, too. President Bush knew we were fucked by
    history, right? He got there day 1, opened the Book, and was
    like, fuck me, this is what’s really going on…? And then he
    looked at America and said, these fucktards couldn’t find Iraq
    on a map of Iraq labeled ‘Iraq’, no way are these Raymond
    loving motherfuckers going to understand anything about
    labor costs and the inevitability of falling foreign reserve
    accumulation. Let’s go with ‘WMDs.’” A decade of historical
    analysis later and the deepest anyone’s been able to go is,
    “they lied, it’s really about oil!!!!!!!!!!!!!!!!!!” Jesus, what
    asshats. Now every time poor Obama looks over his speeches
    he has to say, “no good, too many syllables.”
    So yeah, anything that has to do with thinking or blinking is
    edited out in post. That’s why it cost so much to make. But the
    original script for T3:DOTM is fucking Finnegans Wake, you
    can believe that shit.
    No doubt it more rigorously explained the giant Decepticon
    worm?
    Fuck you. It’s looking for spice.
    I’d also like to ask you about the rumor that actress Megan
    Fox was fired on the order of Steven Spielberg, who
    demanded you—
    Steven didn’t tell me shit, no one tells me shit, I’ll kill you and
    witnesses, fuck that stupid morally ambivalent alien making
    motherfucker. I fired Megan to make a point. I replaced her in
    the third installment of a huge series with a complete
    unknown, and it didn’t affect the movie at all.

    Well, she wasn’t a complete unknown, she was a Victoria


    Secret model—
    You don’t know anything about movies, do you? You probably
    believe it when actors say they do their own stunts or hate it
    when the paparazzi surprises them at the agreed upon time and
    place. Replaced Megan? I could have replaced every single
    one of those actors and actresses with some other
    supermodels, and the movie would have been better. Fuck that,
    I don’t even need people, I could have Simoned the whole
    thing. I did them a favor, they need me, and when you start
    forgetting that you’re just a motion capture device for better
    breast renderings, I kink your feeding tube. Good luck on your
    audition at Lifetime.
    Perhaps a supporting character can be changed, but surely
    you couldn’t replace Shia—
    I could replace him with a fucking glass cylinder of my farts
    and you’d watch it. Twice, IMAX 3D and cable. You think Dr.
    Who and soaps are the only ones who can replace these idiots
    with other idiots?
    But some movies open exclusively on the force of the lead
    actor. Julia Roberts, Will Smith—
    Ha! And you’re criticizing me for making shit movies? Look,
    there will always be a place for them, right? Voice work, what
    have you. “Hey, we got a bad ass talking puma that says
    “motherfucker” a lot. Call Sammy J.” “We need a sassy,
    independent, girl who will immediately and happily conform
    to the requirements of a patriarchal society in exchange for
    material security. Meg Ryan that shit up.”
    Sure, Julia in the trailer brings the boxes to the box office, but
    at this point there’s so much CGI used on her she may as well
    be a fucking Decepticon. Or did you think that’s her natural
    skin? You don’t need big name actresses anymore, you just
    need some mo to say “three generations of women” or a
    montage scene of four divorcees with wine glasses and
    dancing in a kitchen of Final Cut Pro vegetables. You’re
    blaming me for the stupidity of movies? Blame women.
    Your argument that women are responsible for bad movies
    seems untenable. With respect, your movies aren’t even
    aimed at women.
    Hey, fuckly, listen to me, my movies exist because of women,
    because they’ve driven men batshit crazy into ‘man caves’ and
    Call Of Duty XI. Did they have giant robot movies in the
    1930s and 40s? No, all of those movies had dance numbers.
    Back when a guy could punch a dame for overcooking a
    chicken there was no shame in watching some fool tap dance
    his way through WWII. Now these bitches expect you to
    change a diaper and shave your balls? Fuck that. Giant robots.
    Is all modern cinema then reflexively phallocentric? Does
    disposable art created on a background of consumerist
    capitalism necessitate a misogynist subtext?
    I said fuck that. Giant robots.
    Do you truly believe that modern males feel emasculated
    by the rise of the female underclass?
    No guy feels emasculated by women, at all. He thinks men in
    general are emasculated by women, but not himself. His rage
    is that since women have emasculated everyone else, he’s
    forced to sublimate his own urges to fit into this emasculated
    society. So he’s holding two contradictory ideas: that he
    himself is man enough to resist the emasculization that women
    impose on men; and simultaneously justify why he isn’t the
    man he thinks he should be. In essence, he’s created the
    perfect explanation for why he is, and rationalization for
    becoming, Nietzsche’s Last Man.
    So it’s a failure not of assimilating a feminine power, but a
    strictly narcissistic defense of the ego.
    It’s also why you’re going to see more movies where the
    action hero is a little girl. They represent the last attempt at
    staving off death. First you’re going to be a superhero; then
    you’ll meet a superhero; and finally your kid will be the
    superhero. And mom has to die in order for the Electra
    Complex to be fully realized.(4)
    That was— remarkably insightful…
    Bottom line this shit up: everyone loves jive talking robots.
    I sense that perhaps it’s more than misogynist, perhaps it
    goes to the level of minsanthropy, even nihilism? You’ve
    offered a critique of the inevitability of art but the
    irrelevance of the artist.
    Hey, what the fuck do you think I am? I am a great artiste,
    with a capital T,I,T,S,A,R,E,G,R,E,A,T. You don’t think I
    could make “good” movies? I went to school at Wesleyan, I
    studied under Basinger. I can make anything go triple
    platinum, anything. I could make just the poster of a movie
    and it would win every Oscar in every category every year,
    fuck James Cameron and his stupid boat. Do you know what
    would happen to this planet if I made a porno? That would be
    it, done, everyone in the world would drown in their own
    ejaculate. We’d have to Noah’s Ark two of everything and
    start civilization over.
    Then why don’t you make more serious movies, more
    enduring films? Why do you choose to make—
    Because Obama pays me not to, like a subsidies program,
    because otherwise everyone else would go out of business and
    California would have to be returned to the Pacific or sold to
    the Chinese.
    The movie is called The Transformers, ok?— as in I transform
    you from unemployed to employed. I’m a motherfucking jobs
    program, I’m like the New Big Deal. It’s a movie about giant
    robots, what the fuck do I needs peoples fo? Because: Obama
    needs to cut the space program, so I put Buzz Aldrin in a
    movie. I gets him paids. John Malkovich is a versatile actor, an
    artist, but he’s not getting paid shit for any of his crap. He calls
    me up— boom. Payday. John Turturro’s been in 20 movies
    since The Big Lebowski. Name one. Can’t. SAG calls me up,
    boom, his kids go to college. Now he can make shit like
    Somewhere Tonight and tell everyone he’s not an actor for the
    money.
    No more Matrix? Boom, Hugo Weaving is Megatron. Leonard
    Nimoy needs new dentures? Boom, chewing apples like a
    motherfucking horse, vitamins and fiber.
    I own Hollywood, I control destinies, there’s nothing I can’t
    do on film. Not only did I give Frances McDormand a job, I
    got that bitch to look almost sexual. In 3D. Do you know
    anyone else who can do that? You see Fargo? Did you want to
    fuck her in Fargo? No. But I guarantee you someone in
    America saw T3 and jerked off to Frances. Fuck all y’all.
    So the future of cinema comes full circle, back away from
    the cult of the actor to the primacy of the director. You see
    a future where even mass consumption cinema follows the
    director; we’ll choose to see “Michael Bay’s new movie”
    not “Shia LaBeouf’s new movie.” This had previously been
    the privilege of director-artists— Woody Allen or
    Hitchcock come to mind— but who did not enjoy mass
    appeal.
    If someone goes to see Transformers because it’s “Shia
    Labeouf’s new movie” and that person is not Shia Labeouf I’ll
    slit my wrists.

    Thank you for your time and candor.

    This parody is free speech protected by the First Amendment.


    No videos are hosted on this site and remain the property of
    their original owners. The images, stills, and video clips are
    the property of their original owners and their use herein is
    permissible under the fair use provisions of U.S. copyright law
    and under the corresponding legal theories of copyright and
    intellectual property law around the world. Again, I didn’t
    actually interview Michael Bay, but I’d love to.

    1. A much better review of An Education

    2.

    3.
    4. The next phase in the evolution of action movies
    Crazy
    July 23, 2011

    it works not because everyone is different, but because we’re


    not

    Crazy: Notes On and Off the Couch


    The book is about his experiences as a therapist, from the
    difficulties with fees to working with sex offenders.
    It’s a memoir, but once you publish a book readers interact
    with it in their own ways, pulling into it things the author
    hadn’t even considered. It stops being non-fiction and
    becomes a story.
    So instead of reading it like a memoir, let’s read it like a story,
    and see if we can’t learn something about ourselves.

    II.

    Dobrenski’s book is about his work with clients, but it’s about
    two other things.
    The second thing it is about is his own therapy with a
    therapist. It’s a parallel story, as he’s helping people work
    through their issues, he’s working through his own.

    But this is a narrative, and every narrative has a first thing—


    an inciting event. Robert McKee’s Story defines the inciting
    event as “an event that radically upsets the balance of forces in
    the protagonist’s life.” It’s the event that propels the story,
    without which there is no story. Rob Dobrenski complies with
    McKee’s directive to “put the inciting event into the story as
    soon as possible”— he puts it in the prologue. It is this: he
    meets Janet, a beautiful redhead in his training program, his
    soulmate, “the one.”
    And she dumps him.
    Now you have a story.

    III.

    From McKee’s textbook of psychoanalysis:

    Story begins when an event, either by human decision or


    accident in the universe, radically upsets the balance of
    forces in the protagonist’s life, arousing in that character
    the need to restore the balance of life. To do so, that
    character will conceive of an “Object of Desire,” that
    which they [believe] they need to put life back into
    balance. They will then go off into their world, into
    themselves, in the various dimensions of their existence,
    seeking that Object of Desire, trying to restore the
    balance of life, and they will struggle against forces of
    antagonism that will come from their own inner natures
    as human beings, their relationships with other human
    beings, their personal and/or social life, and the physical
    environment itself. They may or may not achieve that
    Object of Desire; they may or may not finally be able to
    restore their life to a satisfying balance. That, in the
    simplest possible way, defines the elements of story.

    Everything that happens in your life is digested by you


    through this process, so it would be worth your time to
    memorize it.
    IV.
    So we have a story about a man who loses his soulmate and
    becomes miserable, Zoloft and therapy miserable, passive
    suicidality and eating her photograph miserable, all while
    becoming a therapist and struggling to help others.

    I’ll grant you that he’s 25 when Janet comes and goes, so some
    confusion, soul searching and drama is to be expected. The
    issue for us therefore isn’t whether his reactions are normal,
    but why they are not uncommon. Why do a lot of men go
    through this, in this way?
    How does a therapist do therapy, which is a kind of story?
    How does a writer do a story about therapy, a story about a
    story?
    Step 1— actually, there’s only ever one step— focus precisely
    on the words.

    Here’s how he describes Janet:

    never before (or since) had I ever believed in the notion


    of Love at first sight… it was as if the film Weird Science
    had come to life and someone had created this physical
    specimen just for me. Or maybe the gods had simply
    decreed that this was the moment I was to meet my soul
    mate. Something clicked, and I made a conscious
    decision to form an indelible bond with her.

    Remember: this is in the prologue. This is what starts the


    story. Of course it’s a book and of course it’s written after the
    fact, and hell, perhaps it isn’t even true but none of those
    things are relevant because psychology operates outside of
    time and space. “Well, that part’s not true, I made it up.” How
    can you understand what’s true, Dusty? Truth has seven levels.
    Instead, just focus on the words.
    Which words? Note the words, “conscious decision.” That’s
    not a throwaway phrase. If it was his soulmate, if the gods had
    decreed it, it wouldn’t be a decision any more than you’d say it
    would be a decision to win the lottery or fall into a hyena pit.
    But that he chose to fall for her, decided that he knew how
    special she really was, decided to fall into a hyena pit— then
    you no longer have a story about unrequited love, you have a
    story about old school Freudian masochism. Think about this.
    As a small point, he didn’t realize it, but at that moment he
    was exhibiting a form of “ownership bias” quite common
    among 25 year olds: since he was able to get this hot girl and
    others didn’t, this must be a special relationship indeed. If you
    consider that the purpose of this ownership bias is the
    reduction of cognitive dissonance, then what it defends against
    is buyer’s remorse.

    But the point for us here is that even before we leave the
    prologue of this story or finish the first session of therapy, we
    should already understand that in order for him to get over her,
    to “restore balance in his life,” he’s going to have to figure out
    why he did this to himself.

    V.

    The other thing of note in that paragraph is the movie choice,


    Weird Science. Here’s a handy life tip: when someone likens
    their life to a book or movie, pay attention, that’s more
    informative than two MRIs and an Amytal interview. Second
    tip: when they do reference the movie, the important thing
    about it is the thing they forgot. So what do we know about
    Weird Science?
    We know it was made in 1985, which means Dobrenski’s
    sexuality began to form around the narratives and images of
    that time, which is why he referenced this move and not Bride
    Of Frankenstein or Simone. This is important because when
    you’re trying to understand someone’s relationship to sex, you
    have know the stories the person uses to value it, i.e. the
    stories they were immersed in during their teens. In the 80s,
    that meant getting not the hottest girl, but the girl from the
    higher class.(1) It also divided society along a two party
    system, preppies vs. nerds, “beautiful people” vs.
    “untouchables.”(2)

    His use of Weird Science was intended to mean, “a perfectly


    constructed woman to my exact physical specifications” but
    that’s not what it means. Three paragraphs later, describing his
    surprise at her dumping him, he says this:

    I was so dumb that I was actually shocked when it


    happened. But we were meant to be together! Didn’t you
    see Weird Science?!

    I saw Weird Science, all the way to the end, the end where the
    boys decide they don’t want their perfect woman and make her
    leave (in this case nicely.) I’m sure Janet thinks she left and
    I’m sure Rob thinks she dumped him but I’m all in that he did
    everything in his power to make her realize he wasn’t right for
    her, to make her do the hard work of leaving him since he
    couldn’t cut that cord himself. When you have your perfect
    woman for the 90 minutes of a movie and you never have sex
    with her, I suppose it could mean you’re just nervous but it
    probably means she’s not your perfect woman. (I’ll grant that
    the opposite is not at all informative.) And Rob may have had
    sex with Janet, but he probably doesn’t have to think hard to
    find a million other examples of things he did that, in
    retrospect, clearly told him Janet wasn’t the One. It’s hard to
    depict psychic resistance in a visual story; in dreams it is done
    by feeling stuck or slowed, but one solid way to do it in a
    movie is by making the character wear pants in a shower while
    Kelly LeBrock is naked. So Weird Science isn’t about getting
    the perfect woman, it’s about realizing you don’t want the
    perfect woman.

    Once she gets dressed, Lisa and Janet’s entire purpose is to


    build up their self-confidence; create some scenarios where
    they can manifest their identities, and then get out of the way.

    The point, however, isn’t that Dobrenski’s movie choice was


    wrong, or that he misunderstood its story. The point is that he
    chose perfectly, but misunderstood why; which is why in
    therapy and in stories, similes aren’t accidents. “Lisa is
    everything I ever wanted in a girl, before I knew what I
    wanted.” I hear you, Rob.

    VI.

    But I’m jumping ahead. Let’s get back to the story.

    Rob is miserable when she dumps him. Janet was perfect, and
    Janet is gone, into the arms of a different man. And another
    man. And another one. And guess what? All the men are hot.
    And so is she. And etc.

    Or so he imagines. Carol, his therapist, tries to clear him by


    asking him to describe these images that plague him, of Janet
    and her other lovers. So he says,

    Janet is in her bedroom… She’s gorgeous; she’s wearing


    a negligee that she bought when we were together. She’s
    smiling and being all seductive.” [And the guy?] “He’s
    tall, like six-foot-two, a little bigger than me. He’s good
    looking. Very good-looking, built and strong.

    Carol correctly interprets this all as a self-defeating negatism;


    he creates a “flawless rival” in his head that he can never best;
    which virtually guarantees his ongoing misery. Only when he
    understands that this image is unrealistic will he get over her.
    So, she suggests, try to take these fantasies to their conclusion.
    What happens after they have sex? Does the guy leave? Is she
    hurt that she was used? Does she go to the bathroom? Etc.
    Make her a real person, and not a porno.
    In this way Rob slowly gains control of these images and
    fantasies. “When images become boring,” says Carol, “they go
    away. And, fortunately, so do your symptoms.”
    So it helps Rob, but it leaves an unanswered question: why did
    he have these images in the first place?

    VII.
    In “The Ghost of Janet” he describes the sessions that deal
    with getting over Janet and his “irrational cognitions,” e.g.

    She was perfect.


    I’ll never meet anyone else.
    I’m a worthless person and I don’t deserve anyone.
    I’m nothing without her.

    The typical way of working these problems is to realize that


    they aren’t true, that they are self-defeating; that they originate
    in childhood, that they are the results of insufficient, or
    inconsistent, parental love. That’s the typical way, and the
    wrong way.
    Tell me about Janet, his therapist asks. What did you like
    about her?
    He describes what he liked about her in detail. We’re in a
    story, so focus on the words:

    1. She was fun to be with.

    2. “I miss being sexual with her.” “I felt good with her.”

    3. She was good looking, but in italics he writes, All these


    guys want to be me.

    I hope it is immediately obvious, through this simple exercise


    of saying in words what you think can’t be expressed in words,
    what’s wrong with his love for Janet: none of those things
    have anything to do with Janet. They are all about him. In fact,
    Janet is pretty much an inanimate object, a MacGuffin. The
    therapist detected it as well: “Could she be more symbolic
    than real in some ways?” Cross out the last three words and
    you have it.
    This applies just as readily to the guy who is upset/sad/angry
    that he can’t get a beautiful woman, not stopping to know or
    care if they should get together. She isn’t real, she’s just a plot
    device to move your story along.
    Hold on: it is IMPOSSIBLE to understand you are doing this
    while you’re in it, while there is a real life woman in front of
    you, “it can’t be all about me, look, she smiles when I buy her
    roses!” Which is why doing this exercise is so important.
    “But I’m not insecure!” you might say, “I just like hot chicks!”
    No doubt. Which is why Dobrenski’s summation is perfectly
    accurate: “I don’t believe I need her to feel good about myself.
    It was just easier to feel good about myself when I was with
    her.” Nothing like an accessory to reinforce a brand.

    VIII.
    Note also that this is definitionally narcissism, but it’s not at
    all abnormal— this is a totally ordinary, mid twenties kind of
    narcissism. It is not pathological. But that doesn’t mean it
    doesn’t hurt just the same.

    IX.
    Back to the upsetting fantasies of Janet with other men. We
    know he got over them by imagining more realistic scenarios.
    The question is, why did he imagine the unrealistic ones?

    “Lots of times I paint a picture that she’s a raging slut


    who’s screwing a new guy every other night,” [he says to
    Carol, his therapist.] “Other times it is her soul mate.
    Both drive me crazy.”

    At that point Carol decided to teach me an interesting


    trick.

    “We’ve talked a lot about how our thoughts influence our


    mood. People make the assumption, however, that we
    always think in words. Here is a great example of how
    your cognitions are actually pictures. The images are your
    thoughts, which are driving this jealous reaction. The
    good news about this is that images are just like a film,
    except you are the director. With a little practice you can
    make the camera do whatever you want. Please, take me
    through one of these images.”

    And he describes the scenario of seductive Janet in her


    negligee and the built 6′2″ guy about to plow her.
    The trick is that Carol’s trick isn’t a trick, it is the entire
    purpose of the fantasies. Carol is going to help Rob make the
    camera do whatever he wants, as if the camera was right now
    doing something he didn’t want, but in fact the camera is
    already doing exactly what he wants. The camera isn’t making
    him miserable, it is keeping him from going insane.
    If we’re in a story, and Rob is, than these fantasies are
    exposition, they are telling the audience something. Look
    closely at these fantasies, at your own cuckold fantasies.
    Inevitably in these fantasies there is a fetish object, something
    that existed in your relationship. It’s seems incidental to the
    fantasy but it is highly energized, eroticized: a piece of
    jewelry, clothing/bathing suit, or a location (car, bar, beach,
    etc). The sex is the visual focus, but the eroticized negligee
    that they bought when they were together is the true main
    character of the fantasy.
    Men make the sex the focus, while women make the fetishized
    object more explicit: they obsess over the ex taking his new
    woman to the same places; or buying her “the same kind of
    scarf he got me”; or saying the same phrases (“that’s what he
    used to call me.”)
    It seems masochistic, driving yourself crazy thinking about
    what you’ve lost, making the loss even worse by finding the
    specific ways that it hurts you.
    But look back at what Janet was to Rob. What he really liked
    about Janet was what <<Janet>> meant about him. In Jerry
    McGuire, when Renee says to Tom, “you had me at hello,” it’s
    in response to the mushiest yet most accurate line in the
    movie: “you complete me.” No kidding. So when Janet leaves,
    he doesn’t lose her, he loses what the part of him she
    completed. That’s what hurts him. The fantasies are a
    battlefield medic sewing up a wound of the self with dirty
    thread and a rusty needle. But at least you’re alive.
    Sure, on the one hand you’ve had a huge piece of your identity
    torn out— you wanted to be the kind of guy who dated the
    kind of girl that Janet represented, and by leaving she’s
    shamed you, exposed you as not that kind of guy, as a loser—
    but on the other hand you were that guy, and you can prove it:
    she’s wearing your negligee.
    That loss of self is what you’re trying to recapture with the
    masochistic fantasies: she’s hot enough to have any guy she
    wants (and she picked you); she is in total control of her sex,
    wielding it for pleasure or for profit however she wants; so
    when she had sex with you, and liked it— it signifies your
    own value. When some faceless stud undoes her bikini top in
    front of everyone, and she confidently flaunts her body—
    that’s your self-confidence she’s flaunting.(3)
    Since you see the fantasies but not the wounded self you think
    one’s real and the other isn’t. The hard part is to accept these
    fantasies as merely information, as part of the story, what do
    they tell the audience? The fantasies aren’t the wound, the
    wound you have to close is the self: I’m not broken now that
    she’s gone, I’m not a worse person, her leaving doesn’t reveal
    me to be a loser. The next woman I meet will not know or care
    that I am the man Janet dumped. I’m depressed but still whole.
    I want her to have sex and be happy, or frankly it doesn’t
    matter if she has sex, because it has nothing to do with me.
    When that wound closes, you won’t need the fantasies
    anymore. Or the negligee.

    X.

    Rob closes his book with parallel stories of endings: ending of


    his therapy, endings of clients’ therapies, and endings of his
    involvement with clients’ ongoing therapies. Actual therapists
    spend offensively little time understanding how and when to
    end a therapy (Rob and Carol do it right); and even ordinary
    humans seem to have great difficulty, anxiety, saying good-
    bye, hanging up the phone, not feeling compelled to tack on a
    “why don’t you text me when you’ve settled in your new
    place?”

    But knowing how to end things, whether it is therapy or a


    relationship or a book, is a fundamental skill that allows us to
    move on. Otherwise the past is dragged around like a deployed
    parachute, slowing your every move and suggesting to anyone
    who sees you that you must only just have landed.

    Every story has an ending, and the more satisfying the ending
    the better the story.

    ––––
    1. An example: Molly Ringwald played the unpopular kid in
    Sixteen Candles, pursuing the preppie jock; yet in The
    Breakfast Club she played the popular, “beautiful” type
    pursued by marginal character Judd Nelson. She looked
    exactly the same in both, but her “value” as sex object (not
    girlfriend) was higher in The Breakfast Club. She went back to
    being a desexualized person (not object) in Pretty In Pink.
    John Cryer, who was in love with Molly throughout the movie
    and eventually loses her to the preppie guy, is compensated for
    his loss by the sex object Kristy Swanson.

    2. Movies like Heathers and ultimately Mean Girls


    permanently disposed of this narrative, and high school
    movies now generally favor parliamentary style politics:
    multiple parties forming coalitions. Teen movies now also
    downplay the ages, so while the plot of Weird Science couldn’t
    be redone using 40 year olds, you could flip the ages in The
    Hangover or High School Musical and the stories and their
    themes stay mostly the same. They are both movies about
    childish adults, or adultish children, which are the same thing.
    Interestingly, Zac Efron’s other movie 17 Again believably
    recreated 80s style power divisions and objectifications
    precisely because it was a movie about a middle aged man
    being 17 again, i.e. the movie was believably the worldview of
    such a middle aged man.

    3. There is an element of aggression in these fantasies, and the


    extent to which this or the other explanation is operational
    depends on how “whole” you were to begin with.
    Unconsciously and deliberately putting your ex in these
    fantasies, forcing her to have sex with strangers, forcing her
    into sex she would not want herself; commandeering her
    image without her consent, destroys the integrity of the
    woman by reducing her only to an object— all of these are
    regressive acts. This is a kind of revenge, compensation for the
    loss— if I can’t have your love, fuck you. (see footnote 1,
    above.)
    Why We Are Terrible At
    Math (And Reading
    Comprehension)
    July 28, 2011

    There are 20% more girls than boys in the class. If there are…

    You’re a teacher in a public school. You give your 3rd graders


    a worksheet of 50 two digit addition questions, e.g. 43+25.
    The kid gets 90% of them right. Pass or fail?

    II.

    Now it’s reading comprehension time, you give the kid this:
    He gets them all right. So?

    III.

    The math example, above, is real, and real(ly) scary.

    45
    +24
    ______
    69
    So the kid had done an entire worksheet of these. But what
    was hidden from view was that the kid had absolutely no idea
    he was adding 2 digit numbers. He had memorized the
    mechanics of the process and nothing else. So when he was
    asked, “if you have 45 beads, and a friend gives you 24 beads,
    how many beads to you have?” he didn’t know to put the
    numbers on top of each other like the worksheet; what he did
    was say the number 45 and then start counting on his fingers,
    46, 47, 48, 49…. and of course he ran out of fingers and had
    no idea when to stop, so he guessed.

    The problem is that as long as he completed the worksheet,


    you wouldn’t know there was a problem with doing math until
    it was way too late. If the kid is clever in other ways— say,
    fast at finger counting— he could easily convey the
    impression that he understands how to add 2 digit numbers,
    and what that means, and so everyone thinks he’s progressing
    just fine; only to reach a later point when his clever shortcut is
    too primitive to work. Now suddenly you have a 6th grader
    who appears to falling behind. But he was never really caught
    up. I suspect that this almost entirely explains Americans’
    universal hatred of word problems.

    IV.

    A second maddeningly infuriating example. There’s a summer


    class of 1st graders with behavioral problems who are learning
    to read. Granted a unique sample set, but it’s the only one I
    have. Ok, so one boy is reading the story of Aladdin.

    I notice that he is reading the words but there’s no cadence,


    there’s no rhythm. At times, he’ll read the first words of a
    second sentence into the flow of the first sentence, i.e.
    “Aladdin took the lamp. Jasmine polished it.” becomes
    “Aladdin, took the lamp Jasmine polished. It…”

    However, he is reading the words correctly. So? So the only


    way you can evaluate his comprehension is to ask him
    questions, which he answers with little hesitation. Great, he’s
    reading on grade level. Except he’s seen the movie. In the
    story, the King of Thieves crashes the wedding and steals stuff,
    and you ask, “who is this guy?” and the kid says, “it’s
    Aladdin’s father.”

    “But Aladdin doesn’t know this yet, right? He finds that out in
    the end. Who does Aladdin think it is now?”

    “His father?”

    The kid can’t be faulted for referencing the movie, but it never
    occurred to the teachers (two of them) that this was going on.

    It’s the same problem with the manatee story, above. A fast
    reader with poor comprehension can quickly re-scan the page
    for the answers. “A+!” Certainly no remedial training needed
    here.” But that works for a paragraph, it doesn’t work for 10
    pages. I accept that he may get better, but he may not; the
    point here is that a lack of comprehension goes undetected
    because he tests well. By the time it is detected, it’s too late.

    V.

    Which brings me to the real point: it would require the


    teachers, and the parents, to be looking for these tricks and
    shortcuts that kids use, and to “test” the kids in specific ways.
    The immediate answer you get is, “look, in a class of 20 kids,
    there’s just no way to test kids individually like that.” That’s
    not the problem I’m citing here.

    The problem I’m citing is that the teachers and the parents
    don’t understand math either, because they used these
    shortcuts when they were kids. I’m sure adults think they have
    excellent reading comprehension, but I hope a survey of the
    universe quickly reveals that they don’t. They get the gist.

    Try this:

    There are 20% more girls in the class than boys. If there are
    45 boys, how many girls are there?
    Some of you will be daunted by the problem, you don’t know
    where to start. Interestingly, people who aren’t “good at math”
    try and start with some abstract idea of the total. The easier
    way is to start with what you know, and draw it:

    I don’t know how applicable this method (Singapore math) is


    to students in general, but it worked for me and I’m already
    good at math. And I’m sure there are other methods that are
    relevant to specific “hangups.” But how do you get parents
    and teachers to be aware of them, let alone use them?

    I’m told that the system of the day is “Everyday Math.” I have
    no idea what that is, but my worry is that every system of
    teaching is designed not to maximize learning, but to facilitate
    the teaching. Standardize a process among teachers who
    themselves lack the deepest, intuitive sense of the material. I
    have no idea what the solution is, though I am open to
    suggestions.
    The Terrible, Awful Truth
    About The Debt Ceiling
    July 31, 2011

    in football, when the game is already won, this is called


    “running out the clock”
    The current debt crisis, the one that goes apocalyptic on
    August 2, the one that is front page news, all the time, is a
    non-issue.

    You don’t need to know any economics or public choice


    theory to know this, all you need to do is look at this pic:

    Somehow this poor woman has been convinced that the


    essence of the problem is this deal. I can’t tell if this photo is
    staged for a photographer standing behind her or she thinks
    she’s testing Congressmen with giant Zener cards, but she
    clearly wants this to be about relationships and non-partisan
    debate and unity and pride. Somehow she has been convinced
    that what makes the U.S. different from Greece is this vote;
    that what confounded the Greeks was really whether or not to
    raise their debt ceiling. “Come on guys, just work it out!”

    She doesn’t appear to know how to read, or see, so whatever


    she thinks she knows came inevitably from the news media,
    the one that is now using her as a symbol of something. So
    with no other information you can assume the opposite and
    trade accordingly. (Get out by Sept 20.)

    In this case, it’s easy to deduce the real issue, which has no
    deadline. The popular phrasing of the real issue is “America’s
    in debt, we spend more than we take in,” but a more
    meaningful understanding of that sentence is this: we’re all on
    the federal dole, one way or another.

    Debt ceilings are accounting tricks. Whether you make the


    minimum monthly payment by August 2 only affects the
    books; as long as you make that payment you look ok on paper
    and so does Visa.

    So it is inevitable that a deal will be struck by August 2,


    because that deal doesn’t actually mean anything. This a is
    husband and wife arguing about rebalancing the household
    budget, each pretending they aren’t going to pay the electric
    until he’s agreed to cut back on beer and she’s agreed not to be
    such a bitch. Whether they do it or not is irrelevant, the
    electric’s still getting paid. The electric always gets paid, it has
    to, we need it for the chairs.

    Not to mention that no politician wants to be remembered as


    the guy who made his constituency go unpaid. Public choice
    theory will save you by August 2, even as it wrecks you all the
    other times.

    So when you get the temporary reprieve tomorrow— and it is


    temporary— you should do whatever you have to to get off the
    dole; you are getting off of it anyway.

    Because one of these days we won’t be able to even make the


    minimum monthly payment, and, keeping to the household
    budget analogy, in those circumstances what happens isn’t that
    the family goes bankrupt, what happens is that the couple gets
    divorced. Pray on this.

    II.

    There’s a game you should play, and it is analogous to Bloody


    Mary, where you and your Tiger Beat reading friends are at a
    slumber party, and they tell you to go into the bathroom and
    hold a candle and look into the mirror, and exactly at midnight
    if you say “Bloody Mary” three times a bloody face will
    appear. And you do it and it works, and you’re like, “what
    the… did that really just happen?” Then you climb back in bed
    only to discover your friends put a tarantula in it.

    The game is you take a major population-grabbing news story


    and ask, “what’s going while I’m focused on this moronity?”

    You can try it with Casey Anthony and get Greek austerity and
    Britain union protests and the commonplace use of the phrase,
    “the end of the euro”; but the lead story doesn’t have to be
    frivolous for the game to be instructive. 9/11 was pretty real
    but if it weren’t for that we might have learned how entangled
    the California and Federal governments were with Enron and
    energy suppliers in general, and the complicity of Arthur
    Anderson in asset price inflation and bubbles all over the
    world. Instead, we didn’t.

    Neither is it necessarily a conspiracy or a cover-up, it is simply


    related to the fact of finite human waking hours. Unless you’re
    chronically running 20 hours a day, to the likely detriment of
    your body and silent deterioration of your sanity, just so you
    can do things other people don’t have time for like look up the
    references in the introductions of research papers or watch
    Susan Sarandon’s naked granddaughter act annoying(ly) in
    Joe, you’re simply not going to get to everything. There’s just
    no time, your mind can only handle one lead story a week.
    “But I do like to get in depth and hear both sides of the issue.”
    That’s why you subscribe to The Atlantic.

    It’s also fun to play “what’s the lead in other countries, where
    this story isn’t?” or “what’s the lead for men/women if this
    story is the lead for women/men?” because it tells you what
    the rest of the world cares about while you’re hearing both
    sides of the J-Lo divorce.

    So let’s play that out now, what’s the lead story if the Debt
    Ceiling isn’t? That one’s easy:

    Throw in the pic of the protestors:


    and observe that in contrast to Revolution Facebook, none of
    those signs are in English— and sprinkle in a little “Gunmen
    attack Sinai Gas Pipeline” and “Dozens Killed As Syrian
    Forces Storm Cities” and you have everything that would have
    previously driven Bush to “illegally” send the troops and
    Cheney to “accidentally” shoot his lawyer. The US may have
    the luxury of employing “watchful waiting” while Sideways
    Glasses Guy retweets his Time Magazine cover and plans on
    voting in the upcoming elections, but the guy above doesn’t
    look like he’s going to wait for anything. Especially elections.

    Right or wrong I have no idea, I only know that when the Debt
    Ceiling Crisis is averted the Egypt problem will still be exactly
    the same and, unsurprisingly, so will the debt. I’m not
    suggesting the radicalization of the Egyptian protests are more
    important than our debt, I am simply reminding you that both
    the cause of the debt and the cause of the radicalization of the
    protests are more important than the “debt ceiling crisis.” If
    anyone knows Obama’s or Boehner’s twitter addresses, send
    them a tweet.

    –-

    3 Things Wrong With the Egyptian Revolution

    The Terrible, Awful Truth About The Tax Cuts


    4 Unintended Consequences
    of Seroquel’s Adjunct to
    Antidepressants Indication
    August 3, 2011

    cutting edge research on this drug should be coming any day


    now

    Part 3 here— short refresher.

    In 1998, I discover something is red. “It’s red.” Sweet.


    In 2010, I discover that same thing is also hard. “It’s hard.”
    Nice.
    The question is: what is its primary attribute? Is it a Red thing
    that’s hard, or a Hard thing that’s red?
    II.
    Imagine you did it the other way around: in 1998 you discover
    it is hard, then in 2010 it’s found to be red. Does that change
    things? Is the primary attribute based on history, or something
    else?
    “I guess it all depends on what you use it for.” You guess?
    III.
    Seroquel is that thing, discovered first to be efficacious in
    schizophrenia (translation: “antipsychotic”) and now found to
    be efficacious in depression (“antidepressant”).
    So is it an antipsychotic that treats depression, or an
    antidepressant that treats psychosis?
    “I guess it all depends—” Shut it. Scientists are talking.

    IV.
    You might think it doesn’t much matter what you call it but
    rather how you use it, but it matters. If you call it an
    antidepressant, regardless of mechanism of action, price, or
    data it gets slapped with a suicide warning. If you call it an
    antipsychotic you forever battle a diabetes warning regardless
    of the truth of it (see Geodon, Latuda.) And call it the wrong
    thing, or the right thing at the wrong time, and your company
    gets to pay $1B to the government.

    V.
    Seroquel is a special case study in the semiotics of psychiatry,
    because much of the naming was intentional.

    1. Excessively high dosing.

    One can’t fault the FDA for striking a balance between safety
    and efficacy. They voted nearly unanimously “Yes” on its
    monotherapy efficacy in GAD and MDD— they agreed it
    worked; but they didn’t want it being used as commonly as
    Prozac, so voted unanimously “No” on safety. So no
    monotherapy approval.

    Recall that one of the monotherapy trials of Seroquel showed


    efficacy at 50mg. However, because the FDA chose to go with
    the adjunct indication for safety reasons, it can only approve
    the doses used in those adjunct trials: 150mg. Three times
    higher than the “minimally” efficacious dose in a monotherapy
    trial.

    So in choosing an indication out of safety concerns, it tripled


    the doses used.

    The reps are not allowed to suggest you use 50mg, or tell you
    that those studies exist; indeed, they aren’t told about those
    studies themselves.
    2. Reinforcement of an erroneous mechanism of action.

    The FDA wants to “protect the public”. They know docs will
    generalize the indication of one drug to others in the class.
    Hence, the FDA’s and AZ’s interests run in parallel: not all
    antipsychotics are antidepressants.

    So AZ avoids all talk about mechanisms of action which are


    shared by all atypicals (dopamine or serotonin antagonism)
    and settles on a mechanism which is specific to
    Seroquel— the NET inhibition.
    However, as I hope is clear, from part 3, the NET probably has
    nothing to do with it.

    3. Reinforcement of the cult of polypharmacy.

    It worked fine as monotherapy; but it’s indicated as an add on


    to drugs (SSRIs/SNRIs) that failed for over 100 days at high
    doses.

    If the combination works, what then? Was it the Seroquel


    alone that did it? Was it the SSRI just taking longer to kick in?
    Or some kind of synergy? The FDA answer is that since you
    don’t know, you use both.

    But you do know: Seroquel worked as monotherapy in at least


    two FDA trials. Given this, it would be most logical to taper
    off the SSRI after a while, because you don’t know two drugs
    are better than one drug, but I can promise they are twice as
    toxic and twice as expensive. But you won’t find that
    recommendation in the PI or any academic journal. The FDA
    is causing psychiatry to move backwards: more polypharmacy;
    less safety; greater costs.

    4. Pharma/academic focus on “bipolar depression.”

    Seroquel isn’t indicated as monotherapy for MDD, but it is


    indicated as monotherapy for bipolar depression. Fortunately,
    1) bipolar depression looks exactly like major depression
    during the episode; 2) it’s indicated at 300mg, so you can be
    guaranteed to get heavier.

    From the company perspective, the obvious marketing strategy


    is to push for “awareness and detection of bipolar depression”
    (read: “recurrent major depression is probably bipolar
    disorder”), and “incentivize” the reps to have their scripts
    skew towards 300mg. Farewell, depression, again.

    For example, if Seroquel is truly an “antidepressant” then the


    competition would be Prozac. But it isn’t; it’s Geodon. Reps
    aren’t measured against SSRIs, only against atypicals, which,
    in theory, they’re not really competing against.

    VI. Should we worry about any of this?

    Nope. Once Seroquel goes generic, the impact of all of this


    nonsense will be minimal. Then no one will care how you use
    it, at what dose; whether you use it monotherapy or in
    combination with nine other drugs none of which anyone cares
    about either. Do a Pubmed search on Zyprexa research in the
    last year. Anything?
    Granted, there’s probably patients who do care. But.
    The Nature Of The Grift
    August 11, 2011

    simplified for the purposes of illustration

    In The New Yorker, a piece about immigration— abuse?


    Cheating?

    “Caroline” is a single woman from “central Africa” who,


    while living in a roach infested NYC apartment (“sometimes
    they get in my handbag, but they’re small”) and working in
    what I assume is a Whole Foods (she thinks “organic” is a
    scam), she works with a lawyer to complete her application for
    political asylum. Back home, she was raped and beaten, and
    would likely be killed if she returns.

    The hook of the article is that she made this up in order to gain
    asylum. She was never raped, never tortured, never etc. The
    article explains that such embellishment is not only common,
    but that applicants are often counseled on how to game the
    system by others (including lawyers) who have been through
    the process.
    But she’s a good person, hard working, she just wants a part of
    the American Dream that is out of reach for native
    twentysomethings. Is it right to deny her? Oh poorly
    considered ethical dilemmas, what would the press do without
    you? The focus of the story—indeed, the climax— comes
    when she finally has her appointment wiith the immigration
    officer: a cold hard-ass (read: white) named Novick in a
    Matrixy/East German/Kafkaesque interrogation room. Think
    fluorescent lighting and the hum of alienation.

    He wants specifics of her rape and torture, when and where; he


    wants to know what African hospital she went to and when.
    She keeps her story tight; she deflects attempts to pin down the
    medical records. She answers questions about local geography.
    Novick checks a newspaper to corroborate her story of being
    in a bombing, but that’s where she got the story in the first
    place.

    So: you can read it as this lying bitch is one step ahead of the
    law, which is harsh, but it’s a reading. Or, you can read it as
    officers like Novick can’t always detect lying, they do the best
    they can. Or you can do what The New Yorker and NPR did,
    pull the left blinker on the Subaru and suggest it shouldn’t
    have to be this hard for immigrants to come in. They shouldn’t
    have to lie. Also: “Mondale ‘84”

    In the end, the officer found her narrative compelling


    enough and granted her asylum, and she is a model
    American citizen by most measures. She has a job, a car
    and a husband. She goes to church every Sunday. She
    pays her taxes, and she’s never taken a dime from the
    government.

    I’d bet every dime of every person she’s never taken a dime
    from that it scalded the editors like holy water to keep the
    phrase “goes to church every Sunday” in there, but they
    probably figured they needed it to appeal to the wingnuts at
    patriotpost.us and everyone in a landlocked state who
    obviously hates immigrants, especially ones who aren’t from
    America.

    All of those readings provide their respective readers with


    considerable emotional comfort and reinforce their own moral
    superiority, which is healthier, I’ll warrant, than drinking
    yourself to sleep in front of (this week) The Conversation;
    nevertheless, all of those readings would be wrong.

    II.

    Here’s an emotional, exasperated criticism from an


    immigration lawyer:

    [The New Yorker story] encapsulated everything about


    immigration law that is both dispiriting and outrageous. It
    is a clarion to new lawyers to keep away from the
    profession and a motivator to honest lawyers in the field
    to want to take a long shower after any day associating
    with his or her peers or “the system.”

    Can’t resist low hanging fruit: “This is what motivates lawyers


    to take showers?? Is this thing on?”

    I get where he’s coming from, and I don’t blame him for
    feeling angry about abuses of “the system”, but he’s not seeing
    the truth: this isn’t an abuse of “the system,” this is the
    intended system. Even though it’s illegal, the system wants you
    to lie.

    To begin to see not how this is but why this is, pretend that
    Caroline had made a left instead of a right and wanted,
    inexplicably, to immigrate to Greece. She shows up, gets the
    necessary binder of paperwork, and of course right there on
    the cover it says they don’t want black people either. But she’s
    highly motivated. What’s the play? Think about the answer.
    The play is: she’s got to figure out who to bribe.

    The play is: she has to bribe a Greek Novick. And


    Novickopoulos already expects it.

    It is both metaphorically and literally accurate to say it isn’t


    rape or torture, but exactly that system, that she is trying to
    escape by coming to America.

    III.

    The system wants Caroline, the system wants there to be a


    way for “intelligent” and “hard working” and “church going”
    resourceful people to game the system. All of those words
    mean “taxpayers.” It wants the kind of person who sticks with
    this tedious bureaucratic process even if it is all a lie; it doesn’t
    want the person who doesn’t bother to try to get legal. And,
    most importantly, when you establish the grift as based on the
    best “rape narrative”, it therefore isn’t about the most money.
    That’s what you want to avoid, because Caroline has none of
    it, and MS13 has lots of it.

    What distinguishes this grift from the overt kind— of Greece,


    Mexico, Pakistan— is that in the former case the cheat occurs
    top down, while in the latter case the cheat occurs bottom up.
    In Greece, you want a permit? You have to know who to bribe.
    Bribery may go “all they way to the top,” but importantly your
    bribe has to start from the bottom and move to the top.

    In the case of American asylum seeking— and everything else


    — the grift is at the top and it lacks a human face. This story is
    in The New Yorker, right? So it’s hardly news, hardly
    investigative journalism. So at minimum, everyone in the
    business knows the score. Novick knows that, in general,
    much of what he hears is a lie, even if he isn’t sure/ignores
    that he is being lied to right now. Unless you piss him off
    personally, or flaunt your lying, he doesn’t care about the
    veracity of your claim exactly, just the internal validity of it.

    That’s the system. The system favors narratives over truth to


    avoid the terrible reality of reflexive human corruption.

    IV.

    “Internal validity over objective reality? The system wants you


    to lie? What madness is this?”

    Say you’re a gay male asylum seeker. “Back in Brasil they


    beat me mercilessly, police have gang raped me. I’m told that I
    can find acceptance in “Southern Carolina.” (Shhh, don’t tell
    him. This will be hilarious.)

    Your documents are all ready. Your day before the


    immigration judge comes. How should you dress? Think about
    this.

    (NYT) In the end, Mr. Castro opted for… pink eye


    shadow, a bright pink V-neck shirt and intermittent
    outbursts of tears… He had been advised by his
    immigration lawyer that flaunting it was now his best
    weapon against deportation.

    “Judges and immigration officials are adding a new


    hurdle in gay asylum cases that an applicant’s
    homosexuality must be socially visible,” said Lori
    Adams, a lawyer

    Being gay isn’t enough, you have to look gay. But importantly,
    while no member of the immigration office can deny you for
    not looking gay:

    Rhatigan [from Immigration] said such behavior by


    immigration officers would not be condoned. “We don’t
    say that someone is insufficiently gay or homosexual”

    “everyone knows” that you have to dress the part. Like your
    life depends on it.

    The system doesn’t want truth, it wants internal validity. That


    sounds bad, but it wants it to be based on the force of a
    narrative because it doesn’t want your life to be determined by
    the whims of a man with two mortgages or a drug habit or a
    hard on.

    But wait: now pretend you’re not gay. Can you… dress the
    part?

    One lawyer recalled a recent client who applied for


    asylum on the basis of sexual orientation, then showed up
    a few weeks later with his wife, seeking help with a green
    card. In 2009, Steven and Helena Mahoney pleaded
    guilty to charges stemming from a consulting business in
    which, among other things, they coached straight people
    on how to file gay asylum claims.

    Is it lying? Yes. Is it a grift? Yes. But is the fake-gay married


    guy more likely to rape a bus of schoolkids or file quarterly
    1099s? That’s the system.

    V.

    The unanswered question is: how? How can a system operate


    on words alone? “All you have to do is say you were raped
    and you’re in?” No, of course not, you have to provide proof. I
    can’t just roll up to the Apple store and say I have $100, I need
    some sort of proof that I have $100. Someone has to take my
    words– maybe even lies— and translate them to tangible
    proof. So maybe it’s the bank, or maybe it’s Visa who takes
    my “lie” that I have $100, and makes it real for the merchant
    by forcing me to pay $15 a month until that lie becomes true.

    Caroline is fabricating a rape narrative. Novick wants proof.


    How does she prove it? What is the mechanism by which the
    American system converts words— truths or lies, either way—
    into physical evidence? What does the system give her—
    indeed, demand of her— as a means of manufacturing the
    necessary proof of her rape?

    To buttress her asylum claim… she had been attending


    group and individual psychotherapy sessions, as part of a
    program for survivors of torture…. She has individual
    sessions with a psychiatrist, who prescribes
    antidepressants: Zoloft, Wellbutrin, trazodone…. “I throw
    it away.”

    Note that she didn’t really have any symptoms; the system
    required her to go as evidence that she was raped. i.e.
    psychiatry is not the unintended collateral damage of a terrible
    system, it is the necessary part of the dialectical workings of
    (American) society, it is the specific way in which
    theory/lies/abstractions are physically manifested.

    By “required” I don’t mean codified. There’s no rule that says


    she has to see a shrink. But she still has to. It will look weird if
    she goes before the judge without a PTSD diagnosis. Nor does
    a person actually need to go to a psychiatrist, but they must at
    minimum employ the language of psychiatry: traumatic,
    depressed, flashbacks…

    I do not use the requirement of psychiatry lightly. I mean


    exactly what I say: psychiatry makes words manifest into
    tangible reality.

    Remember Castro who was not gay unless he appeared gay—


    the reality was irrelevant, what mattered was the narrative?
    Even he was in it:

    He shared a letter from his psychiatrist confirming that he


    took antidepressants for the post-traumatic stress disorder
    caused by his abuse.
    How much did it cost the system to help Caroline game it? 2
    therapy visits/month at $60/visit + 1 “med check”/month @
    $50/visit + medications @ $150/month (assuming generics) =
    $320/month. However, and this is the point, it made a profit on
    its investment, not just in taxes but in “blast radius:” she’ll be
    a positive influence on others, her kids, who will grow up
    educated, employable, etc. This is the same force that gives
    you $700/month in SSI because that is just enough to prevent
    you from robbing a Dunkin Donuts or chasing a dragon, not to
    mention way cheaper than incarcerating you or turning the
    Bronx back into a police state.

    The system wants Caroline because she’s good for the system.
    Of course, she is black, but at least she’s African black; and,
    anyway, you can’t have everything.

    VI.

    No doubt all this talk about “the system” seems too abstract to
    be real, almost at the level of conspiracy theory, so let me offer
    you an everyday example.

    Say you get a bill from Verizon or Blue Cross and you’re like,
    wtf? Is this in base 6? So you call a number that begins with
    800, put it on speaker and surf the internet for the next hour to
    the background music of genocide.

    Finally, Sally comes on, and you know she’s going to want to
    help. Here’s what I do every single time. When Sally says,
    “Verizon’s Blue Cross, I’m Sally, how may I help you?” the
    very first thing I say is, “Hi, Sally. I’d like to speak to a
    supervisor.”

    Because at the level of a Sally, nothing I can say to her to get


    her to do what I want exerts nearly as much pressure as “the
    system” exerts on her to get her to NOT do what I want. It’s
    not just that she doesn’t have any power, it is that even though
    she has power, the exertion of that power in my favor results
    in negative consequences for her. Is she going to get promoted
    if she makes me happy?

    My only recourse is to go high enough in the system such that


    my pressure is greater than the pressure from the top; where
    giving me what I want doesn’t matter to that level. Where
    helping me benefits that person, not hurts them. Sometimes
    that’s pretty high up, sometimes it’s only one more level up,
    but it is rarely at the ground floor. So I always bypass it. In
    small letters on the back of your Verizon bill, it says very
    clearly, “Rookies and rubes, please call 1-800…”

    But if I was in Hungary, this is the last thing I want. In


    Hungary, the move is to work Sally and keep her supervisors
    out of it, because Sally is cheaper to bribe than her
    supervisors.

    Another example. In The Sopranos, Burt and Patsy try to


    shakedown a local Starbucks; apparently they either believe
    they’re in Hungary or that it’s 1971. So they tell the manager
    about the possibility of tornadoes and smallpox unless he pays
    up, but the manager who lives in America just looks at them
    incredulously and invokes the impassable authority of the
    American system. “Dude,” he says, and I’m paraphrasing,
    “every dime is accounted for by the computer.” Not by CEO
    Howard Schultz; the computer. It’s unassailable because there
    is no such thing. The computer is “the system,” the computer
    is the spirit of America. “You can detonate a nuke in here,” he
    continues,” Corporate doesn’t care about me. They’ll just re-
    open another one the next day.” That’s the system. You may
    say it’s dehumanizing corporate greed, and it is, but on the
    other hand the system has (for example) protected the manager
    from this kind of nonsense and no cops were needed.
    Rail against it if you want, but unless you learn to operate
    within it, then Patsy will have been right: “It’s over for the
    little guy.”

    VII.

    A final example.

    You’re in college, and between the alcohol and the orgasms


    you’re not doing well in your classes. Maybe in danger of
    failing out. You need to convince the Dean to let you redo the
    tests, redo the papers, anything— just not kick you out.

    You’re at the computer. You have his email address.

    What are you going to write? What is the only thing you can
    write?

    VIII.

    The reflexive counterargument is that this system is immoral.


    It allows cheating; it supports the primacy of narratives over
    reality; it shouldn’t be like this.

    But the system doesn’t make moral judgments, it saves those


    for TV, all of the calculations are economic, evolutionary. The
    system isn’t immoral, it is amoral. The fundamental problem is
    that people are easily corruptible. You’ll never be able to close
    all loopholes, so you have to decide which ones are the worst.

    Am I saying Novick knows he’s being lied to, and knows that
    he’s supposed to let her in anyway? That the judges know that
    we need more hard working Africans? Of course not. Yet
    Caroline got in anyway.

    No person or group of people set this up, it developed,


    logically, through the push-pull of individual wants and needs
    in diverse and seemingly unrelated areas. Add up all the vector
    forces in four dimensions, this is what you get. A big vector is
    bribery and personal corruption; another vector is the size of
    the medical field and the incomes it creates (including SSI);
    another vector wants (hispanic) immigrants in jail because
    there’s profit in it; another is institutionalized narcissism,
    where everyone (including judges and psychiatrists) knows
    what you say about yourself matters more than what you are…
    and etc.

    “Not everyone cheats!”

    I know. None of this is to minimize the real difficulties asylum


    seekers have. Only 30% of the asylum cases are approved. The
    point here isn’t how to get asylum; the point here is about the
    nature of the grift. Asylum seeking is merely one example of
    the same grift that is operational in SSI, in criminal justice, in
    getting a mortgage. How does the American system “fail” at
    the margins— allow itself to be gamed? It fails in specific
    ways and not in other ways; bribery, for example, isn’t
    rampant. Neither is kidnapping or trading sex. Before you say
    Caroline shouldn’t be able to cheat, ask why does the
    American system favor this kind of cheating?

    Don’t make a moral judgment, don’t ask if it’s “right,” just


    sum the vector forces.

    Consider also the consequences. If narratives are valued more


    than reality, or at least serve as proxies for reality, then right or
    wrong, what happens when that narrative is challenged? What
    happens when society changes course and says, “I don’t
    believe all these asylum seekers were tortured, I want physical
    non-psychiatric proof.” Or: “I don’t believe you all are
    disabled, I think you should all be working at McDonalds.”
    Or: “I don’t think you all have any chance of paying this
    mortgage back, you should be living in an apartments.”

    What happens is the same thing that happens at the individual


    level: rage. Now you have to sum some vectors to decide
    whether paying them $700 a month or letting them become
    Americans is better than the alternative.

    The immediate problem is that the grifts all rely on one key
    element: money. The system can allow itself to be cheated if
    there’s money to support it, just like a grocer can toss you a
    free apple as long as the margins are still good, because
    ultimately it’s good for the business and hence for the system.
    But when that money dries up, the institutional grift has to be
    closed but it will by necessity open elsewhere. Down the
    chain. From institutional to individual. Now instead of Novick
    being a cog in what looks like a giant carny act based on
    words, Novick himself starts demanding a little payout. Uh oh,
    now all your lies and diagnoses and credit cards don’t matter a
    lick because Novick just Red pilled everything— he wants
    cash. Now the system is wrecked, because the system’s
    inherent cheats fulfilled a larger purpose; Novick has
    obliterated the purpose. So the Carolines don’t stand a chance;
    bribery is the new grift, and no one trusts anyone. Now you
    have Greece. You can do what they do, choose your prime
    minister by heredity and placate the people with long
    vacations and low retirement ages, until the day you can’t.
    And then they’ll thank you for two generations of free lunches
    by rioting.
    Grade Inflation
    August 15, 2011

    speculate on the use of a Tardis


    Today we’re going to talk about the causes of grade inflation. “Wait,
    is this going to be on the test?”

    You’re a professor and you grade the paper a C. The next day Type
    A Personality Only Child comes up on you, “how is this a C? I
    answered the question correctly, didn’t I?” Yes, but you write like a
    nine year old, 80% of this is the syntactical equivalent of “umm” and
    “ahhh”, and many of your sentences are minimally altered passages
    right from Wikipedia. “But this is a history class. Why are you
    grading my writing style?”

    There’s really no good way for a professor to respond to this nut.


    The depth of his stupidity precludes any explanation from being
    meaningful; he will not be able to understand that the writing is a
    reflection of the rigor of the ideas which is a reflection of the
    knowledge of the material and etc. So you give him an A and head
    to a strip bar. I sympathize.

    Two explanations are commonly offered for grade inflation— and


    let me clarify that the grade inflation people complain about is the
    kind that happens in the introductory survey courses. No one worries
    about grade inflation in the 400 level thermodynamics class. 1.
    Universities don’t incentivize teaching, they incentivize research, so
    the teaching suffers. 2. Students are drunken idiots. While both have
    merit, let’s see if there isn’t another explanation that shrewdly
    protects the unconscious of most of the players..

    II.

    Here’s a nice graph:

    The only surprising thing to me about this graph is nothing. Since no


    one over 90 is reading this, let’s focus on 1986. What happened in
    1986 that changed the grading trend?

    Generation X went to college, that’s what. Coincidentally,


    psychological researchers Twenge et al found that that was the year
    narcissism on campus began to rise:
    And by “coincidentally” I mean “not coincidentally.” It’s hard to tell
    a growing population of narcissists that their schoolwork blows, so
    you don’t: A. Makes sense.

    Most people stop their analysis right there, but you should really go
    the extra three steps and not just pee in the sink: now those students
    are 40. They grew up to be the Dumbest Generation of Narcissists In
    The History of the World, so narcissistic that not only are they
    dumb, but they do not know how dumb they are and cannot be told
    how dumb they are. They are aware that there are things they don’t
    know, but they are certain that they have at least heard of everything
    that’s worth knowing. Whenever the upper management guys at
    Chronicle Of Higher Education or The National Review pretend to
    disagree about the “classics” or “Great Books” or the “value of a
    liberal education,” after five minutes it becomes clear that even they
    haven’t read all those books, or most of them, or even a respectable
    minority, or three. They’ve read about them, ok, that’s what America
    does, but when you finally pin them down and they admit they
    haven’t read it— which would be fine— their final response is of the
    form “there’s no point in reading Confessions now since we’ve all
    moved beyond that.” Oh. And those are supposed to be the smart
    ones; everyone else in the generation thinks that the speed at which
    they can repeat the words they heard on TV or read on some
    magazine’s website is evidence of their understanding.

    II.

    Which brings me to the main point, the other cause of grade inflation
    that no one ever talks about: in order for a grade to be inflated, a
    professor has to inflate it. In other words, grade inflation isn’t the
    student’s fault, it is the professor’s fault. A kid can complain and
    whine/wine all he wants, but unless that professor buckles, there’s
    no grade inflation. So the starting point has to be: why does a
    professor inflate a grade?

    Yikes. Now that shudder you’re feeling is not only why you never
    thought it, but how it is possible no one else ever brought it up? The
    answer is: every discussion about grade inflation has been
    dominated by educators.

    The “college is a scam” train is one on which I’m all aboard, but that
    doesn’t mean each individual professor has to be scamming
    students; there’s no reason why he can’t do a good job and teach his
    students something that they aren’t going to get simply by reading
    the text. If a student can skip class and still ace the class, the kid is
    either very bright or the professor is utterly useless. Right? Either
    way, the kid’s wasting his money.

    And I know every generation thinks the one coming up after it is


    weaker and stupider, that’s normal. But why would a professor who
    thinks college kids are dumb turn around and reward the King Of
    Beers with an A?

    The answer is right in the chart and in a book by Allan Bloom that
    most college professors have read about. When that professor who
    was 40 in1986 was back in college in 1966, he was part of a culture
    that believed there are no “wrong answers, only wrong questions”,
    like “you really think we should we stop shaving?” or “should we
    listen to something other than CCR?” And meanwhile the rate of As
    doubled. So now you have to put up your money: if you believe that
    grade inflation at that time masks/causes a real shallowness of
    intellect and education, then those students, now professors, simply
    aren’t as smart as they think they are. Unless you also believe that
    bad 60s music and even worse pot somehow augmented their
    intellect.

    And if you accept my thesis that narcissism prevents insight because


    it is urgently and vigorously self-protecting, then these same
    professors are not aware of their deficits. They think they know the
    material they are teaching simply because they are teaching it.

    The problem is they are grading your papers and they do not know
    how to value a paper. Of course they can tell an A+ essay and they
    can tell an F- essay, but they are pretty foggy on everything in
    between. But they do not realize they are foggy. They think the
    problem is “the students complain.” So they judge essays in
    comparison to others in the class or they fall back on the usual
    heuristics: page length, sentence complexity, and “looks like you put
    a lot of work into it.”

    And worse— much worse, given that they are supposed to be


    educators— they have no idea how to take a so-so student and make
    him better; what, specifically, they should get him to do, because
    they themselves were similarly mediocre students who got inflated
    As. Do you think they got their A in freshman analytic philosophy
    and said to themselves, “Jesus, I know I really didn’t deserve this A,
    I better go back and try and relearn all this stuff.” No: they went
    ahead and got jobs in academia, so that when a student comes to
    them asking, “how can I do better?” they can respond, “You need to
    apply yourself.” Idiot. The system is broken. You broke it.

    III.

    Here’s an example. Say your essay question is, “describe the causes
    of the American Civil War.” Ok, so far everything the kid knows he
    learned from Prentice Hall, but something inside him thinks the
    answer is: LABOR COSTS. Hmmm. Insightful and unexpected, let’s
    see what he does with it.

    But there’s not much he can do with it, there aren’t many obvious
    resources to pursue this “feeling” he has. He does what he can. It’s
    not that good. C. Grade inflation gives him a B.

    Meanwhile, Balboa the el ed major searches carefully in his


    textbook and discovers the cause was… SLAVERY. He airlifts two
    sentences each out of five other books, asks for an extension because
    his grandmother died, adds nine hundred filler words including “for
    all intensive purposes” and “he could care less”, and then waits in
    the parking lot to threaten you with “but this is a history class. Why
    are you grading my writing style?” He gets an A.

    The problem is that the first kid is strongly disincentivized from


    pursuing his idea, from becoming a better thinker, in very specific
    ways.

    First, and obviously, since the majority of the students are going to
    get an A, he just has to do just as well/horrifically as the average
    student, and if they’re all writing about slavery with the enthusiasm
    of a photocopier then if he wants an A he better buckle down and
    learn the truly useful skill of masking the words of a Wikipedia
    page.

    Second, he is very nervous about offering a professor anything that


    he didn’t hear the professor explicitly mention, let alone endorse.
    What if it’s “wrong?”

    Third, because grading an essay is subjective, all professors try to


    make it objective by attributing value to measurable quantities which
    are actually stupid. For example: in most undergrad classes, the
    bibliography counts for 5%, maybe even 10%. How you (that’s
    right, I said “how you”) going to pad a bibliography with six sources
    when you can’t even find one to support your thesis? So the pursuit
    of an interesting thesis is blocked by the 5% of the grade that comes
    from something that should count for exactly -20% of your grade,
    i.e. if you have a bibliography, you’re a jerk.(1) This false value has
    two consequences: it “pads” the grade (e.g. the student already starts
    with an easy +5-30%) so it is easier for him to get an A. But more
    importantly, it is now easy for the professor to justify giving him an
    A. “His content wasn’t that great, but the points added up; and
    besides: what the hell would I tell him to improve?”

    I can’t emphasize that last part enough— the cause of the ridiculous
    grading is not the complaining of students but the convenience of the
    professor.

    This is why if you are in a class and you feel the need to ask, “how
    many pages does this have to be?” and rather than look at you like
    you just just sneezed herpes on his face he instead has a ready
    answer, you are wasting your money. I get that you need the degree,
    I understand the system, but you’re wasting your money
    nevertheless.

    IV.

    Take a quick scan of what these academics consider the highest level
    of academic scholarship: read their own journals. Here are the first
    three paragraphs of the first article (“Terrorism and The American
    Experience: A State Of The Field“) in the temporally coincident
    month’s Journal of American History, and I expect you to read none
    of them:

    In 1970, just months before his death, the historian Richard


    Hofstadter called on U.S. historians to engage the subject of
    violence. For a generation, he wrote, the profession had ignored
    the issue, assuming that consensus rather than conflict had
    shaped the American past. By the late 1960s, with
    assassinations, riots, and violent crime at the forefront of
    national anxieties, that assumption was no longer tenable.
    Everywhere, Americans seemed to be thinking and talking
    about violence, except within the historical profession.
    Hofstadter urged historians to remedy their “inattention” and
    construct a history of violence that would speak to both the
    present and the past.1
    Over the last four decades, the historical profession has
    responded to that challenge. Studies of racial conflict, territorial
    massacres, gendered violence, empire, crime and punishment,
    and war and memory make up some of the most esteemed
    books of the past generation. Yet on the subject of “terrorism,”
    the form of violence that currently dominates American
    political discourse, historians have had comparatively little to
    say. Since the attacks of September 11, 2001, a handful of
    conferences have addressed historical aspects of terrorism,
    from its nineteenth-century origins to its impact on state
    building and national identity. Scholarly journals (including the
    Journal of American History) have devoted the occasional
    special issue to examining terrorism’s roots and present-day
    implications. Within the historical profession, several book-
    length works have taken up episodes of terrorism, examining
    the production of both violence and state repression. Social
    scientists and journalists have offered sweeping global
    histories, tracing the problem of terrorism from antiquity to the
    present.2
    As a result, we have a better understanding of terrorism’s
    history than we did a decade ago, but it would be hard to
    classify this surge of work as a flourishing subfield or even a
    coherent historiography. Almost a decade out from 9/11, most
    U.S. historians remain hard-pressed to explain what terrorism
    is, how and when it began, or what its impact has been. There is
    little consensus about how best to approach the subject or even
    whether to address it at all. This is partly because the issue
    poses knotty political questions: How do we talk about
    terrorism without reinforcing the “war on terror” or lapsing into
    hopeless presentism? It also brings serious methodological
    problems: Is terrorism a word to be traced through centuries of
    semantic permutation? Is it an epithet to be applied to forms of
    violence we do not like? Is it a concept to be defined, however
    loosely, and followed through time?
    Like any project that takes its cue from current affairs,
    constructing a historiography of terrorism requires caution and
    a light touch…

    If a student wrote this I’d punch him in the bladder and get a good
    defense lawyer, assault charges be damned. I’ve deliberately avoided
    the easy targets like the po-mo journals; this is “the leading scholarly
    publication and the journal of record in the field of American
    history” and the author goes on like this for 20 pages. Can you trust
    this professor to grade an undergrad paper? The first two paragraphs
    are filler, meaningless noise in the guise of a sophisticated
    introduction. Maybe she can tell an A+ and she can tell an F-, I have
    no idea, but is she in any position to know a C from a B? And help
    you improve? Do you want to write like her? If you had questions
    about the history of terrorism, or terrorism, or history, would you
    call her?

    I picked her because she was at random, but the same forces apply
    ubiquitously: academic journals are long, boring, poorly written
    academic-ese that no one reads because whatever insights or
    information they possess are buried in…the syntactical equivalent of
    “umms” and “ahhs.” Even those who theoretically need journals to
    do their jobs every day (e.g. lawyers and doctors) avoid them.

    Apart from boycotting any classes taught by these people I don’t


    know what the solution is. Some professors cleverly include a “class
    participation” grade, and these professors pride themselves on using
    “the Socratic method.” Sigh. Asking random students random
    questions is not the Socratic method, it’s annoying, In order for it to
    be a true Socratic method, the professor would have to ask the
    student to state a thesis, get him to agree to a number of
    assumptions, and then masterfully show, through dialogue, how that
    agreement undermined his own thesis. In other words, the professor
    would have to have considerable fluency with his topic and be
    interested in each individual student, as an individual. Good luck
    with that. (2)

    V.

    If you reconsider grade inflation not as a function of the quality of


    the output but rather as the result of a hesitating lack of confidence
    about what constitutes good quality— and again, I’m talking not
    about A+ and F- but the differences between the B and C levels
    where most “good” students are; and accept that, simply as a
    numerical reality, these “average” students are then the ones who
    (likely with the assistance of grade inflation) go on to become future
    academics, then a number of phenomena suddenly make a lot of
    sense. And the most important one is the one that students have long
    suspected but never dared say out loud: professors do not know the
    material they are teaching, but they think they do.

    An American History professor may be considered somewhat of an


    expert because he’s been teaching the Civil War for the past 15
    years, but he’s only been repeating what he knew 15 years ago for
    15 years. And every year he forgets a little. How carefully is he
    keeping up with it— especially if his “research interests” happen to
    lie elsewhere?

    I know doctors who have been giving the same receptor


    pharmacology lectures to students for a decade. I know they are
    narcissists, not just because they are too apathetic to keep up with
    the field, but because it never occurred to them that receptor
    pharmacology might have advanced in ten years. They believe that
    what they knew ten years ago is enough. They are bigger than the
    science. These aren’t just some lazy doctors in community practice,
    these are Ivy League physicians responsible for educating new
    doctors with new information. Yet the Power Point slides say 2001.
    “Well, I’m just teaching them the basics.” How do you know those
    are still the basics? Who did you ask?

    You think you philosophy professor re-reads Kant every year? The
    last time he did was in graduate school— when his brain was made
    of graduate student and beer. Think about this. Hecko, has he even
    lately read about Kant? Do you think he tries, just to stay sharp, to
    take a current event and see what Kant might say about it? No, same
    notes on a yellow legal pad from Reagan II. Does he “know” Kant
    because he’s been “teaching Kant” for 20 years? When in his life is
    he “challenged” by someone else who “knows” Kant? Seriously,
    think about this. For two decades the hardest questions he’s been
    asked come from students, and he’s been able to handle them like a
    Jedi. How could he not think of himself as an expert?

    The sclerosis of imagination and intellect that inevitably happens


    over time will make it impossible for him to grade a paper that does
    not conform to his expectations. I don’t mean it agrees with the
    professor, I mean his expectations of what a good paper looks like.
    Students already have a phrase for this: “What he likes to see in the
    paper is…”

    So when it comes time to write a paper about Kant, it is infinitely


    less important that he understand Kant then it is for him to
    understand what the professor thinks is important about Kant— and
    it is way easier to get through college this way. And if you have the
    misfortune of being taught Kant by a guy whose “research interests”
    are not Kant, forget it. You’re getting an A, and he hates you.

    VI.

    This stuff matters, it has real consequences. When one narcissistic


    generation sets up the pieces for the next generation, and you put the
    rooks in the middle and leave out the bishops and hide one of the
    knights, and then you tell the kids that they lack the intelligence or
    concentration to really learn chess, you have to figure they’re not
    going to want to pay for your Social Security. Just a thought.

    Also: TAs are helping grade some of the papers, and some is worse
    than all. In order to ensure grading consistency, the essay answer has
    to be structured in a format that facilitates grading— because if the
    professor can’t value a B form a C, how can a TA? So the answer
    must mirror the six points in the textbook or the four things
    mentioned in class. This, again, means you shouldn’t spend any time
    learning, you should spend it gaming the essay. So if the essay
    question is, “Discuss some of the causes of the Iraq War” you can be
    dead sure that “some” means specifically the ones the professor
    thinks are important. There may be others, but you’re taking a big
    risk mentioning them. The TAs are just scanning for keywords. As
    long as they’re in there, even in grammatically impossible
    constructions, you win. A. (3)

    VII.
    Here’s one solution: abandon grades.

    “But we have to have some way of objectively evaluating students!”

    Haven’t you been listening? You can’t just suck the Red Pill like a
    Jolly Rancher, you have to swallow it. Grades aren’t objectively
    measuring people, the whole thing is a farce. The grades are
    meaningless. Not only do they not measure anything, but the manner
    in which they are inflated precludes real learning. Stop it.

    “Some grades aren’t inflated.” But how would anyone on the outside
    know? Can you tell them apart? The long term result will be: bad
    money drives out good money.

    “Well, I earned my As.” No you didn’t, that’s the point. I’m not
    saying you’re not smart or didn’t work hard, I’m saying you have no
    idea how good or bad you are, you only think you do.

    “Just pass/fail? But how will employers know a good student from a
    bad student?” Again, you are avoiding the terrible, awful truth
    because it is too terrible and too awful: when employers look at a
    GPA, they don’t know anything. The 3.5 they are looking at is
    information bias, it not only contains no information, it deludes you
    into thinking you possess information. You can’t erase that 3.7 from
    your mind. In what classes, in what levels, against what curve? Just
    because employers do it doesn’t mean it’s useful. They use sexual
    harassment videos, too.

    Grades do not only offer incorrect evaluations of a student’s


    knowledge, they perpetuate the fiction that professors are able to
    evaluate. They can’t. Again, they may be able to tell an A+ and an
    F-, but a B+ from a B? Really? That’s the level of their precision?
    But a professor cannot ever admit that he doesn’t have that
    precision, because it cannot enter his consciousness that he doesn’t.
    “I’ve been teaching this class for 15 years.” And I’m sure it gets
    easier every year.

    VIII.

    Speaking of Iraq: on the eve of the Iraq War many Americans got
    together to demonstrate. I’m not in the protest demographic, the only
    way I’m going to be at a march is if there’s alcohol, but I accept the
    fact that a protest is sometimes the only way to be heard and the last
    resort against a government that has forsaken you. I get it. Ok. So
    I’m watching the protests on TV, and a lot of people quite obviously
    don’t want to go to war, and want it stopped at all costs. And I see a
    group of people with signs walking behind a long banner, and the
    signs and the banner say, basically, “UNIVERSITY PROFESSORS
    AGAINST THE WAR.”

    I’ve no doubt that there wasn’t a little bit of the old Vietnam
    nostalgia there, but what made me furious was the signs. They
    actually believed that identifying themselves as university professors
    was helping the cause? Did they think Americans were going to slap
    their foreheads, “wow, educated people are against the war, maybe I
    gots to rethinks this?” Yes, that is exactly what they thought.

    They could not see that they were sabotaging their own cause, that
    anyone ambivalent about Iraq would either not think anything or be
    blinded by white rage, “look at these mother—” and vote for Bush
    six more times. These professors were coming from such a
    profoundly narcissistic stance that they didn’t see this, or they didn’t
    care. They may have wanted to stop the war, but what was much,
    much, much, much, much more important was to be identified as
    against the war, even if by doing that they were causing other people
    to support the war.

    Here’s what TV didn’t show: the next day, those professors went to
    their classes, taught a bunch of anxious, restless but bored students
    stuff that they really had no business teaching, and later asked them
    to write essays that could be graded essentially as multiple choice
    questions so that they wouldn’t really have to read them. If these
    professors didn’t realize or care that that they were violating their
    own principles about war merely to self-identify, do you think they
    care about you? They have much bigger things to worry about. A.

    –
    1. Bibliography, as distinct from references. Anyone who produces a
    Bibliography without specific references as some sort of support of
    the truth of their idiocy is on notice. I’m talking to you, DSM.

    2. An interesting educational experiment would be to come at things


    form a negative perspective. “Look, class, Hegel was a complete
    jerk, and his ideas were infantile pseudo-buddhism garbage. I’ll give
    50 points and a candy bar to anyone who can explain to me why.”
    And see if that doesn’t inspire the student to want to understand
    what Hegel was trying to say. I don’t know if this will work. I know
    that a disengaged professor saying that Hegel is a great German
    philosopher and then reading lecture notes written back in 1986 on a
    yellow legal pad very clearly doesn’t work.

    3. Here’s an essay I’d love to read, hell, love to write: “There are
    numerous “established” causes of the Iraq War, yet they almost
    always cite reasons that occurred after 1990. Please watch the 1975
    film Three Days of The Condor. Other than a Tardis, what
    explanations could there be for director Sydney Pollack’s ability to
    predict the future with such accuracy? Please discuss some of the
    events of the late 1960s to early 1970s that made the finale’s
    prediction possible.”

    Also: Here is precisely one of these professors


    What To Do About Sexy
    High School Girls Having A
    Slumber Party
    August 19, 2011

    wait, that’s not sexy


    A case, the summary of which is everywhere:

    During another sleepover, T.V. took a picture of M.K. and


    another girl pretending to kiss each other. At a final
    slumber party, more pictures were taken with M.K.
    wearing lingerie and the other girls in pajamas. One of
    these pictures shows M.K. standing talking on the phone
    while another girl holds one of her legs up in the air, with
    T.V. holding a toy trident as if protruding from her crotch
    and pointing between M.K.‘s legs. In another, T.V. is
    shown bent over with M.K. poking the trident between
    her buttocks. A third picture shows T.V. positioned
    behind another kneeling girl as if engaging in anal sex. In
    another picture, M.K. poses with money stuck into her
    lingerie - stripper-style.
    And up to facebook went the pictures; and the school got
    involved; and the court got involved; and now I got involved.

    Important to the story, these high school girls were volleyball


    players. Not important to the story, but featured in every one
    anyway, is that they were cheerleaders. We get it. They’re
    white.

    The judge ruled that the pictures were protected under the First
    Amendment, which is fine, but then said this, which is weird:

    I wish the case involved more important and worthwhile


    speech on the part of the students, but then of course a
    school’s well-intentioned but unconstitutional punishment
    of that speech would be all the more regrettable.

    Why wish that? If it was more important and worthwhile, we


    wouldn’t really have a controversy. The importance of the law
    is in these cases that don’t have worth or importance.

    II.

    The set up is one of free speech, but there’s a different game in


    play.

    The judge explained that it isn’t true that just any old
    photo/speech is protected, but speech that is “intended to
    convey a particular message” “understood by those” who
    would view it. In this case: this is funny (message) to the
    people on my facebook page who would understand that it
    was funny.

    The fact that adult school officials may not appreciate the
    approach to sexual themes the girls displayed actually
    supports the determination that the conduct was
    inherently expressive.
    This is where free speech gets really interesting, when it
    bumps against generational mores. The only thing “bad” about
    the speech was that the school officials didn’t like it. Nothing
    else. Is that enough to allow the school to shut the kids down?
    No.

    But what about the argument that the pictures affected the
    school or other girls by causing “divisiveness?” Isn’t this kind
    of like harassment, or bullying, or intimidation, even if it is not
    as bad? Wouldn’t the “pure” girls feel reluctant to play
    volleyball with a team of sluts?

    Petty disagreements among players on a team… is utterly


    routine. This type of unremarkable dissension does not
    establish disruption with the work or discipline of the
    team or the school…Consider, for example. [the case in
    which] getting a phone call from a disgruntled parent, and
    evidence that a student temporarily refused to go to class
    and that five students missed some undetermined portion
    of their classes… did not rise to the level of a substantial
    disruption.

    In other words, get over it. If you don’t meet these girls in
    school you’ll meet them in college or in their 30s in
    Indianapolis (the whole city is horny.) The fact that you have
    to avoid them or deal with them or sleep with them or argue
    with them is mostly your problem. I sympathize, sure, and I’m
    happy to help, but it’s still your problem. You can’t change
    other people, even if they are wrong.

    III.

    But wait a second: how did the school even see the pictures?
    Take a moment and come up with an answer.

    …a parent brought printouts of the photographs to the


    [Superintendent]… The parent reported that the images…
    were causing “divisiveness” among the girls on the
    volleyball team… Separately, but on the same day… the
    principal was contacted by a second concerned parent,
    one who happened to work at the school as an athletic
    department secretary.

    The school has a problem, and it isn’t high schoolers wrestling


    with their hormones. The school is infested with rats.

    The true social implications of this case aren’t about the girls’
    behavior, but the parents’. To what extent are they allowed to
    impose their values on their kids, and, separately, what is the
    proper structure to impose these values?

    This popular reading of this case is that the school (i.e.


    government) doesn’t have the right to reach into the private
    home and control the speech of students, but that evades the
    important cause of this case: the parents want the government
    to control the kids because they aren’t willing to do it. See?
    It’s not just black kids. Parents all over the U.S. have checked
    out, can’t be bothered and anyway don’t really know how to
    bother. How can I explain to my daughter that this is bad? I
    know: Tinker v. Des Moines Indep. Cmty. School Dist. Yeah.
    That’ll show her.

    The way it should have worked is that one concerned mother


    calls the other mother, and she opens up with, “I just want to
    bring something to your attention” or “Jesus, do you know
    what your wenchy daughter is up to?!” and they work it out
    and stuff gets handled, and if it doesn’t it gets kicked to the
    fathers, who freak out on their daughters and then reluctantly
    agree to talk to the other father about it and settle it once and
    for all, and if that doesn’t work they can agree to meet in the
    Woolworth’s and Woolco parking lot and punch each other
    like girls. I recognize this is all quite sexist, but that’s the way
    it should have gone down. That’s the way it has always gone
    down.

    But the parents couldn’t handle this as parents, i.e. as the


    ultimate arbiter of a controversy, because they are not
    practiced at being the ultimate anything. Stripped of all power
    as children, and never given either power or responsibility,
    they drowned in freedom and looked for a practical solution to
    their existential crisis: everything always has a higher
    authority. Call the school, call the cops, call the government.
    The joke used to be, “hey, lady, don’t make a federal case out
    of it!” but that’s no longer a joke, it’s the preferred method.

    The idiocy of such parents is mind boggling, certainly, but


    even more compounded by the message that it sends to their
    own kids: higher authorities always exist for everything. Just
    not God. That’s for stupid people.
    Can The Court Force
    Treatment on Jared
    Loughner?
    August 24, 2011

    my attorney has advised me to punch you


    Jared Loughner shot Representative Gabrielle Giffords and 18
    other people, which immediately suggested that he was a right
    wing nutjob, but, apparently, he was actually psychotic, which
    is ok because Webster’s says those are synonyms.

    He was found not competent to stand trial. This means his trial
    is postponed until his mental illness resolves enough for him
    to: understand the charges against him; participate
    meaningfully in his own defense; control his behavior in court;
    etc. See that last “etc?” That’s the part that allows courts to do
    anything they want to you.
    Loughner, however is refusing to take antipsychotic
    medication to get better. A more accurate restating of that
    sentence would be, “it is extremely likely that Loughner’s
    attorney is refusing to allow him to be medicated, with the
    hope that trial is postponed forever, or at least until the
    attorney comes up with a really awesome defense, or people
    forget who Loughner is.”

    Let’s Michael Foucault this whole discussion and recall that


    psychiatry is a medical specialty that is also used to set social
    policy.

    Practically, this means that if the court wants to medicate


    Loughner against his will, they can. There is a legal process to
    follow, but it is simple and straightforward and completely not
    in any kind of dispute.

    There should be no issue.

    II.

    So I was surprised to read that the American Psychiatric


    Association and the American Academy of Psychiatry and the
    Law, through Paul Appelbaum, filed an amicus curiae brief in
    support of forced medication. Why? Isn’t this a non-issue?

    In fact, there are two reasons you can forcibly medicate (only)
    prisoners. The first is Sell v. US: you can force antipsychotics
    for the purpose of restoring the defendant to competency to
    stand trial.

    The second reason is Washington V. Harper, which allows


    forced medication of psychotic prisoners in the situation where
    they were dangerous to themselves or others.

    So, again, I was confused. What’s the debate?

    The APA’s brief had two purposes:

    1. “When the courts address issues concerning psychiatric


    disorders, we want them to have accurate data on the nature
    and consequences of those illnesses and on appropriate
    treatments.” The reason antipsychotics have traditionally been
    disallowed is because, as in Sell, there are significant
    irreversible side effects (tardive dyskinesia) that may outweigh
    the benefits. So the APA wants to update the court on the real
    risks, especially of the atypicals.

    2. Sit down:

    The second key issue the brief addressed was the


    importance of permitting authorities who have custody of
    a defendant to make decisions of forcible medication
    without having to go through a time-consuming judicial
    hearing on the matter.

    The brief pretends that the issue is unscrupulous lawyers


    keeping their poor psychotic clients psychotic forever, to their
    great distress, just to avoid trial. Appelbaum would like Harper
    to be the standard; Sell is too bureaucratic.

    In addition, we believe psychiatrists working in


    correctional facilities need the flexibility to deal with
    dangerous persons without the delay involved in lengthy
    court proceedings.

    The APA assumes that treatment decisions should fall to


    psychiatrists, but it seems not to appreciate that these are
    psychiatrists in prisons who work for the government. There is
    massive, gargantuan pressure on psychiatrists to medicate and
    commit and diagnose inmates for all kinds of legal reasons.
    Harper may seem like the more psychiatrist-friendly standard,
    but it isn’t. You want the standard to be Sell, because you want
    a way to avoid the pressure from the government.

    The Loughner case is misleading because he is mentally ill


    and dangerous, but the APA wants to massage Harper to focus
    on the dangerousness. Here’s a more typical example: the
    defendant is a violent rapist who has significant personality
    disorder but no clear psychosis (“no Axis I pathology.”) He
    punched his lawyer. Now what? You commit him to the
    psychiatric ward because he’s incompetent to stand trial and
    forcibly medicate him because he’s dangerous. But he’s not
    psychiatric! “Yes he is, it says it right there on the commitment
    papers: Psychosis NOS.” So you ask how he got that
    diagnosis, and of course the answer is: we needed it to be able
    to forcibly medicate him.

    I’m not going soft on rapists— go ahead and sentence him to


    life. But don’t send him to psychiatry because you don’t know
    what else to do with him.

    Doctors are given considerable deference to use their


    judgment; they are given greater latitude to violate a person’s
    rights. The government will use the back door of the doctor’s
    privilege to get what it wants. It is inevitable.

    The issue is not whether psychiatrists should medicate people


    who are obviously psychotic and dangerous— you don’t need
    an APA amicus curiae brief for that. The issue is whether you
    want to force all prison psychiatrists to be responsible for the
    “treatment” of every violent person out there, simply because
    they are “dangerous.”

    The APA has always wanted the answer to be yes. And here,
    again, they do not understand the consequences of this. I can
    thus say, according to the strictest definition of the term, that
    the APA is completely insane.

    Miscellany:

    1. In the Harper case, the American Psychological


    Association filed an amicus curiae brief in support of Harper,
    i.e. that forcible medication without a hearing violated the due
    process and equal protection clauses. You are welcome to
    explore the disparity between the APAs.
    2. Harper does not apply to civilians. You can force
    hospitalization on a guy for being dangerous and psychiatric,
    but you cannot force treatment on him without a court order.
    You can lock him down, but you cannot touch him.

    If a psychotic diabetic patient whose sugar is life threateningly


    high is refusing insulin because aliens tell him to, upon
    psychiatric review you can force insulin on him, but you still
    can’t force antipsychotics on him because the insulin is
    necessary to his survival and the antipsychotics are not.

    We know that psychosis takes a few days to improve, even if


    the right dose/drug is hit on immediately. The fact that it takes
    days to work means you can’t argue they are life saving, so
    you can’t get past the need for a court order.

    I will point out that even though what I’ve written is true,
    psychiatrists still routinely force medication on people, in jails
    and in hospitals. They’re doing it for noble reasons, and I
    don’t fault them, but it’s important to know where the line is
    before you cross it. And, as importantly, it is far preferable that
    a doctor violate the law in order to do what’s best for a patient,
    then it is for the government to sneak past people’s civil rights
    by hiding inside their doctors’ white coats.

    Competency to be executed

    Then I change my mind: Competency to be executed II


    The Wisdom Of Crowds
    Turns Into Madness
    August 31, 2011

    less independent than they think


    In PNAS, an article which is intuitively obvious but terrifying
    to see played out in science.

    The “Wisdom Of Crowds” concept is that the average guesses


    of a crowd will be closer to the truth than a randomly selected
    individual guess.

    The reason this works is that because the crowd has different
    individuals with different types of systematic error, e.g.
    prejudices. With more individuals, the prejudices negate each
    other.

    The Swiss study took 144 college students and asked them a
    series of questions (population of Switzerland, murder rate,
    etc). It recorded 5 consecutive guesses, as well as the
    confidence for the first and last guess.
    I.

    The first interesting finding is that the crowd is sometimes so


    incredibly wrong that the mean of their responses is just…
    really wrong. How many assaults were there in Switzerland in
    2006? 10? 100? 1000? 10000? 100000? Those are
    exponentially different guesses, so an arithmetic mean could
    be way off, factors of ten off.

    In such cases, a geometric mean is much closer to the correct


    answer. So, point number one, when you are crowdsourcing,
    choose your mean/distribution appropriately.

    II.

    The diversity of guesses is quite large— everyone comes to


    the question with their own prejudices and errors.

    But merely by giving the subjects access to the previous


    round’s guesses— either the mean of the guesses (“aggregated
    information”) or everyone’s individual guess, the diversity
    disappears and everyone’s guesses begin to converge.
    The first round the guesses were wildly disparate, but as
    everyone got to see the other guesses, they converge
    remarkably.

    Why did having the full information (all 12 people’s individual


    guesses) seem to cause less convergence than having the mean
    of their guesses? It didn’t, really; but also because the
    aggregate is only one number that you converge to; having 12
    wildly disparate numbers to converge to is harder. But by the
    third round, it hardly mattered— a systematic bias had been
    introduced into the crowd, which is ironic since it is systematic
    bias that the Wisdom Of Crowds is supposed to negate. Moo.

    III.

    People following the herd would be boring but not disastrous,


    except for the other finding.

    Since the guesses converge, since other people are converging


    with you and you can see that, the confidence in these guesses
    goes up: a false belief of collective accuracy with no increase
    in actual accuracy. “It’s unanimous!” Yikes.

    Also remember, these people weren’t being given an expert’s


    guess to converge to, just other (regular) people’s. As the
    authors point out, they didn’t even attempt to measure group
    leader effects, persuasion, talking heads on TV, or twitter.

    This is not a trivial problem. It isn’t just saying that the beliefs
    converge; it is saying that since the beliefs converge along
    with greater confidence in their “truthfulness”, it becomes
    more difficult for any individual to not converge as well— and
    feel confident about it.

    If you do manage to run from the herd you have to climb a


    high wall. “Can so many people be so wrong, yet so close
    together in their guesses? So wrong, yet so confident? Is
    everyone insane?”

    You can imagine the social implications of a highly energized


    crowd, or electorate, or laity, or polity, or tax base, all
    converging on a “truth” of which they are supremely confident
    by virtue of the fact that others believe the same (which is the
    result of similar convergence on their part.) This is probably
    supercharged when you have a charismatic figurehead leading
    convergence, and by “charismatic figurehead” I mean media;
    no one person came up with this, everyone just knows it’s true.

    IV.

    So much for the paper. Now consider the more general


    implications.

    “Well, I’m going to be an independent thinker and not be


    affected by the herd and make my own educated guess.” No,
    you won’t.

    The moment you have the other people’s guesses, you cannot
    shake that information. Your “independent” guess necessarily
    includes that guess in some way, you can’t unlearn it. Either
    your guess converges towards the herd, or your guess is
    characterized as against the herd. Either way, the herd affected
    your thinking in ways you don’t realize. You’re part of the
    dialectic and you didn’t even want to be. That you don’t want
    to be part of it ensures you are part of it.

    The existence of the convergence of ideas, knowing that a


    convergence exists, either attracts further groupthink, or sets
    up a second groupthink in opposition to the first. Groupthink
    certainly reinforces one idea; and it can cause the setting up of
    a second large idea in opposition, but it makes a third
    independent idea highly unlikely (unless, again, it forms in
    opposition to ideas 1 or 2.)

    In other words, in cases where social influence is impossible to


    avoid, the wisdom of crowds becomes the madness of crowds
    even for those who disagree with the crowd. All it takes is one
    idiot with a megaphone.

    How to use your own inherent narcissism to guess more


    accurately

    The special circumstance which causes the wisdom of crowds


    to fail
    “What should I say/do to my
    son after this happened to
    him?”
    September 2, 2011

    count
    From Ask Reddit:

    I’m a single parent living with my 15 year old son. On Sunday


    a classmate of his died. (I will not say how or where as the last
    thing I want to do is bring the parents more grief by me
    posting it all over the internet.) I didn’t know the girl
    personally but she was in most of my sons classes to my
    knowledge. He was very shaken when he heard the news,
    which is to be presumed but he has not talken to me since the
    incedent, he has stayed in his room since sunday night, I leave
    his dinners at the door.
    Today while looking at the girls facebook, which is crowded
    with messages, I saw a post made by my son.
    I have never told this to anyone but I have had a massive
    crush on you since the seventh grade. This was the year I
    was going to ask you out. I hate myself because I didn’t
    ask you sooner and I miss you so much. Goodbye.

    I had no idea he felt this way about her as he has never told
    me. I am starting to think he is depressed. I keep trying to talk
    to him but he wont reply. Should I get a psychiatrist for him. I
    honestly have no idea on how to deal with this. Please help.

    Edit
    Im sorry to say that he did the same thing as before, he closed
    the door before I could speak. Thank you for all the coments
    but I am really stuck now.
    I know people are saying that I am prying into his life too
    much, but I need to know if he is going to her burial.
    Just for clarity, I am his father
    Edit Again
    Hes going to the funeral. I heard his door close and there was
    a note at the door. “I am going to the funeral, if you are at
    work, I will bike there. I will not miss it.”
    Edit Its about 3 am here, I walked into his room about an hour
    ago. I just wanted to see him agian to be honest. He was on his
    bed sleeping. The room was covered in tisues. His eyes were
    bright red from rubbing them.
    I was going up to tuck him in when he siad “What is it dad” I
    was taken back that he was awake and even hearing him was a
    shock. I told him that I will drive him to the funeral if he wants
    and that he should get some sleep. He asked about work, I siad
    that doesnt matter. I kissed him goodnight then left.
    I think we had a breakthrough.

    II.
    These are the four “Best” comments:

    Time. Too much interference an attention during a normal


    grieving process can be damaging (see studies on the
    negative effects of debriefing therapies post-trauma). Be
    there, but let him be. I would only start to worry if his
    grades drop, and he continues to isolate himself (I’m
    talking months later). He will probably benefit greatly
    from attending the funeral and connecting with peers
    there.

    PhD student in clinical psych

    I think sending him to a psychiatrist would make him feel


    like there is something wrong with him. Losing someone
    special always takes time. Whenever you see him give
    him a good hug. Tell him he can always come talk to you
    whenever he needs to, but never force him to talk. He’ll
    come to you when he’s ready, if he ever is.

    I had a lot of friends die when I was growing up. Between


    junior high and the end of high school, the count was
    closing in on two dozen. I’m not a psychologist or a
    counselor, but I went through a fair amount of grief, so
    take this for what you will.
    Everyone deals with grief differently, so it’s hard to say
    how much time your son needs or how this will affect
    him long-term. He needs to talk with someone—talking
    will be like letting poison from a wound—but he has to
    decide when and to whom on his own terms. The key is
    to make sure he has opportunities.
    I didn’t have a great family growing up, nor did I have
    many friends. I was the outcast loner because we moved
    to the school after cliques had formed and I didn’t go to
    church, so I didn’t have an instant social connection with
    anybody. School counselors are usually worthless, and
    several of the people who died were the ones I would talk
    with about serious matters. It was my chemistry teacher,
    late after school one day when I stayed to make up a test,
    who decided to forget the test and just spend time talking
    with me. We talked for over an hour and a half and then
    she drove me home, and that conversation did a lot to get
    me through. Prior to that, I had spent 4+ months locked in
    my room, staring at a wall in the mental equivalent of
    shock, just totally shut down. She was open to talking,
    and that was enough.
    So be open to your son. Don’t ever try to force him to
    talk, and don’t force him to go to counseling if he doesn’t
    want. Just provide space and time, and maybe even
    awkward silences, to give him room to talk.
    If he’s crying, let him cry for as long as he needs. Don’t
    tell him it’s OK or that it’ll be alright. Don’t say a
    damned thing. Just let him cry. Crying’s like talking—it
    lets that poison out and can clean the soul a bit.
    PM me if you want to Skype or something, as I’d be
    happy to talk more. After going through so much of this
    stuff when I was younger, I really want to do what I can
    to help others going through the same stuff. Let me know
    if I can be of any help.

    Just let the kid grieve. Everyone needs time to let out all
    their emotions when someone the loved dies.

    I lost a friend at about that age and I can tell you that 15
    year old boys are primarily going to rely on their peers to
    help them come to terms with this. Seeing that OP’s son
    is a 15 year old in 2011, much of that interaction is going
    to take place online and via cell phone.
    The best thing OP can do is let him know your there to
    talk if he wants to (he won’t, but it’s still good to hear)
    and make sure he’s got enough minutes/texts on his
    phone.

    —
    And the “Best” comment (1061 votes):

    It’s only been two days since the girl died and he’s clearly
    grieving. Just give him some time to come to terms with
    it and let him know you’re there when he’s ready to talk
    about it.

    III.

    Here’s the problem with that otherwise well intentioned


    advice: it isn’t for the Dad, it is about themselves.

    The majority seem to think that the son is grieving a dead girl
    he had a crush on as if he had a relationship with her, but all of
    this grief is over a girl he did NOT have a relationship with. I
    suppose it is possible that he was desperately in love with her
    from afar, and that her death has devastated him because he
    felt she was The One. But it’s far more likely she represented
    something to him that her death has either obliterated or made
    very real.

    Note the manner of death isn’t mentioned. Hmmm. Let’s


    assume, oh, I don’t know, it was a suicide. How would that
    change our reading of the son’s “grief” and his emotional
    connection to her?

    Furthermore, no one thought it relevant that this is a son being


    raised by his father ONLY. I know we live in a post modern,
    nothing-is-remarkable period, but I’d like to suggest that that
    is odd, 3% of kids odd; and that therefore his relationship to
    women, to certain types of women, and to the loss of women,
    is probably of central but clearly unexplored importance.

    And: he posted publicly on facebook. It’s not surprising he


    posted his grief on facebook, it’s surprising that he posted that
    he had a crush on her from afar on facebook. He’s 15, right?
    The age where you are too embarrassed to announce
    unrequited love? Which means he’s not telling her he likes her,
    he’s telling everyone else a message that is encoded, “I was in
    love with THIS girl.”

    “Just let him grieve”, “just give him time” is not good advice,
    because you do not know the context of this grief and most of
    what I am seeing tells me this is not normal grief. I could be
    wrong.. Do you want to wait to find out?

    So, Dad, if you are reading this:

    If your wife died, you need to reach out to your son. If it can’t
    be you, or it doesn’t work, you need to find someone else to
    work through, even if it is a school friend. Even if it is the
    parent of a school friend. You cannot leave him to his own.

    If your wife is alive (e.g. divorced) get her involved. Maybe


    there’s a good reason not to get her involved, but if there isn’t
    a good reason not to, bring her in. Any aunts? grandmothers?
    Sisters? Female friends of his?

    If he’s drinking, it’s not good.

    You’re his father, not his friend. This may make a certain kind
    of conversation impossible, fine, but you still have to represent
    a kind of man, a kind of strength and presence and
    selflessness, “even if you do not want me I am here,
    permanently, no surprises” and you reinforce that by constant,
    honest, non-contrived connections. You don’t approach him as
    a peer because you hope it will make a connection, you come
    at him as Dad. He can reject it, but he needs you to be a Dad to
    reject. You don’t/maybe can’t make him feel better, but you
    have to offer a foundation for his sadness— “any lower than
    this and I’m here.” (Tucking him in and driving him to the
    funeral was great.)

    And, Jesus, no more food at the door, are you Japanese?

    IV.

    But there’s one more piece of information that makes this all
    more urgent.

    Consider you are a 15 year old boy, grieving a potentiality that


    you loved, wondering where that leaves you now. You have no
    place to express this loss, so you put it on facebook.

    Now consider you are the father of such a boy, and you also
    have nowhere to turn, so you turn— to reddit. It may be
    normal for a boy to go to facebook, or a father to go to reddit,
    but it is anything but coincidental that a father who is so out of
    ideas that he is even able to have the thought to turn to reddit
    is raising a boy who who is similarly out of connections and
    defaults to the pseudo-anonymity of facebook.

    This is not a judgment against them, but you have to


    understand the context and the only context we have are the
    words. The father never mentions any other human being
    except his son and the girl. He does not mention talking to
    family, or teachers, or other kids. The father is not depressed
    and yet still operates in a tiny universe of two people. The
    father himself is Alone, isolated, struggling for a connection to
    someone and losing his only real connection to another person.
    So how do you expect a depressed 15 year old to act?

    Both of their universes used to have at least two extra people:


    the father used to have a wife, the son used to have a mother,
    and now the son used to have a potential love. By my count,
    the father lost 33% of the population of the universe, and the
    son lost 50%. No wonder he’s depressed.
    Given this— and, again, not a judgment, just a statement of
    fact— given that they both operate in universes with very few
    people in it, the father must force a connection to his son. He
    cannot wait it out, he cannot give him his space, he cannot let
    him grieve alone in his room for a month and let him come out
    of it on his own.

    If forcing that drives his son in typical teenage fashion away


    from him into the arms of other kids, good— at least there are
    other people in his universe. But if that kid sadly drifts away
    from his father, into isolation, he will have lost 100% of the
    population of his universe. It will then be too late.
    How To Be Mean To Your
    Kids
    September 7, 2011

    stabilize the price, whatever it takes

    A reader sent me a link to an article written by psychiatrist


    Steve Balt, How To Retire At Age 27, in which he describes a
    typical patient in his practice, a 27 year old named Keisha:

    During the interview, she told me, “I just got my SSDI so


    I’m retired now.” I asked her to elaborate. “I’m retired
    now,” she said [boldface in the original]. “I get my check
    every month, I just have to keep seeing a doctor.” When I
    asked why she’s on disability, she replied, “I don’t know,
    whatever they wrote, bipolar, mood swings, panic attacks,
    stuff like that.” She had been off medications for over
    two months (with no apparent symptoms); she said she
    really “didn’t notice” any effect of the drugs, except the
    Valium 20 mg per day, which “helped me settle down and
    relax.”

    I misspoke when I said “typical patient.” She’s slightly


    unusual for his inner city population, because she actually
    graduated high school and even took nursing assistant classes.

    She dropped out, however, because “I got stressed out.”


    She tried looking for other work but then found out from
    a family member that she could “apply for disability.”

    A psychiatrist and a lawyer later and she’s awarded a pension


    of $700 a month. No retirement party, though. And she’ll have
    to buy her own watch.

    The rest of his post is a thoughtful back and forth about what
    constitutes disability, and whether a) giving them this easy
    way out isn’t actually doing a disservice to the human being in
    front of you; b) whether these false diagnoses aren’t artificially
    inflating disease prevalence estimates; c) the extent to which it
    contributes to bureaucracy (and cost.)

    II.

    So when he emailed me the link to the article, How To Retire


    At Age 27,” the reader asked me a tongue-in-cheek question:
    “Now why didn’t I think of that twenty years ago?”

    Thing is, he probably did think of that, or some brief fantasy


    of something like it, but figured he could make much more
    money doing something else. Therein we have the problem:

    Evidently, this woman Keisha doesn’t think she could make


    substantially more than $700/month doing something else, so
    regardless of whether she is truly disabled or not, her
    conception of her opportunities is seriously limited. That’s
    social policy problemo numero uno.

    Note that she even took classes to be a certified nursing


    assistant, and still doesn’t think it’s worth it. So either CNAs
    don’t get paid enough (over SSI) to merit giving up all your
    free time to work with the belligerent poop machines at the
    hospital, or else SSI pays too much to make that decision even
    worth considering. There are no other possibilities. Choosing
    between those without sparking riots is social policy problemo
    numero dos.

    Then there’s a subtle semiotic issue. She calls it “retired.” Not


    disabled, but retired, which means in the language of social
    policy she has understood that she has somehow
    “worked”/contributed to society to merit some retirement
    benefits, and also tacitly accepts she’s not unable to work,
    rather that she’s done working. So what could she have done
    to merit retirement? The answer probably is nothing. Right?
    But no one has tried to correct her thinking about this because,
    well, it just isn’t worth arguing with some unemployed black
    woman at a psychiatrist’s office because you’ll be branded
    uncaring and racist, not just by her but by some other
    busybody with a progressive agenda, free time, and a
    government/media job. You will also likely get punched.
    Besides, you and anyone who values work as a moral good
    and an end in itself don’t have time to explain it to an
    unwilling Keisha, you actually have to get back to work. So
    she’s left with her comforting lies that go unchallenged—
    bellay that: they are encouraged. That’s social policy problemo
    numero tres.

    III.

    But now we have to take three left turns to get at the truth.

    There is a significant misconception of what “disability”


    means, and I’m not going to say what you think I might. Dr.
    Balt, and I’ll wager most people, think Keisha is probably able
    to work. However, the issue isn’t whether she can work, but
    whether any employer would be willing to take a chance on
    her ability to work. Would you hire Keisha to run your office?
    Do billing? In the spacious comfort of an internet comment
    you might hire a woman like Keisha to work at a
    hypothetically inefficient McDonalds, but in practice, are you
    willing to tolerate “3-4 absences a month due to illness?”
    McDonalds neither, which is why the SSI application form
    asks that exact question.
    You will observe the Keisha does not even have the
    enthusiasm to know what is written on the most important
    economic documents of her life. “I don’t know, bipolar, panic
    attacks, whatever they put on there.” She can’t be bothered to
    handle those papers, someone else is in charge of that. How
    attentive will she be to the frier? McDonalds doesn’t want to
    find out.

    That specific issue reveals an important bias and


    misunderstanding America has when it talks about
    employment. Yes, there is an issue about people wanting to
    work but the other issue is that the global economy is too
    quick and efficient to tolerate your idiotic car troubles or your
    imbecilic grandmother’s death or your moronic lack of child
    care (cue Scandinavia) or, and mostly, your stupid health. The
    economy was a Ferrari and now it’s only a Honda, but either
    way, not much time for absences and no time at all for
    Keisha’s learning curve. Keisha isn’t just unemployed, she is
    completely unemployable. We can argue whether auto plants
    should pay $20/hr or $50/hr, but for certain there is no market
    for unskilled labor at all. Let me correct another grand mistake
    of the politicians and the talking heads in the media: this
    problem is likely to get much, much worse, not better, as the
    economy improves. There are no typos in that sentence. Read
    it again.

    The jobs employers would be willing to take a gamble on are


    jobs that pay too little for it to be worth her showing up at all.
    Hence SSI. Sure, maybe you could work at Walmart for $7 an
    hour but they don’t offer benefits so ultimately, what’s the
    point? A rich guy may think he pays his Mexican housekeeper
    good money, but the fact is if Juanita doesn’t show up one
    Tuesday morning he doesn’t miss a step, which is why he was
    willing to hire her. You send the suits to tell him he has to hire
    her legally, pay her wage taxes and offer her health benefits
    and still take the risk she doesn’t show up and he’ll release the
    doberman on you and just hire four high school kids to each
    work a block of two hours a month. Is that fine with you?
    Then go see what Juanita’s next step is.
    All of this comes down to a very important point: the country’s
    economy understands these issues on an unconscious level,
    and it has created a system to absorb 10% of the
    unemployment, i.e. pay them off so they don’t riot, exactly
    like Saudi Arabia buys off its people. Yes, America is a
    Petrostate, but instead of oil money it’s T-bills. However, as is
    evident throughout history, rich white people riot too, hell,
    they’ll overthrow a King because the rum prices fell too much
    or shoot a President because he wanted a third term; and
    they’ll for damn sure John Galt the Senate if they think poor
    people are getting free handouts, so the system pretends to
    offer benefits based on medical disability, just as it pretends on
    your behalf to be appalled by Mexican illegal immigration
    even as every restaurant in Arizona employs illegals, and
    everyone knows it, including the politicians and the
    Minutemen who eat at every restaurant in Arizona, not to
    mention California, not to mention America. Dummy, the sign
    says “Authentic Mexican Food”—oh, never mind.

    For fun, let me point that that another 10% of the unemployed
    in America are relabeled as “incarcerated”, so total you have a
    real rate of 15-20% unemployment, and this does not include
    the unemployable who have been relabeled as “military
    personnel” thanks to two endless wars, or those who manage
    ten hours a week at the Buy-n-Large who are relabeled as
    employed and thus are of no consequence; all of which is good
    because if the unemployment rate printed higher than “9%”
    the credit rating of the US would have to fall to C-. “But you
    need at least a 3.0 in your major to graduate.” There’s your
    grade inflation.

    Psychiatry is the unsuspecting but intentional handmaiden of


    this process. Never once thinking it was being pulled into a
    long con, it self-righteously accepted its grownup label as
    “medical specialty” and began ostentatiously fighting for
    “mental health parity” and the Medicaid funds that it thinks it
    deserves, “we care about patients, about people!” And it
    comforted itself with the knowledge that 25 medications and
    nine academic journals must signify they are scientists, which
    means that all my Foucaltian ranting couldn’t possibly apply
    to them. And yet, here we are. Dr. Balt is obviously earnest
    and even optimistic when he tries to articulate cause and
    solution to these social issues, and he’s to be commended for
    seeing through the Fog Of Prozac; but, lamentably, he is too
    late for change to come from within psychiatry. Note that—
    and this is neither an exception nor a criticism of him— even
    though he sees this truth he cannot stop, he can’t refuse to
    participate, and neither can I, or the other psychiatrists who are
    eyeballs deep in a system none of us conceived yet all of us
    are responsible for. The system has been vaccinated against
    dissent.

    I can sense you pulling away from my abstractions, “that’s all


    very clever and all that, but how does it actually work in real
    life?” This is what I’m trying to tell you: it doesn’t work in
    real life. It only works in theory.

    He closes, “Using psychiatric labels to help patients obtain


    taxpayers’ money, unless absolutely necessary and legitimate,
    is wasteful and dishonest.” Maybe, but if you change the
    system he will lose 100% of his “patients”; and never mind
    him, you do not want to know how the system will relabel the
    patients when that happens, or who will be in charge of that
    relabeling. I am sure he will not believe me. Fortunately for
    him, he will never have to find out.

    IV.

    And this brings us to the essence of the problem, of all of the


    social policy problems that we currently face. “How did this
    happen? How did it get so bad?” The answer is that it has
    always been this bad. We didn’t care.

    Narcissism has been on a steady rise since the end of WWII


    and went parabolic in the 1980s; all social policies have to be
    understood in the context of that psychology, that culture.
    Hence SSI isn’t altruistic but narcissistic, its every (no sic)
    purpose was not to serve others but to serve us.
    Stop thinking of SSI as money. SSI isn’t taxed, and if you
    recall the First Law of Harbors, “taxation=representation”: not
    taxing them is the same as not giving them representation. So
    for $700/month they don’t call you to account for all the rest
    of the money. “Yeah, but don’t they vote?” HA! You kill me. I
    meant actual representation: lobbyists.

    As long as they— and the inmates and the etc— are munching
    on food stamps, weed, and Xboxes, nearly illiterate but
    keeping their nonsense within their neighborhoods, the rest of
    us can go on with our lives. Which means that every
    unconscious force exists to keep this state of affairs going until
    we no longer need it. And if that requires printing money or
    releasing oil reserves to keep prices down or insisting there’s a
    shortage of psychiatrists, “how about some NPs?”, so be it,
    because the system must be preserved, including and
    especially at the expense of the future. It’s a popular political
    refrain that Social Security will soon be bankrupt, but that’s
    meaninglessly obfuscating: it won’t be around for the kids
    when they grow up because it wasn’t for them, it was for the
    people who were around when it was conceived. There was
    never any way it could last forever, no credible way of funding
    it— especially the moment productivity went parabolic
    compared to wages.

    you don’t have to be a labor theorist to recall what else went


    parabolic at the same time
    Don’t say that taxes needed to be higher because it was never
    about funding it, it was always about temporarily buying their
    apathy. Truth be told, it stayed solvent longer than it was
    supposed to— one of the benefits of having a reserve currency,
    aka a private meth lab. But you knew that, didn’t you?
    Temporary measures, just like a psychiatry that is for the
    “management of acute symptoms”— or are you going to tell
    me you expect/want it to look like this in 30 years? Then why
    is it like this now? And so this is the terrible, awful truth of it
    all: we created the system only for us, and will last for as long,
    but only as long, as we are alive, and that was as far as
    anyone ever thought it out. That means that any kids under 10,
    rich and poor, will be left to make do with rubble— on
    purpose. That’s what they will inherit from the Dumbest
    Generation Of Narcissists In The History of The World, who
    say with not the least bit of irony, “may as well spend it
    because you can’t take it with you!” No kidding. You’ve
    created a gigantic Ponzi scheme which is not just morally
    sketchy but downright mean to your kids, but what do you
    care: you’ll be dead.

    In some Bible story Ford Prefect warns the humans, “two


    million years you’ve got and that’s it, at the end of that time
    your race will be dead” and he meant it as a fait accompli but
    that was a guy who took the long view; and when the response
    came back with a soothing smile, “well, still time for a few
    more baths!” that was a guy also taking the long view, the
    difference being his long view was exclusively to justify his
    present frivolity. It should be no surprise that this second guy’s
    brilliant solution to a fiscal crisis was to call leaves legal
    tender and then burn down all the forests. They didn’t survive
    the winter. But the warning I offer the younger generations
    who have to clean up our messes even without the benefit of
    forests or a functioning psychiatry is what consequently
    happened to the first guy: he went mad. It is inevitable.

    –-

    Previously: The Terrible, Awful, Truth About SSI


    September 10, 2011
    The Contagion Is The
    Solution
    September 19, 2011

    wait… why can’t I talk to anyone?


    Seen Contagion yet? Here’s a simple question: can you name
    one character?

    Not the actor’s name, the character’s name. Take your time.
    Nothing?

    A=A, and character driven movies, the kind Soderbergh is


    famous for, are supposed to be about characters.

    Maybe this isn’t a character driven movie. Maybe it’s a


    documentary, aTraffic-style story about “what would people
    do if?”

    But the movie doesn’t depict them doing anything you


    wouldn’t predict (die; panic; kill each other; attempt to profit;
    mourn; protect their own at all costs) or in a new way. So
    characters you’re not emotionally involved in, doing nothing
    unusual… what’s this all about?

    I.

    This is the opening scene:

    Gwyneth is not driving, but is still holding a phone,


    unnaturally, with her left hand. Is she a leftie? No. Did she
    have a stroke? No. Look closely, she’s married. Two ways to
    go with this: either this is a disaster movie about grief, or a
    disaster movie about about punishment. Well, she’s calling
    from an airport and the guy on the phone isn’t her husband.
    The hell you say?! That’s right, she’s having— and this is a
    quote— a “layover.”

    Soderbergh obeys the Rule Of Thirds

    So maybe this is like a horror movie: sexual sin= horrible


    punishment; a subtext which is repeated later as her husband,
    Matt Damon, tries to protect his pretty-but-not-hot (=survives)
    teen daughter from her urges to be with her who-knows-if-
    he’s-infected boyfriend. (The script which I did not find on
    The Pirate Bay maybe says her name is Jory, BTW, but the
    audience doesn’t care.) Is it the virulently contagious virus
    Damon’s worried about? Sure it is. That’s why he pulls out a
    shotgun when he catches them after 15-900 minutes of close
    contact frolicking in the back yard. Jory looks flushed. He
    finally relents to the inevitability of penis and vagina at the
    end of the movie when boyfriend shows up at their house
    wearing the vaccination bracelet. Safe sex. Matt Damon smiles
    as they dance with each other, then walks away, I assume into
    oblivion. That’s what single dads are good for, cuckolding and
    pass interference, and don’t let the door hit you on the way
    out.

    Back to the inception. Gwyneth is infected but she doesn’t


    know it, and is shown partying in a Chinese casino, blowing
    on men’s hands, and forgetting her sin phone at the bar, which
    a Ukranian model (=blonde harlot) returns to her, thereby
    ensuring all sexualized blondes are punished.

    But not before their sins are visited on the son.

    And being an American, you say, “wow, they killed a kid in a


    mainstream movie?” Quite gruesomely, I might add, but don’t
    worry, you’ll feel nothing. He wasn’t really a kid, he was
    merely an extension of her (he was only Damon’s step-kid,
    making Matt twice a cuckold), and he needs to die to free Matt
    Damon to return to his real daughter.

    When a disaster strikes, the answer to “why?” is usually of the


    form, “endocytosis of the virus into the cell” or “plate
    tectonics and subduction zones” which is as satisfying as an
    imaginary bottle of rum. So we convert it to a narrative, a
    story, yes like a movie and yes like 9/11, to which the answer
    is always 100% the same: punishment for guilt. The only
    question is whose.

    Gwyneth is Patient Zero, she is the cause of the outbreak, and


    if this was an ordinary movie about ordinary sin her backstory
    would be enough, it says, “this is a story about individual
    guilt.” Oh, look: her lover was the very first person to die in
    Chicago.

    But it’s a “subtle” political piece like the kinds played on TV


    all day on 9/11/2011, in which the Towers fell not because
    terrorists flew planes into them but because of America’s
    incessant meddling in the Middle East; the same meddling
    which, educated people all know, had nothing to do with the
    Arab Spring at all. So this is a story about collective guilt,
    about how we are all responsible.

    If that’s the story we’re going to see, her sins have to be made
    general enough and collective enough to justify a global
    catastrophe. Hence, though she’s blonde and an unrepentant
    adulteress, she’s also an executive for a multinational mining
    company that destroys the rainforests. Now it makes sense
    why 2M people had to die.

    Closing the narrative loop, the last scene is the big reveal, how
    it all happened: we see Gwyneth’s company destroy a
    rainforest displacing a bat which infects a pig which gets
    cooked at the casino Gwyneth is in, infecting her. Justice is
    served, madame. Chef recommends.
    II.

    The ordinary way to read contagion/natural disaster movies is


    as an expression of collective guilt, what did we do to deserve
    this? Those who survive at the end are either those who don’t
    really share in the collective guilt (e.g. natives, poor, women,
    minorities, and, in this movie’s case, the CDC janitor’s son) or
    those who “change.”

    That’s the ordinary way. The reason this reading is wrong is


    that this movie wasn’t made in 1376, but in 2011. Look out
    your window: those bipeds are narcissists. Narcissism wants
    no part of individual guilt, so it for sure as hell isn’t going to
    take the fall for collective guilt. Collective guilt is created as a
    defense against individual guilt. The individual unconscious
    does not want any part of “we”, especially if “we” did
    something and got caught. The unconscious only cares about
    “I”.

    Gwyneth Paltrow presents us with an interesting test of our


    psychology. Let’s see how good you are at thinking in binary:
    when Judgment Day comes, will God judge her more harshly
    for being an adulteress or an executive in a mining company?

    Oh, you’re not religious? Then you are superstitious (— “No


    I’m not at all, I’m just kind of OCD.” Is that what the kids are
    calling it now?—) which means you don’t deal in judgments
    but in root causes. Ok: why did 2M people have to die? Was it
    because she’s an adulteress, or because she’s a mining
    company executive? Pick one. You sure? Now why did her
    son have to die?

    III.

    Not knowing the characters makes it easy to focus on


    collective guilt, which is really someone else’s guilt that
    you’re benefiting by pretending to take on. Not knowing “Beth
    Emhoff” means you don’t have to parse her individual guilt.

    This movie could have been a straight “Beth is horny and she
    is punished” movie, i.e. an 80s slasher film. But this
    generation demands a defense against that kind of subversive
    thinking. So Beth’s guilt is minimized in favor of featuring
    examples of collective guilt. Who caused 9/11? Nineteen two
    dimensional characters we don’t know the names of. Ah, so
    9/11 is payback for the sins of “The United States Of
    America” which means no one is looking to punish you
    specifically, because it’s not your fault. It’s “our” fault. Which
    means it’s Bush’s fault. Which means we’re all off the hook
    now that he’s gone.

    But maybe taking responsibility for our collective sins is a


    noble, selfless act? No. The ego will do anything to protect
    itself, including publicly accept guilt for something that causes
    it to experience very little actual guilt. “We caused global
    warming!” Really? It was you? You drink yourself to sleep
    because you burn too many fossil fuels? You can’t look a
    person in the eye because you drive an SUV?

    IV.

    Even before the virus kills a lot of people, people begin to


    panic. This is facilitated by the internet, played by Jude Law,
    who blogs about corporate greed, “the CDC is lying to you”,
    and a holistic cure (forsythia) that Big Pharma of course
    doesn’t want you to know about. (Also, it doesn’t work.) But
    people start raiding pharmacies looking for it anyway. (1)

    The virus, in theory, does not discriminate; but the movie


    makes it clear that information very much does discriminate.
    When Dr. Laurence Fishburne and his team at the CDC figure
    out that Chicago is next, he retreats to his office and secretly
    calls his girlfriend, “get out of Chicago, but tell no one.”

    But wait, there’s a janitor standing behind him. “How much of


    that call did you hear?” asks Fishburne. “We’ve all got
    people,” the janitor replies.

    Which is further exemplified by what Fishburne’s girlfriend


    does next: she talks to her people. “You have to promise to
    keep this a secret…” And then that people posts about it on
    facebook. We’ve all got people, and they all panic.(2)

    but first, some shopping

    Information is the parallel virus, but that is not a flippant


    comparison. Totalitarians of the world, take note: in the movie,
    information the public has is always bad for them. I do not
    mean the information is wrong. Jude Law’s info about
    forsythia is wrong and thus troublesome; but the CDC’s
    announcements about the virus are all accurate and stuff you’d
    insist you have the right/need to know. Yet that information is
    irrelevant. Having this information, are you cured faster? Are
    you better able to protect yourself than the obvious intuitive
    maneuvers?

    The single reason to offer official information (and the movie


    distinguishes between “official”=valid=useless information
    disseminated via TV and unofficial=false=dangerous
    information traveling via internet) is that it sedates people; it is
    never to benefit them. Which is why it is more important to the
    perception of safety to keep the electricity going (which they
    do) than the food going (which they don’t.) “We’ve identified
    the virus, it is called MEV-1.” Oh, so that’s what it is. Now
    we’re getting somewhere.
    All media is state run media, especially when it’s not.

    V.

    A case study of individual vs. collective guilt.

    Cobb’s wife in Inception, Mal, in this movie plays a WHO


    researcher who travels to China to identify the source of the
    outbreak. Because of CCTV camera footage, she is able to
    observe Gwyenth infecting various other people, and the
    outbreak can be tracked.

    Because Mal is beautiful, she is most likely be going to die.


    However, she’s a) not American and b) a brunette with an
    atrocious haircut; which means she’s not part of a) the
    collective guilt and b) probably not carrying any individual
    guilt. She could pull out of this.

    Right after she and the Chinese researchers discover how the
    virus spread, she does something very, very important: she
    prepares to leave China. She’s done with China, China is only
    important as a source of information and now of no
    consequence. There’s no way those hominids could find the
    cure, and, anyway, there are dying people in the world she has
    to get to.

    The Chinese researchers therefore kidnap her to a rural village


    and send a ransom note: if the WHO wants to see her alive
    again, they have send a crate of vaccines.

    There are the two guilts: her individual guilt is her aloof
    cosmopolitanism, and her collective guilt is the WHO not
    caring about China. In order for this story to play out correctly,
    individual guilt must be minimized and collective guilt
    maximized. 1. Mal has to repent. 2. The WHO, as the
    collective guilt, has to take on her individual guilt, i.e. get
    more guilty.

    1. The next time we see her, 45 minutes later— she is in a


    makeshift, open air “classroom” teaching the Chinese children
    how to read. She is perfectly happy. I’ll remind you that she
    has been kidnapped. In case the redemption isn’t obvious
    enough, they club you with it: a lingering wide shot of the
    “classroom” reveals a huge cross on the roof. Note that
    Soderbergh’s name is Soderbergh.

    2. When the ransom is paid (crate of vaccines) and Mal is


    freed, she discovers that the WHO tricked the Chinese: the
    vaccines were placebos. Horrified, she runs back to the
    village, and the message is clear: no one cares about the little
    people, especially if they are Chinese. So a lot of people must
    die, but none of them Mal.

    VI.

    Another case study:

    Dr. Fishburne gets his vaccine, but instead of giving it to


    himself he gives it to the janitor’s son. In the language of
    narcissism, that act makes him a hero, and thus guarantees his
    survival. In the language of individual guilt, this is repenting
    for choosing “his people” over society.

    Collective guilt takes on different meanings in different


    cultures. In America, collective guilt is always capitalist guilt.

    Fishburne’s act is a kind of message to global capitalists,


    “everyone has people they care about, your interests aren’t
    more important than the working man’s.” Not explicit in the
    movie is the secret to many vaccines: herd immunity, i.e.
    unvaccinated Dr. Fishburne can benefit from other people’s
    vaccinations. This is a metaphor for the popular refrain that
    global capitalists actually improve their own position when
    they help the poor because the poor will buy the goods that
    make them rich.

    Now this is no longer an ethical question, “what is the moral


    thing to do?” but a cost/benefit one: “how can you maximize
    the benefit?” Which is exactly the way you’d want the
    question framed if you were a global capitalist. But in so doing
    one can avoid the nasty business of taking a moral stance, it
    frames everything in terms of consequences, comparisons of
    utilitarian benefit— and consequently including individual
    guilt, which is the whole point of doing this. Was Gwyneth
    wrong to cheat? No, she’s not a bad person, it’s complicated.
    Is it wrong to loot? No, as long as you don’t enjoy it.

    It’s interesting to see which position, moral or utilitarian, the


    movie chooses, because the movie is a reflection of it’s
    audience’s preference for one over the other. What do we want
    to be true in 2011?

    The position the movie offers is this: Dr. Fishburne gives the
    boy the vaccination, but keeps the vaccination bracelet.

    VII.

    Implied in every disaster movie is “starting over,” but starting


    over isn’t the consequence, but the premise: “in order to start
    over and do it right this time, we need a catastrophe.”

    Now recall what is destroyed in a disaster: the unrepentant


    sinners and those who share in the collective guilt. What
    would starting over look like? It would be some recalibration
    of modernity. Where did modernity go wrong?

    It went wrong with Patient Zero. Now our original Gwyenth


    problem is reversed: Gwyenth is not only an executive of an
    evil mining company, she’s also a modern woman. Which
    means she can cheat when she wants and suffer no guilt.
    Yikes. As much as the image of a banana tree getting plowed
    by a bulldozer symbolizes a particular aspect of modernity, a
    blonde woman guiltlessly getting plowed by some other
    bulldozer is another aspect of modernity— though not the
    cheating itself, but what she is able to think while she cheats.
    “She made mistakes, but she loved you very much,” Matt
    Damon is told at the funeral home. That’s true, and that’s what
    makes it precisely so terrifying: Gwyneth had the physical
    freedom to cheat, and the emotional freedom to cheat and
    simultaneously still love her husband. A man understands a
    woman can be duplicitous, but the expectation is there’s still
    an objective truth to her cheating: if she cheats, she likes him,
    not me. How can it be she likes him and me? How can she be
    two people simultaneously? What am I supposed to do with
    that when she comes home? That kind of existential freedom
    is to much to allow women to bear, and in any post-crisis
    world the first thing society does is take a few steps back into
    the safety of conventional roles. It happened after WWII and it
    will happen after the Great Recession, and everyone will think
    they made the individual choice to do it. After the Contagion
    has passed, Matt Damon’s daughter’s first order of business is
    to express her happiness and love through the last holdout of
    happily accepted gender roles: the high school prom.

    VIII.

    The preference of collective guilt over individual guilt


    suggests a comforting narcissistic arrogance: if this global
    catastrophe is, after all, our fault, then it is also under our
    control. We can stop it. That’s why these disaster movies are
    very rarely about some catastrophe that isn’t our fault: that
    would be too raw depiction of our existential dread. We need
    the defense of collective guilt to explain inexplicable events
    and offer a path to immortality on earth (if we act a certain
    way all will be well). This is especially important for
    narcissists who, not able to feel individual guilt, lack a
    redemptive path towards immortality after earth. The belief of
    control over the earth is all they have left.

    It is the same narcissism that says, “we’re destroying nature,”


    which is a defense against being merely another part of nature.
    That it is a fact that we are destroying nature is secondary; the
    point is to believe it so that nature becomes a bit player in the
    movie of human exceptionalism. That it is a fact that nature is
    a bit player in the movie of human exceptionalism is
    secondary; the point is to believe it so that… and etc, until you
    individually have found meaning in the world.

    You might think that individual guilt would be infinitely more


    amenable to modification than collective guilt— if it’s “your”
    fault, all you have to change is you. But try telling Gwyneth
    she shouldn’t sleep with that guy, that it’s wrong. “It’s
    complicated,” she’ll tell you. Fixing “you”, including the sins
    — is nigh impossible, because those sins are you, the only
    way to stop doing them isn’t to stop doing them but to change
    who you are. “You just don’t understand the whole story”
    you’ll explain in ten million sentences that say nothing. The
    part that I don’t understand, of course, is how important it is to
    do do it to keep your identity intact. But I do understand.
    That’s why I wrote this.

    The trick to understanding disaster movies, and life, is to


    realize that the reason bad things happen is that we partly
    guilty and partly wronged, fully at the mercy of other people
    who use us and manipulate us; but that we still retain almost
    infinite power to alter reality and prevent bad things from
    happening. And the reason that that is the reason is that the
    alternative is there is no reason.

    If 2M people die, you can be 100% certain that someone will


    find CCTV footage of a hateable adulteress destroying a
    rainforest, and that she’ll get what’s coming to you.

    1. The media’s preferred symbol for the disintegration of


    public order is looting, i.e the opposite of shopping. When
    Matt Damon goes into the looted supermarket, he’s distinct
    from the other looters because he isn’t enjoying it, suggesting
    he wasn’t a big shopper, either. Consumerism was never in his
    nature, nor sexuality, as evidenced by two ex-wives, which is
    why he is the only person in the entire movie who is naturally
    immune to the virus. (Another note: in disaster movies, the
    ability to loot is what separates us from the animals. Once
    there’s nothing left to loot, the people are then depicted as
    marauding cavemen, unless they are reorganized into a strict
    proto-capitalist economy. Welcome to Bartertown.)

    2. Note that this must be in 2011: it didn’t seem odd even to


    me that 51 year old medical doctor Fishburne has a girlfriend
    and no kids. In fact, the only character you see married in this
    movie is Gwyneth Paltrow, and you know how that works out.
    Finding Existential Solace In
    A Pink Tied Psycho
    September 28, 2011

    unamerican
    Forbes: “Stock Traders Are Psychopaths”—

    … a University of St. Gallen study that shows stock


    market traders display similarities to certified
    psychopaths. The study… compares decisions made by
    27 equity, derivative and forex traders in a computer
    simulation against an existing study of 24 psychopaths in
    high-security hospitals in Germany. Not only do the
    traders match their counterparts, but, as Der Speigel [sic]
    succinctly puts it, the “stockbrokers’ behavior is more
    reckless and manipulative than that of psychopaths.”

    Der Spiegel:
    Using a metaphor to describe the behavior, Noll said the
    stockbrokers behaved as though their neighbor had the
    same car, “and they took after it with a baseball bat so
    they could look better themselves.”

    The researchers were unable to explain this penchant for


    destruction, they said.

    Hold on. The study compared institutionalized psychopaths to


    a group of German traders and found the traders are worse
    psychopaths, with a “penchant for destruction.” Umm, how
    about the more obvious explanation” they’re German. What?
    Too soon? Hello? Is this thing on?

    The preposterousness of my comment is only slightly less than


    the overall idiocy of this study and the reporting around it.
    Following a rigorous objective analysis, the fact that the
    traders were German is a more plausible explanation for their
    baseball bat smashing behavior than their employment as
    traders. I realize the institutionalized psychopaths were also
    German, but the presence of mental illness is itself a greater
    confounding factor, i.e. in a study of psychopathy, the general
    order of important factors can be approximated:

    mental illness > species of pet > race > employment > favorite
    movie > phone number

    in other words: this study is stupid, which is also a rigorous


    objective analysis.

    But the existence of confounding factors did not stop nearly


    everyone from turning up the volume of their own cognitive
    noise:
    NYMag:

    With rogue traders all the rage, a Swiss university study


    found that brokers “behaved more egotistically…” The
    study’s co-author Thomas Noll said, “Naturally one can’t
    characterize the traders as deranged…” Particularly
    shocking for Noll was the fact that the bankers… Noll
    said it was as if the stockbrokers realize…

    Of course I can’t find the study anywhere, which is suspicious,


    but not half as suspicious as the reporting. Are they “stock
    market traders” or are they stockbrokers? Why did Forbes
    include the above American Psycho poster? Because he’s a
    psycho? But he’s not a trader, he was an investment banker.
    Do these results extend to everyone in a tie or anyone who
    deals with securities? How about the baby in the Etrade ad?

    German

    I’d say this was an example of the media manipulating the


    study to suit their needs, but it appears the researchers
    themselves were pretty liberal with the nomenclature and
    pretty conservative with the N=.
    I’m fairly confident that a study of comparing 27 idiots to 24
    other idiots done by, apparently, idiots, most likely explicitly
    done for the mass consumption of more idiots is not a study
    worth repeating, but you can be sure it will be repeated many,
    many more times and eventually form the foundation for
    future research not to mention conventional wisdom for the
    next 25 years. They don’t really care who or why someone is a
    psycho, so long as you get the hate pointed in the right general
    direction.

    II.

    Interesting how you spin it:

    Forbes: “The study, authored by MBA students Pascal


    Scherrer and Thomas Noll”

    HuffPo: “The research, led by forensics expert Pascal Scherrer


    and prison administrator Thomas Noll”

    III.

    Here’s a happy video:

    I like to watch these kinds of videos when I have to get


    psyched up to wrestle a crocodile or storm a castle.
    Though narcissism demands the right to self-identify,
    narcissists are often unable to do so because they don’t know
    what it is they want to be. Who am I? What are the rules of my
    identity? So people look for shortcuts, like modeling oneself
    after another existing character. But the considerably more
    regressive maneuver is to define yourself in opposition to
    things. “I can’t tell you what I want for dinner,” says the
    toddler, “but I am certain I don’t want that. Or that. Or that.
    And if you put that slop in front of me I swear to God you will
    wear it.”
    Now you can go through life floating, letting hate, the Dark
    Side Of The Force, the easy path, guide your reactions. It
    seems certain that you have a fully formed identity because of
    the magnitude of your passions, emotions, and responses, but
    you can only operate in response, never first, never with
    commitment or vision. I know the young lady with the mace in
    her eyes thinks she is driven by love, but that doesn’t really
    come through here, does it? Her hate defines her. “I’m anti-
    establishment.” We get it.
    What do the protestors want? Can they articulate it
    meaningfully, not in platitudes or “people over profits” or
    “more fair income redistribution” soundbites? They can’t tell
    you because they don’t know. They can, however, yell at you
    what they don’t like, and the louder they yell it the more they
    hear it themselves.

    Nothing is expected to be accomplished, it is all for branding.


    The enemy of the day is “Wall Street” but that’s not an actual
    thing, and the cops they are so earnestly hoping will assault
    them aren’t their enemies either, they are proxies for Wall
    Street which is a proxy for something else that I am going to
    politely refrain from suggesting is their father. This time they
    have a camera. None of that matters, so long as they have
    successfully identified themselves to themselves, a little cover
    from the incessant bitter winds of existential freedom.
    Marijuana will take care of the rest.

    IV.

    The protestors didn’t realize they were themselves bit players


    in someone else’s movie, the media’s movie, which offers this
    clip and others like it so that you, the viewer, can easily define
    yourself by who you hate. “That’s what the ratings said you
    wanted,” studio execs say, perplexed. “Were we wrong?” No,
    no, you were right. Carry on.

    If I hate the protestors, I’m on Wall Street’s side, and vise


    versa, no further branding, let alone thought, is necessary. And
    now you have a quick way to decide if you hate me.
    [The market is] going to fall pretty hard…. Investors and
    the big money, the smart money… they don’t buy this
    rescue plan…. they know the market is toast. They know
    the stock market is finished. The Euro, as far as they’re
    concerned, they don’t really care. They’re moving their
    money away to safer assets like Treasury bonds, 30-year
    bonds, and the U.S. Dollar. So it’s not going to work.

    And:

    For most traders, we don’t really care that much how


    they’re going to fix the economy, how they’re going fix
    the whole situation. Our job is to make money from it… I
    have a confession which is: I go to bed every night and I
    dream of another recession. I dream of another moment
    like this. Why? Because people don’t seem to remember
    but the [’30s depression] wasn’t just about a market
    crash. There were some people who were prepared to
    make money from that crash… It’s an opportunity.
    This is not the time for wishful thinking that the
    government is going to sort things out. Governments
    don’t rule the world, Goldman Sachs rules the world.
    Wow! Did he really say that?
    But what did he say that’s so shocking, that we haven’t heard a
    million times before? Why is he so believable? One lone
    trader? What does he know that we don’t?
    America loves to believe information if it comes by an accent,
    the “otherness” of the speaker implies they have both
    impartiality and additional information, hence Nouriel
    Roubini.
    If you’re watching it it’s for you, and how many of you watch
    the financial news of the BBC? Zero. And yet we have this
    clip, submitted for your consideration. Submitted everywhere,
    from the NYT to Salon, which actually titled its article: “The
    rogue trader: Crazier than a psychopath.” Wow, wildman, not
    even close. So while the trader is an American he is the
    “other” speaking to a British audience which we get to spy on;
    and this information carries greater weight because it is
    delivered over there, via the BBC, not via Fox News to the
    evangelicals of Nebraska.
    After the initial panic about what he said, the controversy
    morphed to whether this is a hoax, whether this guy is part of a
    performance art troupe that tries to impersonate and thus
    humiliate capitalists. This controversy is wildly besides the
    point: what’s the difference? The entire theatre of this clip is a
    hoax. What difference does it make if he is an actor or a real
    trader? How do you think the BBC found this guy in the first
    place? They don’t pre-interview at the BBC? They just wing
    it?
    The media has chosen the easy path because that’s what you
    want, we want to be told that traders et al are psychopaths and
    cops are Wall Street heavies and white women are entitled
    jerks and this guy’s a hoax/for real, all so that the rest of us can
    decide which side of that invented controversy we are on so
    that we remember who we think we are. “I hate something!”
    says the person who is out of ideas. About as nuanced as a
    mace shot to the face, which happens right in the the first
    episode. You can’t be subtle when the bitter winds are
    blowing.

    ––

    Related:
    Are conservatives psychopaths?
    Protestors Get Maced
    Marc Maron’s Mid-Life
    Crisis
    October 3, 2011

    but the point is to go slower, not faster


    Comic Joe Rogan’s podcast, The Joe Rogan Experience, this
    week mentioned a speech by comic Marc Maron.

    Marc Maron is a great comic I’ve referenced before. It’s


    probably not overstepping for me to say he suffers from
    narcissism, i.e. not that he is a narcissist, but that he suffers its
    consequences.

    Rogan said that when he was first starting out in comedy,


    Maron (who was already well established) was nice to him and
    gave him good advice. “I’ve always tried to be nice back to
    him because of what he did for me in the early days,” said
    Rogan.

    But over the years, as Rogan got more popular and then
    became the host of Fear Factor, Maron apparently resented
    him. Maron insulted him whenever he came up; he said Rogan
    was worse for comedy than Carlos Mencia (the two had a
    public battle over stolen material), and one night Maron had to
    introduce Rogan to the stage, and did so with a dispraging
    diatribe.

    Rogan is a savvy student of human nature and a well practiced


    judge of character; and I’d trust his insight way before any
    psychologist, let alone the armchair variety they use to
    stabilize the chairs at The Atlantic. Rogan’s point, therefore,
    wasn’t that Maron was a jerk; Rogan still believed Maron was
    a great comic and a nice guy. The point for Rogan was how
    some people get caught in a self-hating, self-defeating loop of
    narcissistic resentment. Forget about being happy for Rogan’s
    success; or accepting it, or even being jealous of it. Maron
    took it personally.

    For example, from Maron’s speech:

    I have been doing standup for 25 years. I’ve put more


    than half my life into building my clown. That’s how I
    see it. Comics keep getting up on stage and in time the
    part of them that lives and thrives up there is their clown.
    My clown was fueled by jealousy and spite for most of
    my career. I’m the clown who recently read The War for
    Late Night and thought it was basically about me not
    being in show business. I’m the clown who thought most
    of Jon Stewart’s success was based on his commitment to
    a haircut. I’m the clown that thought Louis CK’s show
    Louie should be called Fuck You Marc Maron.

    Whether Maron is or is not a narcissist is not the point; this


    thinking is narcissistic. Anything that happens he relates back
    to himself, even if it reveals him to be a loser. (Hence the
    statement: the belief that narcissism is synonymous with
    grandiosity is itself a narcissistic defense.) So other people’s
    successes don’t exist independently, they necessarily provide a
    commentary, a value, about oneself. His success reflexively
    implies you’re less of a success; his failure reflexively means
    you’re more of a success.
    The end result of this thinking is this:

    Three years ago my clown was broke, on many levels,


    and according to my manager at the time un-bookable
    and without options….I was thinking, “It’s over. It’s
    fucking over.” Then I thought: “You have no kids, no
    wife, no career, certainly no plan B. Why not kill
    yourself?”

    By “the result” I don’t mean the suicidality, though of course


    that option is never flatly rejected, it is a last chance at
    immortality. The result of this loop is the first sentence, the
    “without options.” There are no options not because there are
    actually no independent options, but because there are no
    options which change the balance of worth between you and
    the other person. Because your value is measured relative to
    the other person, and you’ve now discovered that you have no
    control over that other person, you are indeed left “without
    options.” No obvious way to become more successful, OR no
    obvious way to make Joe Rogan less successful.

    II.

    I can’t tell you how to be successful, but I can tell you how to
    successfully get through this kind of misery. Note that this
    advice is not for people in their 20s, it will not work for you, it
    will only work if you’re over 40. (1)

    The trick to solving physics problems is to recognize the form


    of the equation; the trick to solving your life is to know the
    form of the conflict.

    Maron was having a mid-life crisis, which is always of the


    form: “will I do anything useful with the rest of my life?” Note
    the emphasized “always.” There is no alternative question.

    Typically, people misinterpret the mid-life crisis as, “I’m 45


    years old and I’ve never done X” where X equals: blondes; car
    collecting; skydiving, a book, loved, learned Italian. And
    while these things are enjoyable, and will bring the person
    happiness of varying amounts, they don’t solve the crisis
    because the crisis isn’t about doing things but about running
    out of time. “That was fun,” you say as she drives back to
    Wellesley, but then you glance at the calendar and it says
    you’re still 45. There are only two things that will make that
    45 less painful, and one of them is alcohol.

    All the maneuvers indicative of a mid-life crisis— younger


    women, sportscars, new hobbies, new careers, new looks—
    are easily interpreted as new beginnings to help you trick
    yourself that the clock has been rolled back. (That these things
    do, in fact, make you slightly younger is not here the point.)

    So other than alcohol, what answers the question, “Will I do


    anything useful with the rest of my life?” The key to
    navigating this stage is to understand that the word “useful”
    has a very specific definition and can only be fulfilled through
    limited ways: it has to serve the next generation.

    I can see you rolling your eyes. (2) This isn’t touchy-feely
    nonsense; this is how humans were built, no different than
    they were built to see Roy through Biv or to find the absence
    of eyeballs uncanny. It explains why happy people still go
    through this; why making millions of dollars doesn’t solve
    this; why having kids, being celebrated or even famous all fail,
    not because these are intrinsically “bad” but because they do
    not specifically fulfill the human necessity to believe it is
    useful to the next generation.

    Most people get through this by raising kids (not just having
    them), teaching them things, “getting them into college,”
    passing on the culture. The more you feel responsible to this
    process the easier mid-life will be. Nor does it require active
    or even good parenting; it is an internal conceptualization of
    your life, rather than any external activity. Not changing what
    you do, but how you thinks about it. Though it sounds like a
    cognitive trick, it is as simple as not saying, “I want to get
    rich” and instead saying, “I want to get rich so my family has
    a good life.” To emphasize, this is not about the comparative
    morality of wealth vs. poverty, but the inclusion of the clause
    “so that” by which the narcissism is dissolved. (Yes, this
    means one could fool themselves into thinking they are
    “useful,” thus passing through the crisis with not having
    accomplished anything.)

    Maron, however, doesn’t have kids. Other options:

    1. Become someone’s “mentor.” You can unload a lot of that


    rage if you feel valuable, and giving of your wisdom and
    experience serves the dual function of confirming your
    identity (I am the guy who..) and connecting with someone
    else in some meaningful way. (E.g. the ex-player who goes
    into coaching.) (3)

    2. Become everyone’s “mentor.” This is the route that saved


    Maron’s life.

    Broke, defeated and career-less, I started doing a podcast


    in that very garage where I was planning my own
    demise… I started to feel better about life, comedy,
    creativity, community. I started to understand who I was
    by talking to other comics and sharing it with you. I
    started to laugh at things again. I was excited to be alive.
    Doing the podcast and listening to comics was saving my
    life.

    The mistake is to think it is the fame that saved his life. Maron
    might not be sure what, exactly, he is giving 20 million
    downloads that is of value, but he knows it must be something,
    which is why being more famous isn’t helping, say, any of the
    Real Housewives from suicide by collagen injection, but an
    aging ex-football hero can get a patent extension as a sports
    commentator. Maybe it’s the comedy, or the insight, or the
    perspective— what specifically it is doesn’t matter, just that he
    feels as though it is something he is giving others. If Maron
    had simply been given a check for $20 million dollars to
    perform one last show and then obligated to disappear, he
    would have happily taken the money and eventually killed
    himself, if not with a gun, then with

    with internet porn, booze, pills, weed, blow, hookers,


    hangers on, sad angry girls we can’t get out of our room,
    twitter trolls and broken relationships.

    III.

    Unrelated, but a great: Louis CK, on the Opie and Anthony


    show, relates this story:

    I’m at the Comedy Cellar, and I make this 9/11 joke.


    Basically, I was talking about how when you’re in a
    marriage, you always feel like you’re doing something
    wrong, in trouble for something. So the joke is I’m in a
    hotel, and my wife calls, crying, and I’m thinking, what
    the fuck did I do now? Did she find a sex phone bill? So I
    say, “what’s wrong?” and she just cries, and finally she
    says, “turn on the TV” and I see the planes crashing into
    the towers. And my first thought is, “Yay! Phew! I’m not
    in trouble, it was just thousands of people getting killed.”

    So I tell this joke in the Cellar, and some guy just stands
    up and says, “that, that is not funny,” and he stomps out.

    Later on I’m upstairs talking to Marc Maron, and I tell


    him this story, and I’m telling him how much I hate it
    when people choose their one thing to be offended. All
    night I’m doing rape jokes and racial jokes and he has no
    problem, but this is the one thing he decides goes to far.
    How narcissistic this guy must be to think that he’s
    allowed to decide that what offends him is what should
    be off limits.
    So Marc looks at me and says, “dude, are you insane?
    He’s the narcissist? You just told the most narcissistic
    joke in history, about how relieved you were that
    thousands of people died just because it got you off the
    hook with your wife…”

    ––—

    1. When a 20 year old says, “why is he famous?! For what? I


    hate that guy?” It’s normal. As you get older, you learn accept
    the unrelatedness of people’s successes to your own. “I still
    hate him, but it’s got nothing to do with me.” It is a mental
    disease when a middle aged man reacts with rage to the
    success of Kim Kardashian, however underserving she may
    actually be.

    2. “I hate these ‘solutions’ because they aren’t really


    solutions,” you say. “It’s noble and all, but I need specific
    advice that can help me.” That’s the narcissism. You don’t
    want the solution to be “it’s about the next generation”
    because what you want the answer to be is about you— your
    own fulfillment, your own happiness, your own safety, your
    own sanity. All of these are defenses, and none of them will
    work, viz Marc Maron.

    To use an example from The Matrix: The Oracle “lied” to Neo


    when she said he wasn’t the One, but she had to lie in order for
    Neo to believe that Morpheus was more important than he and
    to risk his life to save him; only by making this sacrifice, by
    being willing to exist for someone else, could he actually
    become the One. Had he “known” he was the One, and then
    let Morpheus die so that he, the One, could live, then by the
    atemporal nature of existential logic, he wouldn’t have been
    the One after all.

    3. This is how you could help someone else with this kind of
    “mid-life depression:” making them feel valuable in a
    consistent way. If this is where, say, your father finds himself
    — empty nest or career gone flat— regularly soliciting his
    opinion on things he considers himself an expert in can help
    remind him of his value. The point is not that he needs to
    accomplish something, the point is that he needs to feel he is
    valuable to you accomplishing something.
    Recent Trends in Stimulant
    Medication Use Among U.S.
    Children
    October 7, 2011

    is this a joke?
    A study, Recent Trends in Stimulant Medication Use Among
    US Children finds, surprisingly, that 3.5% of kids under 18 got
    stimulants, vs. 2.4% in 1996. Holy crap!! The reason this is
    surprising is that 3.5% is about 10x smaller than I thought it
    was. American Journal of Psychiatry? Did I move to Romania?

    Then the article informs me that I am both racist and color


    blind: most stimulants are going to white kids (4.4%), not black
    kids (3%), and about hispanics I was WAY off, I was certain the
    number was close to 133% but apparently it’s only 2.1%. Huh?
    Does this study include the 48 states of America that have
    Americans in them, or just Guam and parts of the Virgin
    Islands?

    The article pretends to be shocked by this “steep increase,” and


    then tries to explain it by putting some nouns and verbs next to
    each other hoping you’ll be impressed:

    The significant increase in stimulant utilization in racial


    and ethnic minorities and low-income families indicates an
    increased recognition of ADHD… social and cultural
    factors continue to play a significant role in ADHD
    treatment utilization. Parents of Hispanic and African-
    American children are less likely to report ADHD than
    parents of white children…(15)

    That last sentence, referenced with “(15)”, sounds like the


    conventional wisdom I heard in residency: “African-Americans
    don’t like to admit depression”, excluding those in the packed
    waiting room. (1) But when I eventually (2) found study “(15)”
    I was totally not surprised to find it did not say parents are less
    likely to report ADHD. “(15)” was a survey of parents asking
    them if they had been told by a doctor or school that their kid
    had ADHD.

    The reason that 3.5% of kids are on stimulants is that their


    doctor neglected to give them Risperdal. The kid who got
    Ritalin at age 6 and it helped carried that Ritalin into the teen
    years, hence the growth among adolescents; but any new kids
    coming through the pipe don’t get stimulants, they get
    something else, by which I mean everything else.

    Note the big jump at 6 years old, from 0.1% to 5.1%. Yes,
    certainly symptoms become more prominent, but also they
    become prominent at school; schools have an interest in
    medicalizing the problem, both practically (calm that kid the
    hell down) educationally (diminished expectations) and
    economically (schools get more funding.) Stimulants are the
    natural first line drugs. Well, they were, anyway.

    This ridiculous article pretending to be amazed at the increase in


    stimulants is there to prevent the heart attack you’d experience
    if you looked at another study that has a graph in it:
    Unless you believe bisphenol-A or global warming is changing
    the genetics of kids born after 1990, then the correct and
    terrifying way to interpret this graph is that one in every four
    kids is considered by adults to be in need of psychiatric
    treatment; and only 3.5% get put on stimulants. The other 20%
    we can assume are receiving psychoanalysis.

    Maybe they need the meds, maybe they don’t, the question is if
    these are the same kinds of organ donors that existed in 1896,
    what happened to them before psychiatrists? Did they eat each
    other? And if they are, in fact, more “psychiatric” than they
    were in 1896 and bisphenol-A isn’t to blame, then what is the
    other possibility?

    And as that huge number of psychiatric patients grow up to


    become either unemployed adults, or at least the children of
    unemployed parents, will they

    a) experience spontaneous and permanent remission of


    symptoms
    b) be treated with psychoanalysis
    c) …..
    ––-

    1. The conventional wisdom is backwards. The black patient


    isn’t resistant to admitting he has depression, he is resistant to
    the white doctor’s attempt at labeling him depressed, and
    consequently marginalizing him, diverting attention away from
    the social factors over which the doctor is nervous to discuss
    and powerless to change. “You have depression” is the nimble
    dance around the question of whether a white doctor can
    understand a black patient’s life. It is a delicate thing to say to a
    black woman that perhaps her man isn’t worth a damn, as she
    just said out loud to you but you’re not sure if you’re allowed to
    echo back, maybe these kind of relationships are culturally
    appropriate? It’s tough to know when most of your information
    about black people comes from Martin Luther King quotes and
    The New Yorker.

    Lacking any common language to bridge racial, economic, or


    sexual divides, clinicians hide behind the invented terminology
    of psychiatry. Medications become the physical manifestation,
    the proof, that the language is real.

    2. Whenever I see a reference to a statement that seems insane


    to me, two things will be true:

    1. It will take me as long to get the study as it did to conduct


    the study, i.e. 45 minutes. No hyperlink. No free access.
    Then I have to go into the university’s PubMed, which
    takes me through three windows to Science Direct or some
    other outlet. Why, oh why, can’t I just click “(15)” in the
    original paper and immediately see it? Because:
    2. It will turn out to be actually insane, and the only part of
    the reference that will support the statement will be the
    title.

    See also: The Rise And Fall Of Atypical Antipsychotics


    You Are The 98%
    October 11, 2011

    no, they forced you

    “We are the 99%.”

    Rarely does a slogan perfectly capture the zeitgeist, the ethos


    and the pathos, each word a passionate announcement of a
    popular uprising. And neither does this one.

    It is, however, an important piece of propaganda. It sounds


    like the enemy is Wall Street, but observe that the slogan
    doesn’t point to an enemy, it defines the group. The slogan is a
    twist on an old fascist standby: select a minority enemy, and
    create an impression of opposing unanimity. Once done, the
    leaders of the group have the powerbase to do what they want,
    making it impossible for anyone in the rest of the 98% to
    disavow this madness. When it all goes down you will be too
    terrified, or too busy, to dissent.

    Take a look at the website, see which one you are.


    I very, very much empathize with this woman, but her aside,
    what if I don’t believe education is they key? What if I think
    there should be no such thing as student loans at all? What if I
    think that it, not Wall Street, is a far greater enemy of
    civilization? Do I get to be in the 99%? Do I get a choice?

    Here are some of the demands of #OccupyWallStreet:

    Restoration of the living wage.


    Free college education
    Begin a fast track process to bring the fossil fuel
    economy to an end
    One trillion dollars in infrastructure
    Open borders migration

    Never mind that these demands are internally inconsistent,


    mathematically impossible and downright weird. (“Bank to
    Bank Debt and all Bonds and Margin Call Debt in the stock
    market including all Derivatives or Credit Default Swaps, all
    65 trillion dollars of them must also be stricken from the
    “Books.”” Really? You want that?) What’s important is that
    most of the 99% don’t want all those things, or even most of
    those things.

    Grant me that when Naomi Klein is invited to speak for the


    99%, at least 45% are looking at each other like, wtf, who let
    Linda Tripp in here?

    Do you think that when the movement becomes powerful they


    will represent the guy making $533000 as well as the guy
    making $0? How about the $250k and the $5k? All the way to
    the median income of $30k, but— surprise— that $30k guy
    most definitely does not want anything to do with an open
    border policy and guaranteed living wage and abolition of the
    death penalty. Oh, your plan is to exclude all of the states that
    have >2 right angle borders. Hmm.

    They exist in a quantum superposition of multiple eigenstates,


    but the moment they make an official demand the whole thing
    will collapse into a single state and everyone will hate it.

    Which is why any demands are quickly disavowed, “There is


    NO official list of demands,” they emphasize on the site, and
    yet the point isn’t the demands, the point is the “they.” The
    point is to pretend that there aren’t any official demands,
    attract the largest possible base— who doesn’t hate Wall
    Street?— and then make demands. “‘They?’ You mean the
    loose affiliation of Trader Joe’s shoppers at OccupyWallSt?”
    No, I mean the guys who can say this:

    This content was not published by the OccupyWallSt.org


    collective, nor was it ever proposed or agreed to on a
    consensus basis with the NYC General Assembly.

    They say they have no leader which means it’s pointless. If


    they do get a leader, science suggests it will naturally be a man
    with a long ring finger and some psychopathic traits; all I
    know is that they will simultaneously count me amongst their
    numbers even as they ask me please to die. Or kill, depending
    on how much power they get.

    II.

    What you don’t realize about those pictured as “the 99%”—


    what they have in common is not that they are young or
    college educated or indebted or white females, but that they
    were willing to put a picture of themselves on the internet,
    fully of the belief that they stand for something worth being
    pictured for. Bad move.

    You think marching on Wall Street gives you power, a voice;


    but it is a wholesale surrender to the media, you have signed a
    waiver allowing them to use your image any way they want,
    and they will tell the rest of us what to think of you and titrate
    our exposure and emotional responses, all while feeding us
    with marketing for the very things that got us into our
    predicament. The income disparities, the education pyramid
    scheme, the personal and public debt, the anxiety, brought to
    you by Revlon and the makers of CNN.
    Take a guess which side Fox, MSNBC, John Stewart chose.
    How did you know? Wrong: it isn’t their “bias” because it
    doesn’t matter what the protestors want, it’s because they
    predictably transmorph the protestors into what they need
    them to be.

    “Marching gets our message out.” No it doesn’t, it gets CNN’s


    message out. “We don’t watch CNN, we use the internet.” Yet
    given the infinity of the internet you still surf the same 5
    websites, looking for and finding exactly what you want, like a
    baby playing peekaboo in a mirror over and over and over and
    over and over and over and…

    You are the 98%, you are totally without any access to the
    machinery of power and worse, much worse, you plug
    yourselves into the machinery of media and become a slave.

    “That’s why I don’t watch television!” Well, a) you mean TV


    dramas, and 2) it’s because you’re not a 45 year old woman,
    the target demo of TV. But maybe you’re proud that you skip
    the commercials and avoid the “mainstream media”, you don’t
    want to be part of the corporate consumerist machine and good
    for you, yet your independence is why Whole Foods knows
    you’ll buy anything wrapped in brown and you already have a
    subscription to The New Yorker, which has a curiously large
    number of ads for mental institutions. If you’re reading it, it’s
    for you. The New Yorker is also at the checkout counter in
    Whole Foods, along with Rolling Stone and Psychology Today
    and not along with Sports Illustrated and The Weekly
    Standard. You think you shop at Whole Foods because it has
    better quality food? It’s because of those magazines. Even the
    neocons who shop there— they don’t shop at Acme— shop
    there because of the branding: liberal=organic, so the more left
    wing magazines and the more dred locks the more it has
    reinforced the “liberalism” and therefore the “quality,” and so
    you go, “reluctantly”, shaking your head at the crazy commies
    stocking the store as you hand them 3x more than anything is
    worth. “Would you like to donate $1 to help Ethiopian
    refugees?” Son of a bitch, this apple is delicious.
    III.

    If you hold a protest and you aren’t throwing rocks it will fail.
    I’m not telling you to throw rocks, I’m explaining why your
    march won’t work.

    The reason “peaceful protests” don’t work anymore is because


    now the protests are slower than the media coverage. When
    they threw the tea in Boston Harbor it was urgent, immediate,
    and by the time the press could interpret it it had already been
    digested by the public. But now even before the protest
    reaches critical mass the media, whose agents outnumber the
    protestors 100 to 1, has packaged and produced it, like a
    reality show, and by the time Naomi Klein got there I had
    already been told to expect someone like her. Do you see? She
    had already appeared before she got there. Yes, I can take
    pride in thinking for myself but if I’m going to be honest, all
    I’m doing is reacting to what I’m told. I was once going to
    write something about what Amanda Knox’s innocence
    revealed about our earlier media prejudices, and then I realized
    I still have no idea if she’s innocent or guilty, only that the
    media tells me she isn’t. And then I wondered, why do I even
    care if she is guilty or innocent, why do I even know her name,
    what’s that got to do with me? Because the media decide not
    just truth and falsehood but existence and non-existence.
    #OccupyWallStreet never stood a chance, come one person,
    come ten million people, it doesn’t matter, the only people
    who have any power are people like her:
    and she is stronger than all of you. Close your eyes: do you
    remember anyone else?

    You can agree or disagree, but you must do it with her, not
    with the folks holding signs. And by her I don’t mean her, of
    course, she doesn’t get to decide what she thinks, either— her
    producer tells her, and so on up the chain.

    Late at night as I’m drinking my eyes blind I hear the


    protesters regularly complain that they are not getting enough
    media coverage. They are protesting Wall Street, and they
    want more Wall Street coverage? You lose.

    Those protesters are based in a world that is built on rules.


    Because of this, they will never be as strong, or as fast, as the
    media that exists outside those rules. “Hey, stupid, what’s that?
    a sign? TOO SLOW, we have a thousand satellites and a
    harem of reporters, from beautiful blondes to ugly
    intellectuals, we control the whole thing. You even put a
    hashtag in your official name because your only voice is
    twitter. Bless my heart— twitter! How absolutely precious.
    Don’t forget to rock the vote!”

    “We are the 99%. We want to cut the umbilical cord from
    fossil fuels and consumerism.” Easy, but then what? There are
    two ends to that cord, something has to nourish you and all
    that’s left since you can’t afford what you were told you
    needed is the placenta of the political-media machine. “Get out
    the vote” is truly terrible advice, the only way to win is not to
    play. If you’re at the protest and a guy comes around asking
    you to register and it’s not for a handgun, punch him in the
    face. He’s your enemy.

    “We need a third party!” Come on, do you think the media will
    allow you to have a third party? John Anderson, Ross Perot,
    Ralph Nader— they let them through to “show” third party
    candidates aren’t any more serious than Howard Stern when
    he ran for governor. Poor Ron Paul pulls in more people than
    porn but he can’t get a break, sorry buddy, 100 years too late
    for your kind. There’s a difference between what you need and
    what you want, and the media will always, relentlessly give
    you what you want. Do you know why you have such poor
    candidates every single election? Because you want them, you
    want someone you can easily judge for some sexual
    indiscretion or because they called latinos chicanos. “Well,
    that matters to us!” Then you got what you asked for.

    The media will have data mined the culture and chosen for you
    two cans of Campbell’s Chicken Soup, and then encouraged a
    public debate about which can is a better representation of the
    spirit of the country, the one on the left or the one on the right.
    “Well, that matters to us!” I know.

    IV.

    The protests will fail. They will eventually be co-opted by the


    pre-election media orgasmia, branded as either this team or
    that and assigned a leader no one would have ever picked,
    ever, ever. The Tea Party may have started with Rick Santelli
    but they soon got Sarah Palin, figure that out. Half of you will
    vote, all of you will complain, and nothing will change until
    the day we are buying fake iPads with real yuans, hey, who’s
    the balding guy on the 20? And the 50? And the 100…? And
    the reason it will fail is that you don’t want it to succeed. You
    are still holding on to the mercantilist, zero-sum economic
    delusion that tariffs and gold standards and less money for
    Wall Street means more money for you, and then you can go
    back to living like it’s 1999 again. You can’t. It’s over.

    Of course Wall Street has excessive profits, but just as your


    life has been an inflated delusion of easy credit, so has theirs;
    yes, they have received an obscene share of that fake money,
    and ten-twenty years ago maybe you could have redistributed
    that fake money, but that ship has sailed. Now, the moment
    you take it away from them it ceases to exist, poof, it’s gone.
    It’s fine if you want to do it to punish them, I get it, it’s the
    right thing to do and Glass-Steagall and all that, but it won’t
    help your situation one bit.

    $3.6T out, $2.4T in, those are the numbers, and in case you
    want something on letterhead here’s the CBO saying taxing
    the rich would get us $450B over ten years. Ten years! Double
    the taxes, triple the taxes, it makes no difference, it’s over. The
    only way out is a massive tax on wealth; cold fusion; a war; a
    new media; or inflation. Inflation has the side benefit of
    pushing you into a higher tax bracket and we’ll all get to see
    what a $1000 bill looks like.

    “We are the 99%.” Stop it. There is a 1%, fighting another 1%,
    and while both of those megalomaniancs dominate the media
    coverage the other 98% has no recourse, no representation, no
    allies, and no savings. If you’re over forty 2007 was the best
    you will ever have it, make sure you backup your photos, it
    may not get worse than this but your only hope for growth is
    the next generation so you better change your expectations and
    your priorities. If you want to eat something other than canned
    goods and insects when you’re 80 you better prepare your kids
    now, work them harder in math and get them to read better
    books, make some kind of/all kinds of a sacrifice for them,
    because the only thing keeping you from the hellacious
    Medicare funded nursing homes and the Social Security that
    will not exist is them, the 17 year olds you are screaming at for
    drinking too much of the whisky you are hiding in the
    bathroom.
    And in 2030 don’t tell me “the young should respect their
    elders,” in the oldest of days the elderly were revered not
    because the young were respectful but because in those days if
    you made it to 60 you were a goddamn superhero. “Whatever
    the hell this guy did in his life,” Johnny said to Timmy, “I’m
    copying. How in Sutekh’s name did he not get eaten by a
    hyena?” If the hyenas had slacked off maybe those youth
    wouldn’t have been so respectful. Pray you don’t find out.

    Are you listening to me? Or were you looking at the woman in


    the red dress?

    You are the 98%, and you are too slow.

    The Dumbest Economic Collapse In History

    http://twitter.com/thelastpsych
    How To Draw (This Is Not
    An Article About How To
    Draw)
    October 17, 2011

    easier then it looks


    “Some people have it, some people don’t.”

    The New Drawing on the Right Side of the Brain: A Course in


    Enhancing Creativity and Artistic ConfidenceBetty Edwards.)
    Nevertheless, this is an outstanding book that everyone should
    read once, regardless of your interest in drawing.
    Given my awareness of the biases and cognitive shortcuts that
    make our lives easier yet sabotage us, I was surprised that I
    didn’t naturally appreciate what makes people/me terrible at
    drawing: reliance on cognitive shortcuts, i.e. symbols.

    If I were to draw a person, I would draw a circle, then two


    smaller eye ovals, a triangle nose, and double line for a mouth,
    then tubes for arms and legs. Hence, all my drawings look like
    they belong on a refrigerator. But that’s “how I draw”: head=
    circle, eyes=ovals, legs=cylinders. An example from a
    children’s book I started a long time ago:

    And cave=tunnel.
    Edwards calls this the “tyranny of the symbol system” because
    it dictates to us, forces our hand to draw symbols rather than
    what we see.
    But it isn’t simply that we draw using these symbols; we
    perceive using them as well. I don’t bother to see the actual
    shape of a head because it was never important to; in order to
    see it for what it really is, I need to practice my perception. It
    is easy for me to see a news story as a manufactured construct,
    but it never occurred to me I was seeing every day objects
    wrong. My tilted computer monitor isn’t a rectangle; it’s a
    trapezoid.

    So “draw what you see” requires practice perceiving things


    correctly: without the aid of your symbols. So lesson 1: draw
    something upside down.
    Focus on the lines, not on what you think it is.

    Symbolic drawing also impairs depth perception, angles, sizes,


    overlaps. Hold up your hand and point your fingers at your
    face. How would you draw that? Five long tubes? But in 2D,
    they’re actually irregular stumps.

    To relearn perception, Edwards says to hang a piece of glass


    (or use a window) and place your hand on the other side, close
    one eye (finally, being a pirate pays off) and draw the outlines
    you see.
    It will feel weird, because you’ll want the pencil to go “in” to
    the glass. Instead, you’ll have to draw the line in an unnatural
    direction that will feel wrong. But practice this exercise
    enough times and you’ll see things differently all the time,
    you’ll be able to switch back and forth between 3D and 2D
    and witness the impact of perspective in your every day life.
    Edwards includes the following letter from Van Gogh:

    I remember quite well, now that you write about it, that at
    the time when you spoke of my becoming a painter, I
    thought it very impractical and would not hear of it. What
    made me stop doubting was reading a clear book on
    perspective, Cassange’s Guide to the ABC of Drawing;
    and a week later I drew the interior of a kitchen with
    stove, chair, table and window - in their places and on
    their legs - whereas before it had seemed to me that
    getting depth and the right perspective into a drawing was
    witchcraft or pure chance.

    II.

    Though this is a book about drawing, Edwards includes the


    following quote from George Orwell:

    In prose, the worst thing one can do with words is


    surrender to them. When you think of a concrete object,
    you think wordlessly, and then, if you want to describe
    the thing you have been visualizing you probably hunt
    about until you find the exact words that seem to fit it.
    When you think of something abstract you are more
    inclined to use words from the start, and unless you make
    a conscious effort to prevent it, the existing dialect will
    come rushing in and do the job for you, at the expense of
    blurring or even changing your meaning. Probably it is
    better to put off using words as long as possible and get
    one’s meaning as clear as one can through pictures and
    sensations.

    There is a controversy about whether language expresses


    thought or creates thought. I don’t know. But I do know that
    language offers a feeling of certainty and masks ignorance.

    Your explanation of why Obama or Bush are terrible


    Presidents are the equivalent of my drawing of a person, the
    difference is that you can see how my symbolic drawing
    results in a poor representation of reality, but you are unaware
    of how your explanations are just as primitive. Take a look at
    how many times you use a stock phrase or someone else’s
    words (“in my opinion” “it’s long been held”, “tax and spend”
    “war of aggression” “fiscal discipline”, etc). Cut those out and
    see what’s left. But you’ll use more words to cover your
    revealed ignorance. The problem isn’t that you can’t express
    yourself well, the problem, as in drawing, is that you did not
    perceive well. You relied on symbols, and they made you feel
    knowledgeable.

    No surprise that many “geniuses” report seeing their tasks in


    two modalities, like the physicist who has a mental image of
    what the equations represent or the writer who hears his words
    as music. And when one is stuck at a thought or an emotion, it
    is helpful to translate pictures into words and words into
    pictures. (1)

    III.

    Next lesson: negative space. When you draw a chair, your


    mind is focused on the shape of the chair, but as this is a 2D
    drawing the spaces in between the chair are just as real. You
    should be able to draw a chair by drawing everything else but
    the chair:
    This forces you to pay attention to the shape of the negative
    space, and also the contents of the negative space.

    The analogy to media images is to “see” what isn’t there: how


    is the story constructed out of what is not shown? A typical
    media maneuver is to show a story without showing you the
    media itself, because seeing it tells a different story. So as
    much as this looks cool and makes you feel a certain way:

    it really looks like this:


    Which doesn’t make you feel that kind of way anymore.

    You know this, but willingly unknow it to enjoy the movie.


    But we also willingly unknow that this same setup exists when
    they’re interviewing the President or getting footage of a
    protest. The top picture doesn’t just leave some things out, it
    leaves almost everything out except one tiny part. The top
    picture’s focus is Indy; what is the bottom picture’s focus?

    Looking at the bottom picture, try drawing Indy as the product


    of negative space only. Did you consequently notice the guy
    behind the idol?

    IV.

    I’ve only covered a third of the book, but the three lessons
    discussed here— drawing an inverted image, drawing a hand
    on a glass plate, and drawing the negative spaces are sufficient
    to improve your drawing immensely.

    But I wanted to conduct an experiment.


    pre-test

    An 8 year old girl with Tourette’s “copied” the cover of the


    Junie B. Jones book as part of a book report. Even the slug and
    the rabbit are unhappy about how they turned out. My
    experiment was: could she draw better after practicing those
    three exercises (inverted drawing, hand behind glass, negative
    spaces)?

    This is the first attempt after practicing the exercises:

    attempt 1
    You can already see the improvement. Notably, she is trying to
    draw what she sees, and not relying on the default symbolic
    drawing that gets you slugs and rabbits. But she’s not entirely
    free of the symbolic: the legs and arms are still spaghetti tubes
    that bend unnaturally; Jim’s left hand is not bad but his right
    hand is still a childish heuristic. This happened not because
    arms are harder to draw than faces, but because arms are less
    important to her than faces and so she fell back on the
    symbolic.

    Back to the exercises. Finally:

    attempt 2

    I realize this looks like the final, polished result, but it is


    actually only the third time the girl ever drew this picture;
    there were no other attempts. Note that it is all free hand pencil
    outline, with no mistakes (except one, behind Meanie Jim’s
    head.) It’s an amazing improvement. She is drawing what she
    sees.

    I’d consider this experiment a success, but there is one more


    thing that makes it all the more significant and the real point of
    the experiment. If the problems of drawing are not technical
    skill but cognitive— if it is truly a problem of perception and
    not manual dexterity or talent— then the real work has to be
    done by the mind, not the hand. In other words, in order to
    become a better drawer, she shouldn’t need to practice
    drawing, she needs to practice seeing.

    So I made her practice the three Edwards exercises in her


    head. She never drew her hand using a glass pane; she stared
    at her posed fingers, and imagined how her pencil would move
    across an imaginary glass pane.

    So what you are seeing is not her third attempt at drawing


    Junie B Jones and Meanie Jim; it is the third time she touched
    the pencil.

    I will point out a tremendous secondary benefit to self-esteem,


    and now that she knows how to draw, she wants to draw,
    reinforcing the maxim that the best way to get a child to like
    doing something is to make sure they are good at doing it.

    I wonder how well someone might learn any skill if they


    imagine practicing the skill. It might not be as good as actual
    practice, but how not as good is it?

    1. A common misunderstanding about Freudian dream


    interpretation is that the dream images are explained using
    words, i.e. “I dreamt of a cigar, and a cigar is a symbol for
    penis.” Dream images may be metaphors and rebuses for
    unconscious thoughts, but the descriptions of dreams are
    themselves metaphors and placeholders. Example:
    “In my dream I saw Tom go over to Sally who was wearing a
    really bright white shirt.”
    What comes to mind when you think about the shirt?
    “Just that it was so bright.”
    What comes to mind when you think of the word, “bright”?
    Bright? ‘Smart’, I guess….
    The Plan Will Always Fail
    Catastrophically
    October 29, 2011

    unsee it
    Still light out.

    Driving too fast, there’s still patches of snow on this road. But
    you’re almost there.
    Turn in the driveway. The house is dark. Crap.

    Do not look at the upstairs windows.

    Garage door opens. Empty. Park.

    Still light out.

    You have about 15 minutes.

    Move.

    II.

    He opened the door, reached in and turned on the light. The


    kitchen windows still let in plenty of light, but this was just in
    case.

    He didn’t step inside. He gripped his mobile phone. Breathe.


    Dial.

    Ring. Ring. Ri

    “Hi, baby,” she said.

    Go.

    “Hi,” he responded, locking the door behind him and


    wriggling it. The garage is done. He dropped the bag on the
    counter, not glancing at the window. “How are things there?”
    He reached into the living room and flicked on that light but
    did not look inside, then doubled back to the kitchen and
    headed for the whisky bottle. He took two small gulps, and
    then a third, then out of the kitchen towards the stairs. Another
    light, click.

    “I’m so tired from being here, you cannot believe words words
    words words words words.” At the top of the stairs he had to
    make a choice: right had more western windows but would
    take longer. Last. Go left.
    “words words words,” his wife said. The phone was in the
    hand that was turning on the light. The Checklist: windows,
    closets, cabinets, bed. Windows, closets, cabinets, bed.
    Bathroom had a shower.

    Windows: feel them. locked, locked. He pulled the shades


    down. “Did you guys have dinner yet?” he inserted.

    “No, my mother made words, so we’re words words words


    words”

    He opened the closet door. Nothing. It made an unexpectedly


    noticeable amount of noise as he closed it, and he reflexively
    looked over his shoulder. Come on, get a grip. No large
    cabinets in this room. He fell to the floor and looked under the
    bed. Nothing. He unplugged the phone. He left the light on,
    and hurried to the next room. Windows, closet, cabinet, bed.
    Leaving that light on as well, he left the room and went back
    down the hallway. That room is completely fine. That room is
    completely fine.

    Next bedroom: light first. He scanned the windows. Both were


    clearly locked. These windows cannot be jimmied. He pulled
    the shades down. He slid the closet door open, peeked inside.
    Nothing. He closed it.

    “What are you going to eat tonight?” he heard her say. “Words
    words words words words.”

    He lingered at the closet. He had just checked this closet, it


    was fine. But. But he hadn’t really checked the back right wall
    behind the coats. But it was clearly empty. Don’t be OCD, or
    be sure? No room for mistakes. He opened the closet again and
    moved the coats. Empty. He closed it. Cabinets, bed. All fine.

    The bathroom was tricky to get into, but there was still enough
    daylight to make it inside. He placed his back against the
    hallway wall and reached behind him into the bathroom and
    felt for the light switch. Click. He rolled inside and looked at
    the floor and the walls. The shower curtain was pulled open
    already. Nothing. He shook the shower curtain to be sure.

    Then: tap tap

    Do not look up. It’s a trap.

    “Hey,” he interrupted, “I was meaning to ask you. When is the


    baby’s next immunization? What has she had already?”

    “She has her 9 month well baby visit next week, and words
    words words words”

    Now look.

    The medicine cabinet mirror was fine, of course it was fine.


    He tried to push his finger in through the glass, but couldn’t.
    Too much light. He opened the medicine cabinet, listened to
    his wife say some words, braced himself, and closed it again.
    The mirror was fine. In some horror film a woman was
    washing her face in the bathroom, and when she bent down
    into the sink her reflection in the mirror didn’t bend down with
    her, its stayed there and looked down at her. That was just a
    movie, but it reflected the deeper truth of it: mirrors were the
    most dangerous things in the house because they were the one
    place you could be tricked into looking at IT.

    Stop. He stepped out and thought about anything else.

    You have ten minutes left.

    The last thing was the door to the attic stairs. He reached for
    the handle.

    It was locked.

    “Jane,” he interrupted, “why is the attic door locked?”

    “It’s always locked. What are you doing up there?”


    “Where is the key?”

    “I have it with me. Why do you need to get in there?”

    “You mean we have no other key?”

    “No.” Pause. “Honey? There’s nothing in there.”

    The lock was unpickable. He shook it.

    “Is it locked from the inside? If I went up there, would I get


    locked in?” He could suddenly feel the whisky taking effect,
    calming him, making reality more vivid.

    “Well, no, because you’d have to have used the key to open it.
    If you magically appeared in the attic, yes, you’d be locked
    in.”

    He shook it but not so vigorously as to attract attention to


    himself. It would have to suffice. It was getting dark. Top floor
    is secure. There is nothing on the top floor.

    yet

    Eyes widening, he forced himself to focus on his wife. “I feel


    bad for her that she needs more shots,” he said.

    “Me, too, the last time she had a fever words words words”

    Downstairs.

    Within five minutes and during the recitation of the 9 month


    well baby visit he had performed the Checklist on every room
    in the house. He had lights on in every room and hallway. Out
    of the bag he removed a cheesesteak and broccoli, two beers,
    and with the whisky bottle headed for the living room couch.
    On the coffee table sat two flashlights and two of his wife’s
    scented candles and a 4 gallon Poland Springs jug filled to the
    top. He lit one of the candles and placed it on the far end of the
    coffee table. He turned on the TV. The moment he saw the
    local news reporter talking about the real his entire body
    involuntarily relaxed. 12 hours to go. He could make it.

    “All right, baby,” he summarized. “You enjoy your dinner, I’ll


    talk to you before I go to sleep.”

    “I love you.” Pause. “Are you nervous in there? Did you take
    out the gun?”

    No guns. “No, of course not. What would I need a gun for?”


    Guns proved you were afraid. “I’m fine, go have your dinner.”

    “Ok, I love you. Be safe. Don’t burn the house down.”

    III.

    He had known about the Plan since he was 4 or 5. He did not


    know how he had learned it. The Plan had two parts, The
    Checklist and The Escape Hatch.

    The Checklist had three rules for survival: Rule 1, Important:


    check all the rooms. Rule 2, Very important: leave the lights
    on in the rooms he couldn’t see. Like with roaches. It
    prevented them from wanting to come out. Rule 3, Ultra-
    Important: make sure there was nothing in the rooms that
    could be turned on. So: batteries out of all toys. Alarm clocks
    double checked, or unplugged. Phones, especially the phones,
    had to be unplugged. Only the mobile phone with him was on.

    The problem wasn’t the unknown, but the lack. In a horror


    movie the woman would walk into the unknown house and of
    course there was something relentless and relentless waiting
    for her. In real life it was the opposite: you knew the house,
    knew there was nothing in the house. What was supposed to
    be there— the kids, the wife, activity— were absent. So your
    mind populated the empty spaces.

    If you had a weak mind, your mind populated it with


    imaginary ghosts.
    If you had a strong mind

    IV.

    The Plan could fail catastrophically in two ways.

    One: blackout. All blackouts are attacks. If the power went out
    he had been detected. Using the flashlight to see where he was
    going would only make things worse, but that’s not what it
    was for. It was for The Escape Hatch.

    The other was his bladder.

    He could drink himself into unconsciousness. But some point


    he would have to pee. That meant he had to walk to the
    bathroom.

    The trick was to not see. He could only be seen if he saw, his
    gaze was what revealed him. On the couch he could divert all
    his attention to the TV, but if he walked to the bathroom he’d
    have to unsee the kitchen, the hallway, the bathroom mirror,
    and everything around him, all while calling attention to
    himself by his motions, his noise, his thoughts, his fear.

    Fear of the dark wasn’t that there would be something in the


    dark, but that you would see something in the dark, the terror
    was in the perception and not the reality, and even if it turned
    out to be an illusion or a hat or a shadow that brief moment of
    terror of what could become possible was too much.

    That’s what made the long trip to the bathroom so difficult.


    There were too many things that he had to unsee. He had once
    thought about getting a bedside urinal bottle, but it was too
    risky. It would be unusual, it was a physical representation of
    his fear which would lead to his awareness of what was inside
    the house. He had to act like everything was normal.

    He stood up, took a long look at the TV and tried to empathize


    with the talk show host as he feigned interest in a movie’s
    supporting actress. Amazing legs. His mind wandered towards
    her vagina— then stopped. Not tonight.

    There was a clear line of sight from the couch through the
    kitchen into the hallway and bathroom. Everything was lit.
    With the interview running in his head, he walked calmly and
    assertively to the bathroom. In his mind he was asking her if
    she did her own stunts. He passed into the hallway and didn’t
    look up the stairs.

    Facing the toilet, he started to pee. The mirror was behind him.

    He flushed. He almost never washed his hands after he peed,


    but this time he had to— everything had to be done correctly.
    No shortcuts. No outward display of fear. Another thought to
    the interview and he turned to face the mirror. Nothing. He
    didn’t see what he knew would not be there now: his own
    reflection but turned completely around, facing away, its back
    to him. He had never seen this reflection yet. When he did, if
    he turned his head just slightly he would be able to catch a
    glimpse of the face, his face, proving that it was aware it was
    being looked at by not looking back. The glimpse would
    reveal a sad, terrified face. It had been crying. The mouth was
    gone. Someone had taken its mouth. For minutes it would
    stare away from him, its sobs barely audible through the
    ordinarily impenetrable glass of the mirror. Resigned to its
    fate, it would walk defeatedly away from him deeper into the
    reflection-bathroom that had been telescoped punishingly into
    a hallway, and at the end was a wooden door that he should
    not have in this house. His tiny reflection, trivialized by the
    distance, would open that door inwards, hang its head in
    surrender, and walk through. Not having a mouth ensured it
    would not scream.

    He glanced at the couch back in the living room. Just get back
    there.

    He started towards the living room but made it only as far as


    the kitchen when he heard it.

    tap tap tap tap


    He froze. Think. It was too clear and too obvious to be a
    danger. It had to be something real.

    tap tap

    swish

    He took a few steps to the right to get away from the hallway.

    tap tap

    ah

    Yes. Now he was sure he had heard it, it was definitely real so
    it was defintely nothing. A squirrell on the roof, the heating
    system, mice, elephants, it didn’t matter.

    Relieved, he took another step towards the living room and


    then froze. Oh no.

    Because of the steps he had taken to the right, he was


    approaching the living room obliquely which meant that he
    could no longer see the couch. The couch was hidden from his
    view.

    He had lost his line of sight. He had been tricked.

    He thought about the phone, but that was on the couch. If he


    ran outside he’d never be able to get back in. Upstairs was
    madness.

    He tried to concentrate on the actress. Great legs. Implants,


    too. Had to be implants. Had to be. He took a step forward but
    his concentration was momentarily interrupted.

    tap tap tap tap tap tap ta

    He wasn’t sure if he had heard this, which meant he had heard


    it.
    His back muscles tensed so suddenly that his posture
    straightened. He knew something was behind him.

    He had almost no time. He squeezed all his focus into thinking


    about the actress curling her toes and walked arrogantly into
    the room. He unsaw the couch, looked at the TV and went
    right for the Poland Springs jug. In his peripheral vision and in
    the safety of the TV’s talking he noticed the couch was empty.

    He could salvage this, maybe. Sit on the couch. He sat, his foot
    by the Poland Springs jug.

    Do not look up.

    Look at the TV, the TV, the TV.

    It is above you.

    “We’ll be right back,” the late night host said and it went to a
    commercial, and in the millisecond it took to fade to black he
    realized that TV would become the worst kind of mirror, a
    dark mirror, and he was going to be able to see a reflection in
    that mirror.

    God, please.

    In the instant of blackness on the TV he saw it move to the left

    ah

    It was

    And it said: shhhhhhhhhh

    The TV never went to commercial, it stayed black. Everything


    was still. Now he could not help but see what was there all
    along.

    It was peeking around the doorway into the living room. A


    charcoal grey shape. It is a broomstick. No, it was a blanket
    draped over a broomstick, like a huge puppet, and the
    broomstick emerged from the corner of the doorway, creeping
    slowly, until it was standing fully in the doorway. The handle
    of the broom poked out from beneath the blanket tapping on
    the wooden floor.

    The blanket was staring at him, because it had two black ovals
    painted on it, like eyes, and the broom turned so it was facing
    him.

    tap tap tap on the wooden floor

    He couldn’t move, or else he didn’t try to move, nothing


    moved, nothing did anything except the broom and the blanket
    which glared at him with big black oval eyes.

    “H-h-hi,” he whispered to appease it.

    Suddenly it withdrew back into the kitchen and the house


    rebelled against him, from the upstairs he heard the angry,
    heavy, stomping sound of the worst thing he could imagine,
    and finally heard the voice he had always unheard

    wwwwwwwwwwwwwwwhhhhhhhhhhhhhhhhhhhhhhhhhhhh
    he

    There was no time to get out, and getting out no longer


    mattered. The Escape Hatch. He bent towards Poland Springs
    jug but he was in slow motion, the stomping was coming
    downstairs much faster than he was
    moooovviiiinnngggggggggg

    Get to it get to it get to it

    The whole house was shaking from the rage of the footsteps

    just before IT came around into the kitchen his foot


    cooonnnneeecccttteeeeddddddddd with the jug
    enough gasoline splashed out of it to reach the candle

    fire is real

    The explosion blinded and deafened him. It would be


    surprised. It had never noticed he had a weapon.

    get to the door

    Slow motion again, going too slowly, being sucked back in.
    And his back was on fire but he knew IT had made it into the
    living room.

    He pulled the front door open, so very slowly but as fast as he


    could, and just as he felt something brush at his flaming back
    he was out of the house and suddenly time resumed.

    He collapsed in the snow, arm, back, face still on fire. He


    looked back at the flaming house. There IT was, the blanket on
    the broom standing in the doorway staring at him, enraged and
    confused and trapped in a house that would soon be
    obliterated.

    His whole body was in pain but the pain was real and the
    broom heard him screaming at IT in his mind

    burn
    Judge Beats His Daughter
    November 3, 2011

    oops

    A video from 2004 shows a Texas judge beating his daughter


    with a belt, and America acts like it’s surprised those words
    are in the same sentence.
    Well that was unpleasant.
    There’s no point in saying what has already been said 678418
    times, so let’s do something else. BTW, why are all the
    “Related Videos” MMA clips?

    II.

    First, let’s double back on our souls. If you want to learn why
    you think whatever it is you think, strip away existing context
    and force it into a new one and see what happens. In this case,
    assume this video is a fake.
    Which is surprisingly easy to do: the dialogue is terrible—
    stock phrases probably indicative of narcissistic rage (lines
    appropriate to his movie) but also of amateur screenwriting,
    and though the hits are real plenty of actresses would be
    willing to take them if the movie was going to open during
    Oscar season.
    So now your reaction does not have the luxury of pretending it
    is based on actual events; those feelings are exclusively inside
    you. So, are you feeling empathy for her, or rage against him?

    III.
    It’s surprising that “in this day and age” people still look at
    videos and news stories as if they are actual representations of
    reality. Say it’s real: since she knows there’s a hidden camera
    over there, is it possible she decides, oh, I don’t know, to play
    up the damsel in distress and not throw a chair at him or not
    blow pot smoke in his face or not reveal that what she illegally
    downloaded was lesbian porn? “Oh my God! That’s no excuse
    for him beating her!” Of course I’m not excusing what he did,
    I’m not even talking about what he did, I talking about why
    America is obsessed with this.
    Do me the respect of admitting to whoever is drinking a latte
    next to you that if these people were black, you’d have a
    whole different reaction. If you even had any reaction, because
    most probably this video would have sunk to the bottom of the
    Sea Of Youtube with only one comment that said, “what’s
    amazing about this video is that the father is actually still
    living there.”
    You want to see superb belt technique go visit a Toys-R-Us in
    an inner city, and I have a weird feeling that the reason
    wannabe gangstas never wear belts is because of negative
    reinforcement. Furthermore, after carefully reviewing the data
    coming from every black comic ever those kids are getting a
    beat down from their moms as well, proving my thesis that if
    you punch a white girl it becomes a Breaking News, punch a
    black kid and it’s hilarious. And let me offer without further
    comment a phrase you will inevitably hear the first time you
    try and slap your black girlfriend: “don’t you raise your hand
    to me, you fucking nigger, you ain’t my daddy.”
    I’m making this point not because I want to be on the Jon
    Stewart show, but to point out that our reaction to the video
    isn’t about right and wrong but about identification. And when
    the media elicits your identification, it is never about what you
    like but about what you hate.
    Jim Hopper, a clinical instructor in psychology at
    Harvard Medical School and a child abuse expert, said
    there is no doubt that the judge’s actions crossed the line.
    “This is an act of brutal violence,” Hopper said. “To beat
    someone into submission is not discipline. To beat a child
    into submission makes it harder for that child to take in
    rules and the values that the parent believes they are
    imposing on the child.”

    Jim Hopper’s a pussy. Can I say that on the internet? Note that
    the sentences do not logically follow one another. Is it brutal
    because it fails as a discipline tool? Does it fail as a tool
    because it is brutal? He is not offering any insight into what
    happened, just repeating the feel-good non-sequitors that got
    America into this mess in the first place.
    Properly understood, the beating has nothing to do with
    discipline at all, the discipline is an excuse for a discharge of
    rage that was already there and was coming out one kind of
    way or another. That’s why when he leaves the room after
    beating her he is relaxed, relieved. “Finally, now I can sleep!”
    People have felt compelled to point out that “all she did was
    download music” as if they were looking for some level of
    crime that would fit the punishment but that’s precisely the
    point, there isn’t any, it’s not about the crime but the excuse to
    hit something, which is why I would advise my clients who
    appear before him for sentencing to be as deferential and as
    respectful as possible, explicitly, verbally, recognize his
    authority, because he will most likely be a softie about any
    kind of crime that does not reflect badly on himself. Got it?
    Beat your kid and he’ll sentence you to life, rob a bank or
    plead psychiatry and you’ll be back on the streets in 48 hours.
    But bump a pretty woman wearing just the right kind of white
    heels and just the right shade of red lipstick and you may as
    well swallow your fingernail clippings, justice will be done.

    IV.
    Someone, e.g. the daughter Hillary, is at some point going to
    note the irony that her father punished her for using the
    internet, and she was then able to use the internet to punish
    him back. But that’s not how it’s going to play out, not with
    narcissism.
    Sure, initially he’s going to feel very ashamed that everyone
    sees him this way. But prior to the premiere, he had to carry
    around the secret of her beatings, and if there was any chance
    he ever felt guilty or perhaps thought that at times he was
    excessive, what he will do now is find enough (>1)
    anonymous (= “objective, they don’t even know me”) people
    who say, “well, it’s not that bad” and poof, guilt gone.
    Crowdsourcing the superego means never having to say you’re
    sorry. Never mind 99% of the comments and articles want him
    registered on a database, those guys are idiots or liberals or the
    media or whatever, he’ll align himself with the 1% and walk
    proudly down the sidewalk. “Not only do people know I didn’t
    do anything wrong, now I know it as well. Thanks, Hillary. I
    feel a lot better.”
    Furthermore, there is the very real probability that public is
    going to go Rebecca Black on her, finding it first progressive
    to hate the father, but as soon as the “we have to fight child
    abuse” crowd joins in it will be way cooler to turn around and
    support him. If there is one thing Americans hate more than a
    father beating his daughter it’s finding themselves in
    agreement with people they can’t stand.
    The other equally likely possibility is that the exposure, the
    narcissistic injury, is going to be too much for him and he will
    kill himself. America may cheer this outcome but I suspect
    Hillary will be at least ambivalent.

    “I’m very relieved that these things have been brought to


    light and not because I want to see my father burn or
    anything like that. That’s a hideous way of thinking and I
    don’t want to inflict that upon him,” [Hillary] said. “I
    cannot stress enough — I cannot repeat myself enough,
    that he just needs help.”

    Sorry, not buying it. I understand and empathize, believe me I


    do, but there’s only rage in those words, and I am predicting
    the future by telling you it is of no consequence to him and
    suicide for you. I’m going to be hated by everyone for saying
    this, but there is an important difference between what
    happened to you and how you use what happened to you, and
    one of those you have to live with and the other one everyone
    else has to live with. And you will never be free.
    If all rage comes from narcissism and narcissism is the
    broadcasting of a chosen identity, what identity is she
    broadcasting? Victim. Even if youtubing her abuse is somehow
    cathartic, it reinforces victim as an important part of her
    identity to herself, and this will infect every single relationship
    she has forever, from husband to kids to dog to God. Again, I
    am making a distinction between the abuse affecting her, and
    unconsciously defining herself by the abuse. After a few years
    of rehearsing you will no more be able to get rid of that trauma
    and expect to get on with life than you can pull the power
    source out of Megatron and expect he’ll be able to turn into a
    jet. So I am telling her early, and I am telling you early, you
    who have nothing to do with these people but still feel not
    sympathetic but enraged, as much as you want him to suffer
    that desire is hurting you. I understand it, I respect it, I get it.
    But it will kill you. Forgiveness at any cost is the only way
    out.
    Joe Paterno Fired For A
    Crime He Didn’t Commit
    November 11, 2011

    dressing for the big game


    As background for the German and Danish readers who are
    too busy trying to determine if come Monday morning milk
    will be priced in marks and/or krone, over in America
    everyone’s gone bananas because, allegedly, a Penn State
    football coach named Jerry Sandusky was molesting little kids.
    One day an assistant accidentally stumbled upon Sandusky
    “anally raping” a 10 year old boy in the locker room showers,
    so he went home, took a nap, and the next day told the head
    coach Joe Paterno what he saw. What Paterno did next is
    subject to some debate, but it seems to fall within the broad
    category of “nothing,” which he then did spectacularly for the
    next 11 years.

    Then two days ago riots erupted on Penn State’s campus, the
    kind with pepper spray and armored police, because Joe
    Paterno was… fired. I think that means they wanted him to
    stay, but my eyes won’t let me believe it.

    OccupyWallSt: no violence. Penn State: violence. Americans


    are idiots.

    I.

    Here’s a good place to start: if Joe Paterno wasn’t just a coach


    but a Catholic archbishop he’d be facing the International
    Criminal Court, and if he was a hedge fund trader someone
    would have killed him twice. This tells me that who he is
    matters way more to people than what he’s done, which is
    almost always an alarm to flip over the couch and click off the
    safety.

    Here’s the generational problem, and what’s significant about


    it isn’t so much that it didn’t happen but that no one has even
    thought to mention it: the reason Paterno had to be fired is
    because if he stayed, if he and the administration thought this
    was surmountable, then it would have put the football players
    in the extremely uncomfortable position of having to make the
    ethical decision themselves. “Do I want to keep playing for an
    organization that hides this kind of thing?” That’s a heavy
    question to ask a 20 year old. These players are college kids,
    which means that what is at stake in making this choice is their
    entire futures, whereas what is at stake for Paterno and the
    school is their legacy. Does some defensive end have to
    consider throwing away his entire possible career just to make
    the choice that his elders should have made for him? The
    answer is yes, but it is way unfair of the rest of us to saddle
    him with it.

    Notwithstanding that the future is demonstrably more valuable


    than the past, forgetting about that— it is the responsibility of
    the older generation to take the bullet so that the younger
    generation has a chance. “I don’t know who the hell spilled all
    these banana peels and ball bearings, ” says Mr. Expanding
    Waistline And Declining Penile Tumescence, “but I got to
    clean it up so the kids don’t trip over it.”

    This is why CEOs step down and generals resign, it isn’t


    simply that “they are ultimately responsible” but that it is their
    job is to throw themselves on the grenade so that the area is
    cleared for everyone else, and if your CEO or general or father
    isn’t willing to do that, then you don’t actually have a CEO or
    general or father, you have a politician. Enjoy your democracy.

    II.

    I’m somewhat hesitant to admit that the only thing I know


    about college football is college cheerleaders, and if you think
    that makes me less of a man I’ll patiently listen to you concoct
    some explanation. But thanks to the Fourth Estate I now know
    who Paterno is, how revered he is, and what kind of person is
    doing the revering: this idiot on the top of a news van jumping
    in front of a cardboard cut out of Joe Paterno doing exactly
    what he did when he was told about the anal sex:
    I’d like to draw your attention to three things, first, that
    wildman is standing on a van that is laying unnaturally
    sideways, second that there are seven hundred and fifty
    thousand people cheering him on, and third that he is white.
    That last bit is fortunate because it avoids misunderstanding
    when I say that he looks like a chimpanzee. And moves like
    one. But I’d also have to admit that later that night some poor
    chick from Delta Gamma was on the receiving end of that
    simian’s semen, and she loved it.
    Note that while he is probably just a guy standing on a news
    van, he has been co-opted by the media Semioti-Matic and
    transformed into a symbol of primitive sexuality and moral
    idiocy for which he has no recourse or rebuttal. He may in fact
    be an idiot with a big penis, all of my intuition tells me he is
    an idiot with a big penis, but who the hell knows? The moment
    he got put on TV he became an image slave. The media can do
    what they want with him, and they have.

    But surely not all students at Penn State are so unsympathetic


    to the anal rape of children?

    Ah, there they are, couldn’t get bus fare to NYC, I guess.
    Hmmmmmmmmmmmm, maybe this is the rum talking, but
    anyone else see heptuplets? So it’s not just me. The media has
    now successfully changed the narrative from
    “somethingsomethingsomething anal rape” to a sports analogy
    of two opposing teams: Big Dick vs. Hippie Chick. Now it is
    so easy for me to pick a side, thank you Jesus, a side which
    has nothing to do with child molestation and everything to do
    with which of these two groups I hate more.
    I would be drunk if I did not point out that just as the media
    symbol for the collapse of public order is looting— i.e. the
    opposite of shopping, the media symbol for a collapse of civil
    society is the destruction of a media news van.

    Show me some broken windows or broken heads and I will


    wait to be told who is to blame, but anyone who attacks the
    media is self-evidently a degenerate. The odd thing is that
    while the media are supposed to be impartial and invisible, the
    most active in terms of agenda, framing, and activity, is that
    very media. Their specific function at that riot is to make
    money, and they’re surprised they became a target? If you start
    a riot, the very first thing you should flip over is the news van.
    Just don’t then stand on it.

    III.

    I had hoped that the younger generation was going to have


    better priorities than their highly narcissistic elders, i.e.
    Sandusky and Paterno and the excellent men and women of
    the Board 2002-2011, but it doesn’t look good. It looks real
    bad, in fact. What I see is an up and coming generation unable
    to weigh societal goods, let alone moral equivalences, almost
    entirely because they have to play Nebraska today. Which
    scares me to believe that 2012-2035 will be a repeat of 1978-
    2001. I hope I’m wrong. If you see them bring back
    pantyhose, I wasn’t.
    And there’s this, and again, I don’t know much about football,
    but I do know a lot about human motivation: If Jerry Sandusky
    was indeed having anal sex with a 10 year old in the Penn
    State locker room showers, where anyone could stumble upon
    him, then it is impossible to imagine he hadn’t already done it
    there before. He felt safe doing it. At Penn State. In the locker
    room.

    If this was any other organization but college football, they


    would have detonated it faster than Enron. But since no one
    likes anyone that much, his not being immediately imprisoned
    requires some explanation other than “well, Sandusky saved
    me back in ‘Nam, so I owed him”, and all of them, every
    single one, is going to involve some version of the phrase
    “institutionalization of corruption.” The only open question is
    how big you thing the word “institution” is, campus size or
    national size. When you wake up tomorrow to the
    unbelievable realization that the Zegna suits in Wall Street are
    the least corrupt of your generation, remember that the alarm
    had already been sounded if you had only paused to hear it.
    Flip over the couch and click off the safety. None of you are
    safe.

    http://twitter.com/thelastpsych
    White People Think Black
    People Are Dirty
    November 16, 2011

    obviously he brought the trash with him


    In Science, a study about racial stereotyping. Science, as you
    know, is read by scientists, which means they are progressive
    intellectuals who never racially stereotype. They voted for
    Obama to prove it. Though they unanimously subscribe to
    Evolutionary Psychology Bible they themselves are not subject
    to evolutionary forces; but it is helpful and entertaining to
    learn what makes the animals in the red states do what they do.

    When you’re short on time and long on caffeine skip over the
    study itself and just look at the Introduction, where you will
    always find two things.

    Unnecessary references:

    There is substantial evidence that discrimination has


    serious negative consequences for those who are
    discriminated against, as well as for society in general (1-
    3). A neglected possible source of stereotyping and
    discrimination is physical disorder. The environment can
    affect the relative accessibility of important goals (4, 5),
    and recently it has been found that physical disorder in
    particular can, through shifting the relative accessibility
    of goals, increase littering, trespassing, and even stealing
    (6).

    None of these sentences need referencing, because none of


    them contain a proposition worth referencing. They are either
    definitional (e.g. racial discrimination is negative) or uselessly
    vague. Yet we have exhausted 6 out of the 24 references to be
    told nothing.

    Next: references that don’t actually support the statements they


    are supposed to be supporting.

    There is some evidence that stereotyping is goal-driven


    (7-9), and there is even evidence that when people’s
    desire for structure and predictability is high, they are
    more likely to engage in stereotyping than when it is low
    (10-13).

    Reference 10 is a review article about existentialism.


    Reference 11 has the word stereotyping in it, but isn’t about
    the link to predictability.
    Reference 12 describes the kinds of responses that occur when
    expectations (not stereotypes) are/are not confirmed: “will this
    taste good?” “If you are told Paul is a kind man, how will you
    react when he isn’t?”)
    Reference 13, is about how the goal of interpretation affects
    the interpretation/stereotyping.

    I should also point out that all four of those references happen
    to have been written by the same person who wrote the
    sentence they were all supporting.

    II.

    For no reason I know, works of philosophy are compromised


    by even a typo in the introduction, but in science you can open
    with a golden shower anecdote and no one notices. Oh well.
    To the experiments.

    The setting: a Dutch train station. 40 Caucasian men and


    women were asked to sit in a row of chairs and fill out a
    questionnaire about Muslim and gay stereotypes. Chair 1 was
    occupied by either a white or a black researcher, which they
    term a “confederate.” Yes, like they’re grifters. Where would
    the subjects choose to sit?

    The experiment was run twice: once on a day when the station
    was clean (order condition), and another time a few days into a
    janitorial strike, i.e. in a dirty train station (disorder condition.)
    How did the disorder affect the choices white people make
    about where to sit?

    We predicted that in a dirty train station people stereotype


    more and would choose to sit further away from an
    outgroup confederate than in a (relatively) clean train
    station.

    Conclusions:
    Importantly, this stronger stereotyping in the disorder
    condition was accompanied by a significant increase in
    the distance the respondents chose to put between
    themselves and the black confederate..

    There are a number of reasons why this study is silly, but,


    unlike the researchers, subjects, and striking janitors I am not
    being paid for my nonsense, so I will only list a lot of them.

    The subjects are completing a survey about Muslim and gay


    stereotypes, yet are sitting near a black man. Would the results
    have been the same if the confederate was gay? No? Then it’s
    only measuring racial stereotyping, which is fine, but then you
    can’t say this:

    … In a disordered environment, people are more likely to


    distance themselves from outgroup members than in a
    clean and ordered environment.

    Trust me on this: ‘outgroup’ has a whole different connotation


    in The Netherlands than in the U.S. But the sleight of hand is
    to take a white vs. black racial study and convert it to a
    scientific generalization about stereotyping, the kind where
    some other study can use it to say, “there is evidence to
    suggest that people distance themselves from outgroup
    members.”

    Would the results be the same if black subjects were studied?


    Perhaps this is a study of prejudice and fear, i.e. white people
    are afraid to sit near black people but black people are also
    afraid to sit near black people, which would produce the same
    graph. But you’d have to rewrite the conclusions because it
    wouldn’t be about “outgroups.”

    Right about here I you want to take a drink, because


    apparently the only scientist in The Netherlands that has sex
    with strangers is me. Think about his study, and the results,
    and what you think it means. Now look at these photos:

    Suddenly the seating choice takes on a different hue. Is she


    avoiding the black man in the top picture, or is she looking to
    get penetrated in the second? BE HONEST LIARS. I will
    admit that technically the author remains correct, both
    interpretations are the result of “stereotyping,” but one
    happens to be a negative stereotype and the other happens to
    be a substantial plot point of every drama on ABC. Here’s a
    revised title for the study: “Clean Stations, Dirty Minds: How
    Just The Right Conditions Can Make A Woman Go Black.
    (But She’ll Be Back.)”

    The study assumes that how close whites sit to whites is the
    default, hence a black confederate in a dirty station makes
    them sit “further away”; but why isn’t the distance they sit in
    the disordered condition the default per race, and other things
    make them close the gap? This is especially true if the subjects
    are used to disorder as the typical state of affairs, i.e. they’re
    from Rotterdam. ZING! (It is, after all, a train station.)
    If you want to go Schrodinger, remember that the subjects in
    both conditions are surrounded already by other white people
    who are observing them (the interviewers). They are not alone.
    In ordered environments, does this make people feel
    safe/horny/cold/social enough to move closer? (i.e. if the
    interviewers were not present, perhaps whites would choose to
    sit equally far from black people in both ordered and
    disordered environments. They’d still be racist, but things
    couldn’t make them more racist, only less racist.)

    Note also that the default condition for the station is clean; the
    janitorial strike caused an unusual circumstance. How would
    the results come out if the station was usually dirty and one
    day became unusually clean?

    And etc. Instead, the study closes with this:

    Thus, the message for policy-makers is clear: One way to


    fight unwanted stereotyping and discrimination is to
    diagnose environmental disorder early and to intervene
    immediately by cleaning up and creating physical order.

    That’s the kind of delicious “broken windows” soundbite that


    gets you published in Time Magazine, but why would the
    effects last more than a day? Wouldn’t people become
    desensitized to the disorder?

    I don’t even doubt the conclusions, but you have the moral
    decency not to overlook the flaws just because they match
    your prejudices. This study does not logically lead to those
    conclusions, this study is sufficiently vague and flawed that no
    conclusions can be made, at all.

    The reason this matters is because if the study is published in


    this way, with these conclusions, people will assume it is
    science. This becomes a “known.” Next thing you know it’s in
    a Malcolm Gladwell book and that’s the game.
    These points seem not to have occurred to the following
    people: the two authors of the study; the guy who took this
    photograph; the four peer reviewers; the editor; everyone who
    read the study.

    I don’t blame them, but as I am not the smartest guy in the


    universe it should have at least occurred to someone, and thus
    we have the fundamental problem of psychological research: it
    shouldn’t be reviewed by peers. Not because they are stupid,
    but because they are in the same “world” and can’t see things
    from the outside. It should be reviewed by physicists; but if it
    was, there’d be only one psychology journal left and it would
    be empty. I reviewed Justin Timberlake’s In Time more closely
    than anyone reviewed this study.

    Two things happen with studies like these: either they enter the
    Sea Of Publications, another meaningless ion of sodium that
    does nothing else at all except contribute to the rising sea
    levels that will eventually kill us all; or they get used by
    government policy guys to justify, well, it depends: justify
    making trains stations way cleaner, or way dirtier. Your city’s
    needs may be different.

    III.

    So the study is an interesting observation about which no


    conclusions can be reached. However, there’s a further punch
    line to this: the study was a fraud.

    Diederik Stapel, noted Dutch psychologist, was recently outed


    for massive scientific fraud, i.e. he made up all his studies.
    “All of them?” Does it matter?

    The scientific community is aghast at the extent of his fraud—


    fraud on “Astonishing Scale”, writes Gretchen Vogel in the
    same issue of Science; and Bruce Alberts was so furious he
    wrote an “Editorial Expression Of Concern.” Ooooooooohhh.
    People’s Elbow.
    The battle cry now is that science has to be done differently in
    order to prevent fraud; but the important truth is that this study
    should never have been detected as a fraud because it should
    never have been published in the first place. The cacophony of
    self-righteousness among everyone with “professor”
    somewhere near their name is a diversion from the reality that
    the way the entire field conducts research and draws
    conclusions is suspect.

    Hide behind Stapel, strap some Kevlar to his chest and let it
    draw fire while you deploy a few more studies to the journals
    that are of dubious quality and of no consequence, the system
    has to hold just until you make tenure. I know. These studies
    are useless, worse, they are perfectly packaged for the media
    and popular consumption so that in spite of their
    meaninglessness they will change the way people think and
    change the way society acts. I wouldn’t have used this study to
    win another drink in a bar argument but some minister
    somewhere will use it to demand 300M euros or whatever they
    will use next month for clean stations or racial purity.

    IV.

    “Why is Alone lenient on the judge who beats his daughter?


    Can he really believe Wall Street is blameless? He thinks the
    media is creating a straw man of a college kid angry at
    Paterno’s firing?”

    You don’t need me to point out the obvious bad guys, there is
    no point for me to decry scientific misconduct and pedophilia.
    But when I don’t do it you think there’s something wrong with
    me, that I’m blind. Why do you want me to say the things you
    already know are true? Because that’s what you were trained
    to want.

    What you need me for is to untrain you, force you to realize


    that focusing on the obvious bad guys is a defense against
    looking at everything else, because that everything else is you.
    You were trained by media which labels hypocrisy as the
    worst sin imaginable; and individual instances of corruption—
    hey, there’s a welfare cheat, hey, there’s Bernie Madoff— as
    the appropriate target for your wrath. Bernie Madoff is not
    your problem, he is not your enemy, and unless you lost
    money to him he is nothing to you; and as long as you can be
    reminded to be angry at him you are not going to ask why the
    system needs Bernie Madoffs to survive. Stapel may have
    invented the data that no one will look at but Science didn’t
    vet the conclusions that everyone will remember. Which is
    worse? “Keep your guns trained on the bullet proof straw man.
    Look over there, he’s a jerk!” If they can drive you to rage,
    they’ve succeeded.

    Here’s the synthesis: there’s an argument against


    OccupyWallSt, and another about a beating your daughter, and
    another about raping some kid in a shower, and this, and etc—
    all of these are the same thing. All of these represent the
    institutionalization, the mainstream acceptance, of self-serving
    behavior because that behavior allows everyone else to be
    equally self-serving. Or, in more basic yet precise language:
    individual narcissism is encouraged to permit the existence of
    societal narcissism, all of which is at the expense of your soul.
    Repent.

    http://twitter.com/thelastpsych
    Luxury Branding The Future
    Leaders Of The World
    November 28, 2011

    do you see?
    Want to go buy a $10000 watch? “In 2009-14? Hell yeah, let
    me get my coat.”

    Watches have the same problem diamond jewelry has; it better


    be beautiful enough to keep forever, because if you try and sell
    it you’ll discover there is no secondary market for it. No one
    wants the necklace your ex had waiting for you when you got
    back from Cozumel. “I’ve been doing a lot of thinking,” he
    says, “about how easy it would be for you to get all the penis
    you want. Let’s get married and make sure neither of us are
    ever happy. No, no, moving closer to your parents doesn’t
    sound like a bad idea.” Turning it into an heirloom keeps it out
    of the market and the supply stays regulated by the
    manufacturers, which I think is collusion but I’m no lawyer.

    These ads can be seen in whatever rich people use to relax on


    Sunday afternoons, e.g. The Economist.

    This is a brilliant campaign, for technical and artistic reasons.


    What is the brand that it conveys? Heirloom quality.
    The ads use black and white photos: we’ve been around for a
    long time. Even the advertising campaign self-referentially
    broadcasts this— it has been the same since 1996, i.e. longer
    than a 40 year old has been in the market for an expensive
    watch to notice it wasn’t always thus, reinforcing the longevity
    of the brand.
    I know you probably figure this ad isn’t for you because
    you’re not a railroad baron or a Rothschild, but ask yourself a
    question: have you seen this ad? Then it’s for you. Time to
    learn why they know you better than you know yourself.

    I.

    The demo for this ad isn’t the Rothschilds or the 1%: they
    don’t buy based on ads. And they don’t need to be told what
    constitutes quality or authenticity, they can tell, that’s what
    boarding school was for. Everyone else is going to need to be
    hit over the head with the semiotics of quality—

    i.e. see an ad campaign about those signifiers. Oh, I get it now,


    this is a fancy watch.
    The target demo is not the 1%; the target demo is the
    Aspirational 14%. They know they are supposed to like
    quality and goodness and etiquette and discretion, but no one
    ever taught them what those things look like, so when
    someone does point it out to them they will go all in. Hence:
    anything in Trading Up. And they don’t care about the next
    generation. Not really. They don’t want them to be eaten by
    zombies but anything past 2069 is of no consequence. What
    they do care about is how a product brands them, what it says
    about them now, now that time is running out. Can’t afford to
    be subtle, which is the same thing as saying I’m willing to pay
    $10000 to get the message across. There’s a difference
    between what the brand is and what the brand says about you.
    You’ll pay 10x for the former and 100x for the latter.
    Most products have quick, easy, memorable taglines, because
    most people are idiots. However, Patek Philippe’s tag line is
    complicated and unmemorizable:

    You never actually own a Patek Philippe. You merely


    take care of it for the next generation.

    Which is the kind of tagline a person who wants to be a


    wealthy, complicated, precise man who doesn’t fall for tag
    lines would fall for. The man in the photo is not a
    representation of the target demo; he is the impossible
    aspiration of the target demo. That explains how the kid can be
    in a sweater vest and not trying to murder his family.
    The ad is pairing the legacy of the watch with the other
    imaginary legacy: the heritable family fortune. I don’t know
    what the Dad in that picture does for a living, but you can be
    sure it involves a lot of money and the son will inherit it, along
    with a boat (below) and the means of production (not
    pictured).
    Also not pictured is $15T in debt and war with Iran, which he
    will also inherit, though he’ll only be responsible for the
    former while the bottom 29% will only be responsible for the
    latter. Sorry folks, that’s how it works, take it up with the
    Illuminati. Dad is teaching the son the things a man should
    know, like how to tie bowlines, which Aspirational 14% didn’t
    actually teach their own kids, which, and I hope you are
    appreciating the pattern, is precisely why this ad works. It’s
    not representational, it’s aspirational, i.e. can be done from the
    couch. “If I had a yacht, I would definitely teach my kid
    yachting. Time for a nap.”
    Some Patek Philippe owners do indeed know how to tie
    bowlines but the majority of potential customers are close-but-
    no-cuban to these aspirations, they wish they had enough to
    start a family legacy and get their name on the backs of
    orchestra programs because that would mean that they go to
    orchestras, that they are sophisticated, they have made it. Not
    Hollywood and dotcom made it, which was what they
    dreamed about twenty years ago, but the kind of made it where
    last names matter and “summer” is a verb.
    You can’t buy into class but people will try anyway, so the
    watch gets the nouveaux and nouveauxing rich as close to this
    lifestyle as they will ever get. Not only is it a visible symbol of
    their success but it broadcasts (as per the ad) that they are the
    kind of person that reflectively considers the next generation,
    what they will pass on to them, their legacy. (1)

    “But don’t they already have money to pass on?” It’s not the
    money, but everything else but the money. Ryan Gosling’s
    character in Drive inherited nothing from his dad except a
    Patek Philippe watch, but because it is a Patek Philippe we are
    to understand that it symbolizes the real gifts his Dad left him,
    like masculinity and courage and driving skills. The watch
    symbolizes the intangible legacy gifts that came along with it,
    but in real life there are no intangibles to pass on, so it is being
    used instead of those intangibles. It replaces the intangibles.

    If this is confusing, remember that the watch is for the father.


    The point isn’t to give it to the kid, the point is to convey the
    impression that he is going to give it to the kid. To convey the
    impression that he has other things to leave to the kid as well,
    just like those other high class Americans who pass on
    connections or defense attorneys or the Greek Prime Ministry.
    That’s the kind of man he is.

    It may also help to understand that Patek Philippe is not here


    competing against Rolex or Breguet; it is competing against
    vacations and cars and kitchen renovations. That’s where $10k
    might have gone, so Patek must brand itself as an important
    generational necessity, a marker of European-style class, not a
    frivolous transient American-style expense.

    This is the motivating force of Aspirational 14%: they have


    some money, wish they had a lot more, and want an ethical
    rationalization for their envy: it’s for the kids. Keep telling
    yourself that. Dynasty is the wish-fulfillment of immortality
    through your bloodline. But it’s better than nothing.
    II.

    Then the Great Crash happened. How did the ad campaign


    change to reflect the new economic realities?
    The answer is in the above ads: there’s father and son. What’s
    missing? Mom. Doesn’t she want a watch? Starting in 2009
    she does, so tint the B&W to sepia and let’s see what else
    modern women want.
    Nothing symbolizes the essence of a woman better than
    looking at herself in the mirror. “Something truly precious
    holds its beauty forever.” A tag line even a Wellesley graduate
    can remember.
    Older woman’s left hand conspicuously assures us she’s
    married. The younger woman’s conspicuously hidden in the
    mother’s hand. Mom maintains control of the daughter’s sex.
    In these ads the legacy is quite different: not wealth, or the
    business, or dynasty, but the hopefully enduring commodities
    approved for use by women: beauty, art, joy. It’s mom and
    daughter and love, packaged in refined ostentationism, which
    is defined as subtle quality visible from 1000 yards. Not
    pictured is Dad, because he’s at work or one of those parties in
    Eyes Wide Shut.
    A Financial Times reporter incorrectly interpreted this as an
    expansion of the campaign to target women. This is where my
    training in neurology is helpful: precisely where in the brain
    did the stroke have to occur to cause that kind of deficit in
    logic? Expansion? In 2009? That makes no sense: expensive
    jewelery, like a car, is almost always purchased by or with the
    husband. The wives of the Aspirational 14%, even if they have
    good jobs, do not roll into a jewelry store by themselves and
    buy $10000 watches, unless they are the 0.5% or it is a present
    for their man. Hence, this is an ad for men, not women, which
    is also why this ladies’ ad is prominently featured on the back
    cover of The Economist, the journal of record of Aspirational
    14%, a magazine with 90% male readers. Through the
    triangular magic of Freudian advertising you, the viewer,
    become the Dad, with the aspirational images laid out for you:
    a beautiful and proper wife with culture and delicacy, taking
    care of your perfect daughter, while you’re in the shower
    scrubbing the scent of concubinage off you. So my silly joke
    was wrong: she’s not a Wellesley grad, she’s a Wellesley
    trophy wife. The Wellesley lets you both pretend you married
    her because she was smart.

    III.

    Something else about these ads: men and women never appear
    together.

    Here we see the explicit pairing of same-sex members, never a


    family. They both get a watch but what the son inherits
    (everything) never overlaps with what the daughter inherits (a
    husband). “But that’s how the watch will be passed on.”
    Haven’t you been listening? These are brand ads, not product
    ads, they sell the aspiration, and, if I am reading this right, that
    aspiration is to become European. Not Eurozone European, of
    course, but Hapsburgs and Romanovs European.

    Do these ads appear sexist to you? (2) Shouldn’t some


    “intellectually curious” (the explicit demo of The Economist)
    woman somewhere notice the contrasting aspirational message
    between the men’s ads and the “ladies””— and that word itself
    is a kind of branding— ads? But 40 years after women’s lib,
    this isn’t such a terrible fantasy to women, either. They might
    not want to give up their job as a CT surgeon, but they may
    happily abandon their job as employee of MegaCorp if they
    could afford to. That’s the fantasy, and this high class ad in a
    high class mag is saying high class women not-so-secretly
    want this.
    Why reveal this desire now, in 20XX? Hmm, isn’t it weird
    how just as soon as women entered the workforce it became
    completely impossible for a family to achieve the American
    dream without the woman in the workforce? Turns out that
    part of the drive to get women into the workforce was driven
    by… the workforce owners. Get it? Whenever you don’t
    understand geopolitics just ask yourself where the lowest labor
    costs are, and wait for the headlines to read “human rights
    issues.”
    Of course women should be paid the same and should do
    whatever they want, but the point here is that that is a
    coincident benefit, the other purpose of it is to have a larger
    pool of labor willing to do jobs too good for Mexican illegals
    and not good enough for American men, i.e work in retail. Is it
    really liberating for women to work at Bebe but not be able to
    afford to shop at Bebe? Or is it just stupid, except for Bebe,
    which derives the full value of their employees’ sex for
    $12/hr?
    Here’s an example: there’s a dwindling but vocal segment of
    the female population that thinks that young women in the
    office should not have bare legs, that it is too sexualized. Bare
    legs are okay if you’re a gold-digging whore, but
    “inappropriate” if you want to be taken seriously as a
    professional woman. Simultaneously, however, they believe
    professional office attire should be heels and a tight skirt. “It’s
    called a business suit.” It never occurs to them that the
    requirement of hose/stockings in the office was started way
    back when it was stockings, not bare legs, that was sexualized.
    You can go as far back as a Bob Hope movie where a sailor
    gets his best gal a pair of nylons (swell!) all the way to the
    1986 scenes of Kim Basinger masturbating to a Kodachrome
    art show or stripping to the worst song ever in 9 1/2 Weeks, the
    intense eroticism depicted not by her naked body but by close
    up shots of her stocking covered thighs.

    Once upon a time stockings were so fetishized they put them


    right into movie posters, nowadays the only place you’re
    going to see them is MILF porn or all of Britain. And so the
    prohibition against bare legs has to be rethought— is the
    worry that some 20 year old guy is going to get internet hard if
    he sees his coworker cross her bare legs? Who cares what 20
    year olds think? The non-Lacanian, non-postmodern, super-
    duh conclusion is that the (male) office wanted their women
    all dolled up— the trick, however, was that it convinced
    women to self-enforce this trend, to believe that the stockings
    helped de-sexualize the professional women, gave the power
    back to the women. No one man could pull off that kind of
    mass hypnosis, it has to be programmed into the Matrix. The
    system at one time wanted the office woman to be a
    simulacrum of a woman, all silhouettes and shades and
    posture, the stockings looking more like an idealized pair of
    gams than real gams ever could. Burning the bras wasn’t
    nearly as liberating as getting rid of the pantyhose.
    This is why the return of pantyhose is so revealing; hose
    represents a return to that sublimated female sexuality; to the
    more dangerous implicit, not explicit, masculine control of the
    sex. It isn’t just like the 1960s, it is a retreat to the 1960s.
    “Mr. Davis can’t trust himself around you if you’re naked,”
    says the Human Resources department for a 50 year old
    mustachioed small business owner, “so if you don’t mind we’d
    like you to cover up with this sexy lingerie. Thanks, you’re a
    doll, now he can get some work done. He’s going to need you
    to work late tonight. No, he’ll drive you home after.”

    IV.

    Back to Patek Philippe. That The Economist would want Patek


    Philippe to buy advertising space makes sense, it’s good
    money, it decorates the pages of The Economist, and attracts
    an important demo that will pay the $130 subscription fee (the
    higher price is the magazine equivalent of the Patek Philippe
    Seal). This demo has made The Economist one of the only
    magazines to see a consistent growth in print subscriptions.
    And it’s part owned by the Rothschilds. How do you like that?
    But what is interesting is that Patek Philippe thinks the readers
    of The Economist are a good fit for this campaign. Are they
    insane? Perhaps not. On the one hand The Economist is an
    intelligent magazine that does promote free market, free
    thinking, “liberal” values in a mostly non-partisan way; but if
    you imagine a magazine’s ads as the unconscious fantasies, the
    dreams, of the readers, then the wish fulfillment they depict is
    not riches or bitches but a return to the old feudal order.
    What you are seeing is the slow acceptance among an
    important demo, Aspirational 14%, of rigid class divides. They
    may have some lingering disapproval about income inequality,
    hedge funds and genetic engineering, but it is tired of fighting
    a losing battle and you know what? all men aren’t created
    equal, science keeps saying so and we pay our athletes
    accordingly, why not everybody else? Aspirational 14%
    doesn’t want a monarchy, but they sure as hell don’t want
    democracy, not the American kind, not anymore. I know, I
    know, you’re rolling your eyes, you don’t care what the
    readers of The Economist think or want, but the trouble is that
    as compared to the readers of Wired, Time, or The Atlantic,
    The Economist readers are more likely the ones who are
    shaping the new world order. That’s why the classified ads in
    The Economist are for CEOs and the ones in The New Yorker
    are for mental institutions.

    It is a sleight of hand on the American dream, and it’s been a


    decade in the making, the Great Crash only accelerating it. On
    The Apprentice the big prize is a Rolex and a job with Donald
    Trump, but the person evaluating you for that position are two
    generations of Trumps, take that American meritocracy!
    There’s no illusion you can become a Trump, the best you can
    do is become a wealthy employee of Trump. And you’ll take
    it. But if The Apprentice is indeed a metaphor for this
    European feudalism, then you should observe that the show’s
    original judges were Donald Trump and his business partners
    (=American capitalism); Trump’s kids were a later addition.
    The evolution of the show was towards dynasty, not away
    from it, just as the Patek Philippe ads have moved, after 172
    years in the branding business, towards this:
    —towards this, during a time of social and economic
    upheaval, flattened earths, “student” revolutions in many
    Middle East countries and all out wars in many others;
    towards this, during the time the most important person in
    Europe is a woman; towards this in the pages of higher brow
    magazines for the “intellectually curious.”

    Anyone who thinks the profound changes happening in the


    world now are going to result in greater democracy or equality
    is not reading The Economist as carefully as he should.

    –-

    1. This is also why I think college tuition is likely to remain


    high for another generation. While government loans are
    primarily to blame for the complete disconnect between the
    value of college and the cost of college, parents represent a
    significant part of the demand. Lacking any other inheritance
    to give them, it promises to get them as far as college with
    college prep classes, violin lessons, (unpaid) internships, etc.

    2.
    If you want to know what an aspirational image for a “ladies’”
    luxury watch targeted to actual ladies looks like, i.e. what
    women who will buy this watch want to think of themselves,
    you have to roll back the chronometer to 2003, back when the
    biggest crises facing the world were stem cells and Muslims:

    Forget the watch, why do I suddenly want to buy shoes?


    (Because nothing says “I can be someone new” like new
    shoes.) The campaign was started in 1999 to target 28-35 year
    olds, but how many of those women could actually afford a
    Patek Philippe? Zero, hence the genius of the ad: build brand
    awareness. “We’ll see you at the store when you’re 40 and
    rich,” the ad proposes, though it tacitly admits that a woman
    can’t think more than 24 hours into the future unless it’s to
    imagine becoming a trophy. Wife. NB: these women would be
    40 now and on their second husband/watch.
    Speaking of marriages, note that the single tweak necessary to
    distinguish the American vs. European ad campaign is to hide
    the wedding ring, Inception style, so you aren’t sure.
    In an American ad, if a woman is possibly going to have sex,
    she better not be single. In Europe, she better be.

    See also: If the rich youth can’t get jobs, it means socialism
    has failed.

    –—

    http://twitter.com/thelastpsych
    If You Liked The
    Descendants, You Are A
    Terrible Person
    December 17, 2011

    i’ve seen this movie before


    The Descendants is not the worst movie ever made, but it may
    be the most subversive, and if you think it is one of the best
    you need to rethink your life choices.
    Bring a date. Oh, you don’t have one.

    I.
    The promotional tag line:

    A land baron tries to re-connect with his two daughters


    after his wife suffers a boating accident.

    You’ll observe that the three women are characterized only by


    their connection to him, while he gets an extra identifier— that
    happens to be about his wealth. We’ll come back to this.
    The movie is a pyramid scheme of cliches: you can keep
    heaping them on as long as no one ever asks how it pays off,
    because it can’t. Rich but emotionally distant husband.
    Complicated wife. Family secrets, summed up by the dumb
    stoner toolbox improbably dating Matt’s (Clooney) smart but
    rebellious daughter:
    That may not read like an insightful exchange between men,
    but I’ll translate: men are never much worthy of their women.
    Cue crying, laughing, yelling— no sing-a-longs, this isn’t a
    chick flick so male emotional progress will be symbolized
    instead by either jujitsu (wrong genre) or by forward physical
    motion: driving, walking, running, travel, now we’re getting
    somewhere— lots of blaming, reconciliation, “resolving of
    inner conflicts” and of course Act IV “closure.”
    Love is complicated, death is complicated, and a movie about
    both would be, well, complicated, especially when you throw
    in infidelity. But despite what you will hear and read from
    critics, The Descendants is neither complicated nor about any
    of those things.
    Here’s your first hint: it’s called The Descendants.

    II.
    just saying

    I am not an expert on what makes a good or a bad movie, if


    it’s bad you’ll ignore it and anyway, best case scenario, two
    minutes after it wins Best Picture it will go the way of Cold
    Mountain. The real power of movies that do not involve giant
    robots is not what they tell you about yourself, but that they
    tell you how to think about yourself. You don’t think you
    learned that from your parents, do you?
    This is the “Personal Quote” on director Alexander Payne’s
    IMDb page:

    It’s my hope that we’re getting into an era where the


    value of a film is based on its proximity to real life rather
    than its distance from it.

    By “proximity to real life” does he mean “was playing 20


    minutes away form my real life” because the only
    commonality between the film and my life is that they are both
    shot in color. So whose real life is this proximate to and how
    do they think about themselves? Let’s listen.

    III.

    Here’s what happened about 15 minutes into the movie. I’m


    sitting three or four rows in front of two 50ish women. In a
    key emotional scene teen daughter Alexandra blubbers
    through her mixed up adolescent tears that dying mom wasn’t
    happy and was cheating on him. He is floored, devastated—
    he had no idea. So he literally runs down the street to a couple
    that was friends with his wife, and they reluctantly admit that
    it is true— and that she was planning on divorcing him. At this
    moment one of the women seated behind me says, loudly, as if
    making an important discovery about human nature and I
    swear I am not making this up, “A divorce! And all that
    money!”
    Son of a bitch, am I an idiot. That thought never occurred to
    me. It’s legitimate, it would be a huge part of divorcing
    characters’ reality, and I missed it because, dumb stupid me, I
    was thinking this was about love and infidelity. But of course
    it isn’t. At all. On second viewing (thanks Sweden) it’s
    obvious. There is no love depicted anywhere in this film and
    its target demo knew not to expect it, not to look for it. Yes it’s
    about family and sadness and betrayal but love? Middle aged
    people don’t love, duh, love is for 20 year olds. Besides, what
    does that demographic know about love anyway, where would
    they have learned it? The rom-coms all ended right when the
    relationship begins. There’s no consistent model for love ten
    years after marriage, except ones based on: infidelity, divorce,
    death, finances. Which is exactly why the first two happen so
    often in response to the second two.
    The few happy movies about mid-life “love” are not about
    established marriages (those are always sitcoms) but about
    new relationships, starting over, new beginnings, play-acting
    the story lines of their twenties but with a “mature” take, i.e.
    some middle aged mother of two looks in a mirror before her
    first big date in years and laments how old she is now and how
    ugly she’s gotten, as played by Nicole Kidman or Jennifer
    Aniston. Wow, nailed it, I can completely relate. I’m not
    knocking these movies for existing or for casting these hairless
    nymphomaniacs, I’m simply posing the general question:
    since the audience has learned nothing from their own parents,
    and they don’t read 19th century Russian literature, what is
    their model for love in the 2nd decade of marriage? They don’t
    have one. Which is why when this demo finds themselves in
    the 2nd decade of marriage they feel unfulfilled, anxious,
    depressed, is this all there is? They have nothing to guide them
    except The Discovery Channel and mommy blogs, and they
    lack the courage to analyze their ennui, so these movies serve
    the important function of pretending that it’s normal. “Oh,
    yeah, that’s exactly what I’m feeling.” Fine, but don’t you also
    want to know why you feel that way?
    There are, of course, plenty of people with normal marriages
    who still love each other despite the absence of windfall
    inheritances and relentless drama. But they won’t be seeing
    this movie.
    Normal love between two normal people that is not
    clandestine or inappropriate or impossible or financial is not
    revealed here, it is not even imagined here. The couple with
    the “best” marriage— and no whites in this movie have a good
    marriage— are the wife’s elderly parents, but don’t worry, no
    love there either: mom has severe dementia, so dad is her
    caretaker. That may sound like love but that odd backstory
    means that no male in this movie is ever depicted dialoguing
    meaningfully with a female of his age group, unless they are
    arguing. And no one notices this weird feature of the movie’s
    world because that’s the world the audience lives in as well.
    And what does this grieving but wise old former soldier say to
    Clooney about his daughter’s infidelity and death? “If only
    you had let her go on those shopping sprees women like,
    maybe she wouldn’t have needed to get her thrills elsewhere.”
    I wish I made that up. Life is priceless, but for everything else,
    there’s Mastercard.
    These depictions of mid-life’s relentless pragmatism, isolation,
    and lack of anything— what word can I use that doesn’t bring
    out the psychotics?— “abstract,” dressed up in porno-level
    dramatics to mask the banality of it all are no more realistic
    than a fat guy’s second chance with the girl that got away
    (Charlize Theron), and yet they resonate with a certain
    audience because that’s where they live, too.
    In fact, the only psychologically realistic thing in this movie,
    and not coincidentally it will be the one thing the audience will
    say is the least realistic thing— is that the older generation is
    so emotionally infantile that their children become parentified.
    Example: Clooney passive-aggressively calls his wife’s lover
    and leaves a message pretending to be a client, and when the
    guy calls back Clooney’s paralyzed; so his daughter takes the
    phone (NB: a Blackberry) out of his impotent paw and runs
    the con. Manipulating middle aged men for middle aged men.
    Just the right role for a 16 year old girl. It’ll be easy to tell her
    drinking is bad now. NB: the girl’s mother is dying in the same
    room, but it’s the father that needs all the attention. She has to
    be strong for him. “Save me Anna Freud, save me!” In fact,
    according to the movie, here is how teen girls cope with the
    loss of their mother: they get over it. It takes about 15 minutes.
    It’s supposedly judgmental to say that Matt is a bad father,
    you’re supposed to say, “he’s doing the best he can,” which
    means that it’s okay he’s a terrible role model because by golly
    he gets points for admonishing the kids not to curse. “Watch
    your language,” he says a lot. HA! That’s the movie’s comic
    relief but it’s also some BF Skinner 10th dan ninjitsu. Control
    of expression— language, behavior, appearance— substitutes
    for parenting, it’s not for the kid but for the parent, it makes
    the parent think of themselves as a parent because the outside
    looks all presentable, and then they are just so surprised that
    their micro-parenting didn’t prevent their ADHD teen from
    turning to alcohol. “It’s a disease.” I’ll get my stethoscope.
    “Who are you to blame me my teen’s behavior?” I don’t even
    know you or your teen. YOU ARE PROJECTING. All I’m
    saying is if your teen is an alcoholic AND you think The
    Descendants is a meaningful film, then you need to bring to
    your therapist of ten years the possibility that the two may be
    the same force and that the problem isn’t your teen, or your
    exes. They weren’t Matt’s, after all.

    IV.
    Voice overs are supposed to be an example of bad or lazy
    writing, but I have a theory: when a movie has a voice over, it
    means the character is being dishonest. Not “it wasn’t me who
    stole the cookies” dishonest, but “it’s not as simple as it looks,
    you don’t know the whole story, let me explain” dishonest. In
    other words: BS. This can be consciously manipulative (The
    Usual Suspects) or unconsciously rationalizing (Sex And The
    City). The voice over pulls you into the mind of the character
    and so you are less able to make an objective assessment about
    what you see. What’s important about it is that the story would
    be impossible to tell without the VO because no one would
    buy it. I can see why director Alex Payne needed it for this
    one.
    Here’s a bit of human nature for you and you are most
    certainly not going to like it. Fat George Clooney discovers his
    wife has been cheating on him— and he never suspected.
    That’s a profound insult, a narcissistic injury, and no, people
    who complain I talk about it too much but haven’t actually
    learned the lessons, you don’t have to be a narcissist to
    experience a narcissistic injury, it’s built into the way we relate
    to other people. It’s jealousy AND an existential beat down:
    look at the limits of your power, look at the limits of your
    reach, she is able to have a whole other existence that had so
    little to do with you you didn’t even notice, nor did she feel
    any need to tell you. At least if she had done it to hurt you
    you’d still suffer the jealousy but your place as main character
    in your own movie would be secure. Maybe you’re only
    supporting cast in hers? “Screw that. I’m changing the script.”
    Three ways humans deal with narcissistic injuries, count them:
    1. Rage. But Fat George Clooney doesn’t look like he’s up for
    the physical exertion of attacking his wife, which is why he is
    depicted as fat and not fit (viz Sleeping With The Enemy,
    Unfaithful, The Last Seduction, To Die For, etc) and anyway
    the target is in a coma. 2. Displaced rage: go after yourself
    (suicide: guarantees the Other remembers you forever) or the
    lover. But if Fat George Clooney is too winded to beat up a
    coma patient, how’s he going to fight the Alpha Penis that
    stole his wife? Pass. What he might do— which is both highly
    realistic about the target demo and also the problem with the
    target demo— is channel his inner 15 year old girl and stalk
    him, then kinda-sorta confront him, then mess up his stuff.
    That’ll show him.
    The third way is the interesting one, the one that ruins you: 3.
    Make the cheating be about yourself, your “fault” (minus
    any real introspection.) Increase your pain to save your ego.
    That’s the path the movie chooses: she cheated not because
    she fell in love, or lust, but because he neglected her, he was a
    bad husband, he didn’t take her on shopping sprees. “As long
    as you don’t ask me to change, I’m accepting some blame for
    her cheating on me.” You’ll feel right as rain.
    The movie takes this a diabolical step further. Matt finds and
    confronts the lover, but in an act of “selflessness” tells the guy
    he’s not there to cause trouble, he just wants to give the guy
    the opportunity to say goodbye to her, too. WOW! What a
    guy! And no one thinks this is preposterous. The audience sees
    this as a redemptive act, a kind act, a noble act, and that’s
    because they are all idiots. No, no, I mean every single one of
    them. They are (thanks, VO) starting from a false premise: that
    he actually really loved his wife in the first place. He didn’t.
    That’s why she was cheating. To illustrate just how
    inconceivable “love” is to this audience, I’ll explain that this
    selfless offer is how the scene starts, but the point of the scene,
    how it ends, is with Clooney realizing that the guy bedded her
    for his money. So not only did she cheat because of him, the
    lover chose her because of him. Narcissistic injury averted—
    that’s what passes as “coming to terms with” infidelity for this
    audience.
    While the 50 year old women behind me and every critic in
    America are applauding his apparent selflessness, they
    overlook the fact that while he wasn’t angry when he
    confronted the lover, he became angry when he discovered the
    true target was his finances. That’s what gets him fuming, and
    that’s what makes sense to the audience. Penis and vagina are
    all very well, but if you mess with the inheritance, it’s
    personal.
    Also observe that the lover is not better looking than Matt, not
    richer than him, not more interesting than him, in every way
    Clooney is “better” than him. This is a movie so it was
    scripted this way, but when your wife cheats on you you’ll do
    the same thing, so remember what I’m about to tell you. You
    will “discover” how much better you are than him in every
    way so that her cheating is explicable only as a reaction to you.
    You will cry, you will drink, you will yell and you will rage,
    but you won’t kill yourself and you won’t change and that was
    the whole point. The ego doesn’t want happiness, it wants
    status quo. Yes, you will also simultaneously disparage her as
    a bitchless cunt, but that’s because she did it to you, against
    you, towards you. This will help you eventually “come to
    terms with” her infidelity, but what then did you learn about
    yourself? What then will you change about yourself? Nothing.
    Hence the sequel will be the same as the first movie, with a
    different villain.

    V.

    “This is the first movie review I’ve ever read that attacks not
    the movie but the people who liked the movie.” I’m not
    attacking you you if you liked it, only if you identified with it.
    “That’s not really fair.” American Psycho was an amazing
    movie, but I wouldn’t date anyone who identifies with it. How
    is it different? Again, the point isn’t that movies tell you who
    you are, they tell you how to be.
    Here’s an example: with 100% certainty I can predict that if
    you liked The Descendants, if you think you would like The
    Descendants, then you thought American Beauty was
    “amazing.” That movie was, indeed, an outstanding reflection
    of a kind of a man and a kind of a life, but at some point
    before your divorce or rehab you have to consider that if you
    identified with the main character there is something wrong
    with you.

    Anyone exhausted? Here’s a comedy break (NSFW):

    Louis CK:

    Kevin Spacey playing the man… he’s fantasizing about


    fucking a cheerleader in high school. And the way they
    represent this, in this gay movie, this fucking bunch of
    cum through a projector— according to this movie, when
    you fantasize about a cheerleader, you lie on your back
    and rose petals fall all over your body. Instead of her hot,
    sweaty ass, and the confused look on her face as you cum
    in her stupid eye… No, it’s Kevin Spacey with a sweet
    look on his face, and flower petals, and jazzy music.
    [And at the end of the movie, the ex-marine] is the one
    who’s really gay. ‘None of us are gay, it’s actually the one
    hetero guy, he’s the gay one.’ No one else is gay, Kevin
    Spacey’s not gay. He’s straight as an arrow, he lifts
    weights, listens to Zeppelin, drives a Firebird— and
    thinks about fucking rose petals. And then when he
    actually sees her tits he almost vomits….He finally sees
    the 18 year old tits and says, what have I been doing all
    this time? I forgot I like men….

    Louis CK takes the gay angle for the comedic effect, but he
    understands this isn’t about being gay but about a kind of
    American self-delusion exemplified by the Kevin Spacey
    character: everyone else is broken except me. My only problem
    is I am surrounded by these people. And everything gets
    projected onto them as both defense of the ego and as
    confirmation that it is, indeed, everyone else who is nuts.
    “Look, she’s a crazy bitch.” When he throws the plate of food
    against the wall you’re supposed to cheer his rising manliness;
    you’re not supposed to notice that it’s infantile narcissistic
    rage, i.e. foreshadowing: this isn’t going to have a happy
    ending. The problem for the audience is that there isn’t an
    American Beauty II, the one where he gets the rose petal girl
    of his dreams and inherits a billion dollars and has a perfect
    life in Hawaii only to discover that within 5 years everything
    has regressed to the mean, I mean mean, and everything
    happens all over again. “Jeez, why do I attract these crazy
    bitches?” Because you’re crazy, dummy. The one universal
    constant in all of your failed relationships is you.
    At the end of The Descendants Clooney and his daughters
    have “overcome” or “moved on” or “come to terms with” it
    all. But in fact nothing has changed. And what has at-the-end-
    applaud-worthy-Dad taught his kids about human
    relationships? What kind of a man do you think Alexandra is
    going to eventually marry? How soon afterwards will she
    divorce?
    Remember Clooney was going to forgo revenge and instead
    generously let the lover say goodbye? Well, at the end he gets
    his revenge anyway, in the only way meaningful to the
    audience: he screws the lover out of money.
    Think about this. You’d do it, too, if the opportunity presented
    itself, but that’s not the point. The point is that this is a movie
    and hence not random, the movie chose this method of
    revenge. It is satisfying to the audience, but the kind of person
    to whom it makes sense to punish a wife’s lover financially is
    the kind of person… whose wife has a lover. He will have
    revealed to his wife in countless other ways the transactional
    value of her sex, and while it may be a lot it’s still finite, and
    so she will get the message and eventually Trade Up to an
    equivalent model that costs her more. Indecent Proposal had
    the decency to put love over money at the end, but that didn’t
    stop a gazillion women from shamelessly/proudly announcing
    how fast they’d “totally go for it”, as their whipped boyfriends
    sat on the bar stool next to them hiding behind a frozen smiles
    and pints of Sam Adams. “It’s a Winter Brew.” Choke on it,
    cuckold. Meanwhile none of the giggling women in the bar
    seemed to remember that Robert Redford was offering the
    money for the wife to the husband. The trick to understanding
    that movie is that it isn’t a female fantasy to have a rich guy
    offer you lots of money but a male fantasy to have a rich guy
    value your woman’s sex at $1.57M inflation adjusted dollars,
    it makes the mystery of sex/”objet petit a” a concrete and
    understandable commodity but also puts it fantastically out of
    your own reach, like you’re 12.

    The reason no one remembers that Redford made the deal with
    Woody and not Demi is that it is unremarkable to these people
    that that’s who he would make the deal with, nothing unusual
    or noteworthy there, Woody is the proper owner of Demi’s
    sex. Yeah, they’re married, that’s how it works. I can see
    you’re upset. I know, reality bites. Take a drink, and consider
    that in The Descendants Matt’s relatives are all waiting for
    him to sell the land so they can get their cut, and Matt’s
    hesitant, and then says something the dummies in the audience
    didn’t appreciate, and what he says is this:
    Way to figure this all out way too late and about the wrong
    thing. The land is supposed to be a metaphor for legacy, for
    doing the right thing with your inheritance, but I hope it is
    obvious that the land is a metaphor for vagina. You may have
    got it for whatever bullshit reason 150 years ago, but now as
    the owner of that landgina you have a responsibility to tend to
    it. So yes, it makes sense that the rival thought of it as a means
    to money, it makes sense that the Medicare patient’s first
    thought was to alimony, and it makes sense Woody was
    willing to sell Demi, it makes sense Matt is more attentive to
    his finances then his wife, because if you don’t tend to that
    vagina, to that soul, then all that’s left is it’s resale value. And
    it all makes sense to the audience, because they’re
    psychopaths. Is that too harsh? Didn’t they get choked up
    when she dies? The Descendants has a sad ending, and it
    makes you sad. That’s not the sign of a well crafted movie, it’s
    a kind of porno. That’s why they’re called tear jerkers. If you
    bludgeon a puppy or penetrate a vagina you do not then get to
    yell, “Ha! Made you look!”

    I will concede, however, that the ending of The Descendants


    couldn’t be a more accurate representation of the generation
    that is only able to feel rage, sadness, anxiety, and nothing.
    The last scene of the movie, symbolizing how one moves on
    from death and infidelity, shows Matt and his daughters,
    inheritance intact, watching TV. Roll credits. Oscar.

    –—

    see also: The Strange Ascendance of The Descendants

    http://twitter.com/thelastpsych
    Short Film: Bad At Math
    December 19, 2011

    I wrote a short story called Bad At Math, about me vs. gun vs.
    Xanax, and Henrique Cartaxo asked if he could use the idea
    for a short film.

    Some differences: my bad guy was taller, the room was


    smaller, and my drink was WAY bigger.
    Also, a follow up.
    The Fundamental Error Of
    Parenting: What’s The
    Difference Between a Tiger
    Mom and A Wolf Dad?
    December 29, 2011

    apparently, the secret to success is single parents


    From NPR:

    Tiger Mom Amy Chua… became an overnight sensation


    in the U.S. this year when she wrote about her tough
    parenting style. But she looks like a pussy cat next to her
    mainland Chinese equivalent, “Wolf Dad” Xiao Baiyou.

    “Wolf Dad” wrote a book called Beat Them Into Peking


    University.
    Xiao, 47, describes himself as the emperor of his family.
    As such, he’s laid down an extraordinary system of rules
    for his children.
    “I have more than a thousand rules: specific detailed rules
    about how to hold your chopsticks and your bowl, how to
    pick up food, how to hold a cup, how to sleep, how to
    cover yourself with a quilt,” Xiao says. “If you don’t
    follow the rules, then I must beat you.”

    The last parenting book I read was The Road. I’m not sure that
    counts. I only got a quarter through it, but its principle advice
    appears to be to take all of your instincts and the collected
    wisdom of every movie ever made and do the exact opposite.
    This is terrible advice.

    For my money: this Xiao Baiyou is a nut. But whether this guy
    is a nut or not is not as important to you as what the media
    constructicons want you to think he is.

    I.

    What you noticed first about this story is that he beats his kids
    and they go to Peking University. You did this because you
    assumed the story was a news story and were looking for
    information, and not a media construction showing you a
    facade. What does the journalist want to be true?

    Instead, what you should have noticed first, right off the bat, is
    that the story explicitly juxtaposes this man with Amy Chua.
    That’s the fulcrum of the story, it tells you what your frame of
    reference is supposed to be. The point is NOT that he beat his
    kids into Peking University, the point is for you to compare
    him to Amy Chua and no one else.

    Amy Chua was called a terrible mom for being hard on her
    kids, but if she had been a dad the state would have sent in the
    police and Battle Hymn Of The Tiger Dad would not exist. It
    doesn’t exist, which is my point. She was able to publish
    because her audience— e.g. the readers of the WSJ where she
    first and exclusively published an excerpt of her book— like
    to hear the words “college” and “success” and “how”, but to
    soften it from mean parenting to tough parenting you have to
    make it all come from a woman, especially a non-American
    one. Rule #1 of stupid people trying to make sense of the
    world: the culture you know nothing about has all the answers.

    Then to reinforce Amy Chua’s methods as the gold standard


    for all the other demos who previously hated her, an
    alternative standard that goes too far must be created to appall
    everyone into agreement. One year after Chua went platinum,
    here it is. “Well bless my heart, beatings?! I know I don’t like
    that method of Chinese parenting! And Amy’s daughters are
    all so poised and pretty, not like those porphyria drones he has
    solving Hamiltonians in the basement.”

    Note the four key differences in the story:

    1. He’s physically abusive, so the audience understands him to


    be hatable.
    2. Not American, but Chinese, in China. China = uncivilized.
    Hatable.
    3. His story appears on NPR, Slate, mommy blogs, not on the
    WSJ. This is not an audience weighing the merits of a
    yardstick to the knuckles, they prefer passive techniques like
    evolutionary psychology and chemical coercion. Man acting
    like a man, father like a father? Hatable.
    4. Amy Chua is a Harvard law professor, while Xiao Baiyou is
    a real estate mogul. Hatable.

    With this information, the reader is now invited to choose


    which of the two images represents an American success
    story:

    a.
    b.

    II.

    Question: what kind of a person reads parenting books? I’m


    not being critical, I’m asking. Do the readers feel they are
    failing and need some advice? Or are they just looking to hate
    someone and are willing to pay $23.95 for the ammunition? I
    can see that someone might see the book and say, “hmm, I’d
    like my child to get into Peking University, let’s see what he
    has to say,” but that thinking betrays a cognitive error that both
    makes these books useless to you and is the reason you need
    such books: you don’t think there’s anything wrong with your
    parenting, you think you just need some helpful tricks.

    Hence the popular parenting books/blogs aren’t for special


    populations like Raising The Autistic Child or My Kid Saw A
    Gorgon, What Now? These are ordinary kids being raised by
    parents who are worried about what shows are appropriate for
    kids, but not about the commercials. “What? He’s 7. It’s not
    like he’s actually going to go buy an Acura.” You’ve failed.

    “Good” parenting, apparently, is trying techniques on your kid


    that were never used on you, even though you still turned out
    just fine. “I think TV is bad, I won’t let my kids watch it.”
    Outstanding. But how do you explain how you watched 5
    hours of TV a day for thirteen years straight and still turned
    out ok? Think it over for a moment. You’ll never admit the
    answer: because you’re different. You succeeded despite the
    TV.

    But look around: everyone you know over 30 also did fine
    despite the TV, no lawyer ever says, “Your Honor, my client
    saw every episode of Bosom Buddies and McHale’s Navy, I
    move for dismissal.” Which is why I am telling you: TV is bad
    for the kid, but that thinking is much worse.

    So too: sugary cereals, bullying, Playboys. None of those


    things are good for kids, I am not saying to expose your kids
    to them. But thinking that they will be worse for your kids
    than they were for you is the fundamental, narcissistic error of
    parenting. “My kids are weaker than me.” Then humanity is
    doomed.

    I know many white doctors who have their kids in Mandarin


    classes. Did that help them become doctors? “I want them to
    be able to compete.” With whom? Mandarins? Seriously, what
    world do you envision in which Mandarin is the deciding
    talent, except working in Mandaria? Which is great if that’s
    what they want to do, great if the kid is interested, but
    otherwise is this really how you’re plotting excellence? “It
    also teaches you to think logically.” So does actual logic. “It
    looks good on a college application.” Everyone hates you.

    Part 2 here.

    My Amy Chua post

    http://twitter.com/thelastpsych
    Wolf Dad, Tiger Mom, And
    Why Trying To Be A Good
    Parent Is A Bad Idea
    December 31, 2011

    best mom ever

    Part 1 here

    The people who read books like Chuas hoping to learn


    something start from a wrong motivation: they aren’t looking
    to raise better kids, they are looking to be better parents. If you
    don’t see how those are different, your kids do.

    By example: the NYT’s “Motherlode” section has a year-end


    summary, 2011: Stories That Changed The Way We Parent.
    Sounds important. Let’s see how many are for the
    advancement of children versus the pretense of parenting:

    Amy Chua
    Jerry Sandusky
    Gender-Neutral Parenting
    HPV Vaccines For Boys
    The Digital Classroom
    The actual sacrifice of parenting, the one that happens anyway
    but is resisted bitterly to the dismay of all, I’ve only really
    seen described once. I hate quoting famous thinkers explicitly
    because it puts a distance between the reader and the ideas, it
    makes them less personal, but sometimes it can’t be helped:

    Did you see that wonderful melodrama, Stella Dallas


    with Barbara Stanwyck? She has a daughter who wants to
    marry into the upper class, but she is an embarrassment to
    her daughter. So, the mother - on purpose - played an
    extremely vulgar, promiscuous mother in front of her
    daughter’s lover, so that the daughter could drop her,
    without guilt. The daughter could be furious with her and
    marry the rich guy. That’s a more difficult sacrifice. It’s
    not “I will make a big sacrifice and remain deep in their
    heart.” No, in making the sacrifice, you risk your
    reputation itself. Is this an extreme case? No, I think
    every good parent should do this.

    The true temptation of education is how to raise your


    child by sacrificing your reputation. It’s not my son who
    should admire me as a role model and so on. I’m not
    saying you should, to be vulgar, masturbate in front of
    your son in order to appear as an idiot. But, to avoid this
    trap - the typical pedagogical trap, which is, apparently
    you want to help your son, but the real goal is to remain
    the ideal figure for your son - you must sacrifice that.

    II.

    The book title says he beat his kids into Peking U, but actually
    he did something else:
    “From 3 to 12, kids are mainly animals,” he says. “Their
    humanity and social nature still aren’t complete. So you
    have to use Pavlovian methods to educate them.”

    This is where all the enlightened humanists in the audience are


    supposed to freak-out. Kids aren’t animals, individuality is
    important, blah blah, but what’s important is the word
    Pavlovian: his violence is not random, it is not surprising.

    I could be wrong, but it appears from these articles that Xiao


    doesn’t beat his kids into Peking U out of anger, but out of a
    system. Not saying corporal punishment is the way to go, but I
    am 100% positive it isn’t the beating itself that molded the
    kids, but the very clear rules and consequences, which requires
    an awesome level of energy, vigilance, and self-control on the
    parent’s part, which is why most people who beat their kids
    only get high school dropouts. Parenting requires consistency.
    Protip: this is even more important for The Autistic Child.

    This is very similar to the mechanism of (preventing) PTSD:


    you can be the drunkest parent imaginable, and the kid will
    make it as long as your terribleness is a known quantity, your
    immensely violent behavior predictable, and the kid has some
    control over the consequences, e.g. if he does X he’ll get his
    hand put in a microwave, but if he doesn’t do X he won’t. As
    long as the kid can make sense of the story of his life, if he
    understands its narrative structure— even if it is made up (Life
    Is Beautiful)— he can make it.

    Remember the judge who beat his teen daughter? What made
    the beating worse is that
    it made no sense. The amount of beating had no relationship to
    her behavior, it was entirely dependent on how he was feeling
    that day, not what she did. As a judge he had sentencing
    guidelines for different crimes; as a father he freelanced, and
    terribly. That’s what made it particularly damaging. This is the
    phrase that accompanies all abusive relationships: “I never
    know what kind of mood he’ll be in.” The beatings come from
    rage, which makes them sound like hate. Xiao beat his kids
    more than the judge did, but you don’t get the feeling that
    Xiao hates his kids.

    III.

    Wolf Dad is Chinese, actual Chinese, and his main audience is


    other Chinese. Well, sort of.

    The fact that he attributes, publicly, his children’s success to


    his method suggests that he is not behaving like a Chinese
    Dad, but a Westernized Dad. Real Chinese dads may tell you
    that they beat their kids, but they do not go around bragging
    about their childrens’ successes, let alone as a consequence of
    their awesome parenting. Hence, this is for a very specific
    Chinese audience, i.e. ones interested in taking credit for their
    kids’ successes, i.e. westernized. Xiao may not let his kids
    watch TV and Youtube, but I will bet every cent I have his
    readers do.

    Xiao’s oldest child, 22-year-old Xiao Yao, has his doubts


    about his father’s methods. “Though Dad likes using
    traditional educational methods, he may not fully
    understand the exact forms and he chose his own way…

    Not just apply the traditional methods— understand the


    methods. Even though he is full-on Chinese, these aren’t his
    methods, he is pretending at them, adopting them. In America,
    kids of immigrant parents get caught in this fatal loop, too.
    They partially speak their parents’ language, have a fair grasp
    of the traditions but spent most of their American lives trying
    to be American. But when they grow up and have their own
    kids, they try to make their kids more like their parents— they
    put them in language classes, they try to saturate them in their
    heritage, but it’s fake and it doesn’t stick. How can you expect
    to make your kid more Chinese than you are? We’re back to
    the fundamental error: why, if the parent got through life
    without much of the old ways, do they think their kids
    desperately need what they didn’t? And the answer surfaces:
    it’s not for the kids, it’s for them. You can make up for the fact
    you know little of your heritage by having your kid do all the
    work of adopting it.

    The delicate line I’m walking is that teaching them traditions


    is in itself positive; but they are utter wastes of time when it is
    for the parent. Amy Chua’s kids are being raised “Chinese,”
    but really they’re being raised Jewish— which is also a
    pretense, they’re being raised American. I’m sure they like
    “authentic” Chinese food from restaurants and know how to
    spell Hannukah, but the way they think is American. The way
    she thinks is American. All I need to know is that she
    identifies Chinese and married a white guy to know that one of
    her daughters is going to be named Emily or Sophia. Note: not
    Chinese names, but predictably the names affluent
    Americanized Asians give their kids. She is oblivious to those
    forces, yet those are in fact what control her.

    I’m not at all criticizing her, Sophia is a beautiful name no


    matter how common, but when you look at the forces that
    make “you” you, all of the manufacturing and alchemy you try
    are weaker than reality. And, if that reality includes a
    substantial dose of American media, you don’t stand a chance.

    Americans fear the rise of the China, but that China that you
    see risen was made by Chinese over 50. Their kids, confused
    by conflicting cultures pictured on the internet versus outside
    the window are in no position to “take it from here, Dad, we
    got this.” Those kids who are growing up with money, the
    young college grads and urbanites who are in possession of the
    few, but nonetheless inflated employment positions are going
    to be frustrated when they try to balance their own desire for
    wealth branding with the minimal opportunities for
    advancement. America may have been destroyed by its 50
    year olds, but it will be resurrected by its 20 year olds. China
    has the exact opposite demographic problem. China appears to
    be one generation behind the U.S. in terms of personality
    disorders, and if the rise of psychiatry over there is any
    indicator, i.e. the single best indicator ever, boy oh boy are
    they in for it in 2025.
    That’s Wolf Dad. His beatings are trivial in comparison to the
    other, now unrepeatable factors he had going for him and his
    kids: real estate rich; private tutors and lessons; an expensive
    “international” high school that was taught in English. That’s
    not Chinese parenting, that’s WSJ America parenting.

    If he or anyone else want to brand themselves as a “parent,”


    that’s their business, I guess, though the Chinese media is now
    attacking Xiao for finding a loophole in the Chinese system:
    because his kids were born in the U.S., they get to take an
    easier entrance exam to Peking U.

    But that is the least of China’s problems: the real problem for
    China is that they’ll probably go back.

    –
    http://twitter.com/thelastpsych

    See also: Why Parents Hate Parenting


    Penelope Trunk, Abuser
    January 2, 2012

    I am accustoming myself to the idea of regarding every sexual


    act as a process in which four persons are involved. We shall
    have a lot to discuss about that
    Catchy title, no? I put it there for the stupid people. If you
    think I support domestic abuse— if you think my not
    explicitly writing, ad nauseum, “NO TOLERANCE” or “IT’S
    NOT THE VICTIM’S FAULT” is evidence that I think that
    “sometimes the bitch deserves it,” then I can tell you without
    error that 2012 is going to be way too complicated a year for
    you to endure, and you are seeing a psychiatrist, and it isn’t
    helping. Stop being you. The world does not have to validate
    your prejudices. Take a minute, you may learn from people
    you disagree with.

    I tried my best to read through the comments on Trunk’s blog


    relating to her domestic abuse post, written by people who
    don’t keep diaries about their own abuse history. “YOU NEED
    TO LEAVE!!!!!” Assuming you had a similar experience, how
    long did it take you to leave that earns you the right to a caps
    lock?

    But the title is deadly correct, DEADLY— see, I earned the


    right to a caps lock. Here’s why, and I expect almost no one to
    agree with it but hear it once in your life anyway, maybe you
    make a left instead of a right or you take two more seconds at
    the light.

    II.
    Penelope Trunk is a blogger/entrepreneur who is notorious for
    being “too much information” honest about her life. She
    recently posted about (yet another) fight with her husband, and
    posted the pic you see above.
    I’m pretty sure she doesn’t want my advice, but in the spirit of
    putting herself out there, I hope she won’t mind my using her
    story to explain something that may help other people. And if I
    end up being wrong about her specifically, or if it turns out she
    made the whole thing up, it won’t have any effect on the
    message.

    The adage in psychiatry is you can’t make a diagnosis without


    evaluating someone. That’s fine, except that personality
    disorders aren’t diagnoses, they are descriptions of behaviors.
    So stand down.
    Penelope Trunk has a history of sexual abuse by her father.
    She has a pattern of intense, unstable relationships; a history of
    self-cutting, bulimia; is emotionally labile and reactive; and
    her primary defense mechanism is pretty obviously splitting,
    i.e. things are all good or they are all bad.

    Trunk says she has Asperger’s, and maybe she does, but what
    I’ve described is “borderline personality disorder.” BPD is not
    a description of behavior exactly, it is a description of an
    adaptive coping strategy. In other words, people persist with
    BPD because it works.

    “Works” has a limited definition for borderline: prevention of


    abandonment. Narcissism protects the identity at the expense
    of everything else, Borderline will do whatever it takes to
    avoid abandonment, including giving up one’s identity.
    Abandonment isn’t loneliness or isolation, a person can run
    away to the woods for a year if it preserves the connection to
    the other person, even in a terrible way: “I’m hiding out
    because he’s out there looking for me to kill me.”

    The currency of borderline is affect. Energy. The analogy is


    the kid who doesn’t get enough attention, so acts out: he
    would rather have hugs and kisses, but he’ll settle for the same
    amount of affect in any other form of attention, including
    anger and yelling. Negative affect has long term consequences,
    duh, but short term no affect is completely intolerable.
    Observe (start at 25s):

    The temptation is to view the baby as upset, but in fact what


    he is doing is trying anything to get her attention, including
    screaming. This is why what he is is frustrated, and why it is
    called acting out.

    That plays out into adulthood. Knock down fights and great
    make up sex is psychologically more fulfilling than a normal,
    calm, low-affect marriage. Mind numbing jealousy is
    preferable to being 100% sure of their fidelity, to the point that
    the brain becomes paranoid to keep things interesting. “Are
    you just looking for things to be upset about?” The answer is
    yes. You think Megan Fox’s character in the Rihanna video is
    ever going to settle down with someone who doesn’t wear a
    tank top to facilitate punching?

    Why are borderlines attracted to broken men? To alcoholics?


    To rageful narcissists? Affect. “I never know what mood he’ll
    be in.” The range, the energy means you are connected. No
    abandonment is conceivable if the guy is beating you. “But he
    cheats on her as well!” He’ll be back. Right?

    This is set up in childhood 100% of the time. The kid learns


    what works, learns what gets him the affect he needs. If the
    parents are loving all the time not much “work” is necessary.
    But if Dad is distant, or interested in chasing skirts (such
    daughters grow up trying to look like the kind of girl Dad is
    attracted to), or mom’s always drunk, then “work” happens,
    and the kid starts to try new ways of getting the affect, and
    unfortunately the easiest way to get sucky parents to give you
    affect is to enrage them. That works awesomely. The best is
    when the parent beats you mercilessly, and then does a 180
    and apologizes profusely, hugs you, buys you gifts, “oh, baby,
    I am so sorry I did that, Daddy was just upset…” Nothing in
    life will ever match up to that, except maybe a boyfriend who
    does that. If you are doing that to your daughter, for god’s sake
    join an infantry battalion or become a test pilot.
    Remember: the goal of this strategy is not happiness, it is
    avoiding abandonment. Hence a blog.
    The thing is, BPD “works” when you are young, there are
    always people around to tolerate it. Parents,
    boyfriend/girlfriend, employers, etc— and being pretty, which
    Trunk obviously is, helps a lot. This doesn’t mean people are
    necessarily nice to her, or that she’s happy; only that “crazy”
    behavior is more tolerable to other people when you are
    young.

    The problem for her is she’s not getting any younger, and like
    it or not the only one who will put up with a 60 year old
    borderline is no one. Except maybe the kids, which we will get
    back to.

    III.
    Telling Trunk to leave her husband is just plain stupid, and if
    that was your recommendation you should stop making
    recommendations, you’re stupid. You can’t reduce the
    complexity of a marriage to “he hit you, so you should leave.”
    I know stupid people, I know, domestic violence shouldn’t be
    tolerated, god are you dumb.

    If she chooses to leave, fine, but trying to convince her to


    leave pushes her towards her worst fear: abandonment. She
    either decides to leave, or she doesn’t, it must be 260% her
    decision or else it feels like it isn’t all her decision, which
    means the split is felt like abandonment even though she “did”
    it. She’ll go insane. You advising her to leave means she can’t.
    It also betrays a gigantic amount of arrogance. This woman
    who may possibly be a nut has, at least, raised kids, managed
    businesses, and even survived moving to Wisconsin. And
    you’re going surprise her with “domestic violence is not
    okay?” But the truth is you don’t actually want her to leave,
    you just want a forum where you can take credit for telling her
    to do it.

    She wants this relationship. She’s not a bad or good person for
    wanting it, it is what it is. I can say I have my own opinions
    about what to do and blah blah blah, but the starting point has
    to be what she wants, not what you think is best for her;
    otherwise at best what will happen is she ignores your advice,
    and at worst is she takes it.
    Nothing is to be gained by saying her husband abuses her,
    which he does. The real story is that she is abusing herself. I’m
    not judging her, I’m not saying she is bad or that I don’t
    understand it, but she’s setting up, well, a pattern of intense,
    unstable relationships because she needs the intensity and will
    thus tolerate the unstability. A relationship isn’t one sided, or
    bi-directional, it’s a dialectic. They are very much in it
    together.
    If you wanted to help (someone like) her, you have to take the
    focus away from her, put some objectivity into it. So start with
    her strengths. What is she good at? Raising her kids, for one
    thing. She may have doubts about her methods or her attention
    span, but ultimately she takes it all into account and creates an
    environment that is best for them. Okay, so a good place to
    start is: how she runs her life, how she runs her relationship,
    will be inevitably mirrored by her kids. She probably knows
    this.
    What she may not know, however, is that the mirroring doesn’t
    mean her boys will grow up likely to hit their women, but that
    it is more likely her boys will grow up falling for women like
    her. Or picking someone in reaction to her.

    part 2 soon

    http://twitter.com/thelastpsych
    Ocean Marketing Supports
    Obama
    January 4, 2012

    this better be worth it


    What? Another catchy title that doesn’t mean what it looks
    like it means? No, I meant it. If I had to guess I’d say Ocean
    Marketing actually supports Romney, but that doesn’t change
    the truth of it.

    For those who don’t live on the internet: a customer service


    dispute ended up on the internet. The specifics are below, but
    they aren’t relevant:

    A guy pre-ordered an Avenger Controller from the


    manufacturer. It never came, so the customer complained.
    Ocean Marketing ran the customer service for the
    manufacturer, and Paul Christoforo was the contact person.
    The general form of Paul’s responses to the customer were,
    “you’re a jerk, I have no time for jerks.” That may be a slight
    mischaracterization, but not really:

    Buddy your asking for free stuff and I am trying to help


    you , You have no idea what happened to our ordering
    system or our old customer service reps that told you they
    were going to send you a 100% COUPON AND FREE
    CONTROLLER but never did . So calm yourself down ,
    be respectful and do as I say or ask to get your free
    controller. I DEAD SERIOUS ! Be a little more humble
    we can refuse the right to ship out anything to anyone we
    want , I’m trying to help you. Small claims court for 49
    dollars haha … that’s cute . I’m the President of my
    company not The Avengers so keep your punk smite
    ignorant comments to yourself. If I wasn’t trying to help
    you I wouldn’t have emailed you back. Customer service
    of old is gone were in a new generation now. Sorry for
    any inconvenience , this will ship tomorrow I’m putting
    in the order now .

    The customer is only N=1, so he used the only power he had:


    he forwarded the emails to the the Penny Arcade guy, who
    also happens to own the entire internet. The result: it gets to
    Reddit, who send him thousands of emails, phone calls, outing
    him as a possible steroid user, discovering a police report of
    domestic abuse charges, etc.

    He’s tried to apologize, but his ego keeps getting in the way.

    II.

    There’s one other thing you need to know. Paul Christoforo


    looks like this:
    Paul’s an idiot, and a bully. So what?

    Paul appears like he’s the bully because in that interaction


    between him and the gamer, he is. Additionally, he is pictured,
    in the mind and on camera, like a bully, and a jerk, and once
    you know what he looks like you can’t unknow it. So it
    becomes impossible to judge him in any other way, which is
    bad for him and necessary for everyone else.

    Here’s what no one on Reddit seems to understand. To anyone


    not in the demo for an Avenger Controller, the Avenger
    Controller is a joystick. Which means that thousands of people
    ganged up on this guy, got him fired, harassed him, and
    potentially ruined his career— over a joystick. I can see you
    want to interrupt me and say something about the principle of
    it, let me just say one more thing and I’ll give you your time:
    to the United States government, it looks like the dangerous
    party is the internet.

    Paul’s a bully, but bullies can get bullied, right? Reddit just
    went Dylan Klebold on Paul Christoforo. Who is the state
    going to side with?
    I say this is narcissistic rage, but how I see it isn’t as important
    as how The Big Other sees it. Did the guy steal billions of
    dollars? Kill his followers with Kool-Aid? No, he was a lousy
    businessman in a “meaningless” business. So a bunch of 4
    year olds, arguing over a toy, rage like 4 year olds, i.e. use
    maximum force for every single sleight, because anything less
    than maximum is barely felt.

    The trouble here is that it’s not one 4 year old, it’s thousands.

    You can’t argue this point because I am not telling you what is
    reality, I am telling you how it “looks” to the suits and ties
    who generate your world. The Law doesn’t see Paul
    Christoforo’s hair plugs or legal blindness or broken
    spellchecker. It sees a businessman, it agrees to believe he is a
    businessman so that it can believe he is under attack. It is
    fortunate for Reddit that this picture existed, because they’d
    have to invent it if it didn’t, because if Paul was pictured in a
    suit and tie, if he was in his sixties, if he looked like the
    symbol of businessman that the Law already sees him as—
    Reddit would cease to exist.

    The government’s claim is that we need increased security on


    the net to protect us from criminals, hackers, and terrorists, but
    that is the lie we all agree to believe. The real threat to the
    system, the one that will eventually result in the abolition of
    anonymity is the deepest fear of all Americans, it is so deep
    that it shaped the Constitution: tyranny of the majority.

    The internet community thinks it exposed a bad dealer, gave


    him what’s coming to him. I won’t disagree. I’m only telling
    you that that’s not what the government sees. It sees this, and
    only this:

    I spent my childhood moving from school to school and I


    got made fun of everyplace I landed,” [Penny Arcade’s
    Gabe Krahulik] says. “When these assholes threaten me
    or Penny Arcade I just laugh. I will personally burn
    everything I’ve made to the fucking ground if I think I
    can catch them in the flames.

    Don’t yell at me, I love Penny Arcade. But the government


    sees only this, and it sees this written by someone who has
    way too much power for an internet cartoonist.

    China requires all internet users to register their real names. So


    does Google+. They’re not afraid of criminals. They’re afraid
    of ____________.

    http://twitter.com/thelastpsych
    Sara Ackerman Is Both a
    Nut, and X
    January 7, 2012

    pic removed by administrator


    How to summarize a complex story? Start from first
    principles: what does the author want to be true?
    Sara Ackerman is a student at NYU, and sent a mass email to
    the “Department of Social and Cultural Analysis”
    complaining, inter alia, that a professor forced her to go to
    OWS and do an ethnography. Her complaint was not that it is
    impossible for a college student to do an ethnography of a
    fluid movement comprised of people who in, say, November
    are completely different than the people there in August,
    rendering any conclusions not just moot but misleading, or
    that the term ethnography is correctly spelled “personal
    anecdote,” which would have been my complaint. But then
    again I didn’t go to many of my classes because I thought they
    were full of people who didn’t care or blindly followed the
    typical herd mentality. Was I right? NB: that’s an ethnography.
    Her rambling, highly fonted emails are the typographic
    equivalent of an old time ransom note, and I have every
    suspicion she’s a nut.

    Your problem is that the accompanying pic to the NYU article


    about her is this:
    Uh oh. Things about to go racial up in this joint.

    II.

    Gawker‘s summary of her complaint:

    …objected to being “forced,” in her words, to interview


    “criminals, drug addicts, mentally ill people, and of
    course, the few competent, mentally stable people”—
    [Sara] did not like this [assignment].

    And the NYU paper continues:

    She requested an alternative assignment, but wasn’t


    granted one by CAS Dean Kalb until, she had already
    gone down to OWS “with two other young girls, who are
    quite attractive and thin, and don’t look particularly
    physically fit enough to take on a potential predator,
    rapist, paranoid schizophrenic, etc” and felt like she
    “escaped an extremely dangerous — and even, life
    threatening — situation.”
    So it is pretty clear that she sounds like she was afraid to go
    there.

    But then there’s the picture. That’s a picture symbolizing what


    she is allegedly afraid of. No picture of her is available, which
    is weird, as she has 1000 followers on facebook and I found it
    in 9 seconds (though it took hours to verify), but if you open
    the Textbook Of Media it becomes immediately
    understandable: her picture is not useful to their narrative. If
    this was a story of a sexual indiscretion they would find a pic
    of her in a bikini, and if she doesn’t fit in a bikini they’ll use
    someone else in a bikini as a symbol.

    If you take the phrase, “quite attractive and thin”, and


    juxtapose it with the pic above, or the picture NYMag used:

    You’ve set it up nicely: white girl is afraid of black people.

    In fact, her actual complaint is that she disagrees with OWS,


    on principle: “a movement that runs entirely against my core
    values, and principles”. I’m not saying she’s not a nut; she
    may also believe there are drug addicts and rapists down there,
    she may be afraid of them, but in her brain the secondary
    problem is the rapists, the primary problem is OWS.

    So that’s your second clue: an ideological disagreement—


    albeit an insane one— has been reframed into something that
    seems self-explanatory: this crazy girl who thinks all of OWS
    are rapists is a racist.

    Which isn’t entirely wrong:

    On a side-note have you ever heard of that mega-university in


    Cambridge, Mass. called Harvard?
    Long story short, they had a few disputes between a tenured
    professor, and a big man on campus, and look what happened
    in the end:
    They swapped him:
    http://en.wikipedia.org/wiki/Lawrence_Summers
    For him:
    http://en.wikipedia.org/wiki/Cornel_West
    And got a PR nightmare–does anyone see the parallels? Or do
    I have to continue to spell it out for you, as I have been for
    over 2 months?
    Look, neither Summers nor West is perfect, but why don’t
    you do a little research to see who was more deserving of a
    prominent position at Harvard?

    These are the ramblings of a person whose personality is made


    of paper mache. But listen to the words, the words she felt
    were important enough to underline: highly qualified X guy
    was replaced for terribly inadequate Y guy.

    You fill in the X and Y.

    “Does anyone see the parallels?”


    III.

    So she’s a nut. So what? Why are we reading about this?

    Nothing about her story is interesting or unusual. As a


    psychiatrist in a university hospital, I have seen hundreds of
    situations just like this. I’m not saying they all actually had
    psychiatric pathology, I am only saying that somehow or other,
    referral or kicking and screaming, they have wound up at the
    door of the university counseling service. Psychiatry is the tool
    the system uses when it can’t shoot you in the head.

    And yes, every year five or so nuts send terabytes of emails to


    everyone.edu and every newspaper within the blast radius
    about professorial misconduct, conspiracies, mishandlings,
    promises broken, he said/she said, with multiple quotes from
    the Student Handbook. (Here’s a protip: if you ever refer to the
    Student Handbook, you should take a semester off or lithium.)
    You never see these stories in Gawker, let alone the entire
    emails, and trust me when I tell you they are more interesting.
    So why this?

    She’s a nut, but she’s a nut in the required direction: this nut
    hates OWS, which is to say, only a nut would hate OWS. A
    nut, or someone who doesn’t like blacks, or…. Her nuttiness
    serves a necessary ideological function, which is to set OWS
    in opposition to her insanity; OWS is magnified as the voice of
    reason, the voice of sanity. When the media points out the
    idiocies of Sarah Palin, Bachmann, and Perry, it isn’t to
    discredit them— a maneuver that overt would be distasteful to
    intelligent media; Pailinizing them sends a more subtle but
    powerful message: anyone who agrees with these nuts is a nut.
    The point is not to doubt them, the point is to doubt yourself,
    nudging you closer to center (i.e. leftward.) That’s how you
    win an ideological battle.

    Thought experiment: you come across a story about an OWS


    supporter who is also a nut trying to get her professors fired.
    What network are you watching? So then why are you
    watching?

    IV.

    Sara Ackerman threatened to, and then did, the worst thing
    you can ever do: go to the press.

    The press is not your friend, and when you give them your
    existence they will use you however they need to, and you will
    have no recourse. If you happen also to be a nut, you’re done
    for.

    NYULocal is a student paper, so it’s safe to assume they’re


    deeply pro-OWS. That’s not necessarily a bad thing, but the
    point is that they don’t see it that way, they see it is pro-truth,
    or pro-uncovering the lies of Wall Street. Again, fine; but it
    means that when they use your image for their purposes, like
    they are using Ackerman’s, they think they are doing a good
    thing. You can’t fight against that.

    The essence of an ideological battle is not, “I believe this, but


    you believe that” but rather, “You believe that, but I know the
    truth.” Because of this, not only can you not convince them of
    their bias, but it is impossible for them to ever be aware of it.
    It’s not bias, it’s reality. Hence “basic” and “fundamental” are
    attached to the very things that other people see as anything
    but.

    At around 4pm MST, I wrote a comment on the NYUlocal


    page: “Look at the picture they used. THINK!”

    Sometime within the next 15 minutes, both my comment and


    the pics were gone.

    You’ll either be surprised or not: I knew they were going to do


    that. Which is why I screencapped the before and after:

    before:
    after:

    The point here is not that I “caught” them, that is not my


    interest. What’s important is that they took it down in response
    to my comment. What will they tell themselves is the reason
    they took down the picture? Or used it in the first place?
    Was it that I misunderstood the picture, or was it that I did not
    properly understand the picture?

    End notes:

    1. The scientific problem with ethnographies is that unlike a


    clinical trial or even a straight census, the “investigator”
    cannot be separated from the work. It is simply impossible—
    looking forward to some angry comments— to have an
    “objective” ethnography because the process of the
    investigation requires the investigator to apply his own biases
    and defenses to the work. You strive for neutrality, of course,
    but there is always conscious awareness that you can’t reach it.
    It mitigates this by weaving within it a narrative about the
    investigator, the investigator becomes explicitly part of the
    research, so the reader can (conceivably) make some guesses
    about why this particular investigator saw this particular thing
    in this particular way.

    I tell you this because Sara Ackerman is thus correct in saying


    she cannot perform this study. Her hatred of OWS, misguided
    and shallow though it may be, would interfere, and that would
    inevitably come through in the study. But, and this is an
    important but, since no one on the planet would have known
    who Sara Ackerman was, we wouldn’t have had that needed
    information to properly interpret her findings should she have
    forged ahead. Which means that in refusing to do the research,
    Sara Ackerman was the only honest ethnologist in the class.

    see also: Why does the media ignore Ron Paul? Not because
    they disagree
    http://twitter.com/thelastpsych
    Greece To Pay Disability
    Benefits To Pedophiles:
    America To Report On It
    January 10, 2012

    this story is exactly the opposite of what is happening


    everywhere else in the world
    The Greeks started democracy, let’s see what they’ve come up
    with since then.

    ATHENS, Greece (AP) — Greek disability groups


    expressed anger Monday at a government decision to
    expand a list of state-recognized disability categories to
    include pedophiles, exhibitionists and kleptomaniacs.

    The National Confederation of Disabled People called the


    action “incomprehensible,” and said pedophiles are now
    awarded a higher government disability pay than some
    people who have received organ transplants.

    Also included: “pyromaniacs, compulsive gamblers, fetishists


    and sadomasochists,” i.e. Greeks.

    It sounds crazy, it is crazy. Why would they do this?

    The government is also battling widespread abuse in the


    welfare system, forcing tens of thousands of disabled
    people to be reassessed.

    But this isn’t abuse of the system, this is the system abusing
    you. What the hell is going on over there?

    II.

    FYI: The Illuminati have decided that 2012 is the year the
    Dow is going to 14000.

    Politicians threwout [no sic] the world have a single problem,


    only one: how to convey the appearance of financial stability
    until someone discovers cold fusion. Marx was one step off:
    all costs boil down to energy costs, i.e. oil costs. Fix that
    problem and the deficits will follow.

    The problem of the problem is that the cost of oil has to be


    high enough for someone to want to discover cold fusion; but
    if it is high, though not high enough, then simultaneously it
    will be too expensive for most economies yet too cheap to
    replace— or even to extract more of it. Hence shortages. And
    the cycle repeats.

    In the meantime, politicians try to kick that ball as hard as they


    can down the road. A generation, two, three, far enough out
    that you don’t feel it now.

    Social Security and Medicare represent 640% of the U.S.


    budget. I looked it up. We can pretend that other things matter,
    but really, they don’t. Cold fusion and Social Security. Can’t
    have one or the other, it’s both, or neither.
    2012 will see an American election between Mitt Romney and
    President Obama, and the winner will be whichever one of
    them manages to best avoid questions about Social Security.
    Unless by November we are finally at war with Iran, Social
    Security will be the only topic worth discussing, which means
    we’ll be discussing gay marriage.

    If you want your generational conflict, that’s it. The “old” and
    their 437 elected representatives will block any attempts to
    mess with Social Security, or even mention it, and will use
    welfare and disability— e.g. SSI— as a diversion; but they
    must present the ills of SSI in such a repulsive way that it
    captures the young’s disgust, to distract them from the
    behemoth that is eating them.

    Hence stories about pedophilia. Hence pictures of black people


    abusing the system. There’s one now. He has an XBox. And
    weed. There’s always weed.

    The story that comes out of Greece is a prolegomena to any


    future diversion that will be able to present itself as a news
    story. For the next year, expect to hear how the disability
    system is corrupt, corrupting, socialist.

    All of those things are true, but irrelevant. The “young” should
    not fall for this. My track record on criticizing SSI is
    unassailable, but what is wrong with it isn’t the $, but the way
    the $ are dispensed, i.e through the pretense of medical illness.
    Almost everyone can work, even a little, at something;
    imagine if we could get all those SSI recipients to spend 1
    hour a day clicking on Google ads. We could be as rich as
    astronauts.

    No. The real problem, the one after oil, is Social Security.
    Throw in Medicare.

    Without real numbers we are not going to solve real problems,


    so here they are, memorize them:

    SSI is $50B. That’s it. You could double it, triple it, it
    wouldn’t make any difference. I’m sure the people getting SSI
    wish the payments were higher, but they aren’t not because we
    don’t have the money, but because people hate you. On
    principle. And it is that hate that both Democrats and
    Republicans will cultivate; because it reflexively produces a
    delicious narrative: SSI recipients don’t deserve it because
    they never worked, therefore— and your mind cannot help but
    make this a therefore— Social Security recipients do because
    they did. I am not saying either of these propositions are right
    or wrong, I am making the link explicit so you can see what is
    being done to you. Keep your eye on the black and brown SSI
    while the government smuggles the old folks to heaven.
    “Wouldn’t this be easier if we had euthanasia?” Done.

    SSDI is $124B. SSDI is funded from Social Security taxes


    (1.8% payroll tax) and represents credits the individual earned
    while working, i.e. it is disability insurance. But in oral
    arguments, whether the ex-worker “deserves” it or not will
    overshadow the fact that he did indeed “pay into it” in some
    capacity. Look for SSI and SSDI to be conflated into a
    gigantic “fiscal black hole.”

    Social Security is $712B. It is funded through FICA, which in


    2010 brought in $780B, i.e. $68B surplus, i.e. more than all of
    SSI. Of course eventually the ABC demo will turn the channel
    to CBS, and the payouts will exceed the income.

    Cold fusion, cold fusion. You gotta have hope.

    III.

    No one is interested in knowing that in Greece pedophilia is a


    “disability,” but not one you can get any money for. The AP
    should really talk to some pedophiles before it makes these
    crazy statements about how much they can earn. (The correct
    number is zero.) This doesn’t mean the Greek government put
    this law there on purpose so that people could get angry about
    it; it means the government found it there on purpose so that
    people could get angry about it.
    And no one is interested in knowing that SSI is but a tiny blip
    on our budgetary concerns, the equivalent of penny pinching
    to 89 octane when you fill your Escalade. Won’t that damage
    the engine? “What do I care, I’m leasing.” That’s the most
    American sentence I have ever written.

    What does interest people is “abuse of the system.” That, and


    gay marriage. Romney and Obama will never tire of telling
    you precisely how the SSI system should be reformed to
    prevent “fraud and waste”, and the press will be happy to
    report on it. All of those reforms will be financial, i.e. less;
    none of them fundamental, i.e. more.

    “Look over here, everybody. We’re protecting your interests.


    Don’t look over there, we’re protecting someone else’s
    interests.”

    Distraction, misdirection. Keep it up until November, or cold


    fusion, whichever comes last.
    Couple Reveals Child’s
    Gender Five Years Too Late
    January 23, 2012

    oh boy

    A story that defies understanding until you realize… how old


    the parents are.

    It’s a boy! And he’s five. Beck Laxton, 46, and partner
    Kieran Cooper, 44, have spent half the decade concealing
    the gender of their son, Sasha. “I wanted to avoid all that
    stereotyping,” Laxton said.
    I’m confused. Is being stereotyped as a boy worse than being
    stereotyped as a court jester with an extra chromosome? “Wha
    —! That is so offensive!” Agreed. So why did she do it?

    “Stereotypes seem fundamentally stupid. Why would you


    want to slot people into boxes?”

    On a hunch I checked out her blog to see how opposed she


    was to slotting people into boxes:

    I may be wrong, but this appears to be a woman whose whole


    life is boxes.
    The premise for this unstory is that the parents wanted to
    prevent any gender stereotyping, so hid the child’s gender
    from everyone to let him [sic] grow unstereotyped.
    The problem is that the parents already know the sex. They
    can’t unknow it. They aren’t acting from no information, they
    are acting in reaction to the information. They are saying they
    are raising him gender neutral, but what they are actually
    doing, precisely, is choosing not to raise him as a boy.

    Sasha’s gender was almost revealed when he took to


    running around their garden naked, but Beck was resolute
    and encouraged him to play with dolls to hide his
    masculinity.
    Hide it from whom? The kid knows he’s a boy. If he wants to
    play with dolls that’s one thing, but evidently the dolls aren’t
    for him, for his benefit, but as a signal to other people.
    Not wanting other people to affect his development is fine, but
    as parents they are the most important influence in his early
    years, and their chief lesson is that who he is is less relevant
    than the appearance of who he is. They are telling him reality
    doesn’t exist. Not “boys can do whatever they want” but
    “pretend you are not a boy.”
    As a “radical feminist”, would she have encouraged the same
    denial from a daughter?

    II.
    Here’s where things stop being hilarious:

    When Sasha turned five and headed to school, Laxton


    was forced to make her son’s sex public…

    This is an extremely revealing sentence, because it shows the


    hierarchy of power in this woman’s mind: she doesn’t believe
    in God, she can overrule biology; but the school system is
    inviolable. The school system! What next, a pet store? A
    pumpkin?
    She could have home schooled him; she could have refused to
    tell the school. But instead, she acquiesced to their demand.
    There’s a very specific reason she did this: she is afraid to
    break society’s rules. That’s why she got someone else to be
    transgressive for her.
    She wants to be (thought of as) a progressive, to (appear to)
    challenge society’s rules, but being a coward she instead
    forces her kid to bear all of the negative consequences of this
    challenge. Is she wearing a man’s suit to work? Has she
    stopped shaving her legs “to hide her femininity”? Is she
    willing to risk that someone will punch her in the face at the
    bus stop? Is she willing to sacrifice her own carefully managed
    identity “to make people think a bit”?
    At the risk of me being the kind of sexist she has
    parenthetically announced she is against, let me say the father
    in this story is even worse than she is, because he should know
    better. If you need me to explain why this is, I can’t. Amazon
    suggests you’d enjoy The Descendants.

    III.

    This story seems like it is about gender roles but it is actually


    about the deeper generational pathology that comes out in a
    million different ways, which are all the same way. This isn’t
    about a progressive way of raising children, this is about the
    consequences of narcissism.
    What drove her to using her child as a you-go-first skydiving
    partner is the desire to be something coupled with the terror of
    doing anything— which results in ambivalence and inertia
    camouflaged in a consumerist lifestyle full of meaningless
    choices. This leaves a lot of unused emotional energy left over
    for me me me. She’s had 46 years to obsess over her identity,
    and this is what she came up with, a hail mary pass in the
    second half of a mid-life crisis.
    According to the astronomical guide Being And Nothingness,
    infinite freedom is proportional to infinite terror, which is why
    the infinite universe is filled not with nothing or even magic
    pixie dust but with dark matter. Boo. You may think you want
    freedom, but the Cenobites can imagine a whole lot more
    freedom than you can and are just waiting for you to go first.
    That existential terror is itself frustrating, it is the point of the
    terror. That’s why if you really want a bonerific sex scene you
    turn off the internet and put on a horror movie. Good luck
    trying to masturbate to it, though. Which is why it’s so
    memorably hot.
    And so a person who knows not what to do with freedom, a
    person afraid of power, has a choice: either the transgressions
    are filtered through a proxy that has proven it can stand it—
    modeling your bad ass self after someone already bad ass, or
    projecting your impulses onto someone else; or you pretend
    that something else, entirely artificial, is what frustrates you.
    Knowing where the boundaries are lets you safely pretend to
    test them. “I’m terrified of sex” becomes “I’m terrified of
    getting pregnant” becomes “my Dad would kill me if I got
    pregnant.” That’s a girl you’re guaranteed to get naked every
    time; but she’s given way more blowjobs than she’s had
    orgasms.

    This is why I know that while Beck seems like a hippie-


    atheist-feminist-freethinker, she is undoubtedly a completely
    ordinary middle class housewife, no different than the Kansas
    PTA members she would hatefully roll her eyes at for voting
    Tory instead of Labour. Her life has been marked by nothing
    eventful, nothing challenging, nothing unusual, nothing
    difficult, so she will have created drama out of ordinary events
    in order to self-identify. “Oh, God,” she’d say as she parks her
    Subaru at the Gymboree. “These mums are all so desperately
    conformist. Marry the father of my child? How utterly
    bourgeois. Did I mention my child is a court jester?”

    IV.

    Still, his mom is intervening. While the school requires


    different uniforms for boys and girls, Sasha wears a girl’s
    blouse with his pants.

    Everyone slow down. This is no longer a gender-neutral child


    potentially making his own choices, but a boy dressed like a
    girl, overtly and on purpose. Beck is raising a transvestite.
    If you had asked her if she wanted to raise a transvestite she’d
    have said no— she wants a child free of stereotypes— because
    there are stereotypes of boys and girls but not of boys who
    dress like girls. That mixed logic reveals the true intent of her
    “gender-neutral” project. It isn’t for the kid, it is for her. If it
    wasn’t for her, you wouldn’t have heard about it. Wasn’t the
    whole point not to call attention to the gender? Oh, I had it
    backwards, the whole point was entirely to focus on the
    gender. Sigh. The main character in this story is herself. The
    kid is supporting cast. He is not a person, he is a blog topic.
    Of course she wants the best for him, of course she loves him,
    I’m not saying she doesn’t. Neo loved Trinity, too, but I hope
    it is not necessary to explain which way the force vectors
    pointed. The purpose of this game show was to be the parent
    of such a kid, not to benefit the kid. Amy Chua went on the
    same game show, but at least in her case the kids won some
    prizes for coming in second.

    Let me repeat an important quote:

    Did you see that wonderful melodrama, Stella Dallas


    with Barbara Stanwyck? She has a daughter who wants to
    marry into the upper class, but she is an embarrassment to
    her daughter. So, the mother - on purpose - played an
    extremely vulgar, promiscuous mother in front of her
    daughter’s lover, so that the daughter could drop her,
    without guilt. The daughter could be furious with her and
    marry the rich guy. That’s a more difficult sacrifice. It’s
    not “I will make a big sacrifice and remain deep in their
    heart.” No, in making the sacrifice, you risk your
    reputation itself. Is this an extreme case? No, I think
    every good parent should do this.

    The true temptation of education is how to raise your


    child by sacrificing your reputation. It’s not my son who
    should admire me as a role model and so on. I’m not
    saying you should, to be vulgar, masturbate in front of
    your son in order to appear as an idiot. But, to avoid this
    trap - the typical pedagogical trap, which is, apparently
    you want to help your son, but the real goal is to remain
    the ideal figure for your son - you must sacrifice that.

    She is doing the exact opposite: sacrificing her child’s


    reputation, subjecting him to potential ridicule and god knows
    what else, not for his benefit but in order to promote her own
    identity. It’s not the gender neutrality that’s going to mess this
    kid up, though it might; but being raised by parents who are
    using their kid as something other than an end in himself. As
    was said in a movie I hope has no parallel here: this isn’t going
    to have a happy ending.
    Superman’s A Baby, But
    He’s Still Superman
    January 26, 2012

    it’s so pretty
    So this is how you miss the signs. Pay attention, it’s a kind of
    charade.

    The boy is at a kid’s birthday party and the kids are 7, and
    they’re bowling because nothing suits 7 year olds better than
    perfect spheres made of depleted uranium and 45 minutes of
    waiting your turn.

    A girl wearing a tiara bowls a 71. Superman-shirt bowls a 76.


    A future parole violator quits after two gutter balls because
    this game sucks, an odd assessment since it’s his party. His
    mom is showing another mom texts from a man who is not his
    dad. The boy bowls a 101. Granted, he double underhanded it
    the whole time, but so what.

    Princess says to the boy, “You won!” The boy tries to suppress
    a hesitant, humble smile beaming with incredulous pride.
    Princess gives him a hug and he almost cries.

    Superman says, “No you didn’t.”


    “Yes he did,” says Princess.

    “Yes I did,” says the boy.

    “No you didn’t,” says Superman. “You got the highest score,
    but you didn’t win.”

    I’m not familiar with sports, let alone bowling, so I don’t


    really understand the scoring. Is bowling scored like
    blackjack, where you can have more points but still lose? Or is
    bowling pretty much like football, where more points= the
    other team’s cheerleaders? Which would mean either
    Superman is running a short con or he got into his parents’
    mushrooms.

    The boy says some words, but what he says is irrelevant


    because the boy’s parents are less like parents and more like
    Idiots and Idiocy can overwhelm everything but death, and
    death can overwhelm everything else but denial. The boy’s
    parents are proud of the boy, they want him to feel good, so
    they jump in: you did win! you are the winner! They are
    patting him on the back for his win, sure, they may suspect it
    was a fluke (so he crossed the line a little) but self-esteem is
    what’s important here, right, at this age, right? This is a big
    deal for the boy, he won, f-i-s, come on, let him have his
    moment. Have some more cake! Have another juice box! Hey,
    everyone, come give the boy a high-five! Don’t pay any
    attention to Superman, he’s just a Greenie Meaneenie Jealous
    Butt Crybeanie, he doesn’t like it when anyone’s satisfied.

    Yeah, but Superman is telling the Idiots something important.


    He is telling them that based on his prior history with the boy,
    based on what he knows of the boy, telling him he didn’t win
    might actually work. He wouldn’t have tried this on the
    Princess, or his parents, or some stranger with a beer gut and
    an ankle monitor— no, he tried this on the boy because he had
    a feeling he would fall for it.

    Which means that the correct lesson the boy’s parents could
    have taught him was what is it about Superman that makes
    him act that way? Or more importantly, what is it that the boy
    does to make Superman think he can manipulate him? But the
    one they went with, the one that will make him neurotic for the
    rest of his life, is that he’s a winner.

    But he might not be. Not if Superman has anything to say


    about it.
    What Would You Do If Your
    Fiancee Rejected The Ring
    As Not Good Enough?
    January 29, 2012

    now let’s see what kind of man you are


    “Will you marry me?”

    She covers her mouth with her hands and looks shocked.
    Tears. Oh my God. She can’t believe you did this. (Yes she
    can.) She says yes. (Not like there was any doubt.) The other
    men in the restaurant join their wives in polite fake applause,
    albeit less enthusiastically. Congratulations, they say. They
    don’t mean it.

    Through dinner she turns her hand every which way. It’s so
    beautiful. It’s so clear. How many karats is it, is it ____? and
    the number she guesses will be off by one. Of course.

    How much did this cost you? she eventually asks. Wow. How
    did you afford it?
    Until finally…. It may happen at dinner, or at home, or… She
    says:

    I don’t want you to take this the wrong way

    I really love it

    But

    I was kind of hoping for something a little

    …. bigger…..

    I.

    Cue penis jokes: “She looks down and says, ‘I was hoping for
    something bigger.’” Hack. If she cancels the sex because it’s
    not to her standards then she’s not just a bitch but a slut, and
    not just a slut but a psychopath, because she’s reduced your
    existence to a heated dildo, nothing else matters to her because
    nothing else can matter to her. Sex is mutual masturbation.

    II.

    Assume this is a hypothetical scenario; i.e. imagine it


    happening.

    The most important question for you, the reader, the one that
    will tell you the truth about what is happening in the story, is
    this: what does the hypothetical woman in this story look like?

    III.

    I was listening to Cosmo Radio— what? I’m allowed— and


    Patrick, the host, is discussing this hypothetical story. He had a
    strong reaction to it: “you dump that vapid bitch.” I’m
    paraphrasing.

    The thing is, this isn’t the first time you two have been around
    each other. You have a prior history, you have had other
    insights into her character, you already know what kind of a
    woman she is. Which makes you the type of man that is
    attracted to the kind of woman who would say that. Uh oh.
    And guess what type of man that kind of woman is attracted
    to. You.

    Patrick was right, you should dump her. But not because she’s
    shallow, but because you are.

    IV.

    His co-host, Lea, didn’t say much, and I got the strong feeling
    that she felt, hypothetically, it was totally ok to turn down a
    ring she didn’t think was big enough.

    Some women will say the ring is an expression of love, it


    reveals how much her man thinks she’s worth. It shows to
    what extent he’d be willing to take care of her. What they
    mean is that the ring is a kind of test of his love: does he love
    me so much that he’s willing to “waste” money, abandon
    practicality, when it comes to me?

    I get that there are more sensible women out there, the point
    here is not a critique of the woman’s logic, the point here is the
    man’s.

    The truth is that you knew when you bought it whether the
    ring was what she wanted. What you were banking on is that
    she’d accept it anyway. It was a kind of test of her love.

    That’s why this offer of the less than “perfect” ring that she
    rejects can be understood to be a defensive maneuver: you
    don’t want to marry her. “You know what, you’re absolutely
    right.” Not so fast. I mean you’d be much happier just dating
    her, living with her, status quo. And you know, if she just
    waited, someday, someday, someday, you’ll be rich; and then
    you’ll buy her a really nice ring.

    Yummy. Nothing the kind of woman looking for a perfect ring


    now wants more than a wait-and-see guy. You’re with her
    (partly) for her looks, yet you expect she’ll gamble those looks
    on a single horse race that starts sometime in 2025. “Don’t
    sweat it, baby, I got a system.” Can’t wait.

    But if your patent/stock/novel/horse comes through and you


    later do indeed get her that bigger ring, are you going to spend
    a greater proportion of your wealth on it, or just more money?
    If not, then you haven’t properly understood what that ring
    represents to her— crazy or not— which means that you don’t
    understand her, which means, importantly, that you do not
    care to try. The point here isn’t that she’s right, the point is you
    two are not connected.

    Save your money. You’ll lose it in the divorce anyway.

    V.

    I don’t know if Lea would reject such a ring or not. Her


    hypothetical position is that a ring is a symbol and blah blah
    blah. In real life, she might reject such a ring, or circumstances
    with her fiance might be that she is perfectly happy with that
    ring, or any ring, or waiting for a ring, or who knows what,
    because the difference between what you would do
    hypothetically and what you would do in real life is the other
    person.

    Hypotheticals like this can only be answered because you’re


    controlling for the most important and limitless variable, the
    other person. When you have a real fiancee, who knows what
    you’d do? If you really knew her, the story wouldn’t happen.
    So the point of these hypotheticals isn’t to determine a code of
    behavior but to broadcast to others something about yourself.
    “I’m the kind of guy that wouldn’t tolerate such a gold digging
    bitch.” Oh, you’re a Capricorn. But in your own hypothetical,
    hadn’t you already tolerated her for a year? 40% of the time
    from behind?

    In the example above, what did she look like? You imagined
    her to be hot…..ter than you. You did this because only a
    really hot chick, a kind of woman, would reject a ring because
    it wasn’t big enough. And in this way you have justified not
    being with this woman, “a bitch!”— a woman who doesn’t
    exist but serves a a proxy for a type of woman who also does
    not exist— so that you don’t have to face rejection. In other
    words: blame it on the ring.

    When the woman in the joke rejected you because of your


    penis, do you really believe she liked you except for the penis?

    These hypotheticals are dreams. The lesson isn’t what you


    would do; but how did you construct the fantasy to allow you
    to do it? That tells you who you are.

    VI.

    “Are you saying I have to buy her an expensive ring?” No guy


    wearing Axe who doesn’t read the post before yelling. I’m
    saying that if you spring a ring on a woman which you already
    know is less than what she wanted, hoping that she’ll be
    satisfied but not sure if she’ll be satisfied, then the problem
    isn’t the ring, the problem is you.

    Now go here: What Would You Do If Your Fiance Gave You


    A Ring That Wasn’t Good Enough?

    http://twitter.com/thelastpsych

    Is The Cult Of Self-Esteem Ruining Our Kids?

    The Effects Of Too Much Porn

    ––

    Notes:

    1.

    If you want the history of engagement diamonds, Epstein


    writes the classic. It reveals the extent to which our social
    constructions are…. constructions. Highlights:

    “To stabilize the market, De Beers had to endow these stones


    with a sentiment that would inhibit the public from ever
    reselling them.”

    So began engagement rings for the masses. It all started in


    September of 1938.

    The ad agency of N.W. Ayer started “a well-orchestrated


    advertising and public-relations campaign [to] have a
    significant impact on the “social attitudes of the public at large
    and thereby channel American spending toward larger and
    more expensive diamonds instead of “competitive luxuries.”

    …the advertising agency strongly suggested exploiting


    the relatively new medium of motion pictures. Movie
    idols, the paragons of romance for the mass audience,
    would be given diamonds to use as their symbols of
    indestructible love….

    Did it work?

    Toward the end of the 1950s, N. W. Ayer reported to De


    Beers that twenty years of advertisements and publicity
    had had a pronounced effect on the American psyche.
    “Since 1939 an entirely new generation of young people
    has grown to marriageable age,” it said. “To this new
    generation a diamond ring is considered a necessity to
    engagements by virtually everyone.” The message had
    been so successfully impressed on the minds of this
    generation that those who could not afford to buy a
    diamond at the time of their marriage would “defer the
    purchase” rather than forgo it.
    2.

    Off topic, but there’s a masturbation competition in the US and


    Europe, and the world record holder went 9 hours. Yes in fact,
    he was Japanese.

    But the interesting thing about such a competition is that it


    exists. No shame in masturbating, I guess. “Why should there
    be? We all do it.” My mom doesn’t. I’ll kill you.

    But the lack of shame isn’t what’s really interesting. What’s


    really interesting is that the purpose of it is to masturbate
    together. A previously shameful, previously solitary activity
    now done with other people proximate to you, but no
    connection is needed or even desired; the only goal is the self-
    pleasure, with the pretense of the camaraderie if the other skin
    jobs next to you.

    I could say that it’s a metaphor for social media, or narcissism,


    but it isn’t a metaphor, it is the inevitable conclusion.
    What Would You Do If Your
    Fiance Gave You a Ring That
    Wasn’t Good Enough?
    February 1, 2012

    lawyers are standing by

    (Part 1 here)

    Oh my God, what’s he doing…


    “Will you marry me?”

    You cover your mouth with your hands. In a microsecond you


    saw the ring wasn’t…

    But in this moment you have to follow the script. Action.

    INT. RESTAURANT - DINNERTIME.

    GUY on one knee. GIRL looks shocked.

    GIRL:
    Oh my God. I can’t believe you did this.

    [The silence goes on a bit too long. He widens his eyes as a


    prompt, subtly motioning to the people watching them.]

    GIRL:
    Yes!

    Around them people in the restaurant clap, say


    congratulations. Some men smirk knowingly.

    GUY gets up off his knee, they kiss. He sits back down.

    GIRL:
    It’s so beautiful. It’s so clear. [She holds it towards the
    light.] How many karats is it? Is it 4?

    GUY (off screen):


    No, it’s only 3.

    GIRL:
    Wow, it looks so much bigger. How much did this cost you?
    How did you afford it?

    END SCENE
    Like any woman wracked by self-doubt, when it feels like a
    scene you feel compelled to follow the script. No means no,
    but yes is what it says on the page. Hence yes to the boss’s
    extra work; yes to letting your friend vent on the phone even
    though you’re late; yes to being in a threesome because your
    boyfriend wanted to.

    But later, when you’re done shooting for the day and you have
    a chance to be yourself, you finally say, “I don’t want you to
    take this the wrong way… I really love it… but…. I was kind
    of hoping for something a little… bigger….”

    I.

    Cue penis jokes. “She looks down and says, ‘I was hoping for
    something bigger.’” But you wouldn’t have said anything if he
    wasn’t walking around like God’s gift to women. “Come on,
    baby, let’s get out of here…” Arrogant prick, if this is what’s
    supporting your bragging then your BMW probably means
    you’re living with your parents. Wait— whose house is this?

    III.

    I was listening to Cosmo Radio— research— and the host,


    Lea, was of the mindset that a ring is a symbol of what a guy
    thinks of you, and it’s okay for the woman to tell him she
    wanted something bigger. Patrick disagreed: “it means she’s a
    vapid bitch.” I’m paraphrasing. So Lea compromised: “maybe
    he could get her a pair of earrings, too. Would that be
    acceptable?” I’m quoting. And Patrick, the co-host, said
    absolutely, great.

    Of course she didn’t mean that. If she thinks that the ring is a
    symbol of what a guy thinks of her, then the small ring is what
    he thinks of you. Upgrading the ring after the fact won’t
    upgrade his feelings towards you. Which is the problem.
    Which means Lea took a hypothetical boyfriend who doesn’t
    yet exist and was already covering for him, already making
    excuses for not getting what she wants. For settling. For him
    not loving her. Rather than committing to her own maxim—
    it’s a symbol of love— she downplays it, letting him off the
    hook to maintain the appearance that all is well.

    Lea was right, he should get her a pair of earrings as well. But
    not because he doesn’t love you, but because you don’t.

    IV.

    Her co-host, Patrick, was vocal about just how much of a bitch
    such a hypothetical woman is, and linked it to the story of
    Jessica Biel rejecting Justin Timberlake’s ring. His insight was
    that because Justin had been a voracious cheater in the past,
    Jessica has him by the balls. The ring isn’t a just a symbol of
    love, but restitution. He didn’t say it, but I will: Kobe.

    I get that there are cheap and jerky guys out there, the point
    here is not a critique of the man’s logic, the point here is the
    woman’s.

    Jessica sounds like she’s has Justin whipped— snap!— and he


    has to do whatever she wants to get her back, using his guilt to
    dominate him. As if anyone ever feels guilt anymore. Boy oh
    boy could that not be more wrong. Prove to me you love me,
    says HypoJethica. Prove to me you think I’m worth it. If it
    sounds bitchy you aren’t listening: you prove to me I’m worth
    it. Give me something you don’t give the other girls, can’t give
    the other girls. You, who can get any girl he wants, make me
    know how valuable I am. Because I don’t have any idea,
    otherwise I wouldn’t be shaking you down for a bigger ring
    and I certainly wouldn’t be trying to get you back.

    “Jessica Biel? Doubts her worth? Are you insane? She can get
    any guy she wants!” No she can’t, she wants Justin. And he’s
    like, “meh. See you Wednesdays.” Oh, HELL NO, you did not
    just call Jessica Biel weekday pussy. I didn’t, but that’s the text
    she got, “not good enough.” Where’s she heard that before?
    Oh yeah, everywhere. Sure she was on VH1’s “100 Hottest
    Hotties” but she was number 98 and it was VH1. “But she was
    #1 in Stuff’s ‘100 Sexiest Women’?” Come on. Hair, makeup,
    Photoshop, a publicist, it isn’t real, it doesn’t count. It never
    counts. Which is why even though her biggest movies are
    Valentine’s Day, The A-Team, and New Year’s Eve, none of
    those films appear in her Wikipedia “Career” blurb. You know
    what is there? Plays.

    New Year’s Eve was a vehicle for glamorous actresses to play


    alongside other starlets, but she sees a cast meeting where all
    the hotties are sitting around like, “I play the blossoming girl”
    or “I make out with Ashton Kutcher” or “I wear this Herve
    Leger dress” and Jessica gets to say, “I play a pregnant girl.”
    Damn, yo. Truth bombs. Sort of puts you in your place. The
    only thing worse than that for a hot actress is to be cast as the
    mom of a hot actress.

    You wish that you had Jesse’s life? Why can’t you be a woman
    like that? Maybe because then your Dad would have to call up
    this unfaithful and disrespecting boy-man to beg his trifling
    ass to marry his daughter. “Please! I’ll pay for your wedding!”
    You think any of the other “Sexiest Women In Magazine’s”
    fathers would do this? They’d hire a coupe of Russian guys to
    disappear him. “But he makes her happy!” I can tell.

    Happiness is not the goal, what she’s hoping for is affirmation.


    She wants the kind of guy who is a symbol of the value she
    thinks she wishes she had. She doesn’t really want Justin to
    get her a bigger ring to show off to her friends: Justin is the
    ring.
    make sure Scarlett sees me

    “Is any of this true?” How the hell would I know, Jessica never
    calls me back. I only know that when you break down the
    media story of Jessica Biel, this is the narrative that comes out,
    and it comes out because it’s typical of so many women:
    anything that tells me I’m worth it cannot tell me who I am.
    Next.

    And so happiness is out, the only objective scale you have to


    measure value is energy and emotion. Is there passion? Is there
    drama— of any kind? Can you start a recollection of events
    with “oh my God!”? If you took all of the world’s philosophies
    and lined them up end to end, you’d stab stoicism in the neck,
    stay the hell away from me old man. The only time you’ll go
    to a secluded beach is if it’s with an inappropriate guy like
    your boss or your friend’s husband or a photographer. “It’s
    complicated.” That’s a sentence you’ll never hear a guy say
    because no guy would say it, and any guy who would say it
    could never get close enough to you to hear him. Get thee
    behind me, wuss boy.

    Here’s a prediction: they won’t last. Hmmm. Maybe the ring


    wasn’t good enough.

    V.

    I don’t know if Lea would reject such a ring or not. Her


    hypothetical position is that a ring is a symbol and blah blah
    blah.

    She— you— aren’t asking for a boulder, but it tells you his
    priorities. Why is it that he can save all year to rent a beach
    house in the summer? Or for clothes? He spends almost as
    much on hair products as you do, and half of them are for his
    back. And now his single fling with frugality is with the
    lifetime symbol of your love? “You know, diamonds are just a
    worthless commodity the media has told us are valuable.” So
    are breast implants. Shut it.

    It’s not about the ring, Alone; but about his willingness to
    sacrifice his own interests for you. If he drank two fewer beers
    each night out… is that too much to ask?

    You know what else is crazy? He puts it on the card, going


    into debt. Then you get married and suddenly you’re going
    dutch on your own ring. That’s the kind thing that kind of guy
    would do.

    Some girls are going to call you shallow, “it’s the man that
    matters!” But you know that every one of those women’s
    profile pics are of their kids or cats or both.

    I hear you telling me that it’s not even a symbol as much as a


    test: does he have the ability to put you first? Can he
    physically take from his plate and put into yours? Any guy
    who gives you a small ring is going to get a gentle push back
    to Tiffany’s or a boot to the ass.

    The thing is… hypotheticals like this can only be answered


    because you’re controlling for the most important and limitless
    variable, the other person. When you have a real fiance, who
    knows what you’d do? Or what he’d do? So the point of these
    hypotheticals isn’t to determine a code of behavior but to
    broadcast to others something about yourself. “I’m the kind of
    girl that wouldn’t tolerate a guy who can’t put me first.” But in
    your own hypothetical, hadn’t you already tolerated him for a
    year?

    The kind of man whom you’re going to have to nudge towards


    a bigger ring, to cajole into being more selfless, to whip into
    settling for you— is the kind of guy you are hypothetically
    attracted to. And you know who that kind of guy finds
    attractive? You. And Jessica Biel.

    These hypotheticals are dreams. The lesson isn’t what you


    would do; but how did you construct the fantasy? That tells
    you who you are, and it’s telling you to you think you should
    leave your Wednesdays free. He might come over.

    VI.

    “Are you saying I have to settle for a smaller ring?” No girl


    watching award shows to see what they’re wearing but hasn’t
    seen any of the movies and who doesn’t read the post before
    yelling. I’m saying if you refuse a ring from a guy which is
    less than what you wanted, thinking it’s a symbol of his love
    but hoping it is not a symbol of his love, then the problem isn’t
    the ring, the problem is you.

    http://twitter.com/thelastpsych
    Another Honor Killing That
    Isn’t About Honor, And Even
    Less About Nietzsche
    February 3, 2012

    what a shame

    KINGSTON, Ontario — A jury on Sunday found three


    members of an Afghan family guilty of killing three
    teenage sisters and another woman in what the judge
    described as “cold-blooded, shameful murders” resulting
    from a “twisted concept of honor,” ending a case that
    shocked and riveted Canadians.

    Another killing that involves the words, “Muslim”, “family”,


    “daughters”, “honor.” And “Canada.” Yikes. Do you really
    need the details? You do if you want to get it right. Otherwise,
    feel free to call it an honor killing and get booked on the Glenn
    Beck Show and Al-Jazeera on the same day.

    [Canadian] Defense lawyers said the deaths were


    accidental. They said the Nissan car accidentally plunged
    into the canal after the eldest daughter, Zainab, took it for
    a joy ride with her sisters and her father’s first wife. [The
    son] Hamed said he watched the accident, although he
    didn’t call police from the scene.

    The trouble is that Hamed watched the accident from inside a


    Lexus SUV that happened to be pushing the Nissan into the
    canal. Don’t worry, the four women were dead long before
    they got in the Nissan for their joy ride. The prosecution
    contends the dad and the son conspired to do this, but of
    course prosecutors hate men of color.

    In order for this to be an honor killing in the traditional sense


    — note the words honor and traditional— the purpose of the
    killing has to be to remove shame from the family. In this
    logic, an honor killing is not simply punitive but a selfless act,
    because it puts the murderer at risk of punishment (and grief)
    so that his descendants may live with honor. It is for the sons
    so that they can grow up and marry without carrying the
    shame of their mother or sister’s actions; for the surviving
    daughters so they won’t be thought of as whores like their
    sister.

    So this would make perfect sense:

    Prosecutors said the defendants killed the three teenage


    sisters because they felt they had dishonoured the family
    by defying its strict rules on dress, dating, socialising and
    using the internet.

    The problem is that this isn’t why the women were killed, it is
    the post-hoc rationalization for why they were killed.

    II.
    The prosecution said her parents found condoms in
    [younger daughter] Sahar’s room as well as photos
    of her wearing short skirts and hugging her Christian
    boyfriend, a relationship she had kept secret.
    [Youngest daughter] Geeti was skipping school,
    failing classes, being sent home for wearing
    revealing clothes and stealing, while declaring to
    authority figures that she wanted to be placed in
    foster care, according to the prosecution.

    The daughters had been dressing western, dating, using the


    internet and disrespecting their old man [and brother] for a
    very long time— across three Western countries— without
    ever being murdered, not even once. The father didn’t like
    these things, thought them abhorrent, beat the girls, but did not
    kill them. During all this, this honorable dad had no problem
    resigning his son to the fate of “brother of sluts”, he wasn’t
    worried his other daughters would be the “sisters of whores”—
    or become corrupted themselves; nor did he appear mortally
    wounded by being the father of harlots.

    In other words, this had nothing to do with honor. Why did


    this murder happen when it did?

    III.
    First, let’s dispense with the religion: “He was not religious as
    some have said. I never saw him do prayer.” You will observe
    a ubiquitous lack of religiosity in North American “honor
    killings” up until they are actually committed. Suddenly
    everyone finds God. That’s the history of America: come here
    for the freedom; stay for the cash; and if things get hairy say
    only God can judge you.

    What’s necessary for this kind of a murder isn’t a surrounding


    community that supports honor killings— where in Canada are
    they going to live before some Molsen swilling hockey
    enforcer runs them down?— but a group of people who
    validate that some behaviors are shameful; again, even if they
    abhor honor killings themselves. In other words, someone to
    crowdsource the superego. “I don’t condone what he did, but I
    understand.”

    The family had first moved to Australia, where he would not


    have been able to commit this crime because:

    [The father]Shafia did not appreciate the local Afghan


    women’s support group reaching out to his wives.

    These Australian Afghan women were supporting the women,


    not him. His wives were being “seen” by enough people as
    individuals, more than a reflection on him. So he left. When he
    got to Canada, he found this:

    Despite the overwhelming evidence presented at trial,


    some in Montreal’s Afghan community have trouble
    accepting that the deaths were murder. “The parents were
    building a house for the sake of their children. How could
    they go and kill them?” asked Victoria Jahesh, who works
    with an Afghan women’s group in Montreal.

    The key difference is that even while the Canadian group


    would never condone honor killings, the family is still viewed
    as his family, the women as his wives, etc. He (to them)
    remains the main character, it’s his movie, everyone else
    supporting cast. I’m sure the group thought they were
    supporting the women in various ways, but the manner in
    which they understood the world— for brevity let’s just call it
    in this case patriarchal— reinforced the very problems they
    thought they were alleviating. “A father loves his daughters,”
    they would say. Yes, that’s obvious.

    IV.

    “There can be no betrayal, no treachery, no violation


    more than this,” Shafia said on one recording. “Even if
    they hoist me up onto the gallows … nothing is more dear
    to me than my honour.”

    What could possibly have been so terrible? Such a betrayal?


    She had already had sex, lots of sex, condoms in her drawer in
    her parents house sex. Isn’t that dishonorable enough?

    No. What got her killed was this: she got married.

    In the spring of 2009, Mr. Hyderi learned that [oldest


    daughter] Zainab was to marry her boyfriend [a
    Pakastani-Canadian]… The marriage to the boyfriend
    was annulled after one day, and another plan was hatched
    for Zainab to marry Mr. Hyderi’s younger brother. But
    before that could happen, the Shafias set off on a summer
    road trip….

    You know what happens next.

    Marriage is freedom (weird, I know.) Marriage means she


    belongs to another man, he has no power over her— unless
    she marries an approved castmember. And if she gets married
    to an outsider, then the next thing you know all the daughters
    get married, and he is left…….
    V.

    I can understand (read: smell it from a mile away) the


    motivation of the father for killing his family, but in order for
    the son to have cooperated with this madness his father must
    have convinced him that what he was doing was right even
    though he himself knew it was wrong. From a theological
    perspective, that sin is worse than murdering his daughters,
    because he did the “devil’s work” and corrupted his son’s soul,
    pretending it was God’s will.

    When Nietzsche said “God is dead” he meant that God is not


    necessary for our morality anymore. When he says we killed
    God, he means that our science, skepticism, education, have
    pushed us past the point where believing in miracles is
    possible; but as a consequence of this loss we are lost, have no
    goals, no aspirations, no values. God was made up, but he
    gave us a reason to progress.

    The resulting nihilism requires us to either despair, return back


    to medieval religion, or look deeper within us and find a new
    source of human values.

    Yet… none of those things happened.

    The post-modern twist is that we didn’t kill God after all: we


    enslaved him. Instead of completely abandoning God or taking
    a leap of faith back to the “mystery” of God; instead of those
    opposite choices, God has been kept around as a manservant to
    the Id. We accept a “morality” exists but secretly retain the
    right of exception: “yes, but in this case…”

    Atheists do this just as much but pretend they also don’t


    believe in “God”. “Murder is wrong, but in this case….” But
    of course they’re not referring to the penal code, but to an
    abstract wrongness that they rationalize as coming from shared
    collective values or humanist principles or economics or
    energy or whatever. It’s still god, it’s a God behind the “God”,
    something bigger, something that preserves the individual’s
    ability to appeal to the symbolic.

    “…but in this case…” Those words presuppose an even higher


    law than the one that says, “thou shalt not.” That God— which
    isn’t a spiritual God at all but a voice in your head— the one
    that examines things on a case by case basis, always rules in
    favor of the individual, which is why he was kept around.

    But the crucial mistake is to assume that the retention of this


    enslaved God is for the purpose of justifying one’s behavior, to
    assuage the superego. That same absolution could have been
    obtained from a traditional Christianity, “God, I’m sorry I
    committed adultery, I really enjoyed it and can’t undo that, but
    I am sorry and I’ll try not to do it again.” Clearly, Christianity
    hasn’t prevented people from acting on their impulses; nor
    have atheists emptied the Viagra supplies.

    The absence of guilt is not the result of the justification, it


    precedes the justification. Like a dream that incorporates a
    real life ringing telephone into it seemingly before the phone
    actually rings, the absence of guilt hastily creates an
    explanation for its absence that preserves the symbolic
    morality: I don’t feel any guilt………………………….

    …….because in this case…

    VI.

    But no one likes to see the consequences of abstract


    philosophy played out in a submerged Nissan, so I’ll just offer
    you some advice. Rageful narcissists are the most violent not
    when they are insulted or attacked or hated but when they are
    abandoned to objective reality, the one that doesn’t comply
    with their mirroring demands. Such a person invariably is
    backed by an enslaved God, which means all things are
    possible.
    If you do manage to leave, don’t look back.

    http://twitter.com/thelastpsych
    Pedophilia Is Normal,
    Because Otherwise It’s
    Abnormal
    February 7, 2012

    i ain’t going out like that


    Allen Frances, M.D. is a Duke psychiatrist. If you’re not
    particularly interested in psychiatric politics, then the only
    thing you need to know about him is that after he dies,
    psychiatry goes full Foucault.

    Hebephilia— the sexual attraction to post-pubescent children,


    is currently being proposed for inclusion into the DSM-V as a
    disorder. Should it be considered a mental disorder? (This is
    different than asking if it should be a crime.)

    Allen Frances writes that hebephilia shouldn’t be in the DSM


    because hebephilia is normal.
    The basic issue is that sexual attraction to pubescent
    youngsters is not the slightest bit abnormal or unusual.
    Until recently, the age of consent was age 13 years in
    most parts of the world (including the United States) and
    it remains 14 in many places. Evolution has programmed
    humans to lust for pubescent youngsters—our ancestors
    did not get to live long enough to have the luxury of
    delaying reproduction. For hundreds of thousands of
    years, sex followed closely behind puberty. Only recently
    has society chosen to protect the moratorium of
    adolescence and to declare as inappropriate and illegal a
    sexual interest in the pubescent.

    However, he still thinks it is a crime:

    It is natural and no sign of mental illness to feel sexual


    attraction to pubescent youngsters. But to act on such
    impulses is, in our society, a reprehensible crime that
    deserves severe punishment.

    II.

    If you’re surrounded by carpenters, everything becomes about


    hammers.

    Frances and the debate teams are mostly forensic guys, which
    means their worry about hebephilia’s inclusion in the DSM is
    that it will be used to involuntarily commit people who have
    NEVER committed a crime to psychiatric hospitals, forever.
    The trick is that if hebephilia is in the DSM, TO THE LAW it
    earns the status of a scientifically accepted diagnosis even if it
    isn’t.

    He’s probably right about that.

    He’s wrong about everything else.


    III.

    The problem with media is that it tricks you into debating the
    conclusions while accepting the form of the argument. So you
    get to ask, “is hebephilia a pathological disorder or is it
    normal?” so that no one asks the question, why do we now,
    today, want to have this debate?

    Pedophilia and hebephilia have always been considered maybe


    pathological and maybe not; Psychopathia Sexualis makes
    clear the distinction of the pedophile who has grown weak of
    moral character (not psychiatric, but criminal) vs. those whose
    urge towards children is a “pathological perversion” that to
    him is “quite natural” and is thus “not a criminal, but an
    irresponsible insane person.” The distinction between
    criminality and pathology has to this point been decided on a
    case by case basis: “To examine not merely the deed, but the
    mental condition of the perpetrator.”

    So why formalize it now? The answer is there in Frances’s


    article, the mistake that is in his article: “sexual attraction to
    pubescent youngsters is not the slightest bit abnormal or
    unusual.” Dr. Frances thinks he’s being historically expansive,
    boy oh boy did he walk into that one.

    If you look closely at your calendar, right after the year you
    will see, in tiny font, that interest in pubescent girls may be
    normal; but interest in pubescent boys is always and seriously
    whacked.
    She’s 14. Anyone disagree she’s… what? Hot? Once you
    “normalize” sexual interest in 14 year old girls, you either
    normalize the interest in boys or you quietly suggest
    homosexuality in general is slightly pathological. You can
    only pick one, and the rest of us have to live with the
    consequences.

    If hebephilia— all of it— is pathology, however, you avoid


    having to make that dicey distinction. Phew. America is safe.

    I am not here making a case for what is normal or not; I’m


    pointing out the very specific societal approval—
    encouragement— that allows me to keep drooling as long as I
    ALSO say out loud, “son of a gun, Ali Lohan’s only 14? She
    looks so much older!” but forbids me from even putting up a
    picture of a boy and making any comment— even if I am gay;
    even if I am a woman. Go ahead and try it. And what does it
    mean that society permits a 14 year old boy to choose to be a
    girl who is [her]self attracted to males, but in theory lacks the
    maturity/intellect/right to seduce a grown man? It means stop
    asking questions, wiseguy. We have a society to run.

    As evidence for this, Ray Blanchard, the Chair of the


    Paraphilias Workgroup at the DSM, wrote a 2800 word
    justification for hebephilia’s inclusion in the DSM in which
    the words “boy” and “girl” appear only once:

    In the third place, a distinction between pedophilia and


    hebephilia on the grounds of reproduction makes no
    sense when applied to homosexual pedophilia and
    hebephilia, since neither pubescent nor prepubescent boys
    can become pregnant. Lastly, there is no evidence that the
    arrival of menarche abruptly demarcates girls’
    attractiveness to heterosexual pedophiles vs. hebephiles

    How can you have a debate about what is normal and what is
    pathology in sexual desire and never discuss the gender? He
    pulls it off. The point here is not science; neither is the point
    involuntary commitment. The point is to limit the scope of the
    debate to manageable, politically expedient constructs. The
    point is precisely NOT to answer the question.

    In this way, Frances and the DSM workgroup he opposes are


    actually on the same side, the side of the system: using
    psychiatry as the battleground for difficult social questions.
    This is how the system defends against change.

    The correct way to understand this debate is simply not to


    have it in this way— not to be pro or against the inclusion in
    the DSM: to declare that you refuse to allow it any authority in
    any direction, ever. “Well, it’s in the DSM!” The DSM has the
    scientific and moral authority of the Monster Manual, I’m not
    fooled by its popularity or its binding, and at least that book
    has the intellectual rigor to base things on a mix of convention
    and roll of the dice; and I am most certainly not fooled by the
    antirigorous arguments of the way above their pay grade
    academics who truly believe they could run the world the way
    Plato intended them to. Get thee behind me, Satan.
    “My fiancee is pushing me
    away and I’ve lost hope”
    February 10, 2012

    my advice can’t be worse than his


    Here is an Ask Metafilter question, and my reply. Maybe it
    will do someone else some good.

    If you’ve already read it there, skip to IV, for what I could not
    include there.

    My fiancee and I (both 23) have been together for just over 5
    years and living together for the past 3. There have been ups
    and downs during that time, including a month-long break up
    about 2 years ago, but I love her and want to spend the rest of
    my life with her. She had a rough childhood (alcoholic father
    who left) and I think that this is negatively affecting our
    relationship and her self-image.
    I had a female best friend from high school, who I knew before
    I met my fiancée, but I have largely given up this relationship
    because my then-girlfriend was jealous. It was a slow and ugly
    process and since then my fiancée has thought that I could and
    should find someone better suited to me than she herself is. I
    have tried my best to quell her insecurities, but they have been
    around for most of our relationship.

    I proposed about a year ago and she said yes. Things seemed
    to be going well, but a few months later there was a conflict
    between my fiancée and sister at a wedding planning
    convention. I wasn’t there, but my sister was apparently late
    and then didn’t stay for very long, which my fiancée and her
    mother took offence to. Since then there has been tension
    between my fiancée and sister. This is even more concerning
    for me, since both of my parents are deceased and my sister is
    the only immediate family that I have left.

    This past September was a terrible month for my fiancée, as


    her father died and she was laid off from her job. I tried to be
    as emotionally supportive as I could, but she didn’t lean on me
    as much as I would have expected.

    Roughly 2 months ago she started saying that she didn’t feel
    right wearing the ring that I gave her because the diamond
    that I used is from my mother’s wedding ring, and my fiancée
    thinks that the diamond should stay in the family (sister). I
    talked to my sister about using the diamond before I got the
    ring made and she was ok with the plan and the way I see it,
    once we get married my fiancée will be in the family anyway.

    About the same time she told me that she had started taking
    anti-depressants. She said that she had thought about suicide,
    but had no immediate plans to do it in the future. I encouraged
    her to see a therapist, but she only took the pills which were
    prescribed to her. My fiancée stopped wearing the ring two
    weeks ago and a few days later she said that she really doesn’t
    want to live anymore and that she has been pushing me away
    intentionally. I found her a therapist myself this time, and
    made sure that she went. She said that the therapist was
    insightful, but it hasn’t made her change her mind. She said
    that she doesn’t really want to go again.

    We’ve tried talking about this, but she is emotionally distant


    and insists that I find another girlfriend so that she can leave
    me and not be missed. Feeling confused and unsure about
    what to do, I asked her best friend if she knew what was going
    on with my fiancée. She told me that she didn’t know that my
    fiancée was thinking about suicide but that she did know that
    she was having second thoughts about the wedding and that
    she was stressed out about money.

    So here I am. I’m scare and confused. I’ve tried my best to


    show my fiancée that I love her and that she deserves to be
    loved, but she is pushing me away. I’m tired of struggling to
    keep this relationship going, but now I’m worried that she will
    hurt herself if we break up. She seems to want to continue our
    normal day-to-day routine and act like nothing is wrong, but I
    just can’t play this charade.

    Any thoughts about this situation are welcome. I’m looking for
    some outside perspective to help me figure out what to do next.
    Let me know if I’ve left out any important details. Thanks.

    II.

    Here’s my reply:

    No. Please take this in the spirit it is intended.

    You make it sound like your fiancee is suicidal; that you may
    be the only thing keeping her alive. Most of the Mefites’
    responses are about her depression. Yet your subtitle is: “My
    fiancée is pushing me away and after years trying to make
    things work, I’ve lost most of my hope.”

    “This past September was a terrible month for my


    fiancée, as her father died and she was laid off from her
    job. I tried to be as emotionally supportive as I could, but
    she didn’t lean on me as much as I would have expected.”

    Her father dies, and what your radar detects that is amiss is
    how she treats you.

    Do you think you know her better than anyone? I think you
    believe other people have more facts about her, but that you
    can interpret them better than anyone. That’s unlikely, but
    even if it’s true then this—

    I asked her best friend if she knew what was going on


    with my fiancée. She told me that she didn’t know that
    my fiancée was thinking about suicide but that she did
    know that she was having second thoughts about the
    wedding and that she was stressed out about money.

    — indicates that her best friend’s view of the “facts” is that the
    problem is you/marriage, not suicide. But instead of
    considering what that might suggest, you move to:

    So here I am. I’m scared and confused.

    You wrote that you proposed “about a year ago.” I wanted to


    get a sense of where your head was at around that time. Fair
    guess you got engaged in Feb 2011? At that time, you Asked
    Metafilter: “The Liberal Education ideal is ruining my life.
    Please help disabuse me of it.”

    It started with Mortimer J Adler and his ‘How to Read a


    Book’. I bought it about two years ago, and shortly after
    that time I became fixated on the idea of getting a liberal
    education and reading the Great Books.

    I also have a tendency to avoid my university studies to


    look for “something else”, some other activity or field
    of knowledge which will bring satisfaction to my life.
    I’m not sure if this is strictly procrastination, or if its
    something more. I started with reading books from
    Adler’s list and other similar lists on the internet… Then
    I rekindled my learning of French. I’ve given up on the
    idea of learning to play an instrument, but I feel like I
    ought to, and I occasionally browse the web for pianos
    and piano lessons.

    This much I could handle reasonably well, but then I


    found the The Teaching Company and The Modern
    Scholar. …I’ve downloaded most of the courses that I
    could find through torrents, and have since been listening
    to the lectures for an average of 20 hours each week for
    the past 7 months.

    I also need to find a job as my savings have nearly run


    dry.

    I’m guessing I have a combination of an inferiority


    complex, a habit of procrastination, and a tad of
    neuroticism thrown in for good measure.

    Somewhere around this point you asked a woman, “honey,


    will you marry me?”

    And this is worth asking: what does it mean when a college


    student turns to the Teaching Company for a liberal education?
    College has failed you. Demand your money back. But you
    didn’t really want a liberal education, you wanted to be…
    smarter.

    A month later you Asked: “How can I feel good about finding
    a job and starting a career?” Not how can you get a career—
    how can you feel good about it?
    I’m an economics major who doesn’t know what the
    hell he is going to do for a career after graduating, and
    frankly doesn’t feel qualified to do very much. I went
    into university thinking that I would try for medical
    school, but I was one of those kids in high school who got
    good grades without trying very hard, and my nearly
    non-existent study habits have left me with a C average,
    although even that has been slipping lately. Now that I’m
    nearing the end of my academic career, I’m starting to
    freak out about my career potential, and the related
    anxiety has me neglecting school work even further.

    Last year in a labour economics class, my prof stated that


    first jobs after college correlate with lifetime earnings.
    This has also added to my worrying, and I have been
    putting off getting a much needed part time job (partly)
    because of it.

    The future is indeed terrifyingly unknowable when you can’t


    even focus on the present.

    III.

    I go through all this not to embarrass you or criticize you but


    to show you two things: your life around this time is marked
    by ambivalence, anxiety, uncertainty, yet you decide to get
    married. But of course it makes sense that you would try to
    lock down at least one aspect of your life. You chose marriage
    — which is typically what girls do when they’re looking to be
    taken care of, to be defined by someone else. Right?

    But what if she’s as ambivalent as you about the future, but


    she wants something else (other than marriage) to lock down?
    Now a marriage is one more burden of uncertainty she has to
    carry around with her.

    The second thing all this shows you is what your words reveal:
    that you are intelligent, interested, eclectic, hungry— AND
    you are very conflicted, ambivalent, and uncertain. These
    aren’t psychoanlayses, these are explicitly your words. This is
    the message you want people to hear. If I can see all this just
    from Metafilter posts alone, it is absolutely certain that your
    fiancee knows it. Maybe she senses that you’re grasping on to
    her because she’s an anchor, and she doesn’t want to be an
    anchor, she needs an anchor. Most women don’t want to be
    responsible for their man’s stability, and she sounds like she
    wants some attention all for herself, of her own. Maybe she
    doesn’t want to be married, maybe she’s depressed, maybe
    she…

    …regardless of the reason, she needs to get help, a therapist,


    and you need to get focused and NOT a therapist. Your
    problem is not unique: too much freedom. If you were stupid
    you could plug into the system easy, one talent= one job. But
    for you there are too many possibilities.

    Your parents being deceased, being in college, being smart…


    that’s the ether in which a naturally worried, “is this good
    enough?” young man finds himself. The mistake many with
    that problem make is thinking that the problem is
    “themselves” and they need more introspection, or more
    insight, or more “brain hacks.” You need less of those things.
    What you need are goals with concrete steps that you force
    yourself to boringly take.

    So I think your relationship will end, hopefully you’ll both be


    strong enough and mature enough to do it without drama and
    the stickiness that accompanies furtive attempts at breaking up
    (this is your third time?) I’m sorry for you, these things are
    inconsolably painful for a while. But whatever happens, your
    future happiness is entirely related to your ability to impose
    your own limits on your freedom. The time has come to not be
    everything you want to be, but to be one thing you’ve wanted
    to be.

    I may as well tell you that once you’ve chosen a specific goal,
    and begin to legitimately work towards it, you may then find a
    different path suits you better; but that kind of insight is only
    possible after activity, after doing. Less thinking, more doing.
    Good luck. I hope it works out well for you.

    IV.

    That was what I posted at that time.

    But what I did not put in that post, the thing that I deliberately
    withheld because I didn’t want it to get lost in all the other
    words; because it is the most important thing, and the thing
    most likely to be denied— is that this guy chose that girl on
    purpose, for the purpose of maintaining his ambivalent world
    so no concrete decisions need to be made. Concrete=loss of
    potentialities= no thanks. Math and graduating is very forward
    looking; it’s much easier to say, “can’t study now, my
    girlfriend needs me, she’s in pain.” I’d bet it makes him feel
    like a good person, too, all that sacrifice, just for her.

    I doubt very much if he truly believed she was going to say


    yes. Her friends didn’t think she’d say yes, apparently. The
    point was not really to get married, the point was to create a
    dramatic event upon which to focus energy and thus delay any
    kind of physical forward motion. By engaging in conflict that
    is impossible to resolve.

    This is why I say he chose her to get rejected; to get jealous; to


    get sad over; to obsess over. And then to recruit the rest of his
    world into this problem. Nothing matters more than ego
    integrity; nothing matters more than the status quo. Do you
    see?

    All of that is unconscious, and as soon as I say that word a


    specific group of people goes bananas. No one likes to think
    they’re not in control of their own lives, that they’re saddled
    with an Abusive Boyfriend that wants nothing to change; but
    if they are in control, why are they anxious all the time? Why
    so little progress despite resources, opportunities, and
    freedom? If they’re in control of their own lives, why do they
    all dress alike?
    If you’re in control, why do these relationships happen to you?
    Isn’t it more likely you chose them?

    Others/the same people will take issue with my derision of


    introspection, because they believe it to be a Socratic ideal.
    I’m not against introspection, I am against masturbation. I’m
    against edging. The critic wants to be able to contemplate, to
    go to therapy and discuss and introspect and what he will do
    there is talk about himself, think about himself, identify
    patterns in his life, things that have held him back— and
    nothing will change. So then he will tell me that he has “a
    really good therapist, she really pushes me!”

    The therapy becomes an elaborate narcissistic defense, the


    promise and appearance of progress while protecting an at best
    artificial and at worst non-existent identity. “I want to learn
    why I am this way.” Then what? Will learning why you made
    those choices be what changes your choices? You’re still
    eating junk food, aren’t you? You’re eating it while you’re
    learning how bad it is.

    “But… why am I this way?” That question is a narcissistic


    defense. It doesn’t want an answer, it wants you to keep asking
    the question.

    “I’m a good person, I just am making bad choices.” Wrong.


    You’re not a good person until you make good choices. Until
    then you are chaos.

    And you know it.

    –-

    http://twitter.com/thelastpsych
    The Father That Shot His
    Daughter’s Computer
    February 22, 2012

    it succeeded

    I. “I’d love for you to write about the dad who shot his
    daughter’s computer because she posted something nasty
    on Facebook. “

    This one’s easy. He’s insane. How do you work in IT but it


    takes you hours, let alone hundreds of dollars, to upgrade a
    laptop? Doesn’t he know you just pick up an unattended one at
    Starbucks? I got a MacBook Pro with a OccupyMyPants
    bumber sticker on it. Sweet.

    He’s the Dad, he’s held to a higher standard. What was his
    intention? To change her behavior? But there were a million
    ways he could have done this, including reading that letter and
    shooting that laptop in front of her and not in front of other
    people. Would he have dared? But the very point of the
    operation was the video.

    The mistake is thinking that he was trying to shame her into


    improving. That never works, it simply reinforces that outward
    appearances matter more than what’s true, which not
    coincidentally is the very purpose of facebook.

    But never mind that, look carefully at what Cat-5 Tex revealed
    about her that was so shameful: nothing. She never appeared
    in the video. Her terrible facebook post that he read was
    already on facebook for all to see, we learned nothing new
    about her, all the information we learned was about him. He
    was repairing his own image as the kind of father who’d have
    the kind of daughter who’d do this— this being not her
    goddam behavior (after all, he had lived with her and her
    goddam behavior a goodly number of years without incident)
    but her publicizing her behavior. He was shamed not by her
    behavior but Facebook revealing it, which is why Facebook
    had to die. If he was Muslim they’d have called it an honor
    killing.

    Is she going to change? Not likely, and it’s not evident what
    about her needs to change except her address. No, I don’t
    mean she has to flee, I mean she has to grow up, so does he,
    both of the dummies involved violated one of the cardinal
    rules of family: don’t disparage someone in the family to
    someone outside the family. If you need me to explain this you
    are a terrible person.

    II. Uh oh, why is there a II?

    Here is a thought experiment: how would you feel if you


    found out this video was a hoax?

    Why were you so passionate about the video? Now that time’s
    passed, it hardly seems like it was worth the energy. But at the
    time it was urgent that you expressed either one of the two
    approved opinions:

    “Kids today are so goddam spoiled. When I was their age I


    had to work, now all they do is play video games…”

    Who bought them the video game? What did you think they
    were going to do with it? Trade it for a calculus tutor?

    Who spoils them? Maybe you’re not to blame if they turn to


    meth, but who else could be to blame if they’re spoiled?

    “The problem with kids today…” Stop right there, I’ll finish:
    is parents today. Parents today suck. I’ve checked. The
    Illuminati let me see the CCTV from every American
    household and in all of them everyone is in separate rooms
    staring at a glowing lie.

    Do you have a child who is like that guy’s daughter? Then


    you’re an idiot, not for having such a child but for diverting
    energy to support of that guy, in the same way that the reason
    your wife left you is the porn. It’s not the from-behind action,
    it’s the neglect. I know you are not going to believe this, but
    the reason your child is trouble is that you support that man. “I
    don’t understand kids today.” Tell me if I’m close: “You need
    to study to go to college, major in business, get a job working
    for a salary and if something goes wrong let the government
    you hate so much cover your medical, disability, and
    retirement needs. Saturdays are for yard work. Sundays are for
    church and football.” Sound right? Kinda surprising that
    they’d want a different future, and that’s why your kid smokes
    weed but calls it pot.

    “That father is a narcissistic jerk!”

    Why so serious? Think about how little rage you feel for the
    99% prevalence of incest in an inner city. Let me check your
    facebook, see if that sexual abuse didn’t prompt an all caps
    comment. Hmm. No. “I’m not that angry about the dad…”
    Rage isn’t about quantity, but about certainty.

    “So I can’t have an opinion about this?” Of course you can,


    there’s value in that and you’ve discussed this video with lots
    of people, I’m sure. Did you discuss this with your parents or
    your kid? That should have been your first thought. Did you
    sit your Dad or your Mom or your 15 year old down and say,
    “I’m going to show you something and I want you to honestly
    tell me your thoughts, random, unfiltered, and I swear to you I
    will treat you like a human being and listen and not get
    defensive and angry like I always do every time we talk about
    something that reveals you to be something other than what I
    see in you.” Because that would be an illuminating
    conversation.

    This is the point: it didn’t occur to you to do this. It occurred to


    you to voice your opinion publicly to anonymous strangers,
    but not directly to people that matter. That’s what you’ve been
    trained to do, that’s where your priorities have been taught to
    be. That’s the Matrix. You’re not thinking about your child’s
    development, you’re being tricked into thinking about your
    identity while the system uses you as a battery. No Red Pill for
    you. And no Red Pill for your kids, either.

    III.

    How do you think you came across this enraging video of a


    red state psychopath with a .45 and .NET certification? If
    you’re watching it, it’s for you.

    How do you think you found this video of a decent Father


    resisting the AP Obama Studies his disrespectful daughter
    learned in those liberal public schools? If you’re watching it,
    it’s for you.

    It’s not completely your fault. The system is much bigger than
    you, it is a spirit; and you think you stand defensively because
    you were taught to think that the deep insight is that it’s selling
    to you, telling you what to love or what to hate when it is
    actually telling you how to love and how to hate, not what to
    be but how to be. It nudges you towards the binary extremes so
    it is easier to control you. It wants you to have opinions, it
    wants you to “pick sides”, “get involved”, “take a stand.” It
    doesn’t want you to be indifferent, it wants you to love or to
    hate, rage or lust, so you feel alive— but always your strongest
    passions focused on the irrelevant. “That Dad is awesome!”
    Then you’ll vote Romney and the system has won, not because
    it wants Romney but because it wants to minimize your
    political involvement to voting. That shows you care; and if
    you really care you’d vote in local elections, too; and for the
    really active among you, why not donate your time to the
    campaigns? Grass roots! But the only thing that comes from
    grass roots is grass, and it doesn’t really need your help. It just
    needs you not to have the time to consider planting something
    else.

    ––––-

    http://twitter.com/thelastpsych
    Shame
    March 12, 2012

    abre los ojos


    Shame is a movie that if you haven’t seen by now, you won’t,
    but for damn sure don’t attempt to watch it on a flight to
    Chicago. What you’ve probably heard is that it is a bleak but
    honest movie about sex addiction and maybe about incest, full
    of nudity and uncircumcised penis dangling deliciously
    between some toned Irish Catholic’s legs as he urinates. Sound
    like something you want to see? Hold that thought.

    How do you feel after three hours on the Pornotron? You’re


    able to focus on the math homework afterwards, ok, but at the
    very instant a blast of semen hits you in the neck your first
    thought is, “Jesus, I need to kill myself.”

    That thought— that instant— is what the sex addict feels all
    the time. The question is not why does he feel that— shame is
    what you’re supposed to feel after anything that involves
    Craigslist. The question is why it doesn’t make him stop.

    II.

    If you want to understand a behavioral disorder, watch the


    behavior.

    One common explanation sex addicts offer is that it is the


    novelty that they crave, and when enough people with
    pathology agree on something you can pretty much guarantee
    that that agreement is part of the pathology, i.e. an unconscious
    defense. Sorry artists, broken people aren’t given greater
    insight as a consolation prize. The novelty is in fact trivial:
    yes, different partners, but the same kinds of sex, with the
    same kinds of people, in the same places, in the same ways,
    bolstered by the same kinds of porn. Repetition compulsion
    masquerading as novelty seeking. “You don’t understand,”
    says the analogous alcoholic, “I’m always looking for new
    drinks.”

    The important point is that in sex addiction the addict is not


    satisfied by the sex he just had because he is self-consciously
    aware that something unidentified is missing, and that lack
    leaves the orgasmer with an abundance of disgust and shame.
    Just went from being a made up disease to a typical Friday
    night. Right ladies?

    This is something the movie does depict very accurately: after


    Brandon has some sex, he then immediately has some other
    kind of sex. This isn’t an overactive sex drive, it is trying to
    get the sex right. That’s the dialectic. After he has a quickie
    with a hottie, he goes home and masturbates. He climaxed
    with her, he was done, but it didn’t take. It is easier to get it
    right with masturbation, not because the hand knows better
    than the vagina/mouth/butt/breast but because there are always
    micro-corrections to the fantasy happening in real time— so
    the movie you’re shooting in your head has a woman fellating
    a guy, but then she gives a certain look, and then you make her
    repeat a half-second of that scene using a different look, then
    you reverse time by two seconds and make her phone her
    husband; then that disappears and they’re outside on the deck,
    and it’s not her but another woman, now it’s a whole other
    scenario with a different cast, and an instant later back to her
    again; and impossibly seeing the scene from all possible sides,
    distances, perspectives— nudging it this way and that to suit
    that instant’s arousal. In effect, you are not watching a movie
    but improvising from a melody, or, in more psychoanalytic
    terms, playing with yourself.

    III.

    There’s a possible incest subtext between Brandon and his


    sister Sissy.

    If you can’t see it, it’s in the back: they’re watching cartoons.

    But if you are looking for a hard link between incest and his
    sex addiction you are wasting your time, there’s no answer
    because it isn’t the point of the movie.

    Take the unexplained backstory as a placeholder: X happened


    to these characters in the past, and now they’re here; where X=
    incest, child abuse, murder, cannibalism, school shooting,
    war…

    So the movie inadvertently makes an important point about


    your life: yes, that does sound terrible, but now what?

    IV.

    I’m going to offer an interpretation. It won’t matter whether


    this interpretation is correct— none of this actually happened,
    after all. The point is to ask why no one else thought of this
    interpretation that, once you read it, will seem to you an
    obvious one. Here we go.

    The key to understanding Brandon’s problem is not just to


    look at the sex he pursues, but also his attempt at having a
    normal relationship. That’s behavior, too, right?

    For the first half of the movie he’s rubbing his penis against
    anything sufficiently (com)pliant, and then he’s disgusted with
    his life and decides he needs to become a normal person. This
    is your American Psycho/Matrix moment: he knows he’s
    whacked, and he knows what normal looks like— he can fake
    it— but he can’t feel it inside. What to do? Patrick Bateman
    created an alternate universe and then gets confused which one
    is real— he becomes psychotic. Brandon tries to create a fake
    world where he acts like a normal person and substitute it for
    the real one where he is not: This would be The Baudrillard
    Matrix. This is why he walks around as one who is in a dream.

    See that guy? What he’s looking at isn’t an elevator door or a


    floor or a wall, he may as well be seeing cascading green
    characters. Everything he sees is sex. In the staggered brick
    pattern of the wall he sees a 69; the rounded elevator button
    reminds him of a clitoris; a footstep behind him is a woman
    sneaking out of her husband’s bed. These are instantaneous
    and millisecond association flashes that happen all the time.

    So with that seeing of a world within a world, Brandon


    decides to try a normal relationship— go on a date, connect,
    love. Of course he runs the date like it’s a movie scene, does
    things he assumes normal people do in normal relationships:
    he asks out a nice girl named Marianne, takes her out to a nice
    dinner, orders wine, talk about where she’s from, etc.

    However— and this is of such importance that no one else has


    even dared to mention it— the woman he chose to go on a date
    with is black. From his job.

    Slow down, multicultural lemmings, this isn’t some dumb TV


    commercial with a blacks/asians/whites all inexplicably
    smiling about a shared taste in fast food. This guy is a porn
    addict: all day, every day, constantly, he micro-scrutinizes
    every aspect of sexuality to find just the thing that will get him
    off, and he chose to find love with a black woman.

    “Well, she seemed nice, so he asked her out.” So run it the


    other way: Brandon picks up one night stands in bars, ok, but
    it’s not Mos Eisley, those are nice bars, which means the
    women he meets there are probably nice, ordinary people.
    People he could fall in love with if he chose to. So Brandon
    could have attempted a relationship with the hot blonde he
    picked up in Act I that he instead used for a quickie— that was
    a decision he made.

    Right? She looks nice enough. The law does not require <<hot
    blondes>> to only be used as sex objects, in most states you
    are still permitted to love them into their old age. And she was
    already attracted to him and he to her— 80% of the way there.
    So?

    Nope, he chose a black woman from Brooklyn. Don’t you


    want to know why? Was this someone he’s had his eye on for
    a while? Someone whose personality he knows fits with his?
    Shared values, common goals, etc, etc? Again, no, he knew
    nothing about her. He does a cold approach in the break room.

    What’s interesting for our culture is that in all the discussion


    about this film and the nuances of sex addiction, no film critic
    has wondered about the significance of Marianne’s race,
    maybe because they think its normal and probably because
    they don’t want to be thought of as someone who notices race.

    So while everyone pats themselves on the back for their non-


    judgmental acceptance of the nature of Brandon’s addiction—
    “it’s not immorality, it’s a disease”— they overlook what
    might be of pivotal significance. “You’re a racist!” protests the
    horrifically bad therapist you should throw your shoe at.
    “There’s nothing wrong with interracial dating!” I happen to
    agree, but how do you know Brandon does? Why don’t you
    put down your Mont Blanc and yellow legal pad and ask him?

    What drives Brandon is his sexual addiction. So why would


    we assume Matrix Brandon’s pursuit of a girlfriend comes
    from a different power source than his pursuit of other
    women? Everything he sees is porn: what is the pornographic
    significance of black women to white men? Did he pick her
    because he’s MORE sexually attracted to black women, or
    because he was NOT attracted to black women? Because he
    thought they were “better” than white chicks? Or because he
    considered them inferior?

    Without understanding that— without understanding what he


    sees as a “normal” relationship— without believing that there
    is critical information in everything other than his sex
    addiction— you inevitably make the wrong interpretation
    about his sex addiction. For example, the date is awkward but
    she still goes home with him— and, surprise, he’s impotent.
    Here’s where you’re supposed to think, “oh, sex addicts have
    difficulty with intimacy.” WRONG. Maybe he didn’t try
    intimacy and fail. Maybe he did everything he could, upfront,
    to sabotage his chance for a real relationship. He chose her
    because he “knew” it would fail, and when it wasn’t failing he
    hit the failsafe: impotence.

    I don’t mean interracial relationships fail in general, I mean


    that there is a good chance this character would have
    diminished expectations for the relationship he was attempting
    relative to other women, which is why he attempted it. Just to
    be sure, he tells her on the first date he doesn’t think there’s a
    point to marriage. Glad we got that out of the way, gives a gal
    a sense of possibilities. That’s him trying to be normal? No.
    That’s him trying to fail.

    Of course this is a movie and of course Brandon didn’t pick


    her, the director picked her. But if you follow this
    interpretation, then it may be that he picks women he won’t
    get along with to reinforce his belief that he isn’t normal— so
    that he can just throw himself into his sex addiction. He
    doesn’t want to change.

    If this is true, it brings us to a very important conclusion: he


    was using her. No, he wasn’t going to use her for sex, but he
    wasn’t going to really love her either. He was using her for his
    identity. Read this again and understand: when he uses the
    whores and the quickies to get off he feels SHAME, but when
    he uses a very nice girl with a legitimate interest in him for his
    pathetic charade at normality, he feels NOTHING for her.
    “We’re not bad people,” his sister Sissy says to him at one
    point, “we just come from a bad place.” God would disagree,
    but fortunately for you he is dead.

    V.

    I certainly don’t begrudge anyone looking to lay some pipe or


    a woman looking for a pipelayer, but again, I am neither a film
    critic nor a therapist, I do not assume normality for you, I let
    you decide that for yourself. I may secretly believe that harlots
    and gays go to H-E-double toothpicks, but I do not think
    harlots and gays can’t be happy until then.

    However, if you tell me you are unhappy, if you tell me you


    are all mixed up about the life you are leading, then expect a
    critique of the life you are leading, not just the pathology you
    are projecting it all onto. “I’m a sex addict!” says the guy who
    can’t get it up with black chicks. You picked your life. You
    may not think you picked it, you may think you were forced
    into it and inescapably tied to it, but I saw Badlands and I
    know that every moment is a choice, right up to and including
    blowing your brains out. So not sleeping with that hill giant is
    a choice you chose not to make. Saying, “I had no choice,” is
    itself a choice. Your choices may be stupid, but they’re still
    choices. And as all choices in life are ultimately binary, you
    really have no one else to blame for them but yourself.
    Flipping a coin should win you happiness 50% of the time. If
    you’re running less than that……………… consider getting a
    coin. Unless you’re one of those double-bind mofos, then the
    key advice here is to Costanza the situation and do the
    opposite of every natural impulse you have. NB: same goes for
    stock trading.

    I get that sex addiction looks like fun taken to excess, but a
    real addict doesn’t think any of it is fun, he thinks it’s all
    terrible. So that’s where we start: why are you doing terrible
    things?

    “I can’t help it, sex is an innate evolutionary drive that I just


    have set to turbo!” Funny, that. The popular lie nowadays is
    evolutionary biology, so that a pursuit of beauty is somehow
    hard wired, evolutionary, but curiously no one can explain
    why it’s hard wired towards 36-24-32 and not the 36-37-38
    lassies in the Yoruba tribe. (They like it from behind.) Oh,
    maybe natural selection is rendering American white humans
    more sexually perfect, a process accelerated by their below
    replacement level fertility. Or maybe not. Beauty is a social
    construction. I’m all in, but it is a construction nevertheless.
    The reason I think women are hot today is that they are today,
    not that they are hot. I watch pornos from the seventies and I
    think to myself, “well, it would be better than bestiality, I
    guess.” Everyone from the cast of Shampoo to the special
    guest stars on The Love Boat make me want to be a
    promisekeeper, meanwhile Wilt Chamberlain had sex with
    10000 of these gorgons. Get it? It’s a calendar problem, not an
    aesthetics problem. So when you say you’re addicted to “sex”
    or porn, you’re actually addicted to the work product of a
    Madison Avenue brainstorm run by guys whose names are
    initials. “Quick, call J.T., the rubes’ll eat this up!” Still feel
    ashamed? Yeah, you should. I do.

    VI.
    The problem with sex addiction, unlike the other addictions, it
    is always framed as harm to you. No one uses the actual
    consequences as a reason to stop. Be careful: yes, you get to
    feel “shame”, but the real problem with sex addiction isn’t that
    it destroys your life but that it destroys everyone else’s life. No
    wife has ever questioned her self-worth, let alone killed
    herself, because she found a vodka bottle in the back of a
    toilet. Try and “admit you have a problem”— this problem—
    to your daughter, and see how fast she gets a neck tattoo. And
    the risk of sex addiction isn’t that you contract a disease, the
    risk is that you spread the disease. How can you stand there
    and pretend that any of your hundreds of partners are more
    likely to be infected than you?

    Brandon is toxic death, he just cleans up well. Hookers have


    the savvy to resist him— after sex, he asks a pro, “can I get
    you anything? A drink?” and she just smirks and dismisses
    him. But what defense does Marianne have? Imagine he
    married Marianne: why did he do this? He wants a normal life
    with a wife, super, but he’s not willing to give up his reckless
    sexual pursuits. Is that fair? The analogy to Patrick Bateman is
    worse than you think: Bateman only imagined he was killing
    people. Brandon simply doesn’t care if he’s killing anyone.

    The incomprehensible thing about Brandon’s pathology is that


    there doesn’t need to be anything wrong with him for him to
    be addicted. He might have a history of childhood abuse, of
    course, but he may just as well have not.

    Brandon has a very specific problem, and it is not sex:


    freedom.

    In order to get sexual satisfaction from anything, that thing has


    to be unattainable, or at the very least it must come with rules.
    You can get release and pleasure from the attainable, but not
    satisfaction. There has to be a limit, a line, which defines a
    transgression which then allows you to bump up against it—
    and be satisfied. In America, almost anything you can imagine
    is sexually permitted even as limits to “appropriate sexuality”
    are everywhere. The awareness of the ubiquity of Photoshop
    on models serves this same frustrating purpose: this super hot
    woman that I take for granted that I get to see almost naked for
    no good reason isn’t actually her— the real her is hidden
    beneath Photoshop. She is still a mystery. So the Photoshop
    enhancement only temporarily heightens the sexual interest—
    which is why it is paired with products to buy now; the real
    satisfaction has to be attained elsewhere— the Photoshopped
    model triggers a desire to look for satisfaction elsewhere—
    e.g. the products, alternatively other women, porn, etc.
    Similarly, while porn actresses are hotter than ever, three hours
    in all you want is amateurs. Nasty.

    Brandon knows he can get any kind of sex any time he wants,
    so it always fails. Not sometimes. Always. Watch the movie.
    But he keeps trying, in the same ways, over and over. He also
    tries to simulate the perfect sexual experience, copy what
    looks like works. He walks by a couple having sex in a hotel
    window, so he then rents a room in that same hotel and has sex
    with a prostitute in the window in the exact same manner.
    Does it take? Of course not— it was too easy. When you sign
    a contract with narcissism there’s a clause you should pay
    attention to: if it’s easy, it doesn’t count.

    If you are a product of your behavior, start wearing a watch


    again to discover who you actually are. If the sex addict gets a
    watch, hell, gets a calendar, what he will discover is that he
    has practiced no other skill more diligently than pursuing
    empty sex that he knows is unsatisfying to him. That’s what
    he’s spent the most time on, that’s what he knows how to do
    the best. Better than driving, better than speaking, better than
    Xbox— he has that mindset down to a reflex. So why would
    you expect he’d use any other technique for any other life
    problems that come up? If all you are is an expert hammerer,
    everything gets hammered.

    The solution to your problem— and of course only 0.3% of


    you are true sex addicts, so I am now talking to those who feel
    a little ashamed at how much porn they use or about the
    ringwraiths they’ve bedded— is not to refrain— you can’t
    resist your desires forever. You must practice a new skill, you
    must become the kind of person who wouldn’t turn to porn
    when they are: lonely; horny; boredy. If you practice a new
    skill enough times, it will become second first nature, and you
    will be a different person. Please note that it is that last part,
    not the giving up of porn, that makes the change difficult.
    Giving up porn is easy squeezy. Becoming the kind of person
    who doesn’t need to use porn on Thursdays at 11:30p because
    that’s when you have a few hours free is hard.

    I’m supposed to say porn is bad for you and you shouldn’t
    start, but too late. And masturbating without porn is probably
    good practice for your brain, which is odd to say but in today’s
    world anything that requires more than 15 minutes of focused
    concentration is technically Olympic training.

    But the practical thing people do wrong with porn is put it in


    the Matrix: pretend to themselves it’s bad, pretend it’s not
    something they do, yet spend tons of time on it. So it drags on
    for hours. Accept it and lock it down to a specific length of
    time. You won’t feel nearly as ashamed.

    Wait, were we talking about Brandon not wanting intimacy?

    VII.

    There is a single remarkable insight in Shame, unfortunately


    buried in the midst of all the penis and vagina. The movie is
    called Shame, but there is a crucial instance of guilt: when his
    sister attempts suicide. (She survives.)

    For a man who didn’t notice he was dating a black woman, he


    is remarkably attentive in other ways; he walks onto a subway
    platform where police have blocked off a scene and magically
    he knows his sister has slit her wrists back in his apartment.

    How did he know? Because he feels guilty, and guilt is


    omniscient. You know it’s guilt because no one else would
    blame him for what she did, and yet he knows with total
    certainty that it was his fault, even though it wasn’t. Yet he
    knows it was.
    What he is actually feeling guilty about isn’t that he wasn’t
    there for his sister— that’s too easy to get out of— but that his
    commitment to his own life made him not be there for his
    sister. Anyone who has ever lost someone to suicide knows
    this feeling, and everyone else does not. The guilt, re-framed
    relentlessly, over the rest of your life: if I hadn’t been so into
    my work; if I hadn’t been so wrapped up in tennis; if I hadn’t
    been cheating on my wife; if I hadn’t been so religious; if I
    hadn’t watched TV every night and instead devoted that time
    to him; if I X, if I hadn’t Y.

    The truth is there is no real answer there, because when you hit
    the bottom of that devotional cycle you wind back up the other
    way: maybe if I had given him more space, if I had given him
    more time alone, if I hadn’t forced him to spend so much time
    with the family, if I had worked longer hours to teach him that
    life is work, or X…

    The only thing I’ve ever found that works, in the absence of a
    God who can forgive you, is to understand your guilt as not
    coming from the failing but generated by you as self-
    punishment, so that you can go on with the rest of your life.
    Have you suffered enough today? Then go have a Reuben,
    they’re tasty. You’ve earned it.

    The guilt always stays with you. Always. It never goes away.
    Never. I’m of course not saying you deserve it, but I know it is
    your inevitable tormentor. So either you reach some kind of
    stalemate with it or it beats you down. That stalemate is
    sublimation.

    In Brandon’s case it is that guilt which motivates him to try


    and change his life, so when he sees the married woman from
    Act I again on the subway he doesn’t get up to flirt with her.
    He lets her go, he has decided to be the kind of person who
    sublimates his sex drive to devote more attention to his
    whacky sister,. To being a better person.

    That’s one interpretation, anyway, but I am telling you now, it


    is the only one that will save you.

    http://twitter.com/thelastpsych
    Shame Is The Desired
    Outcome
    March 19, 2012

    do you see?

    Part 1 is here. If you’re from Metafilter, you should probably


    stop reading now. There are a few articles at McSweeney’s I’m
    sure you’d enjoy.

    VIII.

    If the movie was a straightforward Hollywood docudrama,


    you’d never hear about it unless you watch the Lifetime
    Channel . But— you heard about it. What did you learn from
    what you heard?

    IX.
    One of the big deals of this movie is the NC-17 rating, which
    you might expect for a movie about sex addiction. Except that
    there is nothing in this movie that would deserve an NC-17.
    There is way more nudity and sex in The Hangovers and
    Brandon’s date was never shown with jizz in her hair like
    Cameron Diaz.

    Maybe it was the penis. In an early scene, Brandon walks


    naked to the toilet. We see him from the living room,
    bathroom door wide open and back/butt to us, and you can see
    his penis hanging past his testicles as he is peeing. When he is
    finished peeing, he then closes the door to take a shower. This
    scene isn’t an accident: it took three takes.

    First question: why didn’t he pee in the shower like everyone


    else in NY? Maybe because he’s not a pig. Ok, second
    question: why close the door at all? Or, why not close it for
    both peeing and showering? In my freshman year of college I
    lived in a house with both XX and XY and everyone urinated
    with the door closed; but everyone then opened the door
    during a shower. Freshmen. The exhibitionism was a
    deliberate boldness, a dare, wrapped in the hope of sexual
    maturity that pretended to have forgotten to close the door. By
    senior year, however, everyone was showering and urinating
    with the door open because whatever.

    So the answer to why Brandon does it that way is: I don’t


    know. But I know why the movie did this: it wanted to show
    Brandon’s penis in a way that doesn’t make the censors go
    bananas. In a movie about sex, even a showering penis would
    be too sexual. To unsexualize a penis you have to show it
    peeing, which is why none of my freshman roommates ever let
    that happen.

    So the movie wants us to see the penis (voyeurism=tickets) as


    a source of envy— this is a perfect male specimen— but they
    want to make sure you don’t get too turned on. But there was a
    big penis showering itself back in Sex And The City II—
    Dante, played by that guy on Dancing With The Stars, and that
    was five years ago, and only rated R. So now the question is,
    why is Brandon’s penis, even peeing, so much worse than
    Dante’s SATC2 rated R penis?

    The answer is: you’re supposed to want actor Michael


    Fassbender’s penis, but not character Brandon’s penis. “This
    penis is very bad.”

    X.

    Take a look at Brandon. When media wants to depict a sex


    addict they depict the wealthy, the good looking, the powerful,
    the well hung. There are plenty of slimy basement dwelling
    janitor sex addicts out there, but they are represented as sex
    offenders. There are also plenty of gay sex addicts out there,
    but they are represented as gay. Both of you are dismissed, the
    world has no time for your nonsense. The sex addicts we see
    in movies and on the news are: rock stars, politicians, sports
    guys, CEOs. If you think about the demo primed to receive
    this depiction of lothario as sex addict— women over 35, i.e.
    the demo for Shame— sex addiction needs to be seen as
    terrible because it is terrible for them. It may also be terrible
    for the sex addict, but fuck you, we have a society to run.

    When you see the word “society” look ahead and to the right,
    psychiatry is in a window with its scope on you. Sex addiction
    rarely breaks laws so it can’t be punished, and there’s no God
    so the immorality of it is debatable, i.e. inconsequential. It
    must be a disease, that way other people don’t want to catch it.
    All psychiatric treatment of constructed syndromes isn’t about
    cure but about regression to the mean, where mean= cubicle
    drone. In other words, the point of offering Priapos treatment
    isn’t that the patient gets better— no one cares about him—
    but that everyone else watching understands what he did is
    deeply whacked, so don’t get any ideas.

    When a politician is exposed for enjoying the kind of


    penetration that society’s media arm has always promised is
    available to all— self-fulfillment, be yourself, she’s an adult
    and can make her own decisions, as long as it doesn’t hurt
    people it’s your choice!— what other prohibition does society
    have against him? Shame, aka psychiatric illness, that’s it. You
    can’t tell him it’s “wrong” to do what you’ve encouraged him
    and everyone else to do for three decades, which is why stupid
    people quickly turn to the default: “well, he lied about it under
    oath!” Oh, so that’s what makes him a sociopath.

    And maybe you’re a boring non-sex addicted male with a


    wife, two kids and a longing for a Chevy F10 Blazer so you
    don’t buy this sex addiction gimmick, “come on, that’s just an
    excuse!” and in that complaint you’ve met them halfway— the
    debate is about that guy, is he or isn’t he, and not about the
    existence of sex addiction. The system is perfectly happy to
    give Tiger Woods a doctor’s note if he’s willing to appear on
    TV saying he has a doctor’s note. Saying Tiger isn’t a sex
    addict means that there are sex addicts, and so you should start
    wondering whether your woman is wondering if you are one.
    Better erase your cache.

    the condom is there to remind you that it’s not about poor
    judgment
    When you make behaviors a disease, individuals lose and
    systems win, this is always true, they benefit in still being able
    to call something “shameful” without needing to take any
    responsibility for its creation. You’ll see this in surprising
    places, for example organized religion. You would think the
    church has a ready condemnation for too much casual sex yet
    it still calls it an addiction, not because millennia old religions
    are progressive but because if sex addiction is a disease then it
    can strike anyone, and that it seems to be particularly prevalent
    among deeply religious people from bin Laden to all of Utah,
    well, that’s just the bad luck of DNA, there’s nothing about
    religious institutions that both draw, and create, that pathology.
    And so you are free to speculate if the vow of celibacy has
    anything to do attracting the kinds of genetically predisposed
    sexual deviants disorder patients who would never be able to
    plug into the system normally on their own, but don’t you dare
    wonder if it is significant that so many Catholic priest
    molestations occurred not in a hotel or a van or a Dunkin
    Donuts but inside the church itself, no one is to ask whether
    the setting and the costumes were not incidental but integral to
    the satisfaction. And even as I write this I shudder at the
    possible significance of it. No. Biology and Jesus have no time
    for Freud’s lies. See you in church.

    The point here is not to be anti-religion, nor to claim that


    people who feel shame (not guilt) and disgust after their sexual
    experiences are not suffering. The point is to reveal that any
    individual’s suffering is secretly nurtured to maintain the
    integrity of the larger system. You’re expendable. Eat it.

    XI.

    The point of treatments of “shameful” behaviors isn’t to help


    you (though it might), but to give the system the right to
    decide what’s pathology and what isn’t. “It’s based on internal
    suffering.” No. No it isn’t. When they screen you for
    alcoholism they ask you about guilt, when they screen you for
    sex addiction they ask about shame. Do you know why?
    Because it’s not based on internal suffering.

    Here’s a backwards example: Tucker Max. His most recent


    book has more sex in one chapter than all of Shame. The
    problem is he seems to enjoy it. Is he a sex addict? Not yet,
    but he damn well better be.

    the other Radiation King

    Right off, Tucker Max, and Brandon, represents a problem for


    society: Tucker is a reasonably attractive male with a law
    degree and money who has not only not plugged into the
    system as required, he’s circumvented it for his own purposes
    — and then publicizes it. If he was an overweight cart fetcher
    at the A&P with a cleft palate and a strabismus his sexual
    exploits would conceivably be even more amazing, but no one
    would care because the threat to society (as distinct from his
    entertainment value) would be nil. This is also why no one’s
    made a movie about TyJeezey and the 500 baby mommas he’s
    slept with. TyJeezey and Cart Fetcher aren’t relevant to society
    — people like them passing on matrimony and Rocking The
    Vote would be a miniscule problem easily handled by giving
    them SSI. Ta da, now you’re invisible. But Tucker Max can’t
    be fired, and unless people stop buying his books he won’t
    become invisible. If more people like Tucker— e.g. educated,
    attractive, wealthy, and public— opt out, the whole thing falls
    apart.
    The typical way sex addiction is packaged by the media is to
    show all the harm that comes from it, i.e. self-loathing, i.e.
    AIDS, i.e. divorces, i.e. suicide, i.e. murder, i.e. heroin, i.e
    Shame. Unfortunately for the system, the Tucker Max Trilogy
    doesn’t involve any of these, but the narrative desperately
    awaits them, wants them, which is why you can be certain that
    if his fall ever comes, no matter how it comes, it will make it
    to the front page of Gawker. Then he could be a sex addict (or
    bipolar, or etc); but without the fall, he cannot be a sex addict
    or bipolar or etc. So while America waits for the rape charges
    or the racist voice mails to his Russian girlfriend, on to plan B.

    Plan B is: instead of shaming him, shame you.

    If his only audience was college men no one would have a


    problem with him because then he could be dismissed as
    wishful thinking, i.e. what keeps the college boys from
    following his lead is the implicit criticism that if you like
    Tucker Max, you must be a loser who can’t get girls, or a
    rapist (reinforced by e.g. a story that is entirely about Tucker
    Max yet has nothing to do with him at all.) Unless your
    identity is already well established, known, you can’t risk
    someone “misinterpreting” your liking him, so people try to
    put some distance between them, which is why every time
    someone writes anything positive about Tucker Max there’s a
    disclaimer: “love him or hate him…” “he’s a rude, disgusting
    misogynist, but…”

    That’s the trick of Shame. “He’s an attractive, wealthy, guy


    with a big penis (did you see it, ladies?) but he’s not using it
    properly…” Brandon’s sex addiction makes him very un-
    desirable, no one watches Shame and says, “wow, I want to be
    Brandon” and no woman says, “wow, I want to be with
    Brandon.” The opposite is true for Tucker Max, who is
    popular with women, especially the very women that he
    “degrades.” Now what does the system do?

    There’s only one thing it can do: say that these women don’t
    know better, that they’re broken women from broken homes…
    that they’re not real women. Note that if this were true you’d
    think someone would want to help them, educate them, elevate
    them, but it doesn’t want to “treat” them, it only wants to
    “diagnose” them as a warning for everyone else. In other
    words, the system sacrifices them. They’re expendable. Eat it.

    The sad paradox of this system is that on the one hand it hates
    Tucker Max et al for how they degrade women, but on the
    other hand hates those very women even more for liking him.
    He’s a human you hate, but you hate them as a group.
    Surprise: your misogyny > his misogyny. You should hang that
    above your bed, especially if you are a woman.

    I will delicately avoid all jargon: this is understood as a)


    defining yourself based on who you hate (“I’m not like those
    sluts”); and b) secretly believing that only you have— deserve
    — free will, other people (Tucker Max, the women who like
    Tucker Max) are just too dumb to handle it. I could say that
    that a) and b) are causes of totalitarianism or characteristics of
    narcissism, but it’s more useful to say that a) and b) are why
    you are not happy, and it’s more useful because that’s the only
    thing you really care about anyway.

    X.

    Back to Brandon. What Brandon doesn’t realize is that his


    movie is inseparable from the commentary that comes with it,
    it relies on it. In fact, the movie itself is less relevant than the
    commentary, the movie is an excuse for the commentary. You
    lose or gain nothing by knowing that Tree Of Life‘s brother
    committed suicide when he was 19, but it is absolutely vital
    that you— you who saw it and especially you who didn’t—
    know that Brandon is a “sex addict”, i.e. bad, i.e. not the
    system’s fault for demanding you consume but only the right
    amount, i.e. don’t get any ideas.

    If you weren’t told he was a sex addict, what would you have
    thought Brandon’s problem was? That he was mean; that he
    may have had sex with his sister; that he was cold, distant, and
    infinitely narcissistic; that he watches cartoons; that he had a
    crazy sister. You would have looked at the sex as a convenient
    way of escaping those things, as a consequence of those
    things, and maybe you would have lingered long enough on
    his furtive attempt at a normal relationship to ask whether the
    pathology wasn’t there and not 15 minutes later with the
    hooker. But you were told you were seeing a movie about sex
    addiction, of how sex addiction destroys your life, so the
    Marianne debacle and the cartoon watching was to be
    understood as a consequence of that addiction. But “sex
    addiction” wasn’t what wrecked his life at all. Do you believe
    if he refrains from porn he will be happy?

    To make sure you never consider this, they tell you upfront the
    context in which you are to understand this movie, even and
    especially if you never actually watch it. Fortunately for
    Brandon he’s just a fictional character and doesn’t care about
    being used as means of social control. He’s expendable, but,
    let’s not forget, so are you. Eat it.

    http://twitter.com/thelastpsych
    What’s Wrong With The
    Hunger Games Is What No
    One Noticed
    April 2, 2012

    guess what happens next

    When a media universally misses the point, it’s on purpose.

    I.

    Rue is a little girl in The Hunger Games, and in the movie


    she’s played by a black girl. According to Jezebel, Racist
    Hunger Games Fans Are Disappointed.
    Well, six people are, anyway.

    There’s an underlying rage, coming out as overt prejudice


    and plain old racism. Sternberg is called a “black bitch,” a
    “nigger” and one person writes that though he pictured
    Rue with “darker skin,” he “didn’t really take it all the
    way to black.” It’s as if that is the worst possible thing a
    person could be.

    So there are some racist fans, so what? In itself, why would


    this be surprising? There are racists everywhere. I once asked
    a black guy where I could find some racists and he punched
    me in the mouth, turns out I’m a racist. Who knew? Actually, I
    did, because every time I see a black guy do anything odd I
    say to myself for no reason at all, “oh, hell no, oh no you
    didn’t.” This is going on in my head, silently, no audience.
    Apparently not only do I see race, I hear it. And god forbid it’s
    a black woman, my neck and skull actually start moving from
    side to side as I think, “mmmm hhhmmmmm!” Why do I do
    this? I don’t talk like that. So much for individuality, so much
    for free thought, I am so polluted by the world that my reflex
    thoughts are someone else’s. You don’t even want to know
    whose thoughts I think when I see boobs.
    Of course, if this racism was attached to a Transformers movie
    you can be sure that Jezebel would pronounce all of the
    Transformers audience racist. But in this case, it’s only some
    of the audience who are racist, because progressive Jezebel
    likes The Hunger Games, and they’re not racist. How can they
    be? They’re post-feminists, i.e. the racism for Jezebel is
    merely an opportunity to criticize the bridge trolls who live in
    Central Time, just in time for the elections.

    Most of the “racist” comments I’ve seen about this complain


    about the race from a anti-Hollywood, anti-left perspective,
    i.e. “there goes liberal Hollywood, pushing the liberal
    agenda.” The complaint appears to be not that they don’t like
    black characters in general, but that this was some
    underhanded move to use the story to promote a political
    agenda, like making Sherlock Holmes a gay action hero. Now
    that’s just wrong.

    If that’s the case I don’t completely fault them, the story is


    important to these girls/women, and they feel betrayed that
    someone alters it to suit their interests rather than give a
    faithful telling of the story, which, as happens to stories,
    become partly owned by the audience.

    The point here is not whether Rue should be black or not.


    What’s interesting is how Jezebel seized on the racial
    controversy, but completely avoided the one bludgeoning them
    in the face for two hours: this is a book for females, written by
    a female, with femalist themes, gigantically popular among
    females, yet is more sexist than a rap video.

    II.

    Everything that’s terrible about THG is in this sentence:

    Hunger Games was written by a woman and stars a


    woman (much as we love JK Rowling, her series isn’t
    named after Hermione) — making it a true lady-centric
    blockbuster franchise.

    Here’s your first point of irony: this true lady-centric


    blockbuster franchise isn’t named after Katniss, it’s named
    after what happens to Katniss, which is why it is truly a lady-
    centric franchise.

    How would you classify this book/movie’s genre? Is it an


    action movie with a female twist? Is it a love story? A drama?
    Sci-fi?

    No. It is a fairy tale.

    III.

    We can start with the obvious. The book is about 24 kids


    thrown into an arena to fight to the death, only the toughest,
    the most resourceful, the strongest will survive, and it better be
    you because your whole village depends on it. It is such a
    scary premise that there was some concern it was too violent
    for kids to watch. Well, big surprise: Katniss wins.

    Hmmm, here is a surprise: Katniss never kills anyone. That’s


    weird, what does she do to win? Take as much time as you
    want on this, it’s an open book test. The answer is nothing.

    This is not a criticism about the entertainment value of the


    story, but about its popularity and the pretense that it has a
    strong female character. I like the story of Cinderella, but I
    doubt that anyone would consider Cinderella a strong female
    character, yet Katniss and Cinderella are identical.

    The traditional progressive complaint about fairy tales like


    Cinderella is that they supposedly teach girls to want to be
    princesses and want to live happily ever after. But is that so
    bad? The real problem with fairy tales is that the protagonist
    never actually does anything to become a princess. Forget
    about gerrymandering or slaying a dragon or poisoning her
    rivals: does she even get a pretty dress, go to the ball and
    seduce the prince? Those may be anti-feminist actions, but at
    least they are actions. No. She is given two dresses, carried to
    the ball, and the Prince comes and finds her. Twice. Her only
    direct and volitional action is to leave the ball at midnight, and
    even that isn’t so much a choice as because of a threat. (1) The
    clear problem with this isn’t that girls will want to hold out for
    a Prince, but that it might foster the illusion their value is so
    innately high that even without pretty clothes or a sense of
    agency a Prince will come find them. Sleeping Beauty and
    Snow White are worse: they don’t even have to bother to stay
    alive to get their Prince.

    The Hunger Games has this same feminist problem. Other


    than the initial volunteering to replace her younger sister,
    Katniss never makes any decisions of her own, never acts with
    consequence— but her life is constructed to appear that she
    makes important decisions. She has free will, of course, like
    any five year old with terrible parents, but at every turn is
    prevented from acting on the world. She is protected by men—
    enemies and allies alike; directed by others, blessed with lucky
    accidents and when things get impossible there are packages
    from the sky. In philosophical terms, she is continuously
    robbed of agency. She is deus ex machinaed all the way to the
    end. (2)
    For example, though this is a story about kids killing kids,
    somehow Katniss never actually plans and executes any kids,
    she’s never guilty of murder one. She does kill Rue’s
    murderer, but it was reflexive, a defensive act. Importantly, she
    does not choose NOT to kill, she does not choose a pacifist
    position, she explicitly states twice in the book how much she
    wants to kill. But she never does it. She tries to kill big bad
    Cato at the end, twice, and fails. Only after he is torn to shreds
    by mutants does she perform a mercy killing on him, at his
    request. In other words, she doesn’t choose to kill or not kill—
    it doesn’t come up. (3)

    The story goes out of its way to prevent her from having to
    make choices and especially from bearing their consequences.
    Events unfold in such a way that it appears she made a choice,
    but decisions are actually made for her. At the end she and
    Peeta, her kinda-boyfriend, are the last two contestants left.
    Only one can live. What should happen next? Does she kill
    him? Or let him kill her? Think about it, what does she
    choose? Remember, this is about a strong female character
    forced to play a killing game. Wait— never mind, they change
    the rules at the end: everyone’s a winner!

    “But she chooses to commit suicide at the end!” That would


    have been a choice, but the book robs her of that as well, this
    is the point. The book does not allow her to make irreversible
    choices, it lets her believe she is making free choices and then
    negates them, again, just like a five year old girl with terrible
    parents.

    She does commit one consciously deliberate act, and it’s quite
    revealing. At the end of the book, she’s ambivalent about
    whether she loves contestant Peeta. But the Games allowed
    two winners only because they appeared to be in love; so all
    she has to do, for the cameras, is pretend to be in love with a
    boy she already likes a lot. But after all she’s been through in
    the arena, this— what is coincidentally called ACTING— is
    what is described, in the shocking last sentence of the chapter,
    as “the most dangerous part of The Hunger Games.”

    This is not hyperbole. This is literally correct: for someone


    who has not ever done it, acting with agency would indeed be
    dangerous. But those stories aren’t fairy tales, those stories are
    legends.

    III.

    That the book is successful or exciting is not the point here.


    What’s fascinating/horrifying is that this fairy tale has
    managed to convince everyone, especially people who
    consider themselves feminists, that it represents a form of
    female empowerment when it is exactly the opposite. What
    you should not underestimate is how deliberate this magic
    trick is. This is society successfully pretending to change so
    that nothing changes. The goal is making the other team
    contribute to their own oblivion. The goal is status quo.
    The classic feminist example of “robbed of agency” is the
    woman who “chooses” to wear makeup, do her hair,
    display/hide the right amount of cleavage. Is she choosing this,
    or is society imposing this false choice on her? Because if she
    feels she has to do it in order to land the account, then it’s not
    really her choice. Hence a controversy about agency.

    What makes this such an impossible, lose-lose situation for a


    woman is that this choice isn’t about “what to do” but about
    who she is, what society wants a woman to be: while she must
    make herself look pretty, if she is observed doing this she is
    immediately and simultaneously critiqued for being vain. The
    decision about whether to be or not to doll herself up is thus
    somewhat up to her, but the judgment about whether she is
    vain is entirely out of her hands— it is a judgment imposed on
    her for doing exactly what is expected of her. Her only hope is
    that she is can make herself look pretty enough that it looks
    like it was not on purpose, i.e reveal the results but hide the
    process. (4) This manipulation of her is all deliberate design—
    what society actually wants is that it gets her to be pretty,
    demarcates her as an object to be gazed upon— but not bear
    any of the guilt/responsibility for forcing her into this. If it
    works and you are pretty I guess that’s some consolation, but
    imagine if you’re not pretty but still have to go through all
    this, suspecting but never admitting that everyone is going to
    think, “why’d she even bother?” Being pretty is in many ways
    worse, because you’re not only competing with other pretty
    women but with yourself (“you look tired today”) and, as the
    old saying goes, a beautiful woman dies two deaths. But
    before you go try some of our Nivea skin care products. That’s
    the system, it wants you to participate in your own
    marginalization so you don’t dare unplug. It’s exhausting
    being a chick. I mean girl— woman. Jesus. (5)

    Though this is an example of the feminist agency problem,


    you should note carefully that the “society” that forces this
    false choice on women is actually other women, not men, and
    it starts with the overly invested way mothers reproach their
    daughters to “dress like a lady.” Certainly the original energy
    for this madness comes from men, from “the patriarchy”, but
    if every man was executed tonight nothing would change
    tomorrow. It’s on autopilot. Case in point: this story of a girl
    robbed of agency was written by a woman.

    So this is why we have a book about a post-apocalyptic killing


    game that spends zero pages describing how Katniss kills
    anyone but spends countless pages on how she is dressed, how
    everyone is dressed. What will she wear? What kind of
    jewelry? Hair up? Will the “sponsors” like her better this way
    or that? Her chief weapon isn’t a bow, it’s her appearance.

    This is also a good place to observe that the real life, pre-and
    post movie release controversies about The Hunger Games
    have also been about physical appearances— not just race, but
    is Jennifer Lawrence too tall? Hair too blonde?

    That’s why The Hunger Games is such a diabolical head fake.


    Forget about it being entertaining, which I concede it is. It has
    managed to convince everyone that a passive character whose
    main strength is that she thinks a lot of thoughts and feels a lot
    of feelings, but who ultimately lets every decision be made by
    someone else— that is a female hero, a winner. You wouldn’t
    allow yourself to like a story where the woman lacks agency,
    so it’s clothed in a vampire story or a female Running Man so
    it sounds like she’s making things happen. Or, if you prefer, in
    order to allow you to like an anti-feminist story, it is necessary
    to brand it as a vampire story or a female Running Man.
    Regardless of how you phrase it, the purpose is to get you to
    like this kind of a story. It wants you to think this is the next
    step in female protagonists. But it’s a trick: nothing has
    changed since the royal ball.

    That these “adolescent girl” stories— Twilight and THG—


    have women who are essentially lead by men, circumstance,
    and fate— whose main executive decision is “do I love this
    guy or that guy”— is a window on our culture worth
    discussing. When you have a daughter, your first question
    should be, “how is the system going to try to crush her?” and
    plan accordingly. This story’s answer is, “no matter what
    happens, just talk a lot and it’ll sort itself out.” That Jezebel is
    distracted by the racial angle here strikes me as an
    unconsciously deliberate avoidance of the larger issue. Oh, the
    audience is racist, that’s the problem.

    http://twitter.com/thelastpsych

    –––––—

    I. The threat is not that her coach will become a pumpkin. It is


    “the longer you stay, the more likely you will be detected to be
    a fraud.” This is a critical childhood anxiety (which is why it is
    in a fairy tale), a narcissistic anxiety, and a feminist anxiety.
    The only thing she has to offer are her looks, and those are
    artificial (makeup and clothes) and transient. Eventually, the
    botox wears off. Tellingly, it cannot occur to Cinderella to
    even anti-feministly use her boobs to seduce the Prince and
    then win him over with her charm/grace/personality. Ultimate
    decision and action is always someone else’s (godmother,
    Prince, etc.)

    2. To reinforce this point, consider that “deus ex machina” is


    translated, “god from the machine” where machine= people
    who made the story. So not an act of god, but rather the author
    putting a god into the story to affect things; the important
    implication is that it is not random but deliberate. So when
    Katniss’s potential victim happens to be wearing body armor,
    it is not an accident that Katniss couldn’t kill him, or dumb
    luck, it was the deliberate intention of the author not allow
    Katniss to kill him.

    The purpose of deus ex machina in ancient stories was to place


    the final reconciliation at the spiritual level: God saved you,
    time to commune. But since Nietzsche said there is no god,
    “deus ex machina”= man, for the purpose of delivering earthly
    prizes. This is the essence of the fairy tale— as magical as
    they may be, the end result is always an earthly reward
    (marriage, riches, survival) and never a spiritual one. Hence,
    fairy tales are vital to the religious and non-religious children
    alike because they act as a bridge away from spiritual to
    earthly (“time to grow up”)— the child’s imaginary world
    directed away from more imagination and towards the
    practical; or, in other terms, away from the Imaginary towards
    the Symbolic.

    3. So if Katniss tries to kill someone, and fails, she has agency;


    but if I, the reader, can predict that at no point will she actually
    kill anyone because I can tell the author doesn’t want to put
    her into such a position— and then she tries to kill someone
    and “fails”, then Katniss lacks agency. Note that the person
    who is aware that he has free will feels as though he lacks
    agency (“it doesn’t matter what I do”) becomes either
    depressed or paranoid, or both.

    4. An interesting exception is hair coloring. The brunette who


    dyes her hair blonde isn’t trying to look Swedish, the point is
    to make sure everyone knows it’s artificial because it’s a
    signal: I don’t want blonde hair, I want to be a <<blonde>>.

    5. An example of this and Lacan’s partial object is the 40


    something woman who looks in the mirror and decides that
    her entire sexuality is in a single special part of her, say, her
    butt— so she diets to make the butt look good at the expense
    of bony shoulders and a gaunt face. Men sometimes do the
    same to their spouses, empowering a single body part of hers
    with all of the sexuality, e.g. looking at the calf or the hip bone
    doesn’t simply remind him of the 20 year old version of his
    wife, but becomes the fetish that replaces the long gone 20
    year old version. But this isn’t illusion or delusion, he is not
    imagining what his wife looked like, the single body part is
    enough to generate arousal, in the same way that any fetish
    (specific kind of shoe, or a foot, or a piece of lace) is entirely
    sufficient. The problem is that this doesn’t make the woman
    look hotter, it replaces the woman, so now neither the 20 year
    old version nor the 40 year old version are necessary.

    The extreme of this logic is in anorexia, where the whole body


    is sacrificed in order to get “thin”- but because the thinness
    isn’t directed in a body part but in an idea, a feeling, they still
    wear baggy clothes not to hide their fat but to hide the
    collateral damage of emaciation to their body which they are
    completely aware of. They know other people think they’re too
    thin, they know “87 lbs” is a small number, but the anorexic is
    trying to control an idea. “I can see that my shoulders are
    sticking out, I know everyone can see my ribs, but yet I know I
    am horrifically fat.” The control, the act of not eating, is the
    special body part; it is the obsessed-over fetish that exists for
    its own sake.

    Addendum: if you don’t know how to read, you should


    probably click this.
    The Hunger Games Is A
    Sexist Fairy Tale. Sorry.
    April 10, 2012

    this isn’t going to have a happy ending

    You should probably read this first.

    I.

    Housekeeping: it’s legitimate to accuse me of being drunk or a


    terrible writer, both are true. But you can’t say I didn’t read the
    book and didn’t see the movie. I know I did, I was there.

    When I say Katniss was continuously robbed of agency, that’s


    a simple fact. Let’s examine the commonly cited
    counterexample that she killed two people by dropping a
    hornet’s nest on them. Didn’t that require her to plan and act,
    to know the consequences? Isn’t that agency?

    Chekov famously said “If in the first act you have hung a
    pistol on the wall, then in the following one it should be fired.
    Otherwise don’t put it there” but the flip of that is that if you
    don’t put a pistol on the wall in the first act, you can’t
    suddenly have the main character find a pistol on the wall.
    Unless you’re writing a fairy tale.

    So when Katniss is desperate, trapped in a tree, and has no


    recourse— and suddenly someone points out that there is this
    immensely lethal object right next to her, maybe it’s a hornet’s
    nest and maybe it’s a thermal detonator— so the story then has
    to take a three minute pause so an omniscient narrator can
    explain to the audience what it is because we had no
    knowledge of this before, “oh, it’s magic bees,” then there are
    only two possibilities: 1. Deus ex machina. 2. It’s a terribly
    written story. I favor 1, but I’m open to 2. Oh, and it kills
    everyone but Peeta, that’s lucky.

    II.

    The standard adulation for The Hunger Games is that it has a


    strong female protagonist who is, and I quote, “a badass.” Is
    she more of a badass than Alice from Resident Evil? Come the
    zombie apocalypse, do you go Team Katniss or Team Alice?
    Not who it’s cooler to say you’d pick; assume you have a 5
    year old daughter with one hit point left whose life depends on
    your selection. Because I’m arguing that it does.

    actual badass
    Obviously you go with Alice, which is also why she isn’t
    popular among women: There’s no aspiration, no wish
    fulfillment, it’s too fantastic, too impossible because Alice is,
    in fact, a superhero. It’s not real.

    But Katniss isn’t a superhero, and “women can identify with


    her.” Ok, which part? She isn’t better than her competitors.
    Thresh is still tougher, Cato faster, Foxface more ninjalike, etc.
    And to reiterate, Katniss is carried through the movie by deus
    ex machina or continuously saved by other people. So why is
    she a badass and not, say, Peeta, who spends the entire movie
    sacrificing himself for her?

    I want you to pick one single scene that you think best
    epitomizes her badassness. Got it? You sure? Take a moment.
    The one scene you’d show your friends. “Check this out:
    badass.”

    Is it any of the scenes displaying her spectacular inability to hit


    moving targets at close range? No? But it has something to do
    with the bow, right? Otherwise these wouldn’t exist:
    I’m not a hater, follow the logic. Nothing she does makes her a
    badass. What makes her a badass is that men underestimate
    her. If you don’t believe me, what scene did you pick? The
    same one the audience did, the one that made them cheer the
    loudest, “wwoooooooohhhh!!!!!!”

    There’s a banquet and the contestants have to show off their


    skills, but the overlords are eating a roast pig and bored with
    Katniss (because she misses a target) so Katniss turns her
    arrow towards them and shoots an apple. Katniss says, “you
    better recognize, mothafuckas!”, flashes a gang sign, and the
    audience swoons. That’s when she’s a badass. Yes, she was
    wonderful in the Games, I’m sure, but what got your
    adrenaline going, what made her a badass, is showing off her
    abilities— to men. That’s why more than half of this movie
    takes place before the Games— it’s all about showing what
    you can do, showing your capabilities. Badass = showing she
    can compete on a male level. (1)

    In the actual Games, Katniss is continuously saved by men—


    Haymitch, Peeta, Peeta again, Thresh— but you don’t notice
    that she saves no one, including herself, you think she saves
    herself all the time. You think this because of the first half of
    the movie told you she’s a badass, so you don’t realize that
    during the second half she shows less agency than Princess
    Jasmine.

    And the reason why showing off— or, as the movie ever so
    subtly puts it, “showing them up”— is so important is that
    women still secretly believe they are inferior to men. I know
    most of you aren’t going to want to hear that, and, indeed, the
    vast majority of you will woefully willfully misquote me as
    having said, “women are inferior to men,” but that’s because
    your brain is broken. I read the book. You need to read with a
    highlighter.

    Haymitch, played by a man, says this to a woman, played by


    Katniss:

    You know how you stay alive? You get people to like
    you. Oh, not what you were expecting?

    No, unfortunately it’s exactly what I was expecting. Thanks


    Dad.

    II.

    If you are angry at me you are not reading your own words.
    This is bigger than Katniss, this is the state of human progress.
    If it helps, imagine you have a five year old daughter you have
    to raise in the midst of aspirational images with long legs and
    no power of agency, and your worry is no longer “will she
    grow up and find a job?” or even “will she grow up and get
    married?” but “will she be so conflicted about herself that she
    is unable to choose a career or pick a nice man from the
    hundreds of options that present themselves to her because she
    is ever anxious that any choice is the wrong choice because
    she only gets conflicting messages from everyone on earth?”
    That’s the world I’m stuck in, and though I haven’t burned a
    bra in years I do somewhat rely on feminists to nudge the bar
    consistently higher so my theoretical daughters don’t have to
    rely on penis or Prozac to live happily ever after. So where my
    girls at? I found about a million fawning feminist reviews of
    The Hunger Games which all contain some version of this
    paragraph:

    Katniss, in this season of woman-hating, is a stunning


    example of feminism at its finest hour. She is
    compassionate, yet strong. She cares deeply about her
    family. While she is tempted to run away with Gale,
    instead of leaving her sister and mother to fend for
    themselves, she stays to support them.

    Lord have mercy on all our souls, I’ll take my chances with
    Alice and a zombie attack. None of those things are feminism,
    those aren’t even praiseworthy. Those are basic, ordinary,
    unremarkable characteristics of every reasonable human being
    for 6000 years, and all animals. But that’s the bar the reviewer
    has set for Katniss, for feminism. That’s the fantasy world
    she’d like to see women eventually get to. So either a) she has
    an unconsciously cynical view of women in general; or b) she
    has been tricked by the system about what it is to advance as a
    woman, i.e she’s in The Matrix. Here’s the problem: she’s a
    woman. She represents women. She is a feminist, but she does
    not see that Katniss is allowed to exist precisely because she
    isn’t a threat to men but women can think she is. If I was a 15
    year old girl, and I’m not saying I’m not, then what is being
    communicated to me by the feminist praise of this book is that
    my future expectations are low. Maybe— MAYBE— if I work
    real hard I might someday surprise a boy, “wow, I never
    would have guessed!” Can’t wait till I grow up.
    III.

    The feminists missed this, all of this, and it is their job not to
    miss this. What they yelled about is the racism of a small
    audience, to avoid facing the sexism in themselves. And, by
    the way, the racism in themselves: Jezebel jumped on the
    racism against black actors because they are stupid. I’m sorry,
    that’s just the way it is. Do you know why Thresh doesn’t kill
    Katniss but instead lets her go? Because Thresh is black.

    The boy tribute from District 11, Thresh, has the same
    dark skin as Rue, but the resemblance stops there. He’s
    one of the giants, probably six and half feet tall and built
    like an ox.

    Black guy= strength, so his letting her go is a signal of her


    value as a temporary equal. This is a repeat of the 1980s trope
    that a (white) weakling being bullied winds up being saved by
    black gang members: “Eugene is a friend o’ ours, so we best
    not hear no mo’ trouble.” Thresh doesn’t happen to be black,
    Thresh is intentionally black, a stereotype, for that scene to
    occur, because to a white woman, no one knows the value of a
    person’s life better than a slightly retarded giant homicidal
    black guy. “He’s bad, but he has a internal code of honor.” Oh.
    You know you’re stupid, right? In other words, the racists in
    Central Time are less racist than Suzanne Collins. Bet you
    didn’t see that coming. Which is my whole point: no one saw
    any of this coming, they saw a woman with a bow and flipped
    the hell out. Katniss is a role model for girls like Thresh is a
    role model for blacks. I look forward to your deranged
    responses. (2)

    Katniss lives in a patriarchy, sure there are some women but


    they look completely insane, which trivializes them. Odd that
    no feminists noticed that. They are all wicked stepmothers— a
    problem, but not the problem. The problem is all the men with
    all the power, and any women who have power have it only
    because they are hooked up with more powerful men. Katniss
    seems like a lone hero, outside all this, but she she always
    defers to that patriarchy, and relies on it, operates within the
    rules of the society but, and this is what makes her a
    “badass”— she tests limits. Postures for the cameras. Says the
    right things, but says them with a slightly rebellious inflection.
    Feels like 15 again.

    Deconstuctionists like to ask easy questions like, “why is a


    story for 15 year old girls so popular among middle aged
    women?” They asked this about Twilight, too, but it’s not at all
    surprising that these books are popular among middle aged
    women who still secretly believe women are second behind
    men. Not in terms of theoretical potential, perhaps, but they’ve
    grown up in a world with enough experiences that they can’t
    shake it. It’s still a man’s world.

    The real question is why it’s popular among 15 year old girls?
    15 year old girls should, in theory, have grown up without
    1970s sexism. Schools are hypervigilant about fostering girls
    development, and there are enough female everythings that it’s
    not remarkable that there are female anythings.

    And yet here we are, teen girls are reading fairy tales. This
    book should not resonate with 15 year olds, not this much.
    Which means that these girls are still getting sexist signals
    from somewhere, and, follow the trail, those signals came
    from the 40 year old women who like the story, i.e.
    “feminists.” This is what I mean when I say the system no
    longer needs men to maintain the status quo: it has feminists
    doing the job for it.

    Please, please, don’t misunderstand me, I have nothing against


    The Hunger Games, it’s an entertaining story, I am not
    criticizing the book, I am criticizing you. If it won an Oscar or
    the world declared this the next Star Wars and made action
    figures and lunchboxes I wouldn’t say a bad word about it,
    what’s it to me if it makes people happy? Enjoy what you like,
    it doesn’t have to have deep meaning to be worthwhile.

    But what makes me reach for the now empty bottle is how
    women have convinced themselves and each other that this is
    a pro-feminist story. Do you not see what is happening? You
    are being lied to, by yourselves.

    http://twitter.com/thelastpsych

    1. See also Katy Perry‘s empowerment represented by training


    with the Marines.

    2. Oh boy. Yes, Thresh is retarded. In the movie this is not


    revealed at all— probably because the poor director couldn’t
    take it anymore, but in the book he has stilted speech, limited
    vocabulary, one word answers. The alternative interpretation is
    that English isn’t his native tongue— i.e., he is a giant, black,
    cotton picking, immigrant. I’ll let you decide which
    interpretation is worse. None of this occurred to anyone?
    Outstanding.

    More on the future of feminism here.


    Why We Love Sociopaths
    April 24, 2012

    according to this, it’s sociopaths that we love

    “My greatest regret is I’m not a sociopath,” starts an article


    written by……. well, I reserve judgment. “Are you
    suggesting…?” No, not at all. That’s where the truth lies.
    “Wait— ‘lies’ as in–-”

    This article is important for a specific reason. If you follow the


    thesis that The Atlantic and The New Yorker set the default
    ways which we understand social issues, e.g. sex, money and
    politics— and they do this even if you don’t read those
    magazines— then Kotsko and others like him set the default
    understanding for academic types. This doesn’t mean everyone
    agrees with him, no no no— it means that he sets the frame.
    The trick is you will argue his conclusions but it will be
    impossible for it to occur to you to argue the form of the
    question. So “why do we love sociopaths?” is literally
    understood: “since it is a fact that we love sociopaths, why?”

    II.

    Kotsko’s thesis is that we love sociopaths because sociopathy


    is opposed to social awkwardness. Say you’re in line at the
    store and some jerk cuts in front of you, on purpose, and for
    the sake of clarification let me observe he has a Celtic cross
    tattooed to his shoulder and he just had sex with your
    girlfriend. He’s a different kind of person than you. He can do
    things you can’t, do women you can’t, he sees the world’s
    rules differently, which specifically means he understands that
    there are no “world’s rules,” that rules are decided by those
    with power for their own benefit. After he cuts in line, he
    pockets a Milky Way bar because, well, because he got away
    with it. My grammar is correct: he can do it since he got away
    with it.
    Ultimately, the only thing you have over him, as you seethe
    expressionlessly with your 15 items or less, is sleeves and the
    feeling that you’re not a jerk.
    The media offers us our wish fulfillment by creating characters
    who are “good” sociopaths that we can safely envy, and
    “good” is defined by The Atlantic as “has an internal code of
    ethics” and by anyone else as “makes it up as he goes along.”
    TV sociopaths— Don Draper, Tony Soprano— seem to be like
    that guy. They do what they want and aren’t bothered that you,
    a loser, think they’re a jerk. The difference between you and
    them, according to Kotsko, is that they manipulate the social
    connections whereas you are mired in them. They can detach,
    you can’t. Your only compensation is that you have moral
    superiority.
    But at some point in the breakdown of capitalist society— it
    says it right on the cover of his book— that moral superiority
    isn’t enough. Are you not a person who works hard and plays
    by the rules? You still want to have nice things, you still want
    to get nice women, you still want to feel some power, which in
    a normally functioning society you would be able to get in
    your own natural way. But when there’s unemployment and
    debt and your wife leaves you, and it looks like these are
    happening because the social contract has failed, because jerks
    are taking from you, those real losses aren’t sufficiently
    compensated by “at least I’m not a jerk.” Extend that to Wall
    Street stealing your savings and feeling no shame, having no
    punishment, and all we can do is pretend that our moral
    superiority is enough compensation, and of course it isn’t.
    Hence the aspirational images of TV sociopaths. How great
    would it be to just…

    If only I didn’t give a fuck about anyone or anything, we


    think—then I would be powerful and free. Then I would
    be the one with millions of dollars, with the powerful and
    prestigious job, with more sexual opportunities than I
    know what to do with.

    III.

    Kotsko has it backwards.


    “If only…..” Look deep. There is no if only. They already
    don’t “give a fuck.” No one who wishes they could be like
    Tony Soprano or Don Draper actually cares about anyone. “I
    care about my mom.” No you don’t. You’d be sad if she died,
    of course, but you do not care about her, and I don’t need to
    provide any examples for you to know this is true.
    The “social contract has failed” argument is a rationalization.
    What’s troubling them is that they already don’t care at all, but
    they still aren’t able to manipulate people the way Tony does.
    This is reinforced by the sentences that immediately precede
    “If only…”:

    If we feel very acutely the force of social pressure, they


    feel nothing. If we are bound by guilt and obligation, they
    are completely amoral.
    Point to the guy who is both “bound by guilt”— not shame,
    but guilt— and also wants to be Tony Soprano and I’ll show
    you a person who doesn’t exist.
    To be correct, Kotsko’s sentences should be revised: “what the
    hell is wrong with me that I am exactly like Tony Soprano in
    every single way, except on execution?” Amoral and impotent
    is different than amoral and potent, but you’re a jerk both
    ways.
    This is how I know that anyone who says, “If only I could live
    in Mad Men time where you could pinch a girl’s ass and not
    get in trouble for it” is going to be way disappointed if a
    TARDIS shows up, because they wouldn’t pinch them back
    then, either, not because they are afraid of trouble but because
    they are afraid of girls. Exhibit A: you know what a TARDIS
    is.
    In a sentence, the problem with his Kotsko’s analysis is that it
    isn’t a description of the pathology, it itself is the defense
    against a hidden pathology. Not: because Wall Street steals and
    we have no justice, we begin to admire sociopaths. But:
    because we admire sociopaths, therefore Wall Street is able to
    steal. Not: because the social contract has unraveled, therefore
    we wish to be sociopaths. But: because we are sociopaths,
    therefore the social contract has unraveled. I know this is a
    very unpopular thing to say, but if you find yourself wanting to
    be bad because everyone else gets away with it, then the
    problem isn’t everyone else, the problem is you.
    No, yelling at me won’t make this less true.
    IV.

    I should point out that Kotsko uses the word “sociopath”


    incorrectly.

    The contemporary fantasy of sociopathy picks and


    chooses from those characteristics, emphasizing the lack
    of moral intuition, human empathy, and emotional
    connection. Far from being the obstacles they would be in
    real life, these characteristics are what enable the fantasy
    sociopath to be so amazingly successful.

    Everywhere Kotsko uses the word “sociopath” he is more


    accurately describing “narcissist.” He calls them sociopaths
    because of the way they relate to society, but that would mean
    that the ebola virus is also a sociopath. Society is the collateral
    damage of me me me.

    Kotsko focuses on this a la carte sociopathy because he admits


    no one envies actual real life sociopaths. We only envy TV
    sociopaths— so he infers that it must be a special selection of
    sociopathic characteristics we actually admire.

    But this the wrong inference to make. The reason TV


    sociopaths are admired is that they are on TV. They have a
    story.
    Do you really admire Tony Soprano? Which part? His loveless
    marriage to a crazy person? A mistress who is even crazier?
    His gigantic belly and panic attacks? The fact that no one
    actually likes him? That his daughter was dating a black guy?
    (“I wouldn’t have a problem with that.” Yes you would if you
    were Tony.) What part do you admire?
    The answer you tell yourself is you admire his power, that he
    can do whatever he wants. No he can’t. The whole show was
    nothing but repeated examples of how limited his options
    were. The things you think you admire— having hot sex with
    the other crazy woman at his psychiatrist’s office, eating
    microwaved Sysco at Italian restaurants, avoiding his wife—
    can be done by anyone, you don’t need to be Tony to do it. But
    when you do it…. it just doesn’t feel the same. I know.
    What people admire about Tony isn’t his freedom; that thing
    you think is freedom is actually the lack of freedom. His story.
    His identity— that he has one, an obvious one, a clear one.
    Tony Soprano is not free, his behavior is completely tethered
    to what makes sense for his character. He acts exactly like
    Tony Soprano would act. That’s what people want: the
    limitations of that identity: if I know who I am, I know what I
    am capable of, I know my strengths and my limits, I know
    how I’d react to unknown dangers. And I want other people to
    know this. If other people know who I am, I wouldn’t have to
    keep proving myself. Strike that: I wouldn’t have to prove
    myself in the first place.
    Kotsko makes another mistake in thinking that our admiration
    of TV sociopaths like Don Draper and Tony Soprano reflects a
    universal psychology. It doesn’t. It only reflects the
    psychology of the people who like those shows, which isn’t a
    lot of people but is a very specific and vocal group of people:
    Aspirational 14%. Those people have the unique problem of
    too much freedom, too much money (which is to say they are
    still living paycheck to paycheck, but only because they are
    spending it all on keeping up the identity), too many options
    and, most importantly, nothing to define them.
    The admiration of TV sociopaths is related to this desire of
    self-identification, and not to a lack of power or a failure of the
    social contract. The social contract is working just fine for the
    AMC/Netflix demographic. It does not explain a desire for
    more power; envy explains it. Not knowing who I am, not
    knowing what I am supposed to do next and what I am not
    supposed to bother doing next— makes us long for characters
    who know precisely what to do next even if it is the wrong
    things. They may be flawed, but they are definite. They exist.

    V.

    Telling a modern American that what they really want is less


    freedom seems like some dangerous talk, but it is true
    nonetheless. Cynicism, irony has failed you, but you know no
    other way to be. Don Draper is an ad man, so going to a
    “partners’ meeting” run formally, by a secretary, doesn’t seem
    bad at all. It seems great. Neither does wearing a suit and tie,
    every day, and a hat. But your job doesn’t define you, so going
    to a meeting seems stupid, a farce, play acting, so you display
    a cynical detachment from it. And you’re not going to wear a
    tie for anybody. You know it’s stupid, you’re not buying this
    corporate bullshit. This cynical posture is a front, a wall, it
    protects you from being defined by your actions; but what you
    don’t see is that the very job you think you’re undermining
    still receives the full power of your productivity. That you’re
    unhappy, or cynical, is irrelevant to it. It doesn’t care about
    you. Why should it? You don’t even care about yourself.
    That’s what we envy in Don Draper. That he can exist as
    himself without ironic detachment, that he can be defined as
    something. And what they are and what they do match up
    perfectly, even if it’s “bad.” The truth you must face, now,
    immediately, is that if you were put in Draper’s clothes, in his
    relationships, in his job, you yourself would immediately
    affect that cynical detachment: “A partners’ meeting? What
    for? Come on, I see you guys in the hallways all the time” and
    you’d be as miserable as you are now. But until you accept this
    truth about yourself, you’ll think changing other things could
    save you. Tell the truth: did you consider a career in
    advertising after you watched Mad Men? Then you are lost.
    VI.

    It’s impossible to deconstruct TV shows without considering


    their complement: advertising. Ads, especially TV
    commercials, offer the exact opposite of cynical detachment:
    pure aspiration. So while you resist allowing your career or
    relationship to define you— “I’m more than a software
    engineer!” you beg objects— cars, clothes, women— to define
    you, and of course not actual cars, clothes, or women, but
    whatever other people have said those things represent. Worse,
    cynicism and aspirational branding aren’t two opposite ends of
    a pole, they form a cycle: the chasm between your cynical
    view of real life and the perfect definition of the aspirational
    images in ads makes you even more cynical towards real life;
    which drives you further into the safety of branding. Which is
    why you drink.
    The only salvation to this existential crisis is less freedom, not
    more. The only question is whether you will impose these
    restrictions on yourself, or you will wait like cattle for
    someone else to impose them on you. But they will be
    imposed. It is inevitable.
    –

    http://twitter.com/thelastpsych

    Aspirational 14%, defined


    Don Draper Voted “Most Influential Man”
    Thank God The ‘Heart
    Attack Grill’ Is A Great
    Name; Also, How To Learn
    French
    May 11, 2012

    The Son Of Man will watch over you

    Did you hear about the restaurant called “The Heart Attack
    Grill?”

    For the second time in two months, a customer at Las


    Vegas’ Heart Attack Grill collapsed mid-meal and was
    carted off to a hospital.

    Yummy. Here’s another:

    The Heart Attack Grill in Las Vegas, Nev., has come


    under scrutiny since one of its patrons suffered an actual
    heart attack while eating a Triple Bypass Burger there
    earlier this week.

    Or:

    (CBS News) Another patron of the Heart Attack Grill has


    reportedly fallen ill during a meal at the hospital-themed
    Las Vegas restaurant.

    Seems like such a frivolous story couldn’t possibly be of any


    value to anyone. And yet, I’m about to make a mountain out of
    a molehill. Who wants to see something ugly about
    themselves?

    I.

    You might guess that this news story is itself a kind of


    advertising for the Grill. This cynical view places not just two
    heart attack victims but all of CBS News at the service of a
    company’s self-promotion. And you’d be right, another
    branding piece pretending to be a news story.
    But we know what the author wants to be true, the question is
    what you want to be true: how does this story, like all pop-
    culture and pop-news, represent a wish fulfillment? The story
    does not exist as information, in fact it is deliberately
    misleading— the patron didn’t have a heart attack. There is no
    information there. It is there in order for you to talk about it—
    so you have something to talk to others about, through a
    screen darkly or face to face, because if it weren’t for these
    meaningless media stories which includes all partisan politics
    people would have nothing to say to each other, and society’s
    collapse into hikikomori narcissism would be total. Which is
    why it is correct to say that pop culture isn’t a symptom of our
    dying society, it is its heroic measures. So take your medicine:
    what do you want to say about some dummy who had a heart
    attack at the Heart Attack Grill?
    First interesting observation: the reflex position is to defend
    the corporation, in the guise of pseudo-libertarianism: “No one
    forced her to eat there!” and, “no one takes responsibility for
    their own actions!” and “hey, dummy, how could you go to a
    place called the Heart Attack Grill and not know you’d have a
    heart attack, what did you expect?”
    This position isn’t necessarily wrong, but it is very much a
    mark of our time that the reflexive emotional position isn’t,
    “those corporate scum shouldn’t be allowed to serve that
    poison, do they feel no responsibility for this?”
    Which leads to the second interesting observation: this
    position is delivered as if it were a minority opinion, full of
    wisdom, against an uneducated crowd— as if everyone else
    blamed the Grill. And yet a glance at the comments reveals
    that no one blames the Grill, everyone blames the dummy. The
    only blame they get is for using the story as marketing.
    If you consider how ready we are to blame corporate scum for
    everything else, giving them immunity to this obvious blame
    seems paradoxical.
    So the question for the individual is, why is it so important to
    be allowed to eat at the Heart Attack Grill yet accepted that
    there’s a good chance you’re going to get exactly what you
    paid for? I’m going to hide under the bed and wait for your
    answer. “Is it freedom of choice?” Here’s a hint: that’s never
    the answer.

    II.
    You can run the list of “defense mechanisms” and try to link
    each one to specific personality disorders, which will help you
    understand the spouse who left you or the spouse you’re never
    going to leave but the point for now is that what makes them
    defenses is not that they protect you from pain— they don’t,
    clearly. They suck at doing this, look around.
    The purpose of defense mechanisms is to stop you from
    changing. So that after the trauma or the break-up or the loss
    you are still you. More
    sad/ashamed/impotent/enraged/depressed is fine as long as
    you’re the same guy.
    This is what makes treating narcissism particularly difficult:
    the pathology’s Number 1 characteristic is identity
    preservation. “I want to change.” Nope. You want to be
    happier, sure, more successful, feel love, drink less, but you
    want to remain you. But that won’t work. The identity you’ve
    chosen blows, ask anyone. Change is only possible when you
    say, “I want to stop making everyone cry.” The first step isn’t
    admitting you have a problem but identifying precisely how
    you are a problem for other people. But I’ll save you the
    trouble, you’ll fail at this, too, because of the Number 2
    characteristic of narcissism: inability to see things from the
    other’s perspective. “This isn’t really therapeutic, jerk. You
    call yourself a psychiatrist?” Mother’s Day is Sunday, get her
    anything? I know, I know, she’s a jerk, too.

    III.
    If you want to watch these invisible unconscious defenses play
    out right in front of you, in real time, in a real way, watch an
    adult American try to learn a second language.
    Short of cauterizing your own genitals, nothing seems like it
    would change who you are like speaking in an-other’s
    language. Blech, I’d rather wear someone else’s underwear, no
    thanks, I’ll take the 12 credits but no way am I retaining
    anything. “Well, science says you lose the ability to learn
    languages as you get older.” Oh, did NPR just interview TED?
    Dummies in other countries and dummies in the CIA learn as
    adults, are they all using different science? An American
    describes another American who is fluent in French as “oh my
    God, he’s so smart, he speaks French and everything” but this
    statement is easily unmasked as a defense by getting him to
    describe a Frenchman who speaks English: “well, they all
    speak English over there.” The bilingualism is robbed of the
    “intelligence” signification because it’s seen as customary….
    who they are. America is a branded-identity nation, which
    means hearing yourself speak in not-your accent, with not-
    your vocabulary sounds very not-you, which is why when an
    American tries to speak French he feels self-conscious, but the
    Frenchman hearing it feels you aren’t even trying. He’d be
    wrong, you are trying: trying not to become French.
    “Ugh, I hate psychobabble, why can’t you be more like
    Malcolm Gladwell and give me practical neuroscience based
    tips like ‘get up before dawn’ or ‘play basketball
    annoyingly’?” Fine, here’s your concrete advice that you
    won’t take for shaving 6 months off your second language
    acquisition: master the accent first. Before even one word of
    vocabulary. The accent will teach you the rhythm of the words
    and the grammar— it will make it okay for you to learn the
    vocabulary. And you will think differently. American
    exceptiono-isolationism isn’t arrogance, it’s a cognitive bias
    impressed on us from kindergarten when we learn that there
    are only two languages in the world, English and Everything
    Else. Which teaches us that a German is more similar to an
    Italian than a Texan to a New Yorker, and I can predict with
    100% accuracy that if that made you pause you only speak
    English. Can’t wait to hear your foreign policy ideas over
    drinks. You should work for NPR.
    Once you have the accent down, pick a foreign language actor
    or actress you admire, and learn the language as if you were
    them. Talk like them. This trick works because you are
    thinking like someone else, acting like someone else, yet
    simultaneously distancing yourself from this change— I’m
    doing this, but it’s not me, I’m just pretending. The self-
    consciousness is removed because it’s not “you” who is doing
    it. Yet it is; and after a time, you’ll become it— and the
    positive benefit for society is you’ll hate the guy you used to
    be. C’est la vie.
    Which brings us back to the Heart Attack Grill. All
    psychological defenses have a common structure: that two
    legitimate but contradictory beliefs are held simultaneously,
    one consciously, one unconsciously, alternating variously. That
    way all possibilities are covered. Change is neutralized.

    IV.
    “Hey dummy, what did you expect would happen if you ate at
    the Heart Attack Grill?”
    Why did you expect it? Be careful. It isn’t because you knew
    the food is unhealthy, and I know this because you don’t
    actually know what the food is. You have no idea if a “Triple
    Bypass Burger” is in any way worse than a Big Mac except
    that it is branded as worse. If it said “Double Healthy Burger,”
    would you believe that, or does your cynicism only run in one
    direction? (Let me check the calendar: it only runs in one
    direction.) “Well, there’s a picture of the giant burger right
    there at the top.” Run all you like, Gingerbread Man, I’m still
    going to catch you. The truth is you assumed the burger was
    extra-unhealthy as soon as you read the title, before you knew
    anything else. So why are you trying to pretend otherwise?
    Take an alternative headline and meditate: “Man Has Heart
    Attack At Hooters.” Hooters food is poison but there the
    implication is that the waitresses’ boobs were to blame. But
    the Heart Attack Grill has equally sexy waitresses and no one
    blames their boobs.
    So the expectation is exclusively the result of the names
    “Hooters” or “Heart Attack” and the connotations they carry.
    Not the reality— the connotations of the words. But
    connotation is the purpose of branding. So “hey dummy, how
    could you go to the Heart Attack Grill and not know you’d
    have a heart attack?” reveals our secret hope about branding:
    that it is true, that it has power to affect reality.
    I sense the resistance to this idea. The simple act of naming
    doesn’t give it power, right? The restaurant has to live up to its
    name. Well, now it has. Still think you should be allowed to
    eat there?

    V.
    Is the name ‘Heart Attack Grill’ meant ironically? The
    waitstaff are dressed like sexy nurses and doctors, which is
    meant ironically, i.e. what they provide (fatty food) runs
    counter to the sartorial expectations. But the name is… not
    ironic, it’s literally correct— right?
    Wrong. The name Heart Attack Grill is ironic, because the
    expectation is that you won’t get a heart attack there, and the
    reason you know you won’t get a heart attack at the Heart
    Attack Grill is — and this is where you need to judge the
    strength of your soul— exactly that it is called Heart Attack
    Grill. That’s why it is safe to eat there.
    This will sound confusing, because if you actually have a heart
    attack at the Heart Attack Grill, inevitably someone who
    thinks Kristen Wiig is funny will say: “umm, hel-lo? Mayor
    McCheese? What did you expect would happen?” Well, not
    this…. I thought the name was ironic.
    God may be dead, but we’re not yet ready to shine a flashlight
    into the abyss to see just how abyssy it is; so we put a distance
    between ourselves and the dark abyssiness of reality, and by
    “distance” I mean literally “some other omnipotent entity.”
    And we make that entity exert its power— prove it has power
    — through language. If something is called the Heart Attack
    Grill, then it could not possibly actually cause heart attacks
    because no one would ever allow such a thing, any more than
    they would allow a Vegas brothel called “Syphilis House”—
    unless it was actually free of syphilis. The final step is the
    trickiest to understand but the most natural to execute— it is
    the atemporal logic of narcissism, aka magical thinking: the
    naming of it prevents it from being true. Saying it is ironic is
    protective.
    This is why blaming the dummy is pseudo-libertarianism. It
    seems that we don’t want any restrictions on our freedom, we
    want to be free to do things even if they are harmful; but that
    freedom is always predicated on “some other omnipotent
    entity“‘s supervision. We want our freedom to eat unhealthily
    as long as it is “USDA Grade A” meat from a “Board Of
    Health” restaurant, cooked not by Mexican illegals with no
    training in handwashing but by chefs— sorry, not precise
    enough: “…cooked by Mexican illegals as long as they are
    called chefs.” We want things to be as regulated as possible
    with two absolute conditions: 1. there must be symbols of the
    omnipotent entity’s existence showing we are being cared for,
    like a Grade A seal or the absence of the 13th floor or the
    word “chefs”; 2. the implementation of the power must be
    invisible so we can disavow it. And at the very last step of a
    carefully managed outcome we can bask in the freedom of our
    pretend choice. In other words, the fact that we are allowed to
    choose something dangerous must mean that it isn’t really that
    dangerous, which is more accurately but confusingly
    translated: the fact that we are allowed to choose something
    dangerous causes it to be safe. And thank God. “There is no
    God.” Oh, that explains all the passive voice.

    –—

    http://twitter.com/thelastpsych

    –-

    Notes:

    Two simple examples of this process.

    1. In normal people who did not grow up on a farm, drinking


    milk from a cow will seem more disgusting than drinking it
    from a milk carton. The explanation will be that it isn’t
    “pasteurized and homogenized,” which is both true and
    simultaneously a lie, because you know milk is dispensed after
    pasteurization from an industrial vat into a carton
    but if you had to pick between drinking from that carton at the
    supermarket vs. from that industrial vat, you’d still pick the
    carton. The carton clearly displays symbols of regulation and
    control, but the vat is too real to drink from.
    2. Even if we agree that “taxes are too high” the psychological
    importance of lowering them is that the regulations that we
    know to exist will still continue to exist but we are distanced
    from them; to the point that the person who pays no taxes, or
    the man who pulls off the grid feels he is no longer affected by
    those controls; but of course everything he touches is still the
    result of those forces— his Cabela’s hat and camo jacket are
    flammability regulated, certain dyes prohibited, factories free
    of glass shards; all things that he knows are true, but blocks
    from his consciousness. “I’m totally self-sufficient.” Ok. So on
    the one hand he knows (unconsciously) he enjoys the
    protection of the regulations, on the other hand knows
    (consciously) he is entirely free of their influence. This will
    alternate on the day he e.g. catches fire. This is not a criticism
    but an explanation: since this disavowal/magical thinking is a
    narcissistic defense, it’s easy to predict that he will have other
    narcissistic problems, e.g. alcohol, rage, misogyny, etc.
    To be clear: what makes this a defense is not that he is wrong,
    but that he is right, he has a legitimate point— taxes may
    indeed be too high, the government too large, too many
    regulations, etc. If he believed something that was not true
    he’d be delusional. The defense is effective only if two
    incompatible truths are held simultaneously, alternating
    variously depending on what’s going on, so that change is
    neutralized.
    Are You Mom Enough? The
    Question Is For What
    May 13, 2012

    at what age does it become incest?


    “Has Time Gone To Far?” “Time Cover Causes Controversy.”
    I heard people are actually offended by this cover. Which is
    worse, seeing this or a picture of two gays kissing? No, two
    gay women, of course, come on, don’t be stupid. Alright, fine,
    but what if one’s named Loshanda and the other one may as
    well be? Yeah, graphic design is hard.

    I’ll leave the discussion of the merits of attachment parenting


    to people who actually have parents and attachments, but it’s
    kind of a moot point, I’ve seen more Taliban snipers than I’ve
    seen boob sucking kindergarteners.
    So forget what Time is showing you, ask instead: what does
    the magazine want to be true?

    Postulate: Time doesn’t like breast feeding. If you disagree at


    least grant me that no one at Time thinks four years of it is
    admirable. Right? So you are supposed to hate her. Ok, how?

    “Umm, ‘how?’ Well… there’s a kid sucking on a boob…”


    Come on, man, that’s weird but it’s not hatable, hating her
    doesn’t somehow reinforce who you are— unless you’re a
    woman who didn’t breast feed. What if you’re a guy? “Well,
    she’s hot…” Right. The secret fear of marriage is that the kid
    wins the Oedipal drama.

    At some point someone needs to notice that the intensity of the


    emotions about this issue are way out of proportion to the…
    prevalence of the issue. I’m pretty confident breast feeding on
    the way home from Webelos is a terrible idea but is it worse
    on your kid than getting divorced? Or staying together,
    depending? Extra year of boob or lifetime without a father.
    Hmm. Is this open book?

    Other than the volume of your voice, do you have any reason
    to be sure of what you think?

    So since Time has created a controversy out of thin air, we


    should consider that the controversy is a proxy for something
    else.

    She’s a billion, so either Time was writing a story on


    Attachment Parenting and found the hottest subject they could
    find to make it be ok, or they chose the hottest subject they
    could find to make it NOT be okay. So hot= shallow
    egomaniac using her boobs and then her kid to get noticed.
    That’s what Time wants you to think, anyway. But there are
    things you don’t see that I can’t unsee, which is why I’ve been
    at the bottle stashed behind the big rock at the creek’s bend
    since I was a pre-teen. She’s 26 and the kid is 3, subtraction=
    23, so you have a super hot well manicured blonde having kids
    way the hell too early for a super hot well manicured
    blonde……………….. and there are only two reasons why
    such a person would be pictured in American media: she’s
    from Utah or Jesus is her co-pilot. Amen. The fastest way to
    get Time’s Hatable Person Of The Week cover is to a) work
    for Goldman Sachs or b) praise the Lord. I guess it’s possible
    she works on a trading desk but my money says this is a story
    about why religious people are insane.

    So while the rest of you bah bah black sheep are led to
    complain that she’s hatable because she breast feeds, when the
    Time comes— and praise be to Jesus, it is coming— for you to
    learn she’s nipples deep in the Lord Is My Shepherd maybe
    you’ll then remember which candidate you’re supposed to
    hate.
    There’s hate in them there pictures, the worst kind of hate, the
    kind that makes you hate without knowing why, without
    knowing that you hate. The kind of hate that ends up defining
    you as a person in opposition to something else. And then you
    disappear.

    Once you’ve made this prediction everything else is downhill.


    She’ll homeschool the kid, which is hatable. She’ll be wealthy
    for no identifiable reason: hatable. She’ll be carrying around
    that kid 24/7 with no nanny yet still weirdly find time for
    mani/pedis and barre class. So hatable. And co-sleeping
    doesn’t mess up her sex life or her sex interest because her
    husband plows her on the deck, in the car, in the pool, in
    elevators. Sigh hatable. You can’t make a right on red but this
    woman is forcing the world to accommodate her, bend to her
    way, her life, and she appears to be succeeding and happy.
    Bitch.

    Look at the comments as people struggle to explain why breast


    feeding a 3 year old is bad: they sense it’s bad, but can’t come
    up with a concrete reason to explain it. Well, Time is the
    magazine for you. They offer you a blonde cypher trusting that
    you’ll solve it: she co-sleeps because she’s a religious nut.
    Phew.

    “When you think of breast-feeding, you think of mothers


    holding their children, which was impossible with some
    of these older kids,” Schoeller says. “I liked the idea of
    having the kids standing up to underline the point that
    this was an uncommon situation.”

    That’s Time’s photographer explaining that simply having her


    breast feed wasn’t good enough to make his point, he needed
    to stage the scene to “underline the point.” This is why the
    sentence before that one is this:
    Using religious images of the Madonna and Child as
    reference, Schoeller captured each mother breast-feeding
    her child or children.

    If you have the urge to email me complaining that I’m


    defending religion or attachment parenting, please don’t, your
    brain is broken. The point is to show you how the media e.g.
    Time manipulates you to hate some things by linking them to
    other things: it polarizes you, which means it makes you
    irrelevant. E.g. when an election “is determined by” one
    particular group of “swing” voters— whom you deride for
    being too stupid to have made up their minds yet— it doesn’t
    mean your vote has been factored in but that you are so
    predictable that you don’t count. Power never thinks of you as
    an individual. Power never thinks of you at all.

    Maybe attachment parenting is good? Bad? Time doesn’t care


    to find out. It could easily have PubMeded the story and found
    a hundred scientific articles to discuss. Nope. It needed space
    to tell me that Dr. Bill Sears was a Catholic, converted to
    evangelicalism, and back to Catholicism, and his wife goes to
    Mass every day. Oh, I get it, they’re crazy people. This is a
    typical media trick, rather than exploring an issue it explores a
    person, describes him, his background and his faults, this is the
    kind of person who believes this, this complicated issue that is
    too difficult to understand on its merits. You’re free to choose.

    Do you think Time cares about breast feeding? Do you think


    Time cares about you? Time hates you. It hates everyone,
    especially its readers, it thinks of them as credit card numbers,
    as registered voters, as organ donors. It wants what it wants
    and if we have to throw a kid under a boob, so be it. Like
    Marshall McLuhan once yelled, there’s a war going on out
    there, and it isn’t between liberals and conservatives or atheists
    and believers or attachment parents and detachment parents,
    it’s between us and them, where them is defined as everyone
    who is not us and us is defined as me. You lose.

    –
    http://twitter.com/thelastpsych
    5 Signs Your Child Is a
    Psychopath, According To
    The NYT
    May 22, 2012

    HOLY MOTHER OF GOD, WTF


    The New York Times Magazine has a story describing a 9 year
    old boy who has been diagnosed as a psychopath. “Oh my
    God, that was such a moving article.” Shut it.

    Strangely/not strangely, they spend very little time describing


    the kid’s psychopathy, and a lot of time on describing
    everything else from which you are to infer his psychopathy.
    It’s like badly written female erotica, which is exactly what the
    New York Times Magazine is, penis never goes in vagina, it’s
    all innuendo and mood and words words words words…

    Here are the 5 signs of a child’s psychopathy, according to the


    New York Times.

    1. Ethnicity

    You know how at the beginning of these profiles they always


    write, “In order to protect the privacy of the subjects, the
    names have been changed”? They don’t have that here.
    Instead, to protect their privacy, they use the real first names.
    And where they live. And the name of their doctor.

    Why would they use the real names? Employers/suitors


    already look at your drunken bikini pics and judge you
    hopefully favorably, shouldn’t this kid’s story be a little better
    protected?

    Maybe the real names are important: there’s Anne, the mom.
    Boleyn? No. Oh. Michael’s the psychopath. Myers?! No.
    Dammit. Dad is Miguel…. oh.

    As there are 10 million psychopaths living within 60 blocks of


    the NYT offices and another 200 inside the NYT offices, it’s
    odd they needed to travel all the way to Florida to interview
    one. Maybe this psychopath is really interesting? Nope. Kill
    anyone? Nope. Cosplays The Ring? Nope. Started a hedge
    fund? Nope. Weird. Long way to go for boring.

    2. Feet

    If this kid had a swastika carved in his forehead or a tooth ring


    you can bet they’d photograph it, privacy be damned. No such
    luck, Michael refuses to look disfigured or appear black. So
    instead of his face you’re getting a picture of his feet. Yikes.
    Feet? I suppose kids’ feet are interesting to some readers (e.g.
    psychopaths) but there’s probably another reason for the
    photo. “It shows he’s standing separate from everyone.” Yes,
    but you put him separate, right? To tell us that he’s separate?
    You also told everyone to take off their shoes.

    So other than obvious staging of this crime scene, the NYT


    wants you to know either a) they’re gypsies; b) mom’s got 3
    tattoos on her feet. One’s a star. Do you know what a star
    tattoo means? It means what you are about to read is her fault.

    3. Hands:
    Well, that could be a picture telling us he has reddish hair and
    no swastika on his forehead; or it could be a picture telling us
    his mom has a thumb ring and Lee Press On Nails.

    “Hey, no one’s saying she’s a bad mother!” No. You’re just


    saying it all makes sense.

    4. This:
    This is a picture of a blue dragon breathing blue fire. If the
    TSA saw this laying on a flaming bag of plastic explosives
    they would all go on break, so compellingly normal and safe
    and ordinary this drawing is. It is so normal that I’ve given it
    to babies in the NICU for comfort. They giggle. Here, I made
    it more scary:
    and even now Downy wants to make it the new symbol of
    freshness. I don’t know how the hell this implies Michael is a
    psychopath. Does the Times now include a blotter acid insert?
    Should I lick this?

    5. Science:

    The New York Times loves science, LOVES it, especially the
    kind with no numbers and frequent appeals to authority,
    especially ESPECIALLY if those authorities are from the cast
    of Freakonomics. Here are the seven most important sciences
    according to the NYT:

    1. Sociology
    2. Political science
    4. Climate science
    5. Science fiction
    7. NPR
    8. Law

    So when you see this:


    Michael was almost two standard deviations outside the
    normal range for callous-unemotional behavior

    and

    One study calculated the heritability of callous-unemotional


    traits at 80%

    you can be sure they have no idea what it means and have no
    expectation their readers do either, which is why they wrote it
    like that, in those words. NB: “One study”= it must be true.
    The readers think of genes as cluster bombs, if the father drops
    it into the mother her vagina explodes with untoward
    consequences. If you try to explain gene expression and
    interaction they start to glaze over, and by the time you hit
    imprinting all they hear is the theme to Dancing With The
    Stars. Whenever you read the word “genetics” or “heritability”
    in the popular press as it relates to kids, it means one of two
    things:

    a) It’s not your fault.

    or

    b) it’s your ex’s fault.

    To reinforce this to the target demo, the genetic link of


    psychopathy, in Michael’s case, is through the hispanic guy.

    BUT DOESN’T MICHAEL SOUND LIKE A


    PSYCHOPATH?

    In fairness to the Times, I will admit they list, explicitly,


    several psychopathic behaviors that Michael exhibits:
    he threatens his brother with a chair
    he says he hates his brother
    he watches Pokemon
    he can go from perfectly calm to full rage, and then calm again
    rages include punching toilets, though not people
    his mom is exhausted
    his dad is exhausted, but less so
    he erases the dumb reporter’s digital recorder
    he goes to psychopath summer camp, and doesn’t like it

    Because these aren’t terribly diagnostic by themselves, the


    article is quick to mention the horrendous accomplishments of
    other child psychopaths. One kid chopped up a cat’s tail.
    Another kid named Jeffrey Bailey drowned a toddler in the
    pool just because he was curious. Therefore, Michael is crazy.
    “Dude, that makes no sense.” Dude, I’m just telling you what
    the article says. “Some, including Michael, were actually
    worse; one had begun biting the counselors.” Wait, what?

    Is Michael a psychopath? I have no idea, but I do know that


    the purpose of the story isn’t to describe psychopathy, but to
    entertain a demographic that has nothing else to do on
    Sundays now that Desperate Housewives has been canceled.
    Have you learned anything you didn’t already know from this
    article? “Don’t let Michael date my daughter.” Check. “Or my
    son! You never know, it’s wrong to assume!” Double check.
    And mate. And I’m moving.

    Scroll through the 631 deranged comments in the article, the


    two themes are “they need to remove the kid from the home
    for the family’s safety!” which is totally ok when it’s
    suggested by a deranged Manhattanite with no understanding
    of who “they” is, but everyone gets all Founding Fathers when
    George Bush tries it. “What gives him the right?!” Duh, you
    did. The other popular theme is “My heart goes out to these
    parents, what they must be going through!” but you only ever
    say such things when you’re not at risk; and since the article
    lets you know it only happens to certain kinds of other people,
    your patronizing condescension is encouraged. “It is terrible,
    isn’t it, but I guess it’s true that other people are different from
    me.” I will observe that no one feels bad for Michael even
    though this is supposed to be genetic= “not your fault” and he
    hasn’t actually hurt anyone, which is precisely the kind of
    psychopathic prejudice I expect from the NYT and its
    deranged readers. Does anyone have any other suggestions
    besides extraordinary rendition or military academy? No?
    Then shut it. The kid is nine. You derangetons are 40 and still
    shamelessly retain the fantasy that your decaying mind and
    body will someday pull something off, meanwhile you’re
    wrapping up shooting on his movie before puberty even hits.

    Of course there are 9 yo psychopaths and of course you


    intervene early if you feel something’s amiss and maybe
    Michael after all is one; but they sure haven’t made a great
    case for it or the predictions for his future which, of course,
    are only implied, but you know.

    Here’s one explicit prediction— and it is the Hail Mary of


    psychiatric predictions, offered without the benefit of
    conclusive research but you meet me at the bus stop at 3:30 if
    you want to fight about it— one of the most significant causes
    of psychopathy is being told, at age 9, that you are a
    psychopath, and that the New York Times Magazine wants to
    do a ten page story about you. Yeah. Oops.

    –
    http://twitter.com/thelastpsych – live tweeting the butchery
    that is Fifty Shades Of Grey tonight (May 22) during the finale
    of Dancing With The Stars.
    Amy Schumer Offers You A
    Look Into Your Soul
    June 18, 2012

    the most crucial thing to understand is that the arrow drawn


    above is exactly 180 degrees off course

    On the Opie & Anthony radio show, comic Amy Schumer told
    a sexy story.

    She was 18, and was out with friends in NYC wearing “a
    miniskirt and a tube top— my uniform back then.” At the end
    of the night they pile into a cab. Amy sits in the front.

    The cab driver was “gross, like the cab driver on MTV.” “This
    was back when I used to do dangerous things, sexually,” and
    littered throughout the story were exasperated sighs, like, “I
    can’t believe I did those things.” I sympathize, believe me I
    do.

    So what does a drunk 18 year old coed do in the front seat of a


    cab that’s worth sharing on the radio? She extends her leg over
    towards the cabbie…
    At this point I should tell you that the title of this Opie &
    Anthony segment is “Amy Schumer Gets Fingered In A Cab”
    so of course I already know what’s going to happen, which is
    why I’m parked behind a church. But this surprises me
    nonetheless:

    GUY: So you let the cab driver touch your vagina?


    AMY: No— I took his hand and made him touch my vagina.

    That’s right, she didn’t let this all happen, she made it all
    happen, on purpose. She wanted to get fingered by this filthy,
    ugly, dangerous cab driver.

    So while her drunk friends are passed out in the back, she’s
    riding his “disgusting finger” towards an orgasm and trying
    not to moan too loudly. 10 or so blocks later she climaxes,
    immediately feels horrified by herself, gets out of the cab,
    pays, and runs into her apartment.

    At the end of this story, everyone, including Amy, started to


    play the popular game Why Would She Do That?— was she
    molested as a child, was it self-punishment? But according to
    the Textbook Of Psychoanalysis, every event in your life is
    reprocessed as a story, and every story has five Acts. Acts II-
    IV are the rising action, climax, and falling action; Act V is
    the denouement: what was the result of all this? Taking this
    literally, Amy’s orgasm is Act III. Getting out of the cab and
    feeling disgusted is Act IV. What’s missing from her story is
    Act V. So if you’re brave enough we’re going to play a
    different game, a game with real winners and real losers, and
    that game is Guess What Happens Next.

    I.

    There’s a criticism among male comics about female comics,


    that they only have to look good in a skirt and talk about
    blowjobs and they can get away with not being funny, and I
    want to be clear that when comics make this criticism they are
    talking about Amy Poehler, not Amy Schumer. Amy Schumer
    is very funny and very quick. The funniest thing about Amy
    Poehler is nothing.

    But why is there even a market for sexy but unfunny female
    comics? The answer is that it’s hot to hear a sexy girl talk
    openly about sex, and the only safe way a woman can talk
    openly about sex is….. as a joke, as parody.

    If you heard this as a feminist criticism you have missed 50%


    of the fun: men can’t safely hear about sex from a woman
    except as a joke, or else they are labeled as perverts by women,
    who are still unsure of their (sexual) place in this free for all
    we call Nowadays. “I want to tell you about last night but I
    don’t want you to judge me or appear interested.” Huh?
    Nowadays can be exhausting, but they were also inevitable.

    In America, everything is a commodity, everything has a price.


    So when post-gold standard capitalism gets access to
    everything except the secret desires of women, it will
    necessarily create a mechanism to get them, too, i.e. some
    media to take the bullet as pervert so women can be free to
    talk in exchange for men quietly listening in. It took a decade
    but the system worked: Howard Stern was the inevitable
    synthesis of feminism and Reaganomics, which is a sentence
    you will never read anywhere else.

    Which is why as Amy is describing putting the cabbie’s hand


    on her vagina, this happens:
    DAN: So, were you… prepared to receive him?
    AMY: What do you mean?
    DAN: I mean…. were all systems a go?
    AMY: You mean was I wet? How wet do you have to be to
    slide a finger in?

    Thing is, this is satellite radio, Dan can be as vulgar and


    explicit as he wants, no FCC. And he knows this, he works
    there. You could say it’s a hold over from the broadcast radio
    days, except Dan was never in broadcast radio, which means
    one of two things happened, both of which are the same: 1. He
    was reflexively imitating the style and language he learned
    was allowable for sexy talk with female strangers, e.g. FM
    radio Howard Stern; 2. his own mind had used a distancing
    language— sound like someone else— so as not to appear to
    be the pervy guy wanting to know if her box was wet enough
    to penetrate. Feminists, note carefully that the female is
    allowed to be graphic, but the males in the room still feel they
    have to censor themselves around her. Where do you think that
    censorship is coming from? Amy?

    There is a group of you who will read this and feel enraged by
    a double standard, in front of men women get to be sexy, talk
    about sex, flaunt it, but men can’t introduce the topic, can’t ask
    questions, can’t pursue— can’t even look— because then
    they’re labeled as predators. If you’re in this group you don’t
    get it. The censorship doesn’t come from women, it comes
    from you. If you feel like you can’t ask her about her sex
    because you’ll sound like a repressed stalker, you are, in fact, a
    repressed stalker. You’re not going to kill her, ok, fair enough,
    but you aren’t going to leave her alone, ever. If Trina rolls
    bleary eyed into the cubicle and says, “wow, I got totally
    plowed by this guy last night” not only are you not going to
    get any coding done that day, but you will make it impossible
    for her to ever get any coding done or keep her cell number
    because of your subtle pushes for more stories and passive
    aggressive inquiries about her relationship status and near
    constant innuendo. “Cubicles. Blech. You know what job I’d
    be good at? Riding a backhoe.”
    So, radio fans, if you hear a woman tell you she got fingered in
    a cab, you’re being offered a chance to see inside your soul:
    what do you think next?

    If you think, “I sooooooo want to come on her tits,” you’re


    normal. Also a pig, but a normal, 21st century pig. Sigh.
    We’ve been trained to be aroused by imitation. “Well, men are
    visual creatures.” Let me guess, you heard that on TV, big
    surprise. Your deepest desires come out of a box, against your
    nature. Tell me, which is more arousing: watching a porno
    with the sound off, or listening to a porno without the video?
    Yeah. I love staying in hotels, too.

    Men aren’t visual, they are trained. Back when men were the
    labor force TV told them to be visual so they could buy some
    crap, but when women started taking over the labor pool they
    told women to be visual, too, or did genetics suddenly decide
    male chest hair was out starting exactly 1989, the year the
    Dumbest Generation Of Narcissists In The History Of The
    World graduated college? People don’t think visually, the
    system has trained them to think visually. Most of the world
    uses computers for words, right? Yet it seems never to occur to
    anyone to do what is the most obvious thing in the world, ever:
    Duh. But now that I’ve told you you still won’t do it, the
    infrastructure is against you. So even though the world is
    coded in 8.5:11 it is experienced in 9:4, and the system
    facilitates the sheeping, not the shepherding. You want to
    change that? Good luck, you’re not cool enough to have a
    following and the moment it occurred to Steve Jobs his
    pancreas was detonated.

    Back to Amy: so normal= “come on her tits”; abnormal,


    unhealthy but sadly the norm Nowadays would be to turn
    Naughty Amy’s Barely Legal Ride Along into something
    masochistic and think: why not me? Why does this slut allow
    herself to get fingered by some ugly cab driver yet I can’t even
    ask about it? Which is the answer to your own question. You
    are operating from a position of self-loathing which you then
    project as a judgment onto everyone else, and she can sense it.
    And you can sense it, which is why you self-censor. See?
    You’re not all bad.

    II.

    That women can’t talk as openly about sex is really a subset of


    a larger difference, which is that while both are allowed to do
    anything they want, only a man can identify with it. Women
    must distance themselves from it, more or less depending on
    situation. When a man has sex it is a reflection of who he is;
    for women it has to be something that happened.

    Say you’re lucky enough to have the most wonderful of all


    experiences, the menage a trois. Right on. “Umm, dude, I’ve
    had threesomes and they’re not that great. They’re actually
    pretty awkward.” Um, dude, you’re not doing them right, they
    have to be sisters. So afterwards the guy will tell… everybody.
    And for the rest of his life. Any future girlfriend will hear
    about it within the first month of dating: Things That Make
    Me Cool. The woman may tell her friends, but she’s not going
    to tell guy friends, and certainly not bring it up to potential
    boyfriends, and it sure as hell never reflects on her character.
    “It happened, but it’s not who I am.”

    The thing is, in any MFF, there are three people who could be
    telling you the story, yet the narrator is always a penis. He had
    a threesome, the supporting cast say they “were in a threesome
    once.” Assuming you live in a town where X number of
    threesomes happen every year and there’s no repeats, then
    there are twice as many women with a history of menages than
    men. Yet despite being the majority, it’s the man’s story to own
    and the woman’s to disavow.

    You could play it the other way and say, well, some women do
    repeat, but then in that case those individual women have had
    more threesome than guys, more experience with them, but
    they’re still not allowed to own it, and if they do it’s still at a
    distance: “I don’t know, it just kind of happened.” The only
    time you’ll hear a guy says those words is if you’re his
    girlfriend and he just cheated or you’re the police and he’s
    holding a head, and that’s not a joke but a description of the
    motivator: shame.

    But the point isn’t simply that women do it but disavow it. I
    just told you a fact which, as a man, you must disavow
    yourself in order to continue dating. In order to see the world
    as ordered, you have to pretend that very few women as
    compared to men have had threesomes.

    There are, of course, an unusual few women who “own” it,


    talk freely about their sex without shame, but unless they are
    comics they run the risk of inviting stalkers and anyways, no
    matter how much they are otherwise liked or respected, people
    will still whisper quietly to each other: “what happened to her
    in her life that made her do these things?” Sexy women, you
    have a choice: you’re either a slut, or broken.

    III.

    Someone in the studio suggested that Amy’s behavior was the


    result of childhood molestation. Jim Norton, a comic,
    explained it as “self-punishment.” Jim’s perspective is unique
    because he is a recovering alcoholic and a current sex-addict,
    frequently detailing his relations with hookers, transsexuals,
    etc. He would know, right?

    The problem with this kind of backwards analysis is that it


    tries to universalize a behavior into its cause. But the fact is
    that people get fingered by ugly men in cabs for all kinds of
    reasons, including they just like it. Last Tango In Paris was
    about a beautiful young woman who was inexplicably drawn
    to a billy goat. It happens. No, you’re thinking of Streetcar
    Brando. This is 1972 Godfather Brando.

    baaaaaah

    “Aww, older men can be sexy.” I guess, if you’re even older


    than them.

    Modern and pop psychology spend a lot of time taking a


    behavior and tracing it back to a single source— genetics,
    trauma, whatever— but there’s no money there, the money is
    in the meaning, what they do with it. So Norton’s an addict.
    Do you want to know how he got that way or what he does
    with it?

    Before, the experience of addiction was entirely subjective, is


    it messing up your life? Now, it’s been objectified, the
    subject’s relationship with the drug is is no longer relevant, it
    is the fact of the drug that is relevant. The obvious example of
    this sleight of hand is that there’s alcohol use and alcohol
    abuse, but there’s no such category as cocaine use, even
    though the vast majority of its ingestion has nothing to do with
    addiction. The reinforcement is from the outside to comply
    with this idiocy: say you party down one weekend, then a
    random drug test at work, oops! So two things can happen,
    Guess What Happens Next: you could tell the truth that the
    coke was on her ass and how could you not? doesn’t make you
    a bad person; or pretend/admit you’re an addict and agree to
    go to rehab. So it’s unanimous? You keep your job at
    McDonalds and the system gets another data point confirming
    it is right. I hope the parallel between this and anything written
    by Solzhenitsyn is immediately obvious, if not, read anything
    by Solzhenitsyn. The Matrix doesn’t need you, but it will offer
    you a free pass if you help get the other batteries in line.

    Note that when scienticians talk about, say, the increase in


    alcoholism, they never go back before WWII, otherwise
    they’d have to label most ancient Greeks, all Vikings and
    everyone in colonial America as alcoholics. “Well,” they’ll
    explain, “it wasn’t until then we started rigorously treating
    people as data points.” While I’ll accept that an amount of
    alcohol does the same damage to your innards regardless of
    what kingdom you’re born in, there’s something sneaky about
    the current kingdom getting to be the sole judge of what is
    addiction and what isn’t, but we rarely complain unless the
    addiction is the internet and the kingdom is China; and the
    reason we don’t complain is that the system has cleverly made
    it very easy for us to abuse it selfishly when we want to, which
    was the plan all along. But it doesn’t make it right. Sorry,
    wildman, you can’t judge a person based on two generations
    of observation of a single culture that happens to be driven by
    TV.

    The interesting thing about addictions— include gambling and


    sex and internet and “dangerous behaviors” and whatever else
    you want— is that they all share something in common.
    Allegedly this thing is dopaminergic pathways to the striatum
    and etc, but saying that gets you nothing. It’s astounding that
    the layperson chooses to think in these terms which though
    they are true are utterly meaningless, utterly unactionable,
    until you remember, oh, of course, in narcissism believing
    something is preferable to doing something because the former
    is about you and the latter is about everyone else.

    Slightly off topic but here’s an important example: say you


    yell every day at an/your eight year old girl for sloppy
    homework, admittedly a terrible thing to do but not
    uncommon, and eventually she thinks, “I’m terrible at
    everything” and gives up, so the standard interpretation of this
    is that she has lost self-confidence, she’s been demoralized,
    and case by case you may be right, but there’s another
    possibility which you should consider: she chooses to focus on
    “I’m terrible at everything” so that she can give up. “If I agree
    to hate myself I only need a 60? I’ll be done in 10 minutes. “

    It is precisely at this instant that a parent fails or succeeds, i.e.


    fails: do they teach the kid to prefer (find reinforcement in) the
    drudgery of boring, difficult work with little daily evidence of
    improvement, or do they teach the kid to prefer (find
    reinforcement in) about 20 minutes of sobbing hysterically and
    then off to Facebook and a sandwich? Each human being is
    only able to learn to prefer one of those at a time. Which one
    does the parent incentivize?

    If you read this as laziness you have utterly missed the point.
    It’s not laziness, because you’re still working hard, but you are
    working purposelessly on purpose. The goal of your work is to
    be done the work, not to be better at work.

    For a great many people this leads to an unconscious, default


    hierarchy in the mind, I’m not an epidemiologist but you got it
    in you sometime between the ages of 5 and 10:

    <doing awesome>

    is better than
    <feeling terrible about yourself>

    is better than

    <the mental work of change>

    You should memorize this, it is running your life. “I’m


    constantly thinking about ways to improve myself.” No,
    you’re gunning the engine while you’re up on blocks.
    Obsessing and ruminating is a skill at which we are all
    tremendously accomplished, and admittedly that feels like
    mental work because it’s exhausting and unrewarding, but you
    can no more ruminate your way through a life crisis than a
    differential equation. So the parents unknowingly teach you to
    opt for <b>, and after a few years of childhood insecurity,
    you’ll choose the Blue Pill and begin the dreaming: someday
    and someplace you’ll show someone how great you somehow
    are. And after a few months with that someone they will
    eventually turn to you, look deep into your eyes, and say,
    “look, I don’t have a swimming pool, but if I did I’d drown
    myself in it. Holy Christ are you toxic.”

    “Well, my parents were really strict, they made me—” Keep


    telling yourself that. Chances are if your parents are between
    50 and 90 they were simply terrible. Great expectations; epic
    fail. Your parents were dutifully strict about their arbitrary and
    expedient rules, not about making you a better person. “Clean
    your plate! Go to college!” Words fail me. They weren’t
    tough, they were rigidly self-aggrandizing. “They made me
    practice piano an hour every day!” as if the fact of practice
    was the whole point; what they did not teach you is to try and
    sound better every practice. They meant well, they loved you,
    but the generation that invented grade inflation is not also
    going to know about self-monitoring and paedeia, which is
    roughly translated, “making yourself better at piano.”

    “You don’t know how hard it is to raise kids,” says someone


    whose main cultural influence in life was the Beatles. The fact
    that you will inevitably fail in creating Superman is not a
    reason not to try. Oh: I bet I know what you chose when you
    were 8.

    The mistake is in thinking that misery and self-loathing are the


    “bad” things you are trying to get away from with Ambien and
    Abilify or drinking or therapy or whatever, but you have this
    completely backwards. Self-loathing is the defense against
    change, self-loathing is preferable to <mental work.> You
    choose misery so that nothing changes, and the Ambien and
    the drinking and the therapy placate the misery so that you can
    go on not changing. That’s why when you look in the mirror
    and don’t like what you see, you don’t immediately crank out
    30 pushups, you open a bag of chips. You don’t even try, you
    only plan to try. The appearance of mental work, aka
    masturbation. The goal of your ego is not to change, but what
    you don’t realize is that time is moving on regardless. Ian
    Anderson wrote a poem about this, you should study it
    carefully.

    Coincidentally, four days after Amy told her story I heard


    Howard Stern railing about an uncle who liked to play golf. “It
    infuriated me that he never took a lesson, never tried to get
    better. He was happy just playing, he didn’t care if he got any
    better. It made no sense to me. How can you enjoy something
    and not want to get better at it?” Answer: some people are
    happy with par. He isn’t, which is why he succeeded. The
    retort is, “well, I don’t want to have to improve on everything,
    some things I just want to mindlessly enjoy.” I sympathize, but
    I also own a clock, and there are only 24hrs in a day. Look on
    how many of those hours go to true self-improvement vs.
    mindless enjoyment, and despair.

    That hierarchy you learned— and yes, it was learned in


    childhood— applies to everything, including addictions.
    Addiction may be biological, but no one ever claims that
    getting clean is biological. “When I hit 45, my testosterone
    levels fell which also lowered the dopaminergic activity in the
    reinforcement pathways of the brain, so I was able to get off
    dope.” Wait, is that true? HA! No. It’s a decision, made at that
    time in those circumstances. I know it’s a hard decision, but
    like every other decision in life it is ultimately a binary one.
    Biology is pulling you towards 0, learning pulls you towards
    1.

    “All this happens at age 8?!” Think of how many years you’ve
    since practiced that hierarchy. “So after childhood, you’re
    screwed? You can’t change?” Oh, no, people change all the
    time, once they figure out how they’re sabotaging themselves.
    Now it’s your turn.

    IV.

    So the thing that addictions— drugs, internet, sex, etc— all


    have in common is that they displace and replace something
    else. If you think of yourself as containing an amount of stuff,
    or energy, or emotion, addiction isn’t in addition to that, the
    total amount of emotion and energy stays constant. The nature
    of the emotions change, but the overall quantity of
    anger+sadness+happiness+ etc is the same. The addiction
    replaced something, and you can’t get rid of an addiction
    unless something replaces it.

    Broadly speaking, addiction replaces one of two things: human


    connection or change. Jim Norton frequently complains that
    his sex addiction prevents him from pursuing a show or
    writing scripts, but the verb is wrong: the sex addiction allows
    him not to work on scripts. Doesn’t he want a pilot? Sure. But
    this way he doesn’t have to do the mental work of change and
    eventually he can die. “Is he afraid of success?” No, why
    would he be? The more invested you are in your “self”— not
    happy with, but invested in— the more you will resist the
    potential of change. “Self”-loathing means there is a strong
    “self” that you loathe, and that self doesn’t want to
    disintegrate.

    In the other category is human connection. What I don’t mean


    is that a person lacking human connections turns to addiction,
    ha, you don’t get off that easily: what I mean is that the
    addiction satisfies the same needs as human connection, but
    better. It bypasses the <mental work> of maintaining human
    connections. Say a married guy becomes an alcoholic, and this
    pushes his wife away, which of course makes him drink more.
    The problem now is that if he stops drinking, his wife doesn’t
    automatically come back, right? She’s pulled away as much as
    he’s pushed. I’m sure she wants him to get clean and etc, but
    the energy math doesn’t balance: he goes sober, the
    relationship may improve, but there’s still a gap, still some
    emotional connection lost. Ergo: he cannot give up drinking.

    More optimistically, the only way he is going to stop is: a)


    they split up; b) they double down on each other and talk
    MORE to each other, more than they do now, maybe that
    means that he skips rehab in order to go to couples therapy.
    “But the problem isn’t the marriage.” It is now.

    This idea of having a finite “amount” of emotion seems


    preposterous, and weirdly it’s usually most preposterous to the
    people who don’t believe in soul or God or whatever yet also
    don’t want to believe we are finite human beings with finite
    capacities.

    Anyway, here’s a very real example of it. Two wives are


    talking, “after ten years of marriage, we don’t cuddle anymore.
    He used to always hug and kiss me, and now….” And the
    standard interpretation is kids + work + age = lost a
    connection, took it for granted, relationship is worse than it
    was. And then she sees her newlywed friends or anyone on
    ABC and they’re constantly touching each other. Sigh. So
    maybe you misread one of my posts or studied Deepak Chopra
    for a decade and think, “ok, I’ll just DO it, I’ll just force
    myself to touch/kiss/cuddle and then behavior will lead
    emotion and we’ll connect again.” You try it and–- it feels
    fake.

    Eventually the marriage ends, and you tell your friends: “when
    he stops touching you, it’s the first sign.”

    That may be the interpretation, and if you’re merely dating it


    probably is the interpretation, but there’s another to consider:
    all that touching/cuddlying is now more appropriately given to
    the kids, it is more correct for them, and so doing it to an adult
    seems fake because it IS fake. You can’t touch a 5 year old the
    same way you touch a 40 year old, not unless you’re a [TBD
    priest/football joke here]. The point isn’t that your relationship
    is worse, the point is that it is different because it has to be
    different because otherwise you would explode. What remains
    is for you to figure out some new, adult way to “touch”,
    whether that’s backrubs or a bondage mask I have no idea, but
    your love has to grow up or else you will think you’ve fallen
    out of love. “How can you incorrectly think you’ve fallen out
    of love?” How many times have you incorrectly thought you
    were in love?

    V.

    I’m not judging Amy, at all, but her story is so representative


    of what countless women go through, the “I can’t believe I did
    that” repeated 1000 times, so I hope she won’t mind my using
    her story to make a point about how we frame our experiences
    for the very specific purpose of NOT changing.

    It’s not possible to overstate the importance of interpreting


    everything as a story— by which I mean, you don’t know the
    full story unless you know all of the acts. If one is missing, it
    is on purpose.

    To be clear, as Amy was getting fingered in the cab, it wasn’t


    happening as a story; but she’s telling it to us as a story, with a
    beginning and an end. But the beginning and ending she chose
    are arbitrary, she chose them for a reason. She said the
    beginning was when she got in the cab and the end was when
    she got out of the cab, which sounds expedient, but you should
    be very, very suspicious of the way you frame a story because
    the goal is almost never to help you understand it but to make
    you be able to live with it. The goal is identity preservation.
    Make sure you stay the main character in your own movie.

    So even though I have no idea why she wanted to get fingered


    by a cab driver, I have heard this type of story before, I know
    the structure, and I know the payoff is in Act V, which she
    conveniently forgot to mention.
    There are people who like doing dangerous sexual stuff, and
    people who don’t, and those who don’t are divided into those
    who never tell anyone and those who do tell someone. I
    already knew Amy was in the latter category because she was
    telling the story on the radio, and people usually tell stories
    about things they are ashamed of for one reason: absolution.

    The thing is, we are ten years later, and according to Amy
    herself not much has changed— i.e. she still finds herself
    doing things she wish she didn’t. Again, I am not judging her,
    I am only explaining a very common phenomenon. So in order
    for more stories like that one to occur in her life, there had to
    be an Act V in that story that allowed future repetition; and
    that Act V would be hidden— she would always tell and
    remember the story without that part.

    Which is why Guess What Happens Next is a rigged game, I


    knew exactly what was going to happen next at the beginning
    of the story: she’d run and tell the story to the one person in
    her life who had, simultaneously, full power of absolution and
    zero power of punishment, and if she was 28 that would be a
    therapist but at 18 it could only be one person: her mother.

    Psychological detectives take note: Amy would not have


    mentioned that she told her mom, she thought the story was
    finished, except that someone accidentally asked what she did
    next explicitly. Yet it is the key to the whole story.

    Telling mom may seem like madness but remember, the goal is
    always NOT to change. Imagine what would happen if she
    didn’t tell mom: she’d either repeat these behaviors in a death
    spiral until she discovered meth and flamed out; or would be
    so guilty she never did it again. Mom recites the necessary
    spell to protect against future change and allow for repetition:

    MOM

    What were you thinking? You’re not like that! You’re not that
    kind of person! You’re so much better than that!
    AMY

    Thanks, mom, I feel a lot better.

    END SCENE.

    Every time you crowdsource the superego a piece of you is


    split off as bad keeping the rest of you intact as good. “I’m not
    a bad person, I just did a bad thing.”

    Women who engage in “dangerous behaviors” (NB: for gays


    and women this ALWAYS refers to sex, for hetero men
    NEVER) and then tell people about them are not punishing
    themselves, at all. “But it makes me feel so bad about myself.”
    That’s the hierarchy, that’s the point. Two hours of sobbing
    hysterically and then off to Facebook and a sandwich. Thanks,
    mom.

    People will do whatever has worked for them since childhood,


    which in this case is split off unpalatable pieces of themselves
    and disown them, protecting the rest. “I did that, but it’s not
    who I am.” When “it” is really bad you move to Step 2: find
    someone who can substitute for your atrophied superego to
    confirm “you’re not like that”, and you’re good for a decade of
    emotional stagnation and the following crazy sentence: “I’ve
    changed a lot in ten years.” Ha, yeah— wait, you’re serious?
    Dude, no one who is not you agrees. No one. Ask anyone. Not
    even your therapist. “That’s not fair, my job isn’t to judge.”
    You’re hired.

    The downside of this, apart from candida, is that you train


    yourself to think of all events and behaviors as happening to
    separate parts of yourself— you don’t fully own them— which
    means that when something good does happen you can’t own
    that, either. Everything will come with self-doubt. “That was
    good, but I was lucky/right place/other guy died/connections,
    otherwise it wouldn’t have worked.”

    VI.
    I know what you’re thinking, you’re thinking, “ok, all this is
    fine…. but why did she do it? Why did she get fingered in a
    cab if she didn’t want to?”

    You’re thinking, “I don’t want to hear about how everything is


    interpretable through the artificial paradigm of narrative
    structure—” as if it was me and not your god who made it this
    way, as if I was better able to invent a convenient fiction that
    happened to apply to you rather than describe a process that’s
    been used for millennia. You think you’re the first? You think
    no one but you has lived your life? Do you think you are so
    unique? Do you think I just took a guess? This isn’t the first
    time this game has been played, there’ve been over 100
    generations of Guess What Happens Next and it is the exact
    same answer every single time. All of this has happened
    before and it will happen again.

    But you want “why”, you’re drawn to “why” like you’re


    drawn to a pretty girl in the rain. Let me guess: she has black
    hair, big eyes, and is dressed like an ingenue. “Why?” is the
    most seductive of questions because it is innocent, childlike,
    infinite in possibilities, and utterly devoted to you.

    “Why am I this way? Why do I do what I do?” But what will


    you do with that information? What good is it? If you were an
    android, would it change you to know why you were
    programmed the way you were? “Why” is masturbation,
    “why” is the enemy, the only question that matters is, now
    what?

    But you want “why”. Ok, here we go.

    The clue is that she did this at the end of the night. “Is it
    because she was drunk?” I’m drunk now, and I’m in an air
    taxi, and no one is fingering me. No.

    You will observe that most of your “I can’t believe I did that”
    behaviors are at the end of the night, the end of the day, the
    end of the party, the end of the story, which means the
    narrative has less in common with a porno than with the last
    chip in the bag or the last swig out of the bottle— there are a
    billion possible reasons why you started the bottle or plowed
    through the bags, but that very last one has only one unique
    motivation, and it is in understanding that last one that you
    will or will not change your future.

    When you’re in a casino and you blow $50 on the slot


    machine, pull, pull, pull, pull, pull, pull, each and every time
    you’re hoping that this will be the one that hits, and once in a
    while you get a little something— it is the randomness, the
    suddenness, the unpredictability of that even tiny reward
    which keeps you pulling through your bankroll. “Variable ratio
    schedule.” Sound right? Well, none of those $50 have anything
    to do with the cab ride.

    But then you’re done, tapped out, and you turn to go but….
    wait a minute………………………. you have one token left.
    Stop now, look at that one, look carefully at it, it is your
    contract with the Devil, it is the selling of your soul. What is
    its value? Look at it, it doesn’t matter what you do, it matters
    what you think— which means what you are about to do has
    already been decided.

    You could pocket that last one. Go home with something other
    than nothing. Or, you could play that last one with
    superstitious hope, praying and bargaining that if you hit
    you’ll X/Y/Z. But neither of those are what you think, right?
    Instead you think, “whatever” and you put it in the machine—
    NOT because you think this time it will pay off— be honest
    with yourself, you know that that initial optimism of game
    play is gone— you do it precisely because you know it will
    fail— you are throwing it away, on purpose, so you can walk
    away from the machine “clean”, finished, so you can play-act
    at catharsis. “This is the last one!” you cry, like you’re yelling
    out “it is accomplished!” The final suffering, look for a brand
    new me in a few days. And unlike Amy’s cab ride, you are
    turning this experience into a story in real time, you are
    writing the ending as if someone else is watching, as if it were
    a reality show or you were offering a voice over, you are
    constructing that experience, saying your lines, as the last Act
    of a story being told to an imaginary audience, a god, your
    future self, the balance of energy in the universe— The Big
    Other.

    And you think you’re done but what you don’t realize is
    you’re only done Act III.

    That’s the last chip in the bag— “whatever, might as well.”


    That’s the last swig, “I’m never drinking again.” That’s selling
    your stocks into a downturn, that’s your sexual history,
    throwing it away one more time not because this time the guy
    is going to be great but because it’s not going to be great, it’s a
    sacrifice to the volcano.

    You throw it away, on purpose, because it’s not worth holding


    on to it, you’ve already disavowed it as useless, evil, pointless,
    hopeless— it is the last remnant of a part of you you want
    gone. You play that last coin, drink that last drink, eat that last
    chip and throw your vagina at a billy goat— all of those are
    the splitting off of a piece of yourself that you then can leave
    behind. The act is the “physical expression of an intrapsychic
    process”— you are acting out what you wish were true, like a
    rape victim scrubbing herself clean. “That’s not me–
    anymore.” If only it were that easy. I sympathize, you have no
    idea.

    What’s most sad about it is that you might have been right— it
    might have worked— except that instead of making that be the
    end of the story you drag it out for one more Act, and ensure
    that the pattern repeats, ad nauseam. You don’t want the story
    to end. It’s not a great story, but it’s the one you know, the one
    you understand, and you’d rather have 500 pages of repetition
    compulsion than take a chance on Once Upon A Time. Writing
    is hard, I know. I know.

    “How can any of this even be real?” you ask, hoping that since
    I drink and since I don’t sleep therefore I must be insane.
    Never mind that: focus on the words. Since you reinterpret
    your life as a story, then your entire book has already been
    written, give me Acts I-III and the beginning of IV I can tell
    you the ending. Ok, maybe in your story you it’s a job and not
    a whale, or you choose a car not a train, or maybe it’s “Reader,
    I married him” or “there’s something we need to do as soon as
    possible”— minor details, the ending always flows logically
    from the beginning— and if you’re young enough you’ll even
    think you’d be satisfied with a tragedy as long as it’s dramatic
    enough. Don’t sweat it, it’s the age. But if I’m permitted I’ll
    offer you one final prediction, you’ll either take this as a
    warning or remember that you don’t believe in all this crap: if
    you are looking for the perfect climax but have no knowledge
    of the resolution, if you do not write your story towards an
    ending, then your life will default to the one ending that will
    terrify you more than any other possible: “He could not refrain
    from going on with them, but it seems to us that we may stop
    here.” It is inevitable.

    –—

    http://twitter.com/thelastpsych
    The Second Story Of Echo
    And Narcissus - Audio
    July 18, 2012

    Buy Now— mp3 format

    Buy Now— m4a format

    m4a for Apple products, everyone else mp3 unless you know
    what you’re doing.
    18 minute story. $2.00. After you pay, you’ll receive an email
    with a link to the download.

    In a few months I will make this into a free video, and I will
    post the free text of the audio as well. So it’s up to you
    whether you value… whatever this site is.

    Don’t tell me I shouldn’t use a Blackberry mic. I know that


    now.

    http://twitter.com/thelastpsych
    Just Because You See It,
    Doesn’t Mean It’s Gone
    August 16, 2012

    This is a post for psychiatrists/psychologists who do long term


    psychotherapy, sorry everybody else. Pandering to my base.
    It’s an election year.

    This is the email I got:

    Dear Alone:

    You wrote a while ago:

    No one ever asks me, ever, “I think I’m a narcissist, and


    I’m worried I’m hurting my family.” No one ever asks
    me, “I think I’m too controlling, I’m trying to subtly
    manipulate my girlfriend not to notice other people’s
    qualities.” No one ever, ever, ever asks me, “I am often
    consumed by irrational rage, I am unable to feel guilt,
    only shame, and when I am caught, found out, exposed, I
    try to break down those around me so they feel worse
    than I do, so they are too miserable to look down on me.”

    If that was what they asked, I would tell them them


    change is within grasp. But.

    I might be asking myself something like that. If I tell you a


    story would you tell me what you think?

    II.

    Imagine a crowded subway, and a beautiful woman gets on.


    Hyper-beautiful, the kind of woman who can wear no makeup,
    a parka, earmuffs and a bulky scarf and that somehow makes
    her look even prettier. A handsome man about her age in an
    expensive suit gets up and says, “please, take my seat.” She
    smiles, and hastily sits down.

    What happened? Raise your hand if you think this is a sexually


    motivated act, i.e. Christian Grey isn’t so delusional that he
    assumes she’s going to have sex with him, but in a Hail Mary,
    longshot kind of way it’s worth the price of standing for three
    stops.

    Now raise your hand if you think he was just being nice— he
    would have done it for any woman. Huh. Really? Then why
    was he sitting at all?

    But why does the woman think she got the seat? Does she
    think, “the only reason he gave me his seat is because the Hail
    Mary is worth the price of standing for three stops?” Or does
    she think, “no, come on, he was just being nice.”

    We can’t be certain why Hugo Boss gave up his seat. But if the
    woman picked b, we know something about her: she sees the
    world as intrinsically nice, it’s a place where random kindness
    exists and hence must be a reflection on the physics of the
    world, not her specifically— “New Yorkers are so nice!” she
    says, and she actually believes it.

    In other words: the goodness is in him, not in her.

    III.

    One of the frustrating things for therapists is a patient who is


    unable to see reality. Maybe it’s a guy who takes every little
    thing his ex does as a sign she wants him back; or it’s a college
    kid who is failing his classes because he thinks it’s more
    important to “help Jen with the crisis she is going through”; or
    maybe it’s a woman who thinks men aren’t interested in her.

    In the course of therapy she explains she wishes she could


    meet a good guy, nice, with a good job, someone like the guy
    on the subway. And you’re stumped, didn’t she meet a guy on
    the subway who was exactly like the guy on the subway? “Oh,
    no, he wasn’t interested in me, he was just being nice.”

    You can guess the backstory: father left when she was 8, mom
    was always telling her she was too fat and too skinny, an
    “overly critical maternal superego” which is different than a
    paternal superego because it yells at you not when you sin but
    when you fail. This is the mom who doesn’t want you to have
    premarital sex, of course, but a girl like you should be dating
    the captain of the football team. So the men who do ask her
    out, the ones she ends up dating— fearless, calf tattooed men
    who make their attraction to her explicit, even vulgar, so she
    can’t help but know that they want her and what they want
    from her. Meanwhile, these guys then treat her like crap. So
    she lives her life thinking that the only people who like her—
    the people she has to settle for— are… not great.

    Genetics took care of her body but the upbringing affected her
    vision: the childhood of never good enough filters her present
    reality, obscures it, she can’t see what is plain to everyone else,
    e.g. she’s beautiful. So the process is to uncover the reasons
    why her view of reality is distorted and help her realign with
    reality. Use insight to strengthen her damaged ego, or, if you
    want a ten step approach, block automatic thoughts. In short,
    to understand that she is good, that men do find her attractive,
    not just the brazen ones, not just jerks.

    IV.

    If you think of narcissism as grandiosity you miss the nuances,


    e.g. in her case the problem is narcissism without any
    grandiosity: she is so consumed with her identity (as not
    pretty) that she is not able to read, to empathize with, other
    people’s feelings. She doesn’t care to try because it conflicts
    with how she sees herself. Ergo: Giorgio Armani was just
    being nice.

    I recognize, of course, the countertransference: that I am


    attracted to her, it is impossible not to be. Of course I’m also
    in full control of myself, I don’t break the boundaries of
    treatment. But I also see that she doesn’t see I’m attracted to
    her, in fact I often observe how little attention she pays to my
    “feelings.” She treats me as if I am a voice only. Once I had a
    cast on my forearm and she made no mention of it. What does
    this suggest?

    Two or three years later, nothing has changed except— she


    drinks more. Huh. Things did not go according to plan.

    What happened? What happened is my analysis of the


    countertransference was purposefully self-serving, “see, I’m a
    good therapist in detecting this” which defended me against
    the truth: yes I was able to admit to myself that I was attracted
    to her, but what I was unwilling to admit to myself— that
    anyone outside of me would see immediately— was that
    part/all of my eagerness to help her was that she was beautiful;
    and the way in which I know to impress beautiful women is by
    giving gifts, helping— as it was with my own mother. Not that
    I was so delusional as to assume she’d have sex with me, but
    in a Hail Mary, longshot kind of way….

    And since I was having those feelings, and those feelings are
    BAD, “inappropriate” as we say in therapy, then it is entirely
    likely that rather than not correctly seeing reality, she saw it
    and guarded against it: by deciding that men—me— don’t
    want to have sex with her, they are just being nice.

    What I didn’t consider is that her blindness to the desires of


    men is necessary to her sanity— that she doesn’t want to
    believe that every man’s interaction with her is sexual; she
    doesn’t want to have to live in a world that only sees her
    naked. She wants the world to be… nice. Take as the origins
    anything you want, maybe abuse, maybe she started noticing
    at 15 how all the neighborhood fathers looked at her a little
    differently than they looked at the other girls; too many date
    rape close calls, jealous girlfriends, whatever you want.

    Which means that my push to get her to see reality is


    interpreted by her as yet another sexual advance— because it
    is. When she walked in she was able to block out the
    possibility I was attracted to her, but through diligent
    application of reality testing I forced her to see my erection—
    “look, I really want to help you understand what you do to
    me!”

    Fortunately for her she doesn’t exist, I made this story up, but
    it serves to illustrate an important point: rather than assume
    people are too damaged to interpret reality, the default
    assumption should be: all of this is a defense against change.
    (1)

    V.

    Here’s a story I didn’t make up, though I’ve altered it to


    simplify a complicated situation and protect his anonymity.

    Joe had a girlfriend, and though they were happy the


    relationship seemed to run it’s course, and she took up with
    another man. Despite this, she couldn’t fully let go of Joe, so
    they still talked and texted and met once in a while.
    During talks some things came up, notably things about Joe,
    notably Joe’s apparent indifference in the relationship. For
    example: “I was also hurt,” she said, “that when we broke up,
    it didn’t seem to bother you.”

    Joe told me it did bother him, perhaps more in retrospect (now


    realizing how much he liked her), but he wondered if his lack
    of emotion wasn’t a signal of a larger problem- an inability to
    connect.

    So: multiple texts, chats, and, at one meeting:

    We met and we cried very much, she said she was sad
    that we weren’t together, but it still made sense for her to
    be with that other guy. We ended up kissing and crying at
    the same time. After that I didn’t see her for about two
    weeks. But we continued to talk, she’d said that she
    missed me, and I missed her too. She said she’d been
    crying everyday since she that last meeting, wondering
    if….

    Because of that I arranged to see her again, but this time


    she said she had made up her mind and decided to be
    with the guy. She also said very quickly that she
    fantasized about us getting back together someday, but
    not now. In this kind of situation I always try to be strong
    and say that the person is not responsible for me, but this
    time I collapsed and cried. I asked her if she still loved
    me, she said “Yes, but it can’t be right now”. (2)

    Eventually they meet again, and on the way home… things get
    murky. He says he badly wanted to kiss her, but she did not
    want to.
    “She stopped me. I said “Ok, then I’ll leave”, but then she
    asked me to stay. She said she was divided, and very
    anguished, she thought she was doing something wrong. I
    said it was not wrong, because she loved me and love
    can’t be wrong (or some similar catchphrase). I tried to
    kiss her again, this time she didn’t resist but she wasn’t
    very passionate either. I noticed she was very sad. I said I
    loved her. She said “stop it”, and ran off.

    So I’m trying to think what I did wrong, and what I’m


    asking myself is:

    - How could I not pay attention to her feelings, making


    her anguished just because I needed that kiss? I see that I
    was extremely selfish that day— here she was crying and
    ambivalent, and all I felt was horny— and throughout the
    whole process I could only think that I wanted her for my
    own needs and forgot about how she felt.

    Even though I always asked her if she wanted me out of


    her life and she said no, why do I even need to ask? Why
    couldn’t I just see that she was crying and tried to
    comfort her instead of trying to kiss her?

    So:

    How do I stop hurting people?

    I know that I’m only thinking about that because I had a


    loss and I miss her a lot and I want to be a better person
    so I’ll have a better life, but still it’s good to become a
    better person and stop hurting people.

    This time I really want to change who I am because who I


    am is not working.
    I wrote a reply about their relationship, which highlighted her
    ambivalence and how such ambivalence in women is often
    resolved. However, he wasn’t really asking for advice about
    the relationship, but rather advice about being a better person.
    Was he wrong for pressuring her when she was so conflicted?
    Did he ignore her feelings? How can he change?

    He wrote back (excerpts):

    1. I see her ambivalence and her conflict. Maybe I’d have


    an easier time if I just said “I want you, dump the guy”….

    2. I feel jealous now that she accepted the “no more texts
    or dates or anything”. Because at first the fact that she fell
    in love with someone else didn’t stop her from expressing
    love towards me. Now it did. Now I’m jealous….

    4. Yes, I feel guilty for the day when she was crying and
    all I could think of was trying to kiss her. I didn’t use
    strength, didn’t hold her or anything, she accepted my
    kiss but very sadly. Sometimes I think about it and it feels
    almost like I raped her. This fact specifically is what
    made me write to you: I wouldn’t share that thought with
    anyone who’s close to me. Is that shame or guilt? Or
    both? I know that she didn’t see it that way because later
    that day we talked and she told me she didn’t want me to
    leave her life and she couldn’t forget me. Which is
    consistent with your interpretation.

    4.a. I had noticed narcissistic behavior in me before


    several times and I’ve been trying to change. For
    instance, somehow I thought I’d look ridiculous giving
    someone a gift so I didn’t usually did that, no matter the
    circumstance. I originally thought giving a gift was about
    me, a reflection on me, not about the person receiving the
    gift. When I came back from Denver I brought a Broncos
    jersey for my little brother, but I was worried about what
    my father would think of me and about my choice of a
    gift, and stuff like that, but I focused on how my brother
    would feel receiving the gift. It may sound silly but for
    me that was a big deal. It pisses me off that I forgot to
    pay attention to her feelings in this situation.

    My reply:

    I now understand that this kiss is what prompted your email,


    this specific incident. I recognize you feel guilty for pressuring
    her into a kiss. And she was crying, which should have stopped
    you (you believe) but it didn’t. If you were blind to her feelings
    you could say, in retrospect, you are a selfish person without
    empathy who doesn’t notice other people’s feelings, who only
    does what he wants. But it wasn’t blindness (you tell me), you
    knew full well she didn’t want to kiss you, yet you proceeded
    anyway. This makes you even more of a narcissistic monster. Is
    this a correct hearing of your story as you intended it to tell
    me?

    The problem is that you are telling me two stories.

    On the one hand, you are telling me a story about your “guilt”
    over taking advantage of her vulnerability and kissing her
    when she didn’t want it. Which is odd, because apparently
    kissing her wasn’t really an example of taking advantage of
    her— she didn’t think so, right? She told you so herself later.
    So then it was a kind of dialogue: her ambivalence wanted a
    firm response, and you (against your ordinary nature) were
    surprised to find yourself compelled to give it to her.
    You kissed her; you say— your words— that she didn’t see it
    as any kind of “rape”— but did she feel any guilt for kissing
    you? For cheating on her boyfriend? I’m not saying she
    should or should not, merely that one would expect her to be
    wrestling with her guilt. But instead on the phone later she is
    discussing yours, making you feel like you did nothing wrong.
    If you follow me so far, then talking to you and easing your
    guilt isn’t primarily because she cares about your suffering,
    but because it allows her to avoid looking at her own. If you
    “forced” the kiss— and by saying you didn’t force it she is
    saying it’s okay that you did– in forgiving you she would be
    benevolently implying the fault was yours and she was
    blameless. This isn’t malicious or intentional, this is all
    unconscious, it is performance: can I trick my superego? Since
    I was crying, how much could I really have wanted it?

    But none of that is important, because there’s a second story.

    Your next paragraph to me describes narcissism— my


    “specialty”— and worrying about how a gift would be seen by
    your father, and (ultimately) doing the right thing and focusing
    not on your feelings but on your brother’s. But how can I not
    read that paragraph and think:

    father=TLP
    brother=ex
    gift=kiss

    and

    “I thought giving a gift was about me, not about the person
    receiving the gift” which is, “what will you, TLP, think about
    this, now that I am thinking about other people’s feelings? Will
    you be critical like my father, or will I get your approval?”

    I know you’ll counter that you in fact did give a gift to your
    brother, but the juxtaposition of the example you chose from 10
    million other possibles cannot be a coincidence. Which is why
    it is important to focus on the words.
    So what is the right interpretation of that paragraph, 4a? Why
    does it follow so logically from 4? Why are you telling it to
    me? Like all these things, it’s a defense against change: “see?
    I think about other people’s feelings.” But that’s the
    narcissism. The narcissism isn’t forcing a kiss on her; the
    narcissism is the thinking that all of these events with your ex
    are entirely yours to decide, to bear the responsibility of. She
    is merely a supporting cast member that wasn’t nearly as
    sophisticated, insightful, intuitive as you. You want to bear the
    guilt because it shows you— and me— you are a better person.

    Please understand that this is not a judgment of you, it is (my


    opinion) of how you see yourself.

    Your first story is the age old story of unresolved feelings for
    each other, oozing out between the clenched fingers of a
    tightening fist that thinks it can will emotions into control. But
    the insight for you is that your “narcissism” isn’t a lack of
    empathy but the opposite: other people are all little brothers,
    ex-girlfriends, supporting cast, who are less able to make good
    decisions, so the world needs you to do it.

    I would say that ethically you are still supposed to act as if you
    had unilateral responsibility; but simultaneously you have to
    be able to see the other as a fully autonomous, free, aware
    person.

    In summary: you could feel (a little) guilty for kissing her


    when you knew it was wrong; but the real problem for you is
    that you naturally reduced her to a person with less agency
    than yourself.

    VI.

    The problem with therapy— include self help and mind hacks
    — is its amazing failure rate. People do it for years and come
    out of it and feel like they understand themselves better but
    they do not change. If it failed to produce both insights and
    change it would make sense, but it is almost always one
    without the other.

    In Joe’s case, it is supremely tempting for both patient and


    therapist to focus on the problem he is describing— “I feel
    guilt over pressuring the girl, does this make me a narcissist?”
    And the therapist can generate a series of insights which the
    patient accepts, which although correct lead nowhere.

    What’s missing is an analysis of the transference. Joe added an


    entire paragraph 4a which was— superfluous? It served only
    to stroke my ego, i.e. “you’ve helped me, here is an example
    where I was able to apply your lessons.” It’s that paragraph in
    its seeming uselessness that reveals his real motivation in
    writing me and hence his actual problem. He’s offering ME a
    story about how he forced himself on a girl- and was
    legitimately bothered by doing it— but telling it to me is
    basically saying, as in 4a, “here’s an example where I did
    something bad but I also feel guilt about it— if I feel guilt, I
    must be changing— see, I learned the lessons!” He
    specifically references the difference between guilt and shame
    because he knows I know that narcissists never feel guilt, only
    shame. So rather than that guilt being evidence of self-
    awareness, that guilt is a trick for my approval. He sounds like
    he’s asking for advice, “how can I change?” but what he wants
    is in the transference: “Dad, did I do good?” It is that seeking
    of approval that is the heart of his problem, not his
    relationship with women, not his “narcissism” of kissing her
    when she didn’t want to.

    A really good therapist will be able to get to this kind of depth;


    someone who will not take the chief complaint at face value,
    but will focus on the words.

    And yet: still this will fail to produce any meaningful change.
    Insights plenty, but no change. Is it because I am wrong? No,
    it’s because I am not Alone.

    VII.
    It’s a cliche in psychiatry to “analyze the transference” but
    never mind no one bothers to do this much anymore; it is
    completely impossible to do this.

    I may have been quite clever in telling him the interpretation


    of the transference in 4a, but the problem is that when I told
    him “you are seeing me as a kind of father” I was saying it AS
    his father. Not: I stopped being me and became his father; but
    from the very moment I responded to him, every single word I
    wrote was coming from his father. You can’t step outside the
    transference, there is no objective place for me to stand and
    tell him my thoughts, and there’s no safe distance for him to
    stand and hear them. So if I say, for example, that I do or don’t
    think he handled his ex correctly, I am saying that as his father
    — i.e. critical, judgmental, kind, forgiving, whatever.

    If I think that by explaining the transference to Joe I somehow


    dispel it, as if it were an illusion that once explained could
    never fool him again— then I won’t understand that while I
    offer further insights or interpretations, while my lips are
    moving, all he is hearing is: angry at me; love too easily
    obtained therefore of no value; thinks I’m a fool; thinks I’m a
    genius.

    Then what Joe will do to me, his therapist, is exactly what he


    does to his own father: try and fool me into giving my
    approval. And if he doesn’t get it one way he’ll trick me
    another. His email can be understood as just this kind of a
    trick; the focus on the guilt over the kiss is a way of saying got
    me, “see? I’m changing! Validate me!”

    Here is another danger: if I (TLP) think that when I explain


    things to him, that he and I step outside of the transference and
    speak objectively— as if we are talking about Joe while he is
    sitting in the other room— if I think this objective stance is not
    only possible but desirable— then what I am teaching him to
    do is to self-observation, I am training him to examine his own
    actions and thoughts as if he were a neutral person inside his
    own mind. But that other person would be me. Grant me 50%
    of the time I’m awesome. What about the rest? Would that
    person have helped the beautiful woman on the train, or driven
    her to alcoholism?

    Given that the problem here is a kind of narcissism (a


    description and not a judgement) then by fostering self-
    observation I am actually worsening his narcissism. And he
    will inevitably say, “I know myself better, but I’m still doing
    the same things.”

    VIII.

    So it becomes important not to fall into that trap, to foster


    change and not just insight. If I was actually his therapist then
    the correct thing to do would be NOT to tell him all this, but
    rather to note it to myself as information: “this is the nature of
    the transference.” It’s hopefully of some use in an email
    because since we don’t have any kind of relationship; since I
    am not likely to meet him, it’s better that he understands how
    this works than. But in therapy there is no value in it to the
    patient.

    In fact, as his therapist, my urge to explain it to him would be


    my own unKantian narcissism: using him as a means to show
    off. Telling him my great insight is the same as my desire to
    help a beautiful patient: it is for me, not for them. In therapy
    we see a reversal of my often repeated maxim: if you’re saying
    it, it’s for you.

    And so what? What’s wrong with giving advice? Because (in


    his case) he doesn’t want advice, he wants validation. And if
    he doesn’t get it from me, he’ll do what he already told me he
    would do: “…I was worried about what my father would think
    of me… but I focused on how my brother would feel receiving
    the gift.” In other words, he’ll find someone who does. This is
    his real problem: the constant search for approval from Dad,
    women, wherever. And of course it will never be enough,
    because that’s the nature of the pathology: if he gets validation
    he’ll be temporarily appeased, but eventually devalue it
    because if it was obtainable by him, it must be valueless.

    I can infer from this that he sees his father as generally right
    but overly critical, and Joe says to himself, “I’m a good
    person, everyone else thinks I’m a good person, but no matter
    what I do I can’t convince my father of this.” This is self-
    doubt, and it quickly becomes: “I’ve fooled everyone else, but
    my usual tactics don’t fool my father” and so Joe is trapped
    between hating his Dad for being so mean but still/therefore
    suspects he’s the best judge of character out there, which
    means Joe suffers not from high self-esteem, but low self-
    esteem. This is why my approval (if I were his therapist) is so
    important to him and simultaneously so damaging: “TLP is
    equivalent to my father. I may not be able to get my father’s
    approval, but if I can get TLP’s then it confirms that I am
    good.” And change is thus unnecessary. The point there is that
    he doesn’t want to change, he wants a reason not to change, he
    wants to be seen as good without having to earn (whatever it is
    he believes is necessary to get) his father’s approval.

    IX.

    Therapists should understand the imaginary transference but


    not play into it, and instead stay outside, an abstraction, an
    inexplicable mind that already knows all the answers but
    doesn’t tell them (because telling them is inside the
    transference.) Whose silence is taken by the patient to mean
    something— and the answer to the patient’s problem is how
    they interpreted that silence.

    This is why I know that though Joe will “like” my email to


    him very much, think it helpful, it is this post that he won’t
    like that will actually help him more. He can’t say anything to
    me here, there’s no dialogue, the post just is: all he has is what
    I’ve written here and his feelings about it; and it is those
    feelings, not my post, that hold the answer for him.
    The moment the therapist speaks, he stops being a symbol of
    knowledge and becomes a person to be fooled (or loved or
    devalued or punished or whatever the nature of that particular
    transference is.) A post, a story, and the (mostly) silent
    therapist are the opposite: a screen to project on so that patient
    or reader can then ask, why does this make me feel like that?
    (Or, more rigorously: “what do you want from me?”)

    This is why readers probably find the my posts about other


    readers’ problems so powerful. When you read a post about
    my interaction with someone else, you are assuming the role
    of that outside neutral observer that is impossible inside the
    dialogue. Not completely, of course, there is always some
    fantasy about who I am and who Joe is, what we are like, but
    clearly you are more outside our transferential situation than
    we are.

    For these reasons, I am becoming convinced that the only real


    way to “personal growth” outside of direct action is through
    careful study of fiction. Of course stories may have an
    intended meaning, but a well written story allows you to ask
    not just “what does the story mean?” but “why do I think that
    this is what the story means?” As in The Second Story Of
    Echo And Narcissus: “The story is the pool… what do you see
    in it? It’s a reflection and a projection…” (3)

    1. If you want to observe the extent to which you are not in


    control of your countertransferential feelings (women
    included), get a swimsuit model as a patient— and let
    someone else watch you do the therapy. Do you dare? I once
    had the magical opportunity to watch as a resident was told in
    rounds that the patient being transferred to him by the
    graduating resident was “gorgeous, a model”. Someone threw
    a switch, he changed immediately: more professional; softer,
    more articulated speaking; more mature— all before he ever
    saw her. It was as if some part of him said, “yes, it makes
    sense I would be chosen.” But even more impressive was how
    the rest of the residents treated him over the course of the year.
    There was some envy but his patient elevated him in their
    eyes, as if he was a better person, a better therapist. (Similarly:
    all on-call psychiatrists have had the secret feeling that a
    doctor’s chaotic patient is a reflection on the doctor.) They
    asked his opinion on matters when it was neither necessary nor
    even… a good idea. His proximity to a beautiful woman who
    came to see him made him more of a man— and of course he
    wasn’t dating her, it was random chance he was picked— but
    it gave him a kind of merit as if he had had something to do
    with it, which was in retrospect silently justified, “he must be
    good if she stayed with him.” This was true of the female
    residents as well, and, most importantly, the attendings. (I
    wonder how they would have interpreted it if she stopped
    coming.) The simple fact that he was appropriate in the
    sessions was enough to indicate his talent. It should be no
    surprise that with this amount of unexplored
    countertransference from him (and all of his colleagues) that
    no progress was made in her therapy.

    2. Though this post isn’t about the woman, please observe that
    she is running a kind of story here, the theme of which is, “I
    desire the feeling of desire.” She likes emotional energy. She
    breaks up so that there is a deep sadness (Act III) so that
    there’s back and forth resulting in the climax of reconciliation.
    “We’re in love!” Importantly, in order for her to get what she
    needs from this narrative, they don’t actually have to get
    together in Act IV, it is only necessary that she sees her life as
    a story with these four acts— so the breakup is only possible
    (or easy) because she anticipates that at some point in the
    future there is an Act IV. NB: no mention of Act V. She isn’t
    aware there is one, which is her life’s problem, which is why
    this story will repeat with her other relationships, including the
    one she’s cheating on now.

    3. It would be an interesting experiment to read a story and


    write down your feelings and interpretations of it, and then
    return to the story a decade later.
    Paul Ryan vs. Rage Against
    The Machine
    August 24, 2012

    i got you babe


    Here’s a prediction: This will be the least attended Presidential
    election in history. Over 50% of the voting age population will
    not even bother to find out who won, let alone vote. Unless
    you have money on it when you wake up the next morning at
    6am the first sound you hear will be a clock radio playing the
    counterculture anthem “…then put your little hand in mine…”
    and you will want to kill yourself. Or marry Andie McDowell,
    which is only slightly worse. “She was great in Sex, Lies, And
    Videotape.” No she wasn’t. Ativan is not method acting.

    Paul Ryan says he likes Rage Against The Machine, which


    everyone thinks is ironic since Ryan is “the very machine they
    are raging against.” Get it? You’re going to read that statement
    a lot.
    I’m not political at all, not only am I not going to vote in the
    coming election I’m going to hide in the bushes outside my
    local polling station in a full Raiders uniform and clothesline
    the highly dangerous people who are only there to vote for
    Jesus. But while I don’t know much about Paul Ryan and even
    less about Rage Against The Machine, I do know a media set
    up when I see one.

    Ok, so we know Ryan is an idiot for not knowing he’s not


    supposed to like Rage Against The Machine, but did it occur
    to anyone to ask how we know Ryan likes them, why we know
    this utterly useless and meaningless and distractionary and
    prejudicial piece of miscellany? “It was on Ryan’s facebook
    page.” Come on, pants on fire, don’t act like you even knew he
    had a facebook page, next your going to tell me you’ve read
    the Constitution “several times.” You learned it the same way
    we all did: someone told you it was in a profile about him in
    The New York Times, and that someone was the only group to
    have read that profile: other media.

    The structure of political reporting is 100% identical to the


    structure of celebrity reporting: the double act. Straight man
    delivers the softball pitch:

    Yet even if he is viewed as politically pure by the


    modern-day standards of his party’s base, he is not
    without contradictions. The nation’s first Generation X
    vice-presidential candidate, he is an avowed proponent of
    free markets whose family has interests in oil leases. But
    he counts Rage Against the Machine, which sings about
    the greed of oil companies and whose Web site praises
    the anti-corporate Occupy Wall Street movement, among
    his favorite bands.

    and the rest of the media hit the punchline. Over and over and
    over, five nights a week. “He’s the very machine they’re
    raging against!” We get it, Rockbrain. Was funny once.
    II.

    The real irony of this story is that the clueless one is Rage
    Against The Machine, not Paul Ryan. This isn’t a partisan
    statement, it is simply a fact.

    Ryan’s main sin is not paying attention to the lyrics, believing


    he can listen to music without caring about the band’s
    message.

    The thing is, Ryan and the rest of the Gen-X coven were
    taught not to pay attention to lyrics, not just by the mumblings
    of Nirvana and the distracting Cleveland accent of Rammstein,
    but by our chief connection to all pop culture in America:
    commercials.

    The title says “Songs Ruined By Commercials” but imagine


    those ads playing in a different country: their only connection
    to the songs is those ads. (1)

    You may counter that these songs were already meaningless


    pop songs, but this happens all the time:
    This is an ad of nearly genius creativity if your metric is brand
    identification, brand enhancement. It almost convinces you
    that “Dude, the media has conditioned us to think the world is
    a bad place, but most of the time, humans beings are
    awesome” and the only thing that will stop you from falling
    into that spiral of propaganda is if you say out loud that the
    person trying to convince you of that fact is Coca Cola. Did
    you feel a little bit of global community? Well, I’ve been
    pretty much everywhere, and no. Play the video with the
    sound off and don’t look at the words— a kind of voiceover,
    right?— and what you see is a world with crumbling
    infrastructure, appallingly terrible safety standards, what I
    assume are drunk drivers, and lots and lots of people not
    working. There’s a guy defacing public property at 0:59, but
    it’s all good.

    You know what else I see that deserves mention, by which I


    mean is completely obfuscated by the ad? There are cameras
    everywhere.

    Ryan listened to the Rage Against The Machine in the precise


    way it was produced to be heard: as soundtrack to your own
    movie, stripped of its intended meaning. It is not an accident
    that it found it’s way as an actual soundtrack to an actual
    movie.
    I’m sure Rage is earnest in their core belief system, I do not
    dispute this, I do not claim they are sell outs at all, but you
    can’t argue that you’re part of the counterculture if you’ve
    been #8 on TRL in between Destiny’s Child and Lou Vega’s
    Mambo No. 5. You aren’t the counterculture, you are the
    culture.

    check out the militant poetry, yo. Brought to you by MTV

    In this respect Paul Ryan didn’t misunderstand Rage’s


    message, he simply heard the music exactly as he and
    everyone else were directed to hear it. If the song that changed
    your life is played on a radio station that begins with a K or
    whose symbol is a bee, you are a bah bah black sheep. “This is
    good,” FM program directors said to you in 1999. “Eat it.”

    I don’t begrudge anyone making a fortune from their art, but if


    you allow the system to make you rich from your art, well,
    there’s a trade off.

    Tom Morello may want to do a bit of soul searching: did his


    art really bring awareness to the public, or did it serve the
    system’s function of keeping everyone in line, i.e. a safe way
    to let off steam so that the kind of changes he was earnestly
    demanding were negated? This is the exact same question one
    must ask about the now safely defuncted OccupyWallSt, and
    even Obama himself. You know why you don’t hear about
    Ron Paul anymore? Because you heard about him back when
    it was safe. Now that you have two candidates who couldn’t
    possibly be more similar— not in “ideology”, but in action—
    you are given no third option. Strike that, no second option.

    Here’s the rule, may as well learn it before it’s your head in the
    scope: when you give yourself to the media to do with what
    they will, they will. You can’t go crying about it later, because
    by then you will have ceased to exist.

    Instead of condemning Paul Ryan for not being cool enough to


    get it, Tom Morello might want to ask how it is possible that
    “the embodiment of the machine we are raging against” ended
    up liking him. What was the precise mechanism that caused
    that to happen? Do you think— everyone take a moment—
    that Paul Ryan liked it on his own free will? That if we
    dropped those beats on some 10th century viking marauders,
    they’d be all in?

    And why, when Tom Morello wants to rage against Paul Ryan,
    he does it through the subversive, iconoclastic, angry medium
    of…. Rolling Stone? That’ll get him. Let me be clear: I don’t
    blame Morello for writing in Rolling Stone, I blame him for
    not asking himself what kind of a man is he that attracts
    Rolling Stone. (2)

    Paul Ryan and Tom Morello are 100% the exact same person.
    I realize they and you may think they are different, but they
    are more closely a product of their immediate environment and
    generation than any of their incidental differences. If Morello
    and Ryan went back in time and sideways in geography to the
    November after the October Revolution, they would totally
    lock the door to their shared apartment. “I don’t know what
    the hell is going on outside,” it doesn’t matter which one
    would say to the other, “but I’m pretty sure I don’t want any
    part of it.” The partisanship that everyone desperately clings to
    is a media construction serving the necessary function of
    letting you self-identify, in the absence of anything in your life
    more substantive. In other words, Fox & Friends are doing you
    a favor.

    Both Ryan and Morello have some influence on society, please


    observe what has become of them as individuals, it is
    quintessentially what defines post WWII America: if there is
    something legitimately dangerous to the system— and Morello
    and Ryan both fit this description— rather than send in the
    secret police, it absorbs them by hyperpopularity, edits them
    into TV soundbites, buries them in plain sight. Problem
    solved. Put on your special sunglasses:

    http://twitter.com/thelastpsych

    –
    1.

    The straightforward deconstruction: the ad presents not


    representational images but aspirational images, in this case
    it’s not targeting the demo that likes Oberhofer, but shows you
    that you can be like the five people with the phones who, by
    virtue of their phones, stand apart from the masses. Anyone
    can listen to a concert, these people are, in some way, part of
    that concert experience. NB: they are the only people you
    remember from the ad, other than the band itself. Those people
    let other people in on the big secret, e.g. Oberhofer is great.

    But observe that when they decide to share the video of the
    concert, they share it with other people who are also at that
    very concert— who then divert their attention away from the
    live performance so that they can gaze in wonder at the
    broadcast of the concert. You may think this is an accident but
    it is one of the best representations of consumerist capitalism,
    i.e. branding, so pay attention: there is no expectation that
    people can enjoy, engage, or value something directly,
    especially art, religion, politics— the expectation is that we
    need an intermediary, an “expert”, someone who really
    understands these things. T-Mobile is offering you the chance
    not to experience art more directly— which they know is
    impossible and anyway not that important to anyone— but to
    become that intermediary, to derive identity from that role.
    2. An interesting take on this is the British series Black Mirror,
    three separate stories of “our unease with the modern world.”
    Spoilers coming: In the second story, the youth are put on
    stationary bikes to create energy for the world, and are paid in,
    essentially, Facebook credits that serve also as money. The
    only way out of this enslavement is to get on Hot Spot— i.e. to
    become famous. One young black man rises up against the
    system with the only violence he has available: he goes on Hot
    Spot and threatens to stab himself in the neck with a shard of
    glass unless he’s allowed to rage against the machine. But
    rather than gas the theatre or send in the snipers— they give
    him his own weekly talk show where he is safely allowed to
    rage against the system, in between commercials.

    However, the true import of that episode is only revealed when


    considered with the first episode, in which the Princess (e.g. of
    Wales) is kidnapped, with a single ransom demand: the Prime
    Minister must have sex with a pig, on live TV. Is the Princess’s
    life wirth it? Should they negotiate with terrorists? But all of
    this is cover for the real conflict: if he does it, he’ll be
    disgraced, most certainly not re-elected.

    He does it: it takes over an hour, some tranquilizers and some


    Viagra. It is moving, because as he cries through the sex act,
    all of England is watching from pubs, cheering and jeering.
    However, the final post-credits scene reveals the secondary
    consequence of the always-on, broadcast world: after a year,
    the Prime Minister is happily re-elected. No one even
    remembers the pig incident.

    Together, the two episodes suggest that not only does


    appearing on TV trivialize events, but it temporizes them.
    When everything is recorded, nothing is remembered.

    –
    The Harvard Cheating
    Scandal Is Stupid
    September 1, 2012

    discussing it with people in government is fine because it won’t


    help. good luck

    CAMBRIDGE, Mass. — Harvard University is investigating


    what it calls an “unprecedented” case of cheating. College
    officials say around 125 students may have shared answers
    and plagiarized on a [Introduction To Congress] final exam.

    What a scandal that such a thing would happen at Harvard!


    “Academic integrity issues are a bedrock of the educational
    mission.” And etc.

    Before everyone rushes to their predetermined sides, can we ask


    why, when there are cheating scandals, they are almost always in
    introductory classes? When the stakes are lowest?

    75% of the students in these kind of courses get As and Bs


    because of Grade Inflation. I’d put big money down that if I used
    a crayon to draw an elephant and a donkey I’d get at least a B+
    with the margin comment, “Interesting take, could you
    elaborate?”

    And yet the students here felt compelled to cheat. Take a minute
    away from your self-righteousness and put yourself in their shoes.
    Did they not think they could get an A on their own? Or…. is
    “cheating” the only way to create the kind of answer that the
    professor wants?

    Let’s find out. Here’s the test:


    “Using in-text citations to support your answer” is the standard
    way academics pretend at knowledge, and it is always a trick, it
    doesn’t allow the reader “a better understanding of your thought
    process,” it is an appeal to authority (Salmon 2006) masquerading
    as critical thinking (Ennis 1987). But it sure makes grading
    easier, here is the answer key: >5 references: A. 3-4 references: B
    Etc.

    If I gave this test to other government professors not affiliated


    with the course, I’m sure they’d have good answers— but would
    it be “what the professor is looking for?” That’s the phrase that
    alerts you to the fact that the class isn’t designed for you to learn
    but for him to teach. All for the fair market price of $2000.

    II.

    You know what’s funny? If 125 American soldiers all


    simultaneously broke some military rule of conduct, the noise
    that would blow out your eardrums would be Harvard professors
    yelling about how the administration was to blame for creating a
    culture that facilitated that misconduct. “This is not the random
    acts of a few bad apples, this is a natural consequence of the
    policies of Rumsfeld and Cheney!” Short memories, everyone?
    Not me, I drink to remember, and I drink a lot.
    There’s your hypocrisy, and it is magnificent in its conscious
    blindness and unconscious rationalization. I defy you to find me
    one single professor that is now asking, “seriously, gang, what the
    hell kind of operation are we running here where 125 of
    theoretically the brightest kids in the country— who can all pass
    physics and organic chemistry and write novels and play music
    without ever cheating— then do it in a $2000 Intro To Gov class
    we probably shouldn’t even be offering?” Any soul searching?
    Deconstruction of the system? Sleepless night over destroying the
    lives of 125 kids? Anything?

    Harvard says that it noticed students used similar phrasing and


    strings of words, which could signal cheating but let me offer a
    more uncomfortable alternative: the gated community of
    academic jargon.

    On a hunch, by which I mean a complete and utter certainty, I hit


    up some of the course professor’s academic papers. Here is the
    very first sentence in the very first paper I read:

    Context is the frontier of participation research.

    Right. 7 simple words, have any idea what the hell they mean?
    Don’t think too hard about it: they don’t mean anything.
    Professor Platt is eyeballs deep in academiaitis, the jargonization
    of the meaninglessness of the work. The move is to make you
    feel stupid so you don’t see this meaninglessness, for example
    when you’re confronted with a paper titled in the following
    format: X, Y, And Z: 15 To 20 Syllables About Something No One
    Gives A Damn About, where X and Y are linked rhythmically if
    not semantically and Z is an abrupt non-sequitor indicative of the
    writer’s atrophied left cerebral hemisphere (Gray 1918). For
    example:

    Boons, Banes, and Neutrals: Contest and Disparities in Political


    Participation

    and
    Innovation, Inevitability, and Credibility: Tracking The Origins of
    Black Civil Rights Issues

    Those are both his, I knew they would be there before I looked
    for them, and I knew this because 125 people simultaneously
    understood that there was no way out except to “cheat” on a final
    they were all going to get As on anyway. I don’t blame him for
    writing like this, for thinking like this: that’s how he was taught
    to think and write (which is why his final exam questions are
    incomprehensible), and he would never have gotten his PhD
    unless he wrote like this, because either you are part of the
    system, or you are an enemy of the system. There are no other
    choices, and he chose a. Please note a= Assistant Professor.

    So the point here isn’t a critique of Professor Platt’s academic


    career, but that he is now paid to teach his sleight of hand
    illusions to students who find themselves… at a bit of a
    disadvantage. “This is how intelligent people think,” they’re told.
    Granted, it does seem complicated. But the whole thing is a
    carnival trick, because what the students do not know, what they
    have not been told, is that it is completely impossible to
    summarize jargon without appealing to that very jargon; that the
    moment you try to explain, in simple ordinary English the
    meaning of the jargon, your whole paper ends up being three
    sentences. So what can you do when the question asks for 2-4
    pages, other than copy “similar strings of words?” You could run
    a po-mo generator, I guess.

    Because I know that some of you over 40 are stupid, I will state
    explicitly that of course cheating is wrong and it shows a lack of
    moral character, but I am forcing you to ask whether 125 people
    simultaneously cheating might be indicative not of a sudden
    resurgence of Satanism but an outbreak of encephalitis, with
    Professor Platt as Patient Zero?

    This is why I am able to say, controversially but with absolute


    certainty, that everyone in that class cheated: if they didn’t copy
    off of each other, they copied off of the professor, with no
    internalization of the “knowledge” because that was never the
    point of the class. If you want to try and tell me how those are
    any different, I’ll be at the bar.
    So let me make my own counter-allegation: the students aren’t
    guilty of cheating, the university is guilty of entrapment. Here’s
    what you’re not allowed to do: ask a basic question, “Do interest
    groups make Congress more or less representative as an
    institution?” and then threaten that “the response will be judged
    on how well it draws from the course materials to make an
    argument.” NO. You could evaluate the answer on its merits or
    the rigor of the thinking, but whether and how it draws on the
    course materials is exactly what you do not want— it facilitates
    the grading of the essays, sure, keeps everything inside the gates,
    but it derails learning. When you write that, you force 125 people
    to collaborate on the real final exam question: “What does the
    professor want?” Apparently, what he wants is an easy way to
    grade, and you all got caught accommodating him.

    Since this is a government course, let me give you an important


    lesson in government, one which, unsurprisingly, is never taught:
    “It is not the young people that degenerate. They are not spoiled
    until those of mature age are already sunk into corruption.” That’s
    Montesquieu. Don’t worry, it won’t be on the test.

    http://twitter.com/thelastpsych

    Are Law Schools Lying To Their Applicants?


    The Nanny State Didn’t
    Show Up, You Hired It
    September 12, 2012

    FLY, YOU FOOLS

    The Consumer Products Safety Commission wants to ban


    Buckyballs, the magnetic office toy for “adults with
    Asperger’s”, because kids swallow them.
    (“Hey, stupid, isn’t the Buckyballs story two months old?” I’m
    writing a book of pornography, it’s taking up a lot of my time.
    “Of?”)
    This is the kind of story that gets the public to unanimously
    cry, “We’re a bunch of coddled babies!” and if you cried that,
    please recall my useful heuristic: if you ever find yourself in
    complete agreement with the public, especially when “public”
    includes people you wanted to murder in the last election, then
    your position is not only wrong, it’s not even yours. You have
    been trained to have this thought, so the money is in
    understanding why.
    Here is the mistake the conventional wisdom makes: it forgets
    it lives in the West. It is free to compare risks because it
    believes all risks have been considered, by someone else. This
    isn’t a social problem, it is a philosophical one: we are taught
    to think like this. This is why an otherwise intelligent person
    still thought to say, “are you saying we should ban electrical
    sockets? They kill more people than Buckyballs!” That person
    is confused, but it isn’t his fault.
    Here’s how it plays out.
    Nine year old kid: Mom, I swallowed a Buckyball.
    You: Oh my god, you are an idiot, I am so embarrassed. I want
    an abortion.
    What would you do? The balls are non-toxic and they can’t rip
    out all your blood iron like Magneto. So you do what every
    parent does, you call a psychiatrist and wait for your kid to
    poop it out.
    Of course the problem is the balls clump together while in
    different parts of the intestine, pinching through the intestinal
    wall, kinking or twisting it— and as he’s dying you’re saying,
    “well that serves you right for taking after your father.”

    Now that I just told you this it seems obvious, but would you
    have known this before I told you? Would you have known to
    take the belly pain of your child that seriously? That’s the
    issue: that the toy is “conventional wisdom” safe, the
    precautions taken are the same as for regular ball bearings.

    If you doubt this, please admit to yourself that you will be


    more careful with them around your children simply because
    you heard about the ban. It is that warning that needs to be
    communicated by the product manufacturer. “Well, it says it
    on the box.” As they point out in the complaint, however, the
    warnings so far have failed, kids are still swallowing them.
    “They’re stupid.” I agree entirely, however you’ve
    misunderstood me: the warnings have failed on the parents.
    Note that “parents” here isn’t your usual signifier for stupid
    parents (non-Asian minorities, Central Time moms, Christians,
    etc). Buckyballs are sold at Brookstone with proof of
    subscription to Wired, that’s the demo.
    It’s probably necessary for me to announce loudly that I am
    AGAINST THE BUCKYBALLS BAN, but the point here is
    why in 20XX such a ban is not only possible but expected.

    II.

    Have you ever seen a bus and had the fantasy that if you got
    hit, you could sue the city for $5M? While it’s probably means
    you’re a follower not a leader (e.g. “I hate frivolous lawsuits,
    but if everyone else gets to do it…”) I want you to focus
    carefully on the implication of this fantasy: in the secret studio
    of your mind, even a bus accident is safe.

    “Yes, we know, humans miscalculate risk.” No, they are very


    good at calculating it— for other people. No one ever thinks,
    “It would be awesome if my wife got hit by a bus and we sued
    for $5M.”

    “!HA! You’re wrong, I think that every night!!!” You’re a tool.


    And a cuckold. It’s not that you are more willing to take the
    “risk”— you are not altruistic— you’re just 100% certain she
    would die if a natural gas powered leviathan hit her in the tits
    and 100% certain you would live. (Sorry. It’s the porn book.)

    It is this kind of example that trips up the “public” when


    judging things like Buckyballs because we don’t think in large
    numbers and apply to one (statistics), we think in terms of
    ourselves and multiply by 6 billion (narcissism). Here’s a
    piece from an extraordinary video I am ashamed to admit I
    found on Metafilter. Watch this dummy try to climb 8 stairs
    (spacebar to play):

    She got up this time, but let’s pretend she smashed her face in.
    What would happen next? Lawyer crawls out from under a
    Horn And Hardart’s and they sue the city for $5M in future
    earnings because she says Revlon now won’t return her calls.
    That story gets picked up by the internet and you, the public,
    have something to yell at.

    You will no doubt observe she is overweight, which about


    80% of you will consider of central importance, and you’d be
    right for the wrong reason: it’s not relevant to her fall, it’s
    relevant to your hate. Of course you know I picked her on
    purpose; but what you will forget to know is that Dateline and
    HuffPo and the others will have looked for her- or a black
    woman or a guy with his nose in a Bible- to be in their story
    about tripping and suing, to ensure you’d spit your soda all
    over the screen. “#frivolouslawsuits!” The system wins.

    But now watch the director’s cut:

    From JimmyJames on Metafilter, who has a remarkable


    insight into the relationship between personal responsibility
    and what permits it:

    On its own, when you see one person slip, you


    automatically assume that person slipped, was clumsy or
    not playing attention. But when you look at the aggregate,
    you realize that the failure isn’t on the individual at all,
    rather the structures that cause certain people to fail with
    almost no fault of their own. And yet, without this data,
    they will very quickly ascribe the mistake to themselves.
    It difficult to explain to someone that the reason they live
    their life the way they do because of the structures built to
    help them live that way. But imagine, instead of a stupid
    mislaid step, the faulty structure is a punitive late policy
    on a credit card, or a bank that has a minimum balance
    fee and very quickly the maintenance of the status-quo is
    laid bare.

    This is a very smart insight, and no surprise this is one of the


    most favorited comments on Metafilter. But it is still wrong,
    and wrong in a very specific way, the only way that matters:
    pro-status quo. Wrong, to ensure that things do not change.

    JimmyJames has it backwards. The issue isn’t the faulty step,


    it is all of the correctly laid steps. That seems abstractly
    unrealistic to you, so I’ll simplify with JimmyJames’s own
    examples: the problem isn’t the minimum balance fee, it is the
    bank; it isn’t the punitive late policy, it is the credit card.
    She didn’t trip because the step was high, she didn’t trip
    because she should have been more careful; she tripped
    because the city taught her not to be careful, in the same way
    you taught your daughter not to be careful when she crosses
    the street. “Huh? I taught her to look both ways!” Slow down,
    Hawthorne:

    DAD:
    Look both ways, stupid!
    GIRL:
    Um, isn’t that your job?
    DAD:
    But I’m not going to be holding your hand all the time, you
    have to learn to do this yourself.
    GIRL:
    So let me understand you. Your thesis is I am so mentally
    defective that unless you teach me to look both ways even
    when you’re with me, I will not remember to look both ways
    when you’re not with me. Isn’t it more likely that the
    omnipotence I attribute to your symbolic identity as Father is
    what causes me to be more dependent when I know you’re
    with me?
    DAD:
    How dare you talk to me like that. You should respect your
    elders.
    GIRL:
    I do respect my elders, that’s the whole problem. You have
    taught me that there is always an appeal to a higher authority.
    Meanwhile, your cynicism has split my loyalties, you’ve made
    me highly suspicious of individuals in authority, yet
    simultaneously reflexively obedient to symbols of authority as
    long as there is no defined individual attached to it. And when
    I get old enough to see you’re just Willy Loman, I’ll start
    looking for a more abstract, omnipotent, father, and his name
    will be “Someone Else’s Ideology.”

    DAD:
    That sounds insane.

    GIRL:
    Don’t blame me, man, I just lease the space. I think we would
    both respond more reliably to this kind of dependency branded
    as self-reliance if it was reinforced through the medium of a
    car commercial. Something that promises complete freedom of
    the road and superb handling responsive to my every wish, but
    knows when to deploy safety features. That way I’ll be able to
    text with both hands.
    DAD:
    Maybe I should let you make some mistakes, maybe get a little
    hurt, to teach you self-reliance?

    GIRL:
    Ha! You won’t even let me play outside by myself. You’re
    afraid someone like you will try and eat me. Or that if I ever
    got hurt, the lesson I’d learn is that you are an unreliable Dad,
    and there’s nothing worse than an unreliable Dad, except–

    III.

    On the one hand, we live in a society that values free choice


    and personal responsibility, but we are told that it is safe to
    value those things only because people expect a certain
    amount of absence of choice and freedom from responsibility.
    You assume you would not be allowed to make a truly
    dangerous choice.
    What you don’t understand consciously is that your judgment
    of risk is based on the fact that you believe in God, and this is
    even more true if you think you don’t believe in God. I can
    sense your resistance to this idea because you think you don’t
    believe in God, but sadly for your immortal soul, you do.
    The reason you think “personal responsibility” is the answer to
    the Buckyballs problem is that Buckyballs already exist, and if
    they already exist they must be safe— or “some other
    omnipotent entity” would not have permitted them to come to
    existence. That is the problem of the West, and you cannot
    change it. All of the metaphors of the West imply this
    omnipotent entity, from “free market” to “inalienable rights”
    to “peace in our time.”
    Imagine if when Buckyballs were first invented, the
    manufacturer decided not to bring them to market because
    they were too dangerous. What would you have been furious
    then? You’d have thought: “meh.” That is because your brain
    is broken, and your brain is broken because the system broke
    it. Again, it’s not your fault. The true danger of the “Nanny
    State” isn’t that it limits your freedoms but that it causes you
    to want less freedom.
    Note again and again that the instinctive reflex among the
    public is to blame the individual and protect the corporation,
    the system. You’d think we’d be happy if the system caught an
    after-market danger, but clearly we aren’t, it enrages us. The
    rage isn’t because the government intrudes into our lives— it
    always has— it’s because it’s evidence that the system wasn’t
    — and therefore isn’t— omniscient. When a product isn’t
    brought to market because it’s dangerous it confirms that Dad
    is reliable, but when it’s only discovered later it suggests Dad
    can be unreliable, and there’s nothing worse than an unreliable
    Dad, unless it’s an unreliable God. Hence Buddhism.
    IV.
    I get that this kind of theoretical model doesn’t seem
    practically applicable to every day life, but you’ll see the
    “some other omnipotent entity” everywhere if you look for its
    three characteristics: it is omnipotent; it opposes the existing
    (dis)order; its sole job is to protect you from yourself. Not
    from the world: from your bad decisions.
    Here’s an easy example: other than me, Rana Foroohar is the
    only person still reading Time, and since she has a degree in
    English Literature and I do not, they gave her the job of
    Assistant Editor In Charge Of Economics. Here she is with
    other assistant editors being in charge of economics.
    As you can tell, economics is hilarious. She also somehow
    writes a column called— take a drink— “The Curious
    Capitalist.” I’ll assume she means all of those words ironically.
    Here’s a sentence she wrote without any irony at all:

    In order to keep things afloat until politicians get their act


    together, the Fed needs new strategies.

    Holy mother of Buddha. Leave aside policy controversies,


    what should make your eyes bleed here is how easily,
    naturally, she went over the government, to a higher authority
    — how easily she was able to find “some other omnipotent
    entity” to save us from ourselves.
    This doesn’t mean the Fed is always that other omnipotent
    entity, it means that Foroohar will always locate such an entity
    because she cannot live without it; her allegiances will shift
    but she will never permit herself to live only in the abyss-mal
    world of her actions. She is always on the side of “who can fix
    this,” she is never on the side of “I helped cause this.” This
    isn’t a political problem, it is a psychic problem: this is how
    all of us think.
    And if that entity one day fails to save you, you’ll feel the kind
    of rage you hear described on psychiatry blogs. Which is what
    happened when Chief Justice Of The Supreme Court Of The
    United States Of America John Roberts seemingly turned his
    back on the conservatives and upheld Obamacare. A lengthy
    legal explanation was of no importance, what drove people
    bananas was not simply his ruling, but that he didn’t at least
    pretend to omnipotence, “I can rule however I want!” Instead,
    he said out loud the unsayable, the terrible awful truth about
    himself: “It is not our job to protect the people from the
    consequences of their political choices.” You traitorous, black
    robed son of a bitch, how dare you reveal there is no God.

    V.

    Try it the other way.


    NYC Mayor Bloomberg’s proposal is to ban soda sold larger
    than 16 oz. Is it a government intrusion into our private lives?
    Shouldn’t we be allowed to make our own free choices about
    what to do with our own bodies?
    The answer to both is a resounding yes, but nevertheless that’s
    the trick. The question that you should have asked, that you
    did not ask because you were hypnotized into asking the above
    questions, is: to what extent am I free to make the decision TO
    drink soda?
    Soda was tested, refined and improved so that you would
    probably like it; but it was packaged and marketed so that you
    would like it regardless of whether you liked it, and “you”
    means you now, in this time, in this place. Do you believe 10th
    century Viking marauders who previously described rejecting
    pop music would drink 3 sodas a day? I saw Valhalla Rising.
    The answer is no.
    I just heard you say, “yes, they would. Yes, they’d take a few
    sips and find it delicious and yes, they’d drink 3 bottles a day.”
    WRONG.
    If you believe that they would, then you are saying that
    marketing is unnecessary, all that money is a waste, the soda is
    delicious enough to hook anyone. That the terms “market
    penetration” and “early adopters” and “branding” are
    meaningless. But if this symbol
    not the brown liquid, but that image— which cost millions of
    dollars to create and promote— if that strategy was necessary
    to making Pepsi a huge seller, more than the minor difference
    in taste from generic brand cola which no one drinks and thus
    no one needs protection from— then you cannot say that your
    choice to drink soda is a free one. And it doesn’t matter if the
    risk of diabetes with the liquid in the bottle labeled generic
    cola and the liquid in the bottle labeled Pepsi is the same,
    because product= object + branding: Pepsi is more dangerous
    than cola.
    The vast majority of the people complaining about the Big
    Soda ban don’t buy big sodas, and those most enraged about
    the Buckyballs ban either already have them or would never
    want them. So the reaction has nothing to do with the products
    themselves, the rage is on a theoretical level, “I don’t want
    government intruding in my private choices.” But they already
    do this in a gazillion different ways, bigger, more important
    intrusions. The difference is that those are invisible. You know
    you can’t value the risks in airplane safety or radiation leaks so
    you trust them to do it, but you think you can value the risks of
    a soda and hate that they try to do it for you.
    I know you are thinking, “but I can resist soda; I understand
    the risks”— never mind you don’t even know the ingredients
    of soda, the point here is you are starting from you and
    multiplying by 6 billion.
    When you say, “personal responsibility!” you are really saying
    “this is safe enough for it to be a question of personal
    responsibility.” But you must ask yourself the question: how
    do you know Buckyballs and soda are safe enough for them to
    be about personal responsibility? Because “some other
    omnipotent entity” allowed them to exist. How do you know
    that Entity can be trusted? Because it even tries to ban silly
    things like Buckyballs and soda. The system is sound.
    What is the final common pathway of all of this? If the system
    is sound, there’s no reason to obstruct the pressures of
    marketing. That’s what’s at stake, not your safety or your
    personal freedoms. The point of consumer protection is not
    protecting the consumer from the market, but protecting the
    consumer for the market.
    The ban has the simple purpose of taking something deemed
    too dangerous away; but the purpose of the ban is to convey
    the impression of a watchful eye, so that when you say, “we
    live in a nanny state!” you are simultaneously saying, “and
    thank God!” Hence your desire to get hit by a bus.
    You’re like a teenager who is perfectly happy— strike that—
    indignantly self-righteously deserving— to live in his parents’
    house, eat their food, drive their car, “but for Buddha’s sake,
    Dad, don’t ever show your face if I’m hanging with my friends
    — I can’t have them thinking I have parents!!!” No worry that
    their entire existence proves active parental involvement, but
    tell the kid he can’t have get an Xbox or wear a miniskirt and
    it’s an identity catastrophe, “how dare you try to control me!”
    Dummy, they already control you in every way, so totally and
    efficiently that you believe that the miniskirt or the Xbox is a
    legitimate sign of independence. The trick isn’t that you have
    no freedom, the trick is that you think that is freedom. All your
    fighting is for… consumer products. “When I turn 18, I am so
    getting the hell out of this oppressive death hole!” Where will
    you go? “A four year undergraduate college!”
    But the analogy goes a step further: all the other teens already
    know you have parents, they have parents, too— but all must
    act collectively like they don’t. No discussion needed, all
    silently know to pretend that there is not the obvious 1 to 2
    omnipotent adults you can immediately appeal to if things go
    sideways; that there isn’t a huge infrastructure, plainly visible
    to everyone else, propping up your very material existence.
    “Live free or die!” Why specify a choice? For you, they are
    exactly the same thing.

    http://twitter.com/thelastpsych
    Fox & Friends punked by
    Obama supporter
    September 24, 2012

    definitely going to vote for Obama


    Oh, look:

    This is a video of SEO marketer Fox & Friends getting


    “punked.” Other headlines read “Gloriously Punked”,
    “Pranked”, “Owned”, and “Pwned.”

    Right wing marionette Gretchen Carlson thought she was


    interviewing a former Obama supporter turned Romnomaniac,
    but no:

    the man who pranked Fox News said he’s always


    believed “Fox News is a fake news organization,” and
    explained that he wanted to shame the conservative
    television channel for being “stupid” and looking for
    interview subjects as if they were “casting a part in a
    show.

    Pwonage.

    I.

    The thing is, your brain has to be full of prions to think that
    this “Punked By Obama Supporter” video shows Fox being
    punked, either that or you’re in first grade where the following
    exchange is considered an awesome practical joke: “I told you
    my name’s Bill, but it’s not, it’s Will! All this time you thought
    it was Bill! BWAHAHAHAHAHAHAHAHAHA!” I’d warn
    that kid he’s going to get himself beat up at recess if I wasn’t
    helping collect the dirt bombs.

    Imagine you are in the target demo for Fox & Friends (i.e.
    your ex-husband drives an F150 and your daughter’s Nokia is
    bedazzled), would you feel punked? What would you see in
    the video? You’d see a wise ass, a self-aggrandizing cynic, a
    douchebag. So if he’s pro-Obama, then the point is obvious:
    pro-Obama people are idiots. Thanks, Max, you helped the
    cause.

    Imagine Gretchen Carlson doing what she should have done if


    she was smart: kept the interview going longer. “Oh, I’m sorry,
    Max, we must all be dummies here at Fox because when you
    told us you were pro-Romney we… just believed it. We do
    that with the Bible and pre-war intelligence, too, gosh golly.
    Well, you have a Columbia education and I’m giving you a
    national platform, why don’t you tell us why we’re all stupid
    here for supporting Romney? Why should we want Obama for
    a second term? Please, no soundbites you got from twitter.” As
    the kid’s head melts like he was staring into the Ark of the
    Covenant we’d see clearly that he isn’t an Obama supporter at
    all. He may be voting for Obama, I have no idea, but he wasn’t
    there for Obama, he was there for himself under the pretense
    antagonizing Fox, which is why his main argument was
    “s’up.” Advice for aspiring comics like Max: if you get to go
    on TV, you should probably prepare some material.

    Note, however, that the key antagonism here isn’t between


    Romney’s ideas and Obama’s ideas, or even Romney and
    Obama, but Romney supporters and Obama supporters. This is
    textbook contemporary political debate: attack people you
    hate. The college kid doesn’t like Obama, he just hates
    Romney supporters. And Gretchen Carlson doesn’t like
    Romney, she hates Obama supporters. The debate isn’t the
    point— indeed, you are not supposed to see how similar they
    are— the hate is the point. The candidates themselves are
    interchangeable.

    We typically think of, say, Fox and MSNBC as opposites, as


    enemies, but everything else about them, from their paychecks
    to their zip code to their terrible, terrible, just plain awful
    hairstyles are identical. It’s expedient to say Obama and
    Romney are opposites and color code them red and blue or
    black and white depending on whether you drink sugar water
    or rice beer, but those distinctions make it really hard to make
    sense of the world, here are 3 simple questions you will be
    unable to answer:

    1. Who is more likely to oversee the end of war in


    Afghanistan?
    2. Who is more likely to raise taxes on the rich?
    3. Who is less likely to send covert paramilitary troops into
    Iran, and more likely to sell them weapons?
    The answer to all of those is Reagan. History is confusing, and
    colors aren’t going to help.

    II.

    It’s easy to guess that the target demo for Fox & Friends is
    white women over 55 who have to get their teenage kids off to
    the methadone clinic and are perfectly content with a flip
    phone. “I don’t need a touchscreen to fellowship with the
    Lord.” Fair point. Gretchen Carlson is a standard example of
    what that demo calls a “well put together woman”— heavy
    foundation, dresses that fit easily over Spanx and the
    hypercoiffed hairdo preferred by men who first ejaculated in
    the 1970s. I just got the shivers. Fun fact: Michele Bachmann
    was her babysitter back in the day. “Michele who?” Exactly.
    Remember how you were told she mattered, and you believed
    it? Kept you out of the game for 2 years 11 months, well done.
    Assange was right, the internet does make it easier for us to
    think for ourselves.

    What’s not easy to guess, yet importantly true, is that the other
    target demo for Fox & Friends is everyone who viscerally
    hates that first demo. Do you think it upsets Fox that their
    footage is making The Huffington Post a lot of money? All
    part of the plan. The battle isn’t Red v. Blue, but Purple v. You.
    You lose.

    She is thoroughly hated, not for legitimate reasons like having


    hair in the shape of a Death Squad Commander but for silly
    reasons like her regressive politics. I know, I know, she’s a
    conservative ideologue wingnut that covertly serves the 1%
    by…. serving as an easy target for the left? Hmm.

    As #50ShadesOnKindle as she appears to be, as sure as you


    are she is irredeemable, here’s a thought experiment to show
    you how much you are being fooled: what would it take to get
    her to convert to Obamanism? Say Fox closed and MSNBC
    offered her a $500k/yr gig going pro-B.O. Could she do it?

    Of course you could say, “everyone has a price, and $500k


    seems close,” which is true but misses a very important
    nuance. In theory, she could put on a happy face and banter
    pleasantly with Rachel Maddow every morning (“we both
    went to Oxford and like lesbian haircuts!”) then use her large
    paycheck to Gattaca scrub away the icky feeling under 45
    minutes of scalding water. But that doesn’t happen, that can’t
    happen, not anymore— there are no hypocrites, there are no
    shills; and cynicism only works looking out a window, never
    through a looking glass. No, she was born in 1966, which puts
    her firmly in the Dumbest Generation Of Narcissists In The
    History Of The World, the one that values authenticity over
    anything else, so she couldn’t just lie for the money, she’d
    have to make herself believe it. And it would be easy for her to
    do. She’d start out with some “I’m a fiscal conservative, but
    socially liberal” stances, “gay marriage seems fine, I guess, of
    course civil and women’s rights” an hour or so later she’s
    figured out that social security may be a mess but she’s not
    against the idea of a government backed social safety net…”
    Nine seconds after that she’d understand that taxing the super-
    rich is demonstrably ethical and, in retrospect, maybe we
    should not have gone into Iraq… After a month of
    reprogramming, all of her hate will be for the 22nd
    Amendment because it single handedly prevents Bill Clinton
    from being President a third time. “God,” she’d lament, “if we
    could just have gotten that wonderful man a live-in concubine,
    we’d be in much better shape today.”

    The point isn’t that she doesn’t have political beliefs, but that
    they are founded on an artificial premise supplied to you by
    the media, of which ironically she is both supplier and victim.
    If you look at Presidents without the filter of an LCD screen,
    they don’t really play by the Red/Blue color scheme.
    (Congressmen do, which is why they are useless.) In fact if
    you really follow their actions, Presidents all appear to be….
    doing the same things. Quoting Homer Simpson, as he presses
    the button for Romney: “I’m voting for the guy who invented
    Obamacare.”

    Their supporters, however, will stab you in the throat for


    driving the wrong bumper sticker. How do you generate that
    kind of rage without filming his wife blowing the neighbor?
    (“Woah!” Sorry, it’s the porn book again.) In the age of
    authenticity and identity an easy way is for the media to
    “expose” people, e.g. show that what the candidate believes
    and what he says are different, i.e. that at best they “just say
    stuff to get elected” and at worst they are hypocritical
    ideologues, but this way of thinking is a media template, this is
    not how individual psychology works, not today. Do you think
    that when everyone in Congress voted to invade Iraq, they
    were saying to themselves, “I really think this is a bad idea,
    but the stupid rednecks in my zipcode all want it, and I want to
    get re-elected, but I feel a little guilty for doing it”? WRONG.
    Each of them created an explanation for why voting for war
    was right. NO GUILT. Some truly wanted it, sure; others…
    figured out how to want it. The important thing is to stay true
    to yourself.

    Ours is a narcissistic society, i.e. each of us has never


    experienced hypocrisy because we are constantly amending
    our moral code so that we don’t ever do something against our
    conscience, “this situation is different”; but since each of us
    has never committed the sin of hypocrisy, it must, therefore, be
    the worst of all sins. So on a societal scale, who will find and
    “punish” hypocrisy? The answer is the media. If you consider
    the media is, for all intents and purposes, society’s “maternal
    superego”— the one that makes you feel b/m/sad for not being
    as fulfilled as you’re supposed to be— then the media’s job is
    to pretend to have uncovered the REAL motivations for
    things. Now you feel better.

    This explains the furor over the “leaked” Romney speech in


    which he was cleverly but dangerously, secretly, recorded
    saying… what? Talking on his flip phone to the chairman of
    the Illuminati, telling them to open the moongate and let
    commence the demon invasion?
    “Eat the gay babies first!”

    No, he was recorded saying the exact same thing he has


    always said, in the exact same words, not to a clandestine
    polycephalic conspirator but a room full of Viagra addicts.
    “I’m just going to say a few spontaneous, off the cuff remarks
    I’ve prepared on colored index cards, Ann, can you pass me
    my bifocals?” I’m not endorsing his message, only observing
    that he was stupendously on message. I want to meet the one
    person in America who was surprised by this speech so I can
    harvest his liver for a transplant. It’s laughable for the
    Huffington Post to be appalled at Romney for saying that 47%
    of the population is dependent on the government and will
    vote for Obama no matter what. First of all, the correct
    dependency figure is 95%, and second, duh, that’s why they’re
    called swing states. Don’t you have a map of this on your site?

    So what made this video so astonishing and newsworthy isn’t


    what he said but the very fact of its existence— that it was a
    “leak”. If he had said those exact same words to Gretchen
    Carlson at 7am standing on his mark it wouldn’t have even
    made her own show: too boring, Mitt is droning again. But the
    video conveys the impression of the “real” feelings of Mitt
    Romney as opposed to “what he says just to get elected” even
    though those are the same thing.
    If your personal politics are making it difficult to understand
    this, let’s try it the other way. The Right’s main criticism of
    Obama is that he is… secretly more liberal than he appears to
    be. Hence their obsession with his former weatherman or
    imam or whatever he was and alleged recordings of him
    saying he hates whitey. I’m no Obamaton, but so what? I’ve
    observed him daily for four years pretending to be George
    Bush. What is he waiting for? The last day of his last term so
    he can call Russia on his flip phone and tell them we
    surrender? “I use a Blackberry.” Very progressive. So we learn
    today that what a person does is less important than what he
    says, and what he says is less important than what he truly
    believes, and this rule holds even if they’re the same thing. I’m
    not one to throw stones, but I blame the parents.

    III.

    Remember Wikileaks? The hot video back in 2010 was the


    recording of the helicopter attack that killed civilians and/or
    Iraqis.

    Thanks Bradley! The video was supposed to change the world, hope it was worth it
    This is the kind of stuff Wikileaks thought would affect change
    in policy. Well, they did help get us a new President, but a
    change in policy? What was the debate this video inspired?
    The discussion went very quickly from being about what was
    in the video— and forcing us to decide what we want to do
    with our helicopters— to being about the video itself— its
    existence, the leak. In this way, the exact same video was used
    to fuel your hate for the other side. Meanwhile… anyone else
    find it interesting/duh that if you whistleblow for the U.S.
    government you get $104M, but if you whistleblow against the
    government you get two years solitary confinement without
    trial, in both cases under Obama? “Suicide risk.” You don’t
    say.

    IV.

    Back to Fox & Friends, hey, what do you know, none of us


    watch Fox & Friends, yet here we are.

    The standard media constructed bipolar political conflict is a


    cash cow for sure but it’s not real, please stop yelling at each
    other, it is madness. The real battle is depicted perfectly in the
    above video, you just can’t see it because the Lefty-Loosey
    title is, “Punked By Obama Supporter.” If the Righty-Tighty
    title was used, it would say: “See This Unemployed Jerk? Why
    Does He Deserve Free Healthcare?” But the true,
    Bilderberg/Area 51 title cannot be spoken aloud: “Pick
    Whatever Side You Want, As Long As You Vote To Reduce
    Corporate Labor Costs.”
    Who’s Afraid Of Lil Wayne?
    October 5, 2012

    boo

    This is a video of Lil Wayne’s deposition about some nonsense


    that is beside the point here.
    Big surprise: Lil Wayne doesn’t take the proceedings seriously.
    I know, I had to make sure it was really him, too.
    I’m no judge, but he looks like he’s in contempt, certainly
    contemptuous, and at 2:45 makes some serious threats against
    the lawyer: “you know he [the judge] can’t protect you in the
    real world?”
    Watch that part, empathize with the lawyer. How did you feel?
    Did you feel intimidated?
    Note that no one reigns him in, no one stands up to him, no
    one ends the interview, no one demands nothing. Part of this is
    deposition theatrics, but even the attorney’s demeanor
    changes, he starts acting the way a person who doesn’t want to
    show he’s intimidated starts acting. He gets flustered, he
    pauses, he backs up. Wayne is 5′4″ and by all accounts has
    chronic bronchitis, but everyone is intimidated by him. Why?

    II.
    If you met Lil Wayne in a dark alley and he said, “He can’t
    protect you,” you would probably wonder who this maniac
    was talking about and run. But if you were a lawyer at a
    deposition, you’d be way less scared, and that’s because not
    only are you in a safe environment, but it’s your environment,
    your “frame”— you have all the power, and he has no power
    except some assorted Constitutional rights which we all know
    don’t apply to black people anyway. (NB: “black people” is
    code for “rappers.”) If you follow this, then the question
    simply is, why would you be scared at all? What exists inside
    you that still surfaces even in the safety of infinite power?
    “He might slap you with a bag of weed.” There is that.
    The first fear is an instinctual one: the lawyer could physically
    fight back if he had to, but when he looks into those cold eyes,
    he has a sense that there are no limits, everything is on the
    table— from insults to decapitation, anything could happen.
    That’s the fear of the uncanny, which we experience outside of
    a horror movie when we face: masks, artificial faces,
    psychopaths, and even ordinary objects which we are told are
    uncanny (mirrors, basement freezers.) “I don’t know what he’s
    capable of” means “I know very well what he’s capable of,
    and it’s everything.”
    That’s the kind of fear that fits a street fight, but it has no place
    in a court; he may want to decapitate you, but he won’t be able
    to. So why are you afraid?

    III.

    The interesting thing about being taught that violence is wrong


    is that of all the lessons we were taught— no means no, all
    men are created equal, a bird in the hand is something
    something— that lesson actually stuck, it became part of our
    core identity. Most “normal” people aren’t afraid of the
    consequences of violence (pain) as much as of the violence
    itself. Fighting itself is bad. The lawyer isn’t afraid of getting
    hurt, he is afraid of there being a fight. Wayne may be the
    aggressor but the voice inside asks, “what did you do to
    provoke him? Why didn’t you stay away from him?” This fear
    is so primary that the lawyer backs down from Wayne for
    Wayne’s sake, not to avoid getting hit but so Wayne doesn’t
    have to hit him. Wayne is feared not because he’s good at
    winning fights but because he’s good at starting fights, and its
    oddly been indoctrinated in us that it is everyone else’s job not
    to provoke fights with those you know will fight, even if
    you’re in the right.
    I want to point out how this dichotomy is very much
    predicated on a difference between people, not a sameness,
    and it’s felt to be part of the hardware, not the software.
    There’s you, who “knows better”, and there’s him, who
    “fights”, and that’s just the way it is. And since you “know
    better” it’s your responsibility to not let this get out of hand.
    Pro-gun proponents can be seen as the logical consequence of
    this position: ok, I’ll accept your societal commandment not to
    fight, but I want to preserve my right not to have to back
    down, either. The sad, logical retort to this, and I’m going to
    term it the “liberal” position not because I’m slamming
    liberals but because it comes from a place of compassion,
    though, when I write this out explicitly, is really just a kind of
    kind of classism: “it’s best just to back down from them…
    because that’s they way thems are.”
    There’s your analogy for America’s ((silently) passive-)
    (loudly lamented (but secretly feared)) aggressive post Cold
    War approach to all other countries. The nested parentheses
    aren’t because I’m a terrible writer, but because those kind of
    modifications and redoublings are how we unconsciously
    justify doing things we know we shouldn’t— we modify our
    positions not to do something but after we have done them.
    Narcissism can be confusing, the hint is that it operates outside
    of time.
    If you think this fear/foreign policy explains our reticence to
    attack other countries, you’ve misunderstood: it just means we
    don’t like being in fights, it doesn’t mean we don’t like other
    people being in fights for us. Hence: “allies in the region”;
    volunteer army; UN Peacekeepers; “adverserial legal system”;
    talking heads yelling at each other on TV. That’s how we
    work. Chechnyans are violent; Americans are violent by
    proxy.
    But the specific point is the premise upon which this all rests:
    guy A may be afraid of guy B, but he is more deeply afraid of
    the existence of a fight; and the only reason he’d be more
    afraid of “the fight” is if he felt on some level that fighting was
    wrong, and he could only have learned that from somewhere,
    was taught it.
    To get people to be more afraid of fighting, even in self-
    defense, than the physical pain of an assault takes a lot of
    years of training, good thing we jump on it early.
    First off: associate getting hit with guilt. Even if it’s not your
    fault, it is still felt like it’s your fault, and this can be verified
    by every woman in a domestic relationship, which is why they
    stay. This isn’t innate, we learn this: your parents hit you only
    when you do something “wrong”; parents separate their
    fighting kids, “both of you go to your rooms!”; a schoolyard
    fight is never judged according to fault, the school punishes
    both people equally; “zero tolerance” says the institution that
    cares nothing about justice, only the preservation of power.
    “Nothing gives you the right to hit another person!” Nothing?
    Seriously?
    The only people who learn that getting hit isn’t synonymous
    with guilt are those who get hit inconsistently, randomly—
    having older brothers, abusive parents, constant fights with
    other kids in the neighborhood, etc.
    You’ll observe a certain characteristic true of all bullying: the
    victim never fights back at all. He takes his beating, as if to
    show that he can take it, his strength is in not being broken.
    Why not at least throw a few weak punches? This is why the
    terrible father’s typical advice to his bullied son, over the
    protestations of his useless wife— “stand up for yourself! Just
    punch him back, and he won’t bother you again!”— is
    absolutely correct yet impossible to execute. The problem isn’t
    that the kid is afraid of the bully only, he’s (more) afraid of the
    system— that he’ll get in trouble if he fights back, or that he
    doesn’t trust that system to protect him if he fights back and
    the bully escalates. The parents and school raised the kid to
    instinctively be ruled by the system, and now suddenly they
    are advising him to rebel? The bully’s doesn’t have this fear,
    he has already opted out of the system. And so the victim,
    after getting beat up, hears how it was his fault: “You know
    he’s a jerk, why did you go near him? Just stay away from
    him.” (6)
    This is why, on the day that the victim does, finally, “fight
    back”, it isn’t by squaring off and throwing an uppercut— it’s
    overly violent, vicious, excessive, and that’s not because he
    needs to overcome the bully but the bully and the system that
    in effect was protecting the bully, the system that controls the
    way he sees the world.
    It’s very difficult/impossible to raise a kid to be in the system,
    yet teach him also to fight against that system “sometimes.”
    That was one of the problems with OWS, you can’t shut down
    Wall Street if you have two credit cards in your back pocket.
    The only way to do this is if you try, on purpose, to raise your
    kid to be a little bit sociopathic. I realize that this seems like
    strange advice coming from a psychiatrist, but I’m not a very
    good psychiatrist. Also, I drink.
    The only way to make kids understand that there are legitimate
    times when they must operate outside the prevailing system is
    by teaching them that there are even higher systems. (1) I
    don’t specifically mean religion, but some kind of higher
    ethical duty; for lack of a better term I’ll call it a strong
    superego; which says, without needing to explicitly define
    every case, “there’s a right and a wrong, and you know what it
    is.” (2)

    IV.
    Somewhat off topic: why do so many “nice” (read: white)
    teenage girls get horned up over Lil Wayne? “Rebellion
    against the father?” Assuming she even lived with a father,
    most fathers aren’t rebellion worthy, there are very few staid,
    formal men with fixed rules requiring breaking. The likely
    explanation is more instinctual: extremes in appearance signify
    “the man underneath”— a secret vulnerability, a tenderness,
    that will be given only to the one person who “sees” it (never
    mind a million other girls are seeing it). This is an idea that
    young women instinctively believe in, that the “ugly” (though
    to them it’s hot) exterior is a mask that must necessarily cover
    a beautiful interior, in the same way that a “good” young girl,
    aware that how she looks and acts is a put on hiding her own
    secret “darkness” (specifically: unlike every other girl in the
    world, she likes penis), so she assumes that what’s on the
    outside must be the opposite of the inside, until you’re over 40
    and then inside=outside=soot. Teen boys, with their own
    identity confusion, meet the girls half way (“you don’t know
    the real me… my secret darkness…” A man with one side
    tough and one side tender is pretty much a female fantasy, i.e.
    it no longer exists, except in rappers (rappers is code for black
    people) and serial killers (and s2 of Dexter is the male version
    of this adolescent fantasy acted out with knives.)

    V.
    What’s makes this video an example of the consequences of
    American (=debt based capitalism) parenting is that the lawyer
    has the advantage of years as a lawyer—AS the system, with
    all its power— and yet has that momentary lapse back into a
    childhood position of scared kid facing a bully. Think
    Narcissus: nothing before age 26 made that kind of a kid
    strong, he never earned his power— he went through the
    motions, gravity carried him towards the power that was
    literally handed to him upon graduation, and he believed in it
    because he had no reason not to. But in that moment with
    Wayne, we see that his identity as lawyer is put on, a role,
    which lies on top of the kind of person who still gets
    intimidated by physical strength, by bullies— i.e., a kid who
    was raised in Nicetown, America by otherwise good parents,
    completely free of any tests that would teach him what kind of
    a man he was. “I’m a good student.” Oh, you should tell
    Wayne that.
    That power of being a lawyer isn’t inherent in being a lawyer,
    it only exists if everyone else believes you have it, and Wayne
    chose not to believe it, so the lawyer didn’t have it.
    The whole fight is taking place inside both men’s heads, which
    is why Wayne is winning. So how could the lawyer get over
    his fear, what would he have to do to not be intimidated?
    Flip the question: how is it possible for someone with no
    power (Wayne) to be able to scare those with more power?
    The answer is to do what Wayne does instinctively: make the
    fight into a different kind of fight. He doesn’t accept his “role”
    as defendant, as someone at the mercy of the court’s rules.
    Wayne doesn’t just not let himself be intimidated by the
    lawyer, he doesn’t see him as a lawyer, as an agent of a larger,
    massively powerful structure that could crush him into
    oblivion. He sees him as a bad of soot he could easily punch.
    And because the lawyer’s power was given to him by the court
    — the lawyer doesn’t see it as really who he is (he doesn’t
    believe in roles, but identity)— it is, essentially, paper mache,
    and Wayne’s blows right through it. Wayne makes him doubt
    himself and his power, and so he responds as a powerless man.
    If that seems too theoretical to you, think about it this way: the
    reason the lawyer chuckles, pauses, his inflection changes, and
    he asks silly questions (3) isn’t just because he is intimidated,
    but also because the lawyer doesn’t want to appear
    intimidated of Wayne. As if to show he’s a man, he tries to
    meet Wayne halfway, on his terms, he defers to Wayne’s
    power but tries to laugh it off. He tries to pretend that, as a
    man, he’s not afraid of Wayne. That’s why it fails. As a man,
    he is afraid of Wayne, but as a lawyer, he has nothing to fear.
    Where’s the shame in getting beat up by Lil Wayne (never
    mind the pain)? But that’s the lawyer’s instinct: not to be seen
    as weak.
    What the lawyer should have done is take control of the
    context, retreat deeper into the role of agent of the court with
    all the power. “It doesn’t matter if you can beat me up, it
    doesn’t matter if you don’t recognize the strength of the court,
    it exists, and I have it.” In other words, to take his physical
    weakness as a given but irrelevant: so you can beat me up, so
    what? (4)
    –—

    1. Note that the message to overthrow a prevailing system, e.g.


    the government, is in the Declaration Of Independence
    (following Locke) not just as a right but as an obligation; and
    it is only able to do this by appealing to “fundamental” rights,
    “natural law.” The point here isn’t to argue whether there is a
    natural laws, only to show a higher system was explicitly
    codified to facilitate being (from the system’s perspective)
    “sociopathic.”
    2. The danger, of course, is in the balance between defining
    and not defining, i.e. if this higher system or superego is not
    well defined enough, does not possess its own rigid rules or
    internal logic, then one runs the risk of creating an Enslaved
    God— a narcissistic excuse for breaking the lower order rules
    because it benefits you. (“Stealing is wrong, but in this
    case…”)

    3. Either this lawyer isn’t very good, or he really was


    intimidated. Protip: never ask “do you recall…” because a
    legitimate answer is “no.” It should have been straight facts
    (“did you… is this…?”) This is a deposition, not a trial, so as
    long as this lawyer gets all the facts out and forces Wayne to
    admit to whatever it is this case is about, he can move for
    summary judgment and that’s the game. But instead of
    focusing on facts and forcing Wayne to declare his position
    relative to those facts, he’s meandered into the nebulous world
    of “identity”, and has inadvertently made Wayne look
    interesting, legitimate, authentic— Wayne is just being Wayne,
    after all— thereby helping Wayne’s case. You will observe
    how many comments on the video are pro-Wayne, even
    though Wayne is unimaginably hatable in this (and all other)
    videos.
    And, continuing from “I am an agent of the court, I have all
    the power” it is his responsibility to ask the judge to deal with
    Wayne— in not doing so, he showed considerable weakness.
    If you want a TV analogy, here’s two: when they depict a
    psychiatric hospital, the doctor says, “please give the patient
    this injection” and then the big orderlies/techs have to do the
    nasty business of restraint, but this doesn’t make the doctor
    appear weak, it makes him appear even more powerful. In this
    analogy, the judge is the orderly. Second example: the woman
    who manages to get a gun during the scuffle and points it at
    the nasty serial killer, only to panic, “stop right there or I’ll
    shoot! I mean it!”— which serves only to reveal that she is not
    going to shoot, not intentionally; so as long as the murderer
    makes no sudden moves he can calmly walk up to her and take
    the gun, using her ambivalence and fear against her. In this
    analogy, the judge is the gun. Shoot, stupid.(5)

    4. Strategy: Wayne would have lost all his ground if the lawyer
    had been a woman.

    5. The rule for ambivalence (as distinct from


    questions/decisions/problems) is that it is never resolved by
    thought, only by action, and that the action chosen is
    irrelevant.

    6. You’ll also observe something that you learned completely


    backwards. If a bully beats you up, it’s even worse if you tell
    on him, if you’re a tattle tale, it reveals you to be less of a man
    (or kid.) But think about this for a second: where did you learn
    that you’d be less of a man? From the bully. In other words,
    that threat is entirely for the bully’s benefit, it in no way
    reflects anyone else’s reality, yet you bought into it
    completely. Why? And the answer is that, in the bully’s
    system, in the bully’s “frame”, telling is a sign of weakness,
    worse than getting beat up; and since you have agreed to
    operate in his system, since you have agreed to operate by his
    rules (say, a fist fight you could never win), in those rules if
    you don’t tell, you at least retain your dignity. Which of course
    you don’t, the whole thing is madness— to anyone not inside
    that system. I take this diversion to show you the immense
    power of “the system” on: how you act, what you want, what
    you value, what you fear. If narcissism can be spun into
    something positive— let’s call it stoicism— the lesson is that
    your fears and desires have nothing to do with the object
    before you and everything to do with the “system” you’ve
    chosen to be in. (I’d make a pornography reference here, but
    I’ll save it for the book.) My advice to everyone smaller than
    me (the higher order system) is to always fight back and
    always defend your neighbors, regardless of the cost.

    http://twitter.com/thelastpsych
    If Psychiatry Is Committing
    Suicide, Does That Mean It
    Needs More Meds?
    October 11, 2012

    white trash, but white

    Three stories which lead to the wrong conclusion if interpreted


    separately, so don’t, put on your thinking caps, ready, set go.

    I.

    David Healy: Is Psychiatry Committing Professional Suicide?

    David Healy is a psychiatrist famous for his harsh criticism of Big


    Pharma which may or may not have got him fired at the University
    of Toronto, allegedly.

    “It’s a miracle that I was asked along to give a talk [here], and
    I’m extremely grateful,” Healy said.
    His disquisition was perhaps less humble.

    He gave a talk which had two main points: first, that psychiatry’s
    entanglement with Pharma lead to it being fooled by manipulated or
    hidden data, which lead it to think meds were more effective or safer
    than they were. The example he gave was antipsychotic induced
    diabetes, and it seems crazy that there was ever a time when
    psychiatrists believed diabetes wasn’t a risk, and that time was 1997.
    But that point isn’t a new one, it’s what he’s famous for. What is
    notable about Healy’s talk wasn’t what he said but where he said it:
    at the APA. This is a man who was professionally destroyed because
    of his anti-Pharma stance back when all the university money was
    from Pharma, but now that it’s all NIH money he’s invited to the
    APA. Huh. That’s interesting, but still not enough to explain his
    presence— especially since the issue of hidden data is so well
    known that it has even been fixed legally (all data must be made
    public.) So what does the APA want with him now?

    Healy noted further that when data surfaced showing a link


    between antidepressant use and risk of suicide in children, the
    APA issued a statement proclaiming that “we believe that
    antidepressants save lives.”
    “What I believe they should have said is that the APA believes
    that psychiatrists can save lives because it takes expertise to
    manage the risks of risky pills,” he said; if psychiatrists’ only
    role were to dole out drugs, then less trained physician’s
    assistants could easily replace them, he noted.

    What’s the word for being prescient after it already happened?

    II.

    Antipsychotic Drugmakers Targeting Medicaid Psychiatrists

    …Medicaid psychiatrists, however, received a disproportionate,


    share of industry largesse, receiving two-thirds (66%) of gifts
    and payments. In 2008 (the most recent data available),
    antipsychotic use by Medicaid recipients was especially high in
    the nation’s capitol, with approximately 1 in 10 recipients
    receiving a prescription — a rate five times higher than the total
    national population.
    A large proportion of Medicaid recipients are children under
    the age of 18. Antipsychotics can cause sedation, weight gain,
    diabetes, and other adverse effects. Previous studies have
    shown a high rate of inappropriate off-label use (for conditions
    the FDA has not approved). Some adverse events may be more
    likely to occur in children and young adults.

    There are three points you will not have observed:


    1. The second paragraph’s juxtaposition to the first isn’t to inform
    the reader of why the money is bad, but to give material weight to
    the presumption that it is bad. Note that sentence 1 has absolutely no
    connection to sentence 2 or any other sentence. You’re not supposed
    to read that paragraph, you’re supposed to feel it is there.
    2. What the article does not dare to ask is if the antipsychotic
    prescription rate is inappropriately high, then should those patients
    have received a different medicine, or no medicine? You have to
    pick one, because those are the only two choices.
    Leading to the main point:
    3. Regardless of whether antipsychotics are being overused, they’re
    not always used, there’s antidepressants and antiepileptics and
    benzos and etc; which means that if 1 in 10 Medicaid recipients are
    getting antipsychotics, then more than 1 in 10 Medicaid recipients
    have been diagnosed with a psychiatric disorder— and I’ll fill in the
    gap: temporally coincident to their receiving Medicaid. Anybody
    want to tell me how that is physically possible? “Linkage
    disequilibrium.” I see, so the answer is science. That’s reassuring, I
    guess.

    III.

    A digression but it’ll make sense later: I have an example that you’re
    probably going to find supremely racist so you may as well get a
    drink, I have an 8 year old patient, black, who has the usual
    constellation of ADHD symptoms that are easily explained by
    everything else except ADHD, and he’s on Concerta and blah blah
    blah, and the mother of this kid— let’s use the appropriate code
    words and call her “economically disadvantaged” and “on crack”, so
    this mom who is herself fully loaded with SSI and pointless
    medications but also Klonopin manages to do what not only is
    physically impossible but out of the realm of even knowing is
    possible: somehow this woman goes off all her meds, and then
    considers, decides, applies and gets her son transferred to a
    suburban, rich white kid, private school. That’s what’s up.
    Now the first thought you and I will be having is, will this kid make
    it in that school? because if he can, it would be awesome. But that
    question really is asking, can a good school override the effects of
    ADHD? Can it override an “urban” mother?
    What happened is significant, results may vary, but what changed
    wasn’t the kid but the mother. You know how they say you can take
    the person out of the ghetto but etc etc? Turns out that’s completely
    wrong. She didn’t go to the school, her education didn’t improve,
    she still lived in the exact same house but everything about the way
    she handled herself, carried herself, drugged herself, even thought—
    all that changed, because she wanted to operate in a world that was
    functioning at a higher level. Yeah, I said higher. The point here is
    that the psychiatric model does not allow this to be a possibility—
    “relapse is the rule” and “bipolar is a chronic illness” and so sees her
    exclusively as a fluke; yet it is the model itself that prevented her
    from making those changes. In an attempt to manage the mass of
    poverty that has been relabeled “psychiatric”, it must necessarily
    sacrifice the 10-90% of people who may be able to force themselves
    up. Another way of putting this: if, instead of medications and
    psychotherapy I instead spent the time tutoring all these kids in
    math, what would be the outcome on the entire community? For the
    purpose of this question assume I am good at math.

    IV.

    Which brings us to the N=1 popular media execution of all this:


    there’s a doctor, a Medicaid doctor, who is handing out Adderall to
    poor kids for the specific purpose of— sit down for this— getting
    them better grades.

    From the New York Times:


    Although A.D.H.D is the diagnosis Dr. Anderson makes, he
    calls the disorder “made up” and “an excuse” to prescribe the
    pills to treat what he considers the children’s true ill — poor
    academic performance in inadequate schools.
    “I don’t have a whole lot of choice,” [said Dr. Anderson].
    “We’ve decided as a society that it’s too expensive to modify
    the kid’s environment. So we have to modify the kid.”
    Dr. Anderson is one of the more outspoken proponents of an
    idea that is gaining interest among some physicians. They are
    prescribing stimulants to struggling students in schools starved
    of extra money — not to treat A.D.H.D., necessarily, but to
    boost their academic performance.

    I should take a second to point out the hopefully now obvious: the
    only reason this is about poor kids and in the New York Times is so
    NYT readers don’t feel so guilty about forcing Adderall on their
    own kids. “He has problems with concentration!” Easy, Katniss, I’m
    not disagreeing. Though not the point today, it is worth repeating:
    stop reading the Times.
    Note the dichotomy being set up. Adderall is good for you,
    antipsychotics aren’t. That’s why we hear about overprescription of
    Abilify but an Adderall shortage. A shortage! Are you telling me
    Big Pharma has pulled off a massive conspiracy to effect a shortage
    of a drug which exists in nine other generic forms and I can make in
    my basement had I a basement? But that’s the story that has to be
    told. “Are you saying there’s no shortage?” How can there be a
    shortage of a drug that you think is overprescribed for a diagnosis
    that you say doesn’t exist? Madness!
    Why is “inappropriately” giving Adderall to kids to get them better
    grades morally superior to “inappropriately” prescribing Abilify to a
    guy so he doesn’t punch his girlfriend during the monotonous
    downtime of SSI? What’s the difference? “Well, they’re both
    wrong.” Then what should be done instead?
    It feels wrong, somehow, and that feeling of wrongness-but-I-can’t-
    explain it is what prompts a national dialogue, but what Dr.
    Anderson really did that causes the consternation isn’t prescribing
    the Adderall but saying out loud that it isn’t for ADHD— breaking
    the unspoken rules of the system by telling the press what none of
    use dare say even to our patients: that we’re not medicating a
    diagnosis, we’re using a diagnosis to justify the medication we have
    to use anyway because we have nothing else to do but give out
    medications.

    It’s like a surgeon trained on the latest laparoscopic techniques, only


    to learn his first and only gig post residency is combat surgery in the
    back of a moving helicopter with a penlight and teeth. “You know,”
    says his colleague who collects white wines, “a mediolateral
    approach is preferred.” You don’t say?

    Here’s a question none of you can answer: how come the thing with
    the greatest amount of empirical support is the only one that isn’t
    covered?
    The question of whether ADHD or bipolar “exists” is loudly debated
    because it is utterly meaningless, in battlefield psychiatry no one is
    treating the diagnosis regardless, we are all treating symptoms; and
    we’re not treating symptoms, we’re calling them symptoms because
    otherwise we don’t get paid, you don’t get the med, somebody’s
    going to get punched and somebody’s going to get sued because
    somebody didn’t “manage the underlying psychiatric process that
    mediated the assault” which doesn’t exist but for some weird reason
    is widely prevalent in poor blacks and hispanics and whites with calf
    tattoos.
    If you are convinced that SSRIs don’t work and antipsychotics are
    dangerous and meds are all prescribed off label, conduct for yourself
    a little experiment: tell a Medicaid patient you’re not medicating
    him. I’ll be in the chopper, where apparently it is safe.
    I’ve said this before and I will repeat it here, you can blame the
    overuse of medication on anything you want and you will all be
    completely wrong, the most important reason a medication was used
    is that the patient showed up, and they showed up because that’s
    where the state told them to go. In 100% of the cases when a
    psychiatrist in urban camo tells me he doesn’t use antipsychotics or
    stimulants, I know that all of his prescriptions say “Xanax” and
    “#120”. And I don’t fault him, how could I? It works for what it’s
    for, and what it’s for is not punching your girlfriend in the face,
    which is the same reason other guys use Abilify or Zyprexa or
    whatever. When I graduated from residency I used to look down on
    the benzo docs because I was an arrogant animal, I had a retiring
    Puerto Rican psychiatrist tell me that back in PR they used Xanax 2
    TID as an antipsychotic “and it worked very well”, and I thought,
    madre dios, this man is a lunatic, how did he get across the border?
    And now I’m not so sure they didn’t have it right all along. Or
    maybe I need a benzo, I don’t know. Jesus Christ, I need a nap.
    I’m happy to point out flaws in clinical trials and studies, it’s fun and
    easy but it is ultimately pointless, no one cares, no one listens, I have
    a blog full of them and it couldn’t be less relevant to anyone.
    Psychiatry isn’t committing professional suicide, Dr. Healy, fear not:
    the government needs its unarmed security services, now more than
    ever, and it will get them at cut rate prices because no one can argue
    that following the next step in a flowchart is worth anything more
    than a pat on the back. On the other hand, I get that they have a lot
    of antipsychotics in Washington DC, but do you know what they
    don’t have a lot of in Washington DC? Riots. I guess it all worked
    out, I have no idea how but you can’t argue with results, ask the
    Athenians and Madridians if their system worked better. I once had a
    patient with no pathology whatsoever try to kill me, the gigantic
    irony of it being that if he had succeeded, who would they have
    blamed? Me— for undermedicating him! And God bless Dr.
    Anderson, I don’t think it’ll help but at least he’s trying despite the
    criticism, at least he’s willing to admit that though the whole thing is
    a carny act he’s still the one saddled with the responsibility.
    But to the government employees in academia, you cannot assume
    something is inappropriate if you have no idea about what is
    appropriate. And to the government employees in government, you
    get what you pay for. No one is saying that there isn’t suffering all
    over the place, but that’s different than a psychiatric pathology. If
    70% of the patients are not truly ill, then the sick ones are only
    getting 30% of the attention, do you see? If the majority of Medicaid
    patients aren’t real patients, then why would you expect them to get
    real treatments?
    The Second Story Of Echo
    And Narcissus
    October 29, 2012

    fixed it for you

    Are you listening closely?

    I.

    This is the story you know:

    “Narcissus was a man who was so in love with himself that he


    fell in love with his own reflection. No one else was good
    enough for him. He stared into the pool, and eventually wasted
    away.”

    But that’s not the whole story.

    When Narcissus was born his mother, Liriope, took him to the
    blind seer Tiresias and asked him for a prophecy: “will he
    have a long life?”

    Before Tiresias became a prophet he had spent seven


    confusing years as a woman, and made two important
    discoveries about women. First, that women get more pleasure
    from love making than men. When he told this discovery to
    Hera and Zeus, Hera, in a rage, struck him blind, which lead to
    his second discovery: not all women want to hear this.

    Zeus tried to make up for his blindness by giving him the


    power to know the future.
    So Tiresias gave Liriope his cryptic prophecy:

    “He’ll have a long life as long as he never knows himself.”

    Now what could that mean?

    II.

    The story you know is that Narcissus was so beautiful that


    everyone wanted to be with him, but he rejected them all: no,
    no, no, no, no, not good enough.

    One rejected lover was furious and begged Nemesis, the


    goddess of vengeance, for retribution. “If Narcissus ever falls
    in love, don’t let the love be returned!”

    Nemesis heard the prayer and caused Narcissus to fall in love


    with himself: he was lead to a pool of water, and when he
    looked into it, he fell in love with what he saw. And what he
    saw wasn’t real, so of course it couldn’t love him back. But
    Narcissus sat patiently, forever, hoping that one day that
    beautiful person in the bottom of the pool was going to come
    out and love him.

    You should take note of this first, easy lesson: if no one ever
    seems right for you, and then the one person who does seem
    right doesn’t want you, then the problem isn’t the person, the
    problem is you.

    III.

    What have you learned so far? Do you think you’ve


    understood?

    You heard the story, you heard the words, but your mind
    unheard it and replaced it with something else. Even after I tell
    you this, you’ll have trouble remembering it.

    You think Narcissus was so in love with himself that he


    couldn’t love anyone else. But that’s not what happened, the
    story clearly tells it in the reverse: he never loved anyone and
    then he fell in love with himself. Do you see? Because he
    never loved anyone, he fell in love with himself. That was
    Narcissus’s punishment.

    You thought Narcissus rejected all those people because he


    was in love with himself, but he rejected them all before he
    loved himself. Loved himself? Do you think Narcissus
    rejected them because he thought he was better than them? Or
    better looking? How would he have known he was so
    beautiful? He didn’t even recognize his own reflection! He
    rejected all those people because they loved him.

    IV.

    You thought nemesis meant enemy, you thought it meant the


    person who always opposes you, the one you struggle most
    against. A person who is something like you, but the opposite.

    But all of those explanations are your lies working to hide the
    truth: a nemesis is the one who makes you fall in love with
    yourself. Without Nemesis, there’d be no story of Narcissus.
    Without your nemesis, you don’t have a story.

    V.

    Some people have tried to say that the pool Narcissus stared
    into was magical, that it tricked him, put a spell on him, made
    it impossible for him to look away. But that’s wishful thinking.
    It would be wonderful to be able to blame the pool the way a
    man blames a woman for tempting him. The truth is that no
    magic was necessary, Nemesis had only to lead Narcissus to
    an ordinary pool and Narcissus would punish himself.

    What did Narcissus do when he saw something beautiful in


    that pool? He fantasized and dreamed all the different
    possibilities of that person, all the things that person could be
    to him. He didn’t stay there for years because the reflection
    had pretty hair. He stayed because daydreaming takes a lot of
    time.

    And, as Ovid described about someone else:

    “But his great love increases with neglect; his miserable body
    wastes away, wakeful with sorrows; leanness shrivels up his
    skin, and all his lovely features melt, as if dissolved upon the
    wafting winds—nothing remains except—”

    except what? What do you think remains? Maybe the answer


    is different for everyone, but I know what you hope is the
    answer: anything else besides nothing.

    VI.

    This is a strange story. You know the main character is


    Narcissus, yet the title is “Echo and Narcissus.” Why do we
    think Echo is only a minor character? Who made Echo a minor
    character?

    Echo was nymph with a beautiful voice, but she talked too
    much, so Hera cursed her to be able to only repeat the words
    someone else said first. “Oh!” I can hear you say. “That’s
    where the word Echo comes from.” Grow up! Do you think
    these are children’s stories, like how the leopard got his spots?
    These aren’t fairy tales, these are warnings.

    Echo fell madly in love with Narcissus. She followed him,


    chased him, pined for him, but he wanted no part of her,
    rejecting her cruelly. Even after Narcissus died she longed for
    him, losing herself to that love, eventually wasting away into
    nothing but a voice.

    He probably was right to reject her: what kind of a woman


    loves a man based entirely on how he looks? What kind of a
    woman still loves a man no matter how badly he treats her?
    Why would Narcissus want that kind of a person? She wasn’t
    a woman with a beautiful voice; there was nothing else inside
    her except a voice.

    But let’s go back to the beginning of her story, no, the true
    beginning of the story, or do you think this is a dream that
    starts in the middle? If it was, we’d have to interpret it as a
    wish fulfillment and not as a warning.

    At the beginning, Echo was watching him, hidden, but


    Narcissus sensed someone was there, and he was excited by it.
    “Come!” he called. “Come,” she could only echo, and stayed
    hidden, which only made him want her more. What mystery is
    this? He couldn’t see her but he could hear her voice, and in
    that unfathomable voice was incarnated all the possible loves
    he could imagine. It helped that this mysterious woman knew
    just what to say to him. She was perfect for him in every way,
    she was the cause of his desire.

    And then she came out from hiding, and he saw her.

    Was she beautiful? Undoubtedly. But the moment he saw her


    he wretched, “Blech— better death than should you have all of
    me!”

    What was so wrong with her? It wasn’t just that she may have
    been shorter or heavier than he had imagined. What was
    wrong was in that instant he experienced her, she stopped
    being anything else.

    But if Echo was no longer a projection, she was still a


    reflection. Echo, like all women, offered her man a peek inside
    his soul, all he had to do look: What kind of a man am I, that
    attracts this kind of woman? What kind of a man am I that
    attracts the kind of woman who only likes me for how I look?
    Despite how I treat her? What kind of a man am I that only
    attracts the kind of women who like me for X? Is it because
    there is nothing else of value inside me except X? But he was
    never taught to ask questions like this. In fact, he was taught
    never to ask questions like that. What kind of a man attracts a
    woman who can only echo him? There must be a name for that
    kind of person, and he already had it.

    If he had considered this, he might have tried to change


    himself, or at least recognized how similar they were.

    And just as Echo wasted away to her X, a voice, he wasted


    away to a pretty flower— his X.

    Nothing besides remained.

    VII.

    How is it that centuries later, Tiresias’s prophecy is still not


    understood?

    Tiresias’s prophecy was: He will have a long life, if he never


    knows himself.

    Now, what could that mean?

    Oh, he was right: Narcissus did live a long life— though not a
    happy one. He spent his life alone, dreaming, and gazing into a
    pool, waiting to die.

    But Tiresisias’s prophecy seems… wrong, counter to the


    Greek spirit, an affront to logic; shouldn’t “knowing thyself”
    be the highest virtue?

    He will have a long life, if he never knows himself.

    But it’s so simple, the explanation. It’s so simple that no one


    has ever thought of it, and the reason no one has thought of it
    is that it is too terrible to think about.

    Forget about whether the prophecy is true. Ask instead, “what


    would the parents have done once they heard it?”

    When Laius and Jocasta were told that Oedipus would


    eventually destroy them, they pinned his ankles and
    abandoned him in the woods, ensuring that he’d someday have
    cause to do it. And so when Narcissus’s parents heard the
    requirements for their child’s long life… they would have
    done everything possible to ensure that he didn’t know
    himself.

    No one knows what Liriope and Cephisus did, but whatever


    they did, it worked: he didn’t even recognize his own
    reflection. That’s a man who doesn’t know himself. That’s a
    man who never had to look at himself from the outside.

    How do you make a child know himself? You surround him


    with mirrors. “This is what everyone else sees when you do
    what you do. This is who everyone thinks you are.”

    You cause him to be tested: this is the kind of person you are,
    you are good at this but not that. This other person is better
    than you at this, but not better than you at that. These are the
    limits by which you are defined. Narcissus was never allowed
    to meet real danger, glory, struggle, honor, success, failure;
    only artificial versions manipulated by his parents. He was
    never allowed to ask, “am I a coward? Am I a fool?” To
    ensure his boring longevity his parents wouldn’t have wanted
    a definite answer in either direction.

    He was allowed to live in a world of speculation, of fantasy, of


    “someday” and “what if”. He never had to hear “too bad”, “too
    little” and “too late.”

    When you want a child to become something— you first teach


    him how to master his impulses, how to live with frustration.
    But when a temptation arose Narcissus’s parents either let him
    have it or hid it from him so he wouldn’t be tempted, so they
    wouldn’t have to tell him no. They didn’t teach him how to
    resist temptation, how to deal with lack. And they most
    certainly didn’t teach him how NOT to want what he couldn’t
    have. They didn’t teach him how to want.

    The result was that he stopped having desires and instead


    desired the feeling of desire.

    Nemesis had an easy job, she only had to work backwards:


    show him something that didn’t return his love, and he’d be
    hooked.

    Narcissus’s parents were demi-gods— didn’t they know how


    to raise a good son, what a proper parent needs to do? Yet they
    listened to a charlatan anyway. They were given meaningless
    information by a supposed expert and abandoned all common
    sense, and so created a monster who brought death to at least
    one person and misery to all.

    VIII.

    I know what you’re thinking. You’re worldly, you’re cynical,


    your skeptical. You don’t go for all this fate crap. You’re
    thinking whether it is true that not loving others comes before
    loving only yourself—it seems backwards to you. You’re
    thinking, what does this little girl know, really? She didn’t
    write this, after all. (Did I?)

    You’re thinking whether it is true that parents create the


    narcissism that plagues their children for the rest of their lives.
    Does that match your own experiences? You’re trying to
    remember back to your own childhood.
    Am I right?

    Which means you haven’t learned the lesson. There you go


    again, thinking about yourself. Your impulse wasn’t to say,
    “am I doing this to my kids?” or “how will I act differently?”
    It was to wonder about your own nature.

    The moral of the story of Narcissus, told as a warning for the


    very people who refuse to hear it as such, is that how
    Narcissus came to be is irrelevant. What was important was
    what he did, and what he did–- was nothing.

    IX.

    I’m being told that I should stop here, that you’ve had enough.
    But let me tell you one more thing: there’s a secret to the story.
    Can you guess what it is?

    Close your eyes.

    Imagine the scene as a large painting on the wall. There’s


    Narcissus, sitting by the pool, head tilted downwards, arm idly
    twirling the water, his mind lost in daydreams. Around him are
    the trees, the grass, the sky. Nemesis is behind him, arms
    crossed, watching the punishment.

    Now look closely at the expression on Nemesis’s face. There’s


    something odd there. Look closely at her eyes.

    She’s not actually looking at Narcissus, it only looks like she’s


    looking at Narcissus. She’s actually looking— right back at
    you.

    That’s right, the story isn’t about Narcissus, it was always


    about you. There never was an objective distance for you to
    watch from.

    It was all a kind of charade.

    The ancients didn’t tell these stories to pass the time or teach
    children a lesson or tell you where the word Echo came from.
    Do you think we took their pop culture and made it into our
    literature? These stories were meditations, case studies: what
    do you see in them?

    The secret to the story of Narcissus is that the story is the pool,
    it is your pool. What do you see in it? It’s a reflection and a
    projection.

    But you know the old saying, when you stare into the pool, the
    pool stares also into you. What does the pool see when it stares
    into you? How does it judge you?

    Look behind you. Nemesis is there. Can you guess what your
    punishment will be?

    Open your eyes.

    You’ve been given a second chance.

    None of this is real.

    –-

    Audio file here.

    Clarifications:

    1. The Carvaggio is inverted: the reflection is gazing back at


    Narcissus.

    2. Though the girl, age 8, is reading from a script, inflections


    and pacing are hers. Interesting to see how she emphasized
    certain passages and not others.

    3. The background music of the audio file is Hymn To


    Nemesis, by Mesomedes (1 AD). It is one of the only
    surviving pieces of music from the old days. The relevance of
    the music is its lyrics:
    Winged goddess, Nemesis, who tilts the balance of our
    lives, dark-eyed goddess, daughter of Justice, who curbs
    with iron bit the foolish brayings of mortals, and who
    through hatred of man’s destructive arrogance drives out
    black envy. Beneath your relentless and trackless wheel
    men’s fortunes turn and twist; unseen you walk beside
    them, and bend low the proud man’s neck. Beneath your
    arm you measure out his life-span, and stoop to gaze into
    the depths of his heart, your scales held firmly in your
    hand. Be benevolent to us, you who dispense justice,
    singed goddess Nemesis, who tilts the balance of our
    lives.

    We sing in honor of Nemesis, immortal goddess,


    formidable Victory with wings outspread, joint counselor
    with Justice, who makes no mistakes, who punishes the
    arrogance of men, and bears it to the depths of Hades.

    Nemesis preceded even Zeus. Is she really the goddess of


    vengeance?

    4. At the end of the audio you can here a (male) voice say, “…
    At least you will still look like you.” This sentence does
    double duty. It sounds like a coda to the main theme, asking
    the reader to consider the implications to his own identity. But
    it’s also the last sentence of an entirely different story, buried
    under the final music: The Second Story Of Medusa, which is
    connected to the story of Echo and Narcissus in a specific way.
    I’m working on a video.
    Hipsters On Food Stamps,
    Part 1
    November 10, 2012

    who wants Haterade

    In the John Waters-esque sector of northwest Baltimore


    — equal parts kitschy, sketchy, artsy and weird — Gerry
    Mak and Sarah Magida sauntered through a small ethnic
    market stocked with Japanese eggplant, mint chutney and
    fresh turmeric. After gathering ingredients for that
    evening’s dinner, they walked to the cash register and
    awaited their moments of truth.

    Those are two “hipsters”, and the punchline is that they pay
    for their foodie porn with foodie stamps, which sounds like it
    should be a terrible thing, except it’s in Salon.com, which
    means they’re going to try and tell you how it’s a good thing,
    which they don’t, because they can’t. It’s madness.
    It’s very easy and satisfying to hate these two, and nothing
    would make me happier than to hit them square in the back
    with a jack-o-lantern. But I also recognize that I am being told
    to hate them, so I have to take a step back and find out why it
    is so important that I hate them. I did. I should have just
    reached for the pumpkin.

    No one but the state and psychiatry can profit from another’s
    misery, and they are the same thing, so let’s see why Election
    Day doesn’t matter.

    I.

    First, the obvious: what’s wrong with hipsters on food stamps


    is that these are college educated people who should be able to
    get jobs, not live off the state. They’re not black, after all.
    Hell, one of the two in the article is even Asian. “What, like
    Russian Asian?” No, like Asian Asian. “Whaaaaaaat?”

    “It’s the economy, stupid!” Thanks guy from 1992, but the
    economy did not tell you to go to college for something you
    knew in advance would make you unemployable, especially
    when that unemployable choice cost exactly the same as the
    employable choice, i.e. too much. Lesson one at the academia
    should be the importance of separating vocation from
    avocation, as character actor Fred Thompson and electrical
    contractor Benjamin Franklin both understood. When I was six
    I wanted to be in Playboy. Just because it’s your dream,
    doesn’t mean you should pursue it.

    So what makes them hatable is the seeming choice they have


    made: they could work, yes at jobs they don’t like but hey,
    that’s America; but instead they choose to feel entitled to
    $200/month from the rest of us salarymen.

    However, secondly:

    Before we blame them for their choice, we should ask why


    they felt they could make that choice. I’m not trying to start
    trouble, but let’s choose something I’m familiar with, i.e.
    women: why would a smart high school junior, 4.0 and AP
    Everything, think that going to Hampshire College for English
    Literature was a good idea? Why would her parents allow this
    madness, other than the fact that they were divorcing? What
    did she think would happen given that she knew in advance
    there were no jobs for English majors? Serious answers,
    please, I’ll offer four I had personal experience with: law
    school; academia; non-profits; marriage. Don’t roll your eyes
    at me, young lady: let’s say you are the daughter of a lawyer
    and you major in English. When you were 17 and you
    imagined your life at your Dad’s age— not the starving
    poetess fantasy you wrote about in your spiral notebook, but a
    glimpse of the bourgeois future you then thought you didn’t
    want— what kind of a house did you imagine in the “if that
    happens to me I’ll Anne Sexton myself” scenario? A lawyer’s
    house or an English major’s house? In other words, the choice
    to major in English was predicated on information she
    received from multiple sources like schools and TV— sources
    I will collectively call the Matrix— that every generation does
    better than the last, that there was a safety net of sorts, a
    bailout at the end, that future happiness was inevitable, and so
    we return to economics: the general name for that safety net is
    credit. America was the land of the minimum monthly
    payment. And if this analogy isn’t clear enough for you, let me
    reverse it: the ability of the economy to offer English as a
    major required a massive subsidy to make you feel like
    $20k/yr was the same as free. If you had to pay it up front,
    you’d either be an engineer or $80k richer. That subsidy is
    now worthless, not because the money doesn’t exist but
    because the bailout at the end, e.g the four options I suggested
    were operational 1977-1999 which guaranteed the payments
    would be made, won’t help.

    Imagine a large corporate machine mobilized to get you to buy


    something you don’t need at a tremendously inflated cost,
    complete with advertising, marketing, and branding that says
    you’re not hip if you don’t have one, but when you get one
    you discover it’s of poor quality and obsolete in ten months.
    That’s a BA.
    II.

    When we see a welfare mom we assume she can’t find work,


    but when we see a hipster we become infuriated because we
    assume he doesn’t want to work but could easily do so— on
    account of the fact that he can speak well— that he went to
    college. But now suddenly we’re all shocked: to the economy,
    the English grad is just as superfluous as the disenfranchised
    welfare mom in the hood— the college education is just as
    irrelevant as the skin color. Not irrelevant for now, not
    irrelevant “until the economy improves”— irrelevant forever.
    The economy doesn’t care about intelligence, at all, it doesn’t
    care what you know, merely what you can produce for it. The
    only thing the English grad is “qualified” for in this economy
    is the very things s/he is already doing: coffeehouse agitator,
    Trader Joe’s associate, Apple
    customer………………………………………….. and spouse
    of a capitalist.

    Of course I’m not happy about this, I like smart people, but
    that’s the new reality. There was a time where women went to
    college to get an MRS degree, and I am telling you that that
    time is today, there is nothing else of value in there. Sure,
    some college women go on to become doctors and CEOs, and
    some go on to become child pornographers and Salon writers,
    none of those things have anything to do with what happened
    in college. If you are going to college to get an education and
    not to meet guys, you are insane, literally insane, delusional, in
    reality one is never going to happen and the other is going to
    happen anyway, and you could have gotten both for free at a
    bookstore. Worked for me. The only question for the future
    single mom is whether it’s worth $XXXXXX a year to meet
    guys, and the answer is of course it’s not, even nightclubs let
    ladies in for free.

    It’s hard to accept that the University of Chicago grad


    described in the article isn’t employable, that the economy
    doesn’t need him, but it is absolutely true, but my point here is
    that not only is he not contributing, the economy doesn’t need
    him to contribute. Which is good, because there’s nothing he
    can do for it. 1. Anything requiring science is out. 2. “He can
    work manual labor!” I love how people assume economics
    doesn’t apply to construction. The demand for those jobs is
    very high AND hipsters suck at them. At any wage, Gerry the
    hipster will always be outworked by Vinnie the son of a
    longshoreman, who will always be outworked by a Mexican
    illegal, i.e. the system will always be able to find someone
    who can do the job better AND with lower labor costs. Bonus:
    no need to pay Jose’s insurance, everyone knows Hispanics
    never get sick, except fake psychiatrically. 3. Hipsters are not
    good at retail or sales unless detached irony is required, which
    it is not, which is why they’re on food stamps. Here’s a quick
    test, watch this video:

    Is Baldwin’s character a jerk or a savior? The genius of the


    story is that half of you will have completely misunderstood it,
    and you like mint chutney and food stamps. The secret is at the
    beginning, at 0:15, where it is revealed that Alec Baldwin
    doesn’t feel any of this, the whole speech is a work. If you
    were in that room, some of you would understand this as a
    work, but feed off the energy of the message anyway, welcome
    the coach’s cursing at you, “this guy is awesome!”; while
    some of you would take it personally, this guy is a jerk, you
    have no right to talk to me like that, or— the standard
    maneuver when narcissism is confronted with a greater power
    — quietly seethe and fantasize about finding information that
    will out him as a hypocrite. So satisfying.

    That same person will retort that the film is a critique of evil
    American capitalism, but then why, in a job sector with 50%
    more women than men, is Alec Baldwin yelling at a room in
    which there is not a single woman? Are there no female
    capitalists? Why does he have to teach them a mnemonic that
    is already posted on the bulletin board behind the chalkboard?
    Same reason Pacino isn’t present: because sales isn’t about the
    product, it’s about the relationship, and women and alpha
    males are better at relationships, while everyone else is busy
    outing hypocrisy. Go get ‘em. “The leads are weak.” Oh, the
    leads are weak. In this example, leads=economy.

    This is where the two mentalities separate. One group of


    people sees the man behind the job, and judges him as an
    identity; and the other group of people sees the symbolic
    importance of the person, what he represents, a judge, a
    doctor, a bank teller, whatever; and that first group of people
    find it difficult to operate in society because they cannot see
    that the person is more than he “is” simply by virtue of his
    position, because that would doubly reinforce their own
    marginalization.

    The hipsters want to believe that because they are not obsessed
    with money/capitalism that they are better people, opting out
    of “materialism”, but that’s an after the fact rationalization.
    There’s simply no drive for anything except existing. “I’m a
    good father.” Go home and play with your kids. “I believe in
    social causes.” For which the minimum exertion is required,
    yes they’ll have wifi at OWS. There’s plenty of attention to
    style, to identity, and regression to our most primitive instinct:
    eating, fetishized. The next thing that should happen in this
    chain is the fetishization of the bathroom, “how pooping can
    be luxurious and how to make it more decadent.” Louis CK
    made a joke about this:
    and in case you think “it’s so true!” note that he was talking
    about how terrible being old is, how life was basically over for
    him. And then, IRL, he went on to make two TV shows. In
    other words, he was kidding about the pooping. He wasn’t
    talking about himself, he was saying it because he knew you’d
    relate.

    “We’re artists, not producers.” Then make some art! “No one
    will buy it.” Are you insane? The point isn’t the money yet, it
    is the drive. Go to the Whole Foods and ask if you can hang it
    for free, and if they say no, hang it anyway. I’d rather look at
    the most horrendous art than subway tiles or “Lose Weight
    Fast” ads. I’m no artist, yet here I sit, clickity clackety clack,
    applying King’s 2000 words a day to write you the best book
    of pornography I’m able to pull off (by Christmas). The
    natural human instinct is to create things, beginning with the
    toddler who is amazed that he was able to create such a
    fascinating product out of his butt, the difference is most
    toddlers grow up and sublimate that drive and create other
    things. You have not gotten past the poop, strike that, you have
    regressed to the oral stage, hence the emphasis on organic
    foods. Yes, the anal stage comes after the oral stage.

    “I have a degree.” No one assumes you’re smart because of it,


    so what was the point? You were tricked, your parents were
    tricked, your peers were tricked, your employers were not
    tricked at all. “There’s more to a college education than
    employability.” No there isn’t. I am not anti-liberal arts, I am
    all in on a classical education, I just don’t think there’s any
    possibility at all, zero, none, that you will get it at college, and
    anyway every single college course from MIT and Yale are on
    Youtube. Is that any worse than paying $15k to cut the
    equivalent class at State? Name me one contemporary fiction
    writer who required his college training to be a writer, and if
    you say David Foster Wallace I swear to god I’m going to
    pumpkin your house. I think the only reason The New Yorker
    keeps shoving him down my throat is because he— the guy,
    not his work— is an academic’s aspirational fantasy, a
    compromise between two worlds: mild mannered writing
    professor by day, brooding and non-balding antihero by night,
    a last chance at “I can be cool, too” for the late 30s associate
    professor who thinks that intelligence alone is insufficient
    reason to be labeled a man. My university is full of them, all
    reasonably smart, all pretending at cool through the hiding in
    plain site of cultural irony and political cynicism and pretend
    alcoholism. “I may be drunk, but why was my polling station
    filled with rednecks trying to take away a female’s somatic
    autonomy?” says the endocrinology patient wearing a blazer
    with jeans as he nurses his second microbrew, trying to
    impress me with what kind of a man he could be in the Matrix.
    Come on, stop breathing. Obviously I’m not telling you to
    become an alcoholic, but don’t tell me you are one and then go
    home at 10:30 because otherwise your wife will cheat on you.
    Man up or stand down, I don’t care which, just don’t
    backwash into a perfectly good beer if I’m going to have to
    finish half of it.

    III.

    Fact: college is a waste, but we haven’t yet hit that point in


    society where we can bypass it. So we have to pass through
    another generation of massive college debt. How to pull in the
    suckers in? Answer: these articles. By getting you to say,
    “these hipsters should be able to get jobs because they are
    college graduates!” you are saying, “college is worth
    something.” It isn’t. But by directing your hate towards
    hipsters, you are protecting the system against change.
    part 2
    Hipsters On Food Stamps, Part
    2
    November 15, 2012

    gross margin 35%. Damn right we voted for food stamps


    part 1 here

    IV.

    “I can’t tell if you’re defending hipsters or hating on them.” They’re


    ridiculous. Feel better? They’re not the problem.

    It’s a simple thesis and no one wants to hear it: hipsters may lack
    drive, but the world they live in wasn’t set up by them, it was set up
    by their parents, i.e. the Dumbest Generation Of Narcissists In The
    History Of The World, the ones who magnified the importance and
    cost of college without having any idea of what should be its
    purpose, let alone its content.

    If you want to tell me a 30 year old hipster should be lashed for not
    trying to better himself, I’ll bring the whip, but the 30 year old chose
    his pointless major when he was 17 and you think the outcome is all
    his fault? A 17 year old can kill two people and still be considered
    too young to be criminally responsible, and anyway in that case you
    think the problem was video games and bullying. Of course Gerry
    The Hipster is made of soy and ennui, but there’s plenty of blame to
    go around. When he was 17 the system incentivized him to destroy
    his life, tempted him with beer, babes, and BS— and the promise of
    an upper middle class lifestyle provided he went to “a good school”
    (read: gave the system $100k of his post tax, pre-interest money),
    never mind for what. Like a good American, he did what he was
    told.

    The society that taught people to want a defective college degree is,
    unfortunately, going to be expected to support those that bought it,
    it’s still under warranty. At the very minimum, it owes them their
    money back, and if they don’t pay you should sue for breach of
    contract. “At the conclusion of this course, students will show a
    proficiency in….” The plaintiff rests.

    “They should have studied more.” Agreed. But then you shouldn’t
    have admitted them, you shouldn’t have passed them. Inflate the
    grade, Gresham’s Law the society.

    All along you’ve said “you need to go to college so you can get a
    good job” but the system was not designed to raise producers, it was
    designed to raise consumers. Well, here we are. Why are you
    surprised that they need consumer stamps? Why are you surprised
    they moved back in with you? “We did the best we could.” No you
    did not, I was there, I saw it. You borrowed against their future, and
    they can’t pay it back. And now you’re yelling at them.

    …A Hobbit’s Tale

    V.

    While the idea of a Metafilter post-doc receiving food stamps AND


    telling me they’re entitled to it makes my eyes go Sauronic, it’s that
    rage that requires some examination. Why rage? Why not just roll
    my eyes and go back to drinking rum and soldering op amps? What
    is the social importance of my rage?
    Society is nothing more than individual psychology multiplied by
    too many to count. If narcissism is what drives this society, then
    only narcissism will explain it.

    So start with an interesting hypothetical: does everybody need to


    work anymore? I understand work from an ethical/character
    perspective, this is not here my point. Since we no longer need e.g.
    manufacturing jobs— cheaper elsewhere or with robots— since
    those labor costs have evaporated, could that surplus go towards
    paying people simply to stay out of trouble? Is there a natural
    economic equilibrium price where, say, a U Chicago grad can do no
    economically productive work at all but still be paid to use
    Instagram? Let me be explicit: my question is not should we do this,
    my question is that since this is precisely what’s happening already,
    is it sustainable? What is the cost? I don’t have to run the numbers,
    someone already has: it’s $150/mo for a college grads, i.e. the price
    of food stamps. Other correct responses would be $700/mo for
    “some high school” (SSI) or $1500/mo for “previous work
    experience” (unemployment). I would have accepted $2000/mo for
    “minorities” (jail) for partial credit.

    VI.

    While all those monies have different names and different


    “requirements” they are all exactly the same thing: paying people
    who are off the grid, whether by choice or circumstance,
    indefinitely. i.e. Living Wages. However, they can never be called
    that. They have to pretend to be something else: this is for food, this
    is because of a medical problem we just made up, this is because
    you were caught with weed so we’ll leave you in here for 6 months
    until we sentence you to probation. And they have to have these fake
    reasons to give taxpayers a little emotional distance, deniability,
    otherwise they’d go John Galt, after all, they have all the guns. If
    they can invade Iraq, how hard is it going to be to take the Whole
    Foods on 3rd?

    That “emotional distance” is not hyperbole, it’s not me being a lefty


    deconstructicon, it is an absolute requirement of a psychic defense of
    identity, of self-worth. The point is not to get you to accept that
    hipsters deserve food stamps, the point is the opposite: to enrage
    you, infuriate you, so that you will resist— because then and only
    then will you pay for it.
    If this seems implausible to you, which it must— that’s exactly the
    point of it— consider the following extreme analogy, which
    surprisingly will be easier to understand, which is also the whole
    point: Say your father raped you repeatedly for a decade. Hold on,
    slow down, it gets worse: now you’re 40, and he shows up asking
    you for $2400 because, and I quote, “you have a responsibility to
    take care of me.” There he is in your living room, eyeballing the nice
    things in your home. If it is a fact that you will inevitably give him
    the money, is it easier to for you to pair it with your venom or your
    sympathy? Though it’s enraging, there is a perverse pleasure in
    giving that bastard the money. It tells you that you showed him that
    you are better than him.

    That’s how America works. The system needs you to be willing, not
    wanting, to pay for this, and getting the existing (narcissistic) society
    to believe that it is their “responsibility” (Left’s word) to pay for
    “laziness” (Right’s word)— to WANT to pay for this— is absolutely
    impossible. Why can’t we just all agree on what a fair share might
    be, take care of each other? Didn’t you major in English Lit? “Homo
    economicus” is not reality, envy is an immutable characteristic of
    our consciousness, it is practically Kantian, some of you will get a
    minor hold of it but even your priests are chock full o’ it. If the porn
    isn’t high res you can’t get horny, but you can hate a guy at 1000
    paces without a scope. That’s human nature. Envy, rage. It’s not all
    we are, but you cannot discount it.

    The only way to get them to agree to pay is to give them a way of
    rationalizing the “responsibility” as, in some way, for them: you’ll
    get a tax break, you’ll be rewarded in heaven, you are a better person
    for it, thanks, this means a lot. Can you imagine a hipster looking at
    a salesman and saying thanks for your service? So that’s out, use the
    default: rage. Just like how you get people motivated to go to war.
    No, no, no, no, not the people already waving flags, I mean the
    people who don’t want war. Said every liberal in Congress one
    magical day in 2003: “I’m not going to let those oil bastards Cheney
    and Bush get away with their racist imperialist plan, which is why
    I’m going to scream obscenities at them as I vote Attack.”

    The system isn’t thinking short term, it needs this to work long term,
    those hipsters are going to be getting food stamps forever, or do you
    think if the economy rebounds, old liberal arts majors will suddenly
    become appealing? Like a woman who squandered her youth on fun
    but disreputable men, she will find herself at 45 wanting to marry,
    but alone. “That is such a disgusting, sexist, archaic thing to say.” I
    feel your rage, and you are right. Alone nevertheless.

    VII.

    You might retort that there’s no money to pay for 25 more years of
    hipster apathy. Admittedly, this is a compelling argument. But the
    total cost of food stamps is $80B. The annual budget deficit is over
    ten times that. America’s economy is one big gigantic retail sales
    event. Is the economy back to like it never happened?

    why Obama won

    The underemployed econ majors will recognize that this isn’t “real”,
    inflation adjusted sales and the last few years are based on
    overpriced high-end goods that only Aspirational 14% can afford,
    and that for the other 85% of America purchasing power has
    dropped to 1997 levels, but as Whole Foods says, whatever.

    $80B is a lot, but how much is actually going to hipsters, how many
    hipsters are there, really? 73? 74? What purpose does this rage
    serve? If you Rage Against The Hipsters, you will be that much
    more likely to “allow” food stamps for everyone else. The hipsters
    are diversions. They are sacrifices. How much hate have you
    focused on Gerry since you heard about him? All of it.

    To clarify, this is not some kind of socialist ploy, it is a function of


    the way America (read: narcissism) works, it doesn’t need to be
    centralized, it is the sum of individual vectors pointing in different
    directions. Here’s the other side’s example: when they talk about
    raising taxes on the rich, why do they pick a “low” point and push it
    higher? Should the highest rates be at $250k/yr? $300k? Another
    way of doing it, which is precisely why they cannot do it, is start at
    the top and move down. “We need $1T. Ok, top five guys pay 90%.
    Not enough? How about top ten guys pay 90%. Not enough?
    Top….” I’m not advocating this or any other policy, not my place, I
    am pointing out that doing it the way it’s done protects the 1% by
    letting the Aspirational 14%— who crave recognition and are easily
    identifiable and hatable because they are poseurs, just of a different
    kind— act as human shields. They take the bullets, the unknown
    mega-rich take tinted window rides to the Hamptons. During those
    tumultuous 80 seconds of OWS— and BTW, those people gave up
    hanging out after only a trimester, do you really think they’re ready
    for 40 hour work weeks?— the majority of the personal attacks
    were against people who made <$300k, not >$50M. It’s easy to hate,
    and so the media nudges you in the wrong direction.

    VIII.

    You might think that the rage is the spark for a transformation of
    America, a full scale Dagny Taggart meltdown or Bolshevik
    revolution, depending on your hat. That’s not how it works. If this is
    narcissism, then its purpose is protecting identity, defending against
    change. Doesn’t matter what side you think you’re on, unless you
    are unplugged you are for the status quo.

    Here’s an example: in the “radical left” (their words) magazine


    Jacobin, the editor writes a defense of Gerry and Sarah as a way of
    arguing for the abolishment of, well, everything Randian. He’s
    against the “work ethic”, he wants a paradigm shift away from
    American producerism— the idea that your value is based only on
    what you can produce for the economy— towards social rights, e.g.
    Living Wages. I disagree with everything in it, so what? but it is
    very well written and reasoned, and if I played the same game as
    him I’d want him on my team.

    The point here is that he wants CHANGE. Here is the last paragraph
    of the article, tell me if you can find anything supporting the status
    quo:

    Rather than the “deserving” or “working” poor, with its


    connotations of moral judgment and authoritarian social
    control, it is time to begin speaking the language of economic
    and social rights. For instance, the right to a Universal Basic
    Income, a means of living at a basic level that would be
    provided to everyone, no questions asked. Against the invidious
    politics of the work ethic, it’s time to argue that some things
    should be granted to everyone, simply by virtue of their
    humanity. Even hipsters.

    Sounds sublime. But Gerry already had a living wage— he spent it


    on the University of Chicago, 41 years of food stamps in 4 years. If
    everybody knew in advance the outcome was going to be
    unemployment and living wages, then why doesn’t Frase challenge
    the capitalist assumption that college is money well spent— could
    have been used differently? He can’t. This thought cannot occur to
    him, not because he is dumb, he clearly isn’t, or because he is paid
    by a college— money is irrelevant to him. He can’t because his
    entire identity is built on college, academia. He is college. Take that
    away, he disintegrates. So in the utopia he imagines, college still
    exists AND people get living wages. Call me a Marxist, that’s what
    we have now.

    Second, and more importantly, he thinks he’s a radical progressive,


    that he wants a paradigm shift away from capitalism towards social
    rights— but he wants to keep everything else about capitalism
    completely intact. He is explicitly against producerism, but he wants
    to replace it with consumerism. He wants to make sure people can
    get what they want, not teach them how to want. In his utopia of no
    questions asked Universal Basic Income, do retail sales go up or
    down? The system has won.

    IX.

    If rage is necessary to keep this all going, how is it elicited


    efficiently?

    Peter Frase, defending Gerry and Sarah:

    But what the [Salon] article seemed to call forth in its readers
    was unending bile and rage directed at people deemed
    insufficiently deserving of a public benefit.
    Let’s do this right. If it is rage, then the rage is because of a threat to
    identity. What possible threat to identity could Gerry and Sarah pose
    to hardworking Americans? The answer is that someone wrote an
    article about how great Gerry and Sarah are, e.g. Peter Frase.

    Frase again:

    But they aren’t the only people who react to stories like this
    with rage or contempt rather than empathy. Consider the
    following comment, left under [Gerry’s] response to the article
    about him:

    I’m sorry but you are a selfish, whiny leach. I can say this
    because I a middle-aged woman and have been trying to
    find work for two years without success though I have a
    masters degree in a fairly desirable field. I have dwindling
    savings and two kids. Because I stayed home with them
    for a few years I don’t qualify for unemployment and that
    has also damaged my marketability in the job world.
    Despite all of this I have never resorted to public
    assistance and will not. In addition, I have a back problem
    that surgery did not correct so I am in physical pain 24 hrs
    a day. Still I have taken temp jobs and we have cut back in
    many ways. I am proud of my fortitude and
    resourcefulness, because we will make it through this time
    and my kids will learn valuable lessons from me about
    self-reliance.

    Here we have a person who has been marginally employed for


    two years and suffers physical pain 24 hours a day—and rather
    than demanding something better for herself, she demands that
    other people suffer more!

    Wrong, read her words, they are right in front of you. Before that
    article in Salon, this mother was allowed to believe that her staying
    off the dole had some honor in itself— some validation of her
    identity— and it allowed her to survive her hardships. Now she is
    forced to swallow that these people are not merely as good as her,
    but more valuable— they get an article, they get defenders like you,
    they are praised for their intrinsic human value, and all she gets is
    mocked, belittled, “she’s too stupid to know what’s good for her!”—
    all she can do is comment on their life— and her small act of
    rebellion is to at least use the space to tell the world she exists. Rage
    is her defense that keeps her intact while the world seemingly
    ignores her.
    Husband hates that his wife reads about the faux-celebrities in
    magazines. They say words to each other. What do they actually
    hear?
    She hears this: “Anyone who likes that is lazy and stupid. You’re
    stupid.”
    He hears this: “I know they don’t actually do anything, but they’re
    more interesting than you.”
    This is the surprising result: since they wall off into psychic
    cocoons, therefore the marriage remains intact, for a while longer.

    X.
    Back to college. Since the problem is college, does college accept
    any responsibility? I went to The Chronicle of Higher Education to
    find out. Surprise, no.

    What did I expect? They apparently intended this picture to evoke


    sympathy, isn’t it a crime that 33000 PhDs are on food stamps?
    You can imagine how the other side reads it, some highlights:
    hyphenated name; stupid thing to get a PhD in; fat; what’s an
    “adjunct”; why so much cheese; tattoos; place is a mess.

    Nowhere does the article address the fact that it should not have
    allowed her to get a PhD in medieval history, let alone help her pay
    for it. Do you know what The Chronicle does focus on? That she’s
    not black. First sentence of the article which is entirely about
    branding:

    “I am not a welfare queen,” says Melissa.

    For a lefty loosy publication like The Chronicle, what difference


    does it make if she’s white? Why does her PhD make her more
    deserving that a welfare queen? Because to The Chronicle, the PhD
    has value. It doesn’t. I’m not saying she isn’t smart, I’m saying the
    PhD in no way communicates to me she knows medieval history
    better than any D&D player. She may know more, but how do I
    know? I don’t even find “MD” particularly valid, but at least you
    can sue a doctor.

    But my reason for showing you her is to highlight the perverse logic
    of the university which will doom us all: since the only maniacs who
    would ever hire these PhDs are universities, then the solution to their
    unemployment is more money for universities:

    Ms. Bruninga-Matteau does not blame Yavapai College for her


    situation but rather the “systematic defunding of higher
    education.” In Arizona last year, Gov. Jan Brewer, a
    Republican, signed a budget that cut the state’s allocation to
    Yavapai’s operating budget

    Why would you expect her to answer differently?

    All the system had to do, starting around 1965, is not incentivize this
    madness. If there were not guaranteed student loans, up to any
    amount, available equally across majors and across colleges,
    independent of skills or promise or societal need, none of this would
    have happened. Easy money got us into this mess, and easy money
    will keep us sailing until we go right off the edge of the map.

    part 3

    http://twitter.com/thelastpsych
    Temper Tantrums In The
    DSM
    November 20, 2012

    let me guess

    From BoingBoing, only slightly more valid than any of the


    journals I read:

    The American Psychiatric Association is set to add


    “disruptive mood dysregulation disorder” to the
    Diagnostic Statistical Manual (DSM), the bible of
    psychiatric disorders. A kid has “DMDD” if she or he has
    “severe recurrent temper outbursts that are grossly out of
    proportion in intensity or duration to the situation… at
    least three times a week.”

    Easy, everybody, if you’re enraged about the wussification of


    America you can assume you watch too much TV and like
    Blue Pills.

    1. Diagnosis is not the same as disease. This just coordinates


    the language, “from now on we’re going to call this this.”
    “Then why is it called a disorder?” Ah, you must have no
    insurance or the best insurance. Healthcare policy is set by
    Medicaid/Medicare, you Blue Cross suckers are merely
    collateral damage.

    In Medicaid America, i.e. America, if you come through the


    door and I ask you all the questions and I determine there is
    absolutely nothing wrong with you, two things will happen at
    the exact same time: 1. You will punch me. 2. I won’t get paid,
    can’t get paid for no diagnosis, no matter how hard I work.

    Can’t order any tests without a diagnosis code, either.

    Someone stupid will ask me this: “then why doesn’t Medicaid


    just offer a billing code for “need three evaluations, but likely
    no diagnosis?” Because if Fox News got wind that Obama was
    paying for black people to get “no diagnosis” they’d blow up
    an abortion clinic. Paying for “temper tantrums” is just the
    right amount of enraging, TV and internet enraging, no
    violence will occur. “Isn’t this why we need universal
    healthcare?” Well, lieutenant, pronounced like I’m a British
    naval commander, if we had a system of healthcare in which
    doctors were paid the exact same regardless of diagnosis or
    severity, then there’d be little attention paid to “correct”
    diagnosis, all of our epidemiological data would be totally
    invalid, and the number one drug in America would be Xanax.
    “Wait, isn’t that the situation now?” Huh, nailed it.

    2. “Is this is an attempt at preventing the erroneous diagnosis


    of “pediatric bipolar disorder?” No. Come on, stop it. Not to
    go full Popper, but how can diagnoses be “wrong” while
    simultaneously “not exist?” You guys have to decide whether
    you’re materialists or idealists, then we can cross blades.

    In other words, regardless of what you call it, assuming the


    MD thinks it is “a problem fit for a pill,” will the pills offered
    be any different in either diagnosis? I’m closing my eyes,
    don’t tell me which diagnosis it is… I’m sensing something, a
    presence…. is it Concerta? Concerta, is that you? And….
    Depakote? Are you here too?
    3. “DMDD is “severe recurrent temper outbursts that are
    grossly out of proportion in intensity or duration to the
    situation.” I’d like someone to explain what behavior is
    “grossly out of proportion” for a situation characterized by
    physical/sexual abuse, parental drug abuse, and visibly
    swarming roaches, every day, while you sleep, while you
    eat….

    “But not all kids are raised in poverty.” True, many are raised
    by nannies who alive in poverty. So what kind of temper
    tantrum is out of proportion for a situation characterized by
    marital infidelity/swinging, overparenting, spoiling them
    materially and depriving them emotionally? “I love my kid, I
    got him a Wii.” You should get them some weed, they’ll get it
    eventually.

    “So then it’s not really a disorder, it’s just caused a response to
    the social environment?” Isn’t that what a psychiatric disorder
    is? “No, a real disease.” Like diabetes?

    4. It’s all very simple, you have it mostly right but the
    direction of the force vector is wrong. In order to create a
    living wage, the system deploys its social services through the
    least offensive department, healthcare. e.g. people are furious
    about Social Security, but not as furious about Medicare. As
    long as it can pretend it’s about “health” or “compassion” or
    “disability” it doesn’t have to worry about politics or race or
    “need”.

    But in order for this to work, the doctor has to get paid. Not
    much, but paid. If he is to get paid, the patient must have
    insurance, i.e Medicaid. In order to get Medicaid, the patient
    must be temporarily disabled, for which he needs to have a
    diagnosis, so he must see a doctor, who will need to get paid,
    so the patient needs to have Medicaid. Ouroboros. The system
    has won.
    Funeral
    December 10, 2012

    do you have a better system?

    The funeral is attended by 30 people. It’s a military funeral


    because he was in Korea, and in the front chairs are his wife
    and two grown children, and they are quietly crying.

    When it ends, people disperse hesitatingly, after all, they


    themselves aren’t sad, they didn’t know him, they knew his
    kids. So they are unsure of what they’re supposed to do next,
    but the answer is you keep going, there’s nothing else to do but
    that. That’s the point of a funeral.

    The deceased’s wife has mourned her part, for now, and
    accompanied by her adult son walks away. The adult daughter
    approaches the coffin, sobbing. She is pretty, which
    unfortunately is relevant. Her husband hugs her, and then takes
    their two little girls away from her, down towards the road,
    giving the woman the required freedom to be someone’s
    daughter one last time.
    She kneels at the coffin. She cries. Everyone can hear it. It is
    sad.

    II.

    But some people are unsatisfied with a system that’s been in


    place for more millennia than years they’ve been alive. They
    don’t trust that it’s effective because when the funeral is over
    people are still sad. What kind of stupid ritual is that? These
    people want to change the system, they believe they know a
    better way.

    Most people instinctively turn away and give her some kind of
    privacy, but about ten of them move forward to surround her:
    what’s this? A woman crying? At a funeral?? They huddle
    around her in a semi-circle, hyenas waiting for a signal. One
    hyena steps forward, tries to hug her from behind; and you can
    see the surprise in that dummy’s face when he doesn’t get the
    expected hug back, when it doesn’t seem to help, the grieving
    daughter doesn’t stop crying, she doesn’t even get up. The
    hyena is caught awkwardly, so he rests his paws on the
    woman’s shoulders, and now the sobbing woman must
    associate her last chance to be with what is left of her father
    with the stale breath of a sycophant waiting for his moment to
    be relevant.

    And while that’s going on others are whispering to the


    quivering back of her coat, “oh, I’m so sorry”, “I’m sure he
    really loved you”, “are you ok?”

    Why did any one of them think they had the power, the right,
    to interfere with another person’s mourning? This was
    between her and her father and God and no one else. Did no
    one notice that even the husband had given her space? Did
    they just think he was being a jerk? “I just wanted to comfort
    her.” No, you didn’t know what else to do, so you did that. “I
    didn’t want her to be alone.” That’s because you are a terrible
    person.
    They do not know how to stand in the presence of grief
    because they can’t help but make it immediately a judgment of
    themselves— how can you see a woman crying and not do
    anything? Purposeless hyperactivity to cover up one’s
    impotence and lack of empathy. “But I’m not the one grieving,
    I can’t fake being sad.” Don’t fake it, just be silently and
    unobtrusively available. I know you don’t think you’re the
    most important person there, but you are also not the second
    most important. Or the third or tenth. Get out of the way.

    But they can’t, they think it has suddenly become their


    responsibility to save you. Look around, all those other people
    — yours? Do you think you can? Do you think that anything
    you say is going to bring the dead back? Ease her suffering?

    She’s supposed to be sad, she needs to be sad, if she wasn’t


    crying enough I’d kick her in the shins to make her, otherwise
    she will hold all of that emotion and let it out piecemeal over
    three decades and she will be lost.

    These animals suffer from a deep existential pathology for


    which there is no cure, in ordinary times they will be the most
    ordinary people but when the ship goes down they will kill
    each other to make sure they get a lifeboat all for themselves.
    Medicine won’t help this, religion won’t help this. On the one
    hand they don’t know how to be real, on the other hand they
    they think protocol and formality is dishonest and insensitive.
    They can’t say, “my condolences” because it sounds fake. So
    they improvise, catastrophically.

    We should all be so lucky that as adults we get to attend our


    father’s funeral, doesn’t make it easier but that’s a fact,
    because the alternative is that it happens the other way around,
    and I can think of nothing worse than the other way around.
    But even then the system is in place, if you blindly follow the
    steps— if people let you blindly follow the steps— then when
    you are finished you can begin to go back to your life. Death
    creates a hole in your heart that is unfillable, but if you follow
    the steps you can at least fence it off so you don’t keep falling
    in.
    There is no shortcut to mourning, the shortcut leads to
    madness. When you subvert the system and offer a mourner a
    shortcut, you are leading them to madness.

    But how can she let go, how can she do what needs to be done,
    under the oppressive gaze of self-conscious people who need
    her to know they came? “I just want to support her!” Then
    you’d go back to your car, connect a hose from the exhaust
    pipe to a slightly opened window, and wait it out.

    When she first told people about her father’s death it came
    with a gift to others, a qualifier: “I won’t be there on
    Wednesday, my father passed away and I’ll be at the funeral—
    it’s ok, I’m fine” but nevertheless grown neophytes went to
    Defcon 5. This is one such text message: “OH MY GOD, ARE
    YOU SERIOUS! OH MY GOD, I AM SO SORRY, WHAT
    HAPPENED?? PLEASE CALL ME IMMEDIATELY!!” The
    text message ends there because I smashed it.

    One man, either a friend or a blastoma, came to the funeral


    luncheon mostly to ask the daughter what was up with her
    girlfriend he was trying to date. He’s 50. I know he didn’t
    think he was being selfish or insensitive, he truly believed
    she’d welcome the chance to talk about his relationship, she’d
    want him to be happy, she’d use this sad day to tell him how
    love was the most important thing in the world and he should
    seize it because life is so short. That’s how it happened in Four
    Weddings And A Funeral, anyway. I will bet you all of your
    money that as he got dressed in his black suit and lavender
    shirt, inside his head was playing, “going to the chapel and
    we’re…..” Did he come to support her? No, he came to
    destroy the world.

    Six different psychopaths called her to demand they come to


    the the funeral to “show their support.” Who do you think you
    are fooling? Each of them wanted to be the best friend that
    would accompany her through the terrible day. Each of them
    believed that they were the best friend that would do this. But
    just because she’s on the phone with you all the time solving
    your crises, it doesn’t make you a best friend, it makes you a
    patient. A real best friend wouldn’t use a funeral as a way of
    solidify their own place as “best friend.” A real best friend
    wouldn’t feel jealous that some other friend got to sit closer,
    got more attention.

    One psychophant who came to the luncheon to “show support”


    didn’t get the extra acknowledgement she expected, so she
    decided instead to perform unsolicited grief therapy on the
    woman’s five year old daughter. “Since we didn’t get a chance
    to connect at the funeral,” she said later, “[your daughter] and
    I had a good talk about what happens when you die.” If I had
    seen this happen I’d be in prison now. The only thing this
    woman can connect with is a phone charger, the battery is
    always dying. “Hi, I just texted you, I wanted to see if you
    were free to talk about me, but I only have two hours.”

    It’s not your day, your method sadness is irrelevant, your


    pseudo-concern transparent and you are forcing mourners to
    divert their attention to you. “I had Christ in my mouth for
    over an hour!” was a post funeral text from a woman who…
    what? I’m not a Catholic so it took me a few minutes to piece
    together that this lunatic meant she had kept the Eucharist
    from the funeral mass in her mouth without swallowing it for
    an hour— as if that meant something. Woman, you are insane,
    your personal relationship with Jesus is pathological, I’ll guess
    you voted for Romney but you are the reason Obama won. It’s
    bad enough you think your God wants you to be an hysterical
    neurotic, but why would you then tell this to a woman
    mourning her father? Why would you think she’d derive
    comfort from what you did?

    It’s no surprise that the new DSM removes the bereavement


    exception from the diagnosis of depression— no one allows
    normal bereavement to occur. How can ordinary bereavement
    ever occur when it is subverted, worsened, at every turn by
    people who were never taught how to act around other people,
    who just don’t know? “I just want to help.” You are destroying
    the world.
    I understand funerals can be awkward for those not directly
    grieving, but over-exaggerating your pretend sadness is of no
    benefit to anyone, it merely obligates the survivors to manage
    your fake concern. If you feel compelled to speak in all caps or
    explain how terrible this all is to a person who knows first
    hand and way better than you how terrible it all is, don’t. Stay
    home. When you find yourself in the presence of mourning,
    simply say, “I’m sorry for your loss. If there’s anything I can
    do for you, please let me know,” and if he happened also to
    have been a great man you can add, “he was a great man,”
    then bow your head and fade to back. That’s all that’s
    necessary. The system will take care of the rest.
    Product Review: Panasonic
    PT AX200U (Hipsters On
    Food Stamps Part 3)
    December 14, 2012

    but how will you afford a steak?


    Part 2 here

    Three questions, open book:

    1. Did Hipster Gerry get his money’s worth from the


    University of Chicago, either $100k in future income or
    knowledge? No.

    2. Did society get their money’s worth in sending him, i.e. by


    permitting/facilitating the diversion of his intellect into
    whatever it was he majored in? No.

    Neither of those questions have the force to change reality.


    This one does:

    3. Did the University of Chicago get their money’s worth out


    of him, was $100k worth the dilution to their brand? No.
    Universities are going to need to differentiate themselves as
    something more than a processing plant for future consumers
    of Chinese textiles, local produce, and California pornography.
    But that time is a long, long way off. What can universities do
    in the meantime, to keep up their brand in the face of
    thousands of product recalls every year?

    Time for the go team: The New York Times.

    II.

    The NYT has an article criticizing hipsters. How much would


    you pay for such an article? (NB: you paid zero for mine.)
    That’s a legit question, not “you get what you pay for.” Ten
    cents? A dollar? Remember that figure, we’ll come back to it.

    This is how the article begins:

    If irony is the ethos of our age — and it is — then the


    hipster is our archetype of ironic living.

    If your reservoir for archetypes goes back only one generation,


    you need your eyeball scanned, you’re probably a replicant.
    Keep that in mind, we’ll come back to it, too.

    The ironic frame functions as a shield against criticism.


    The same goes for ironic living. Irony is the most self-
    defensive mode, as it allows a person to dodge
    responsibility for his or her choices, aesthetic and
    otherwise.

    So this is true, but that’s the secondary purpose of irony, not


    the primary purpose: in exchange for this self-defense, it puts
    all of the ironist’s energy in the service of the thing it is
    defending against; that while he affects a distance from “all
    this”, he participates 100% in it. However much the “not
    corporate” hip coffeehouse needs the barista’s extensive
    roasting knowledge or values the ambiance he creates with his
    MFA and thoughts about 2666, it is way more than the $7/hr
    no benefits it is paying him, but they got him, making skinny
    lattes for an organ donor in a light blue North Face coat while
    he and his Julliard buddy Garf roll their eyes disdainfully
    when she asks for two Splendas. “You’re saying he’s
    underpaid?” Yeah, but not the point, the point is why does he
    accept it? It’s only because he can roll his eyes about how
    mainstream she is that he stays, it offers him a perch from
    which he is better than her, while simultaneously and no less
    ironically, this woman thinks she is better than him because
    she’s on the correct side of the counter and her husband works
    on Wall Street. In math terms, the difference between what he
    is actually worth and the amount he is paid is how much he
    values feeling superior to MILFs.

    Or, if I can be permitted a judicious use of psychoanalytic


    jargon: it’s the rationalization that allows you to blow a guy
    you can’t stand, “I hate him but I’m going to make him cum so
    hard he’ll just want more of me, which will be his
    punishment.” Let that analogy sink in for a moment. From his
    perspective, not only did he still get blown, he liked it even
    more. NB: in this analogy, the guy is capitalism and you’re
    not.

    III.

    Christy Wampole is an assistant professor of French at


    Princeton University, so right away you should be suspicious
    of her allegiances, so I figured this was just another NYT hit
    piece for its overeducated and overpaid demo. But then this
    happened:

    [The hipster] is merely a symptom and the most extreme


    manifestation of ironic living.

    Hold on, something is amiss. There’s a gigantic difference


    between an “archetype” and “merely a symptom”, e.g. one is
    cause and the other is effect, and for a Professor of Confusing
    Words it’s a big mistake to make— especially when it’s been
    reviewed by the editor at the NYT. It’s about as big as missing
    the primary purpose of irony. Cause, or effect? They are
    almost opposites, which means she’s wants them to be the
    same, which makes this evidence of a defense. So this article
    isn’t simply “kids today are lazy.” There’s something else
    happening:

    For many Americans born in the 1980s and 1990s —


    members of Generation Y, or Millennials — particularly
    middle-class Caucasians, irony is the primary mode with
    which daily life is dealt. One need only dwell in public
    space, virtual or concrete, to see how pervasive this
    phenomenon has become. Advertising, politics, fashion,
    television: almost every category of contemporary reality
    exhibits this will to irony.

    “Will to irony” may mean she’s an idiot, and if this were true I
    could happily close my computer and buckle down to another
    night of alcoholic hallucinosis, but she’s not an idiot, she’s
    probably smarter than me, which means something far more
    sinister is going on: conflating the irony of the kids with the
    irony of the “public space.” Who does she think made the
    public space? 20 somethings? Who is running the advertising
    agencies? Who is running for politics? How old is every legit
    fashion designer? Who is responsible for the human rights
    violations of the ABC Network? She’s not decrying the hipster
    generation, she’s describing hers.

    IV.

    Here is a paragraph so preposterous I was sure this was a


    McSweeny’s gag. But she didn’t mean this to be ironic, which
    is itself ironic, good luck not laughing:
    Born in 1977, at the tail end of Generation X, I came of
    age in the 1990s, a decade that, bracketed neatly by two
    architectural crumblings — of the Berlin Wall in 1989
    and the Twin Towers in 2001 — now seems relatively
    irony-free. The grunge movement was serious in its
    aesthetics and its attitude, with a combative stance against
    authority, which the punk movement had also embraced.
    In my perhaps over-nostalgic memory, feminism reached
    an unprecedented peak, environmentalist concerns gained
    widespread attention, questions of race were more openly
    addressed……

    “Relatively irony-free! Architectural crumblings! Socially


    conscious! Bosnia Herzigova or whatever!” I realize
    Aspirational 14% wants their beloved 90s to be about
    something more than just bicuriosity and JDSU, but I was
    there, it wasn’t. Anyone who thinks the grunge movement was
    “serious” and “combative” and who thinks feminism “reached
    a peak” also thinks The Hunger Games was a step forward for
    women and 50 Shades is poorly written “but still hot.” Just
    because you call yourself a progressive or a feminist, doesn’t
    make it true, your progressive passions may end up setting
    women back five hundred years— that’s right, 500 years.
    Even 200 years ago Catherine took power away from her
    husband and became something great, Walpole’s is the
    generation that admires Hillary Clinton as a female role
    model, not because she became Secretary of State, but because
    she stayed with her husband so that she could become
    Secretary of State. Read it again if you didn’t get it the first
    time, it’s important. I forbid you from having daughters. Or
    oxygen. I know, I know, I don’t have any real power, but
    maybe someday a man will give me some.

    V.

    When someone hates something that to outside observers


    looks exactly like themselves in every way, you should
    quickly consult a French book to see if they don’t have a word
    for that phenomenon, and they do, it’s called projection.
    Before you nod and use it to hate on her, you should
    understand what projection is. It sounds like you project
    unwanted feelings onto another person, which is both wrong
    and impossible. It’s not an action, it’s a problem of perception.
    The unwanted feelings don’t make sense coming from
    someone like you, so you conclude they must be coming from
    the other person.

    To use the frequent example of “homophobia”: a guy feels gay


    impulses and can’t “handle it” but he doesn’t get rid of them
    by putting them onto someone else, he confuses them as
    coming from someone else. He smells gayness, “Where is it
    coming from? Me? Impossible! Jesus washed my feet. Must
    be that guy.” Sorry, wildman, whoever smelt it dealt it.
    Projection is the most primitive of defenses, circa age 2, and
    the description should make it clear it is a narcissistic defense:
    one’s perception of the world is inextricably, concretely the
    result of one’s inner states. There is no “objectivity” possible.

    The purpose of projection is not to get rid of the feelings, but


    to explain their presence, to defend the self against a label:
    “I’m not gay….. even if I have gay sex once in a while.” The
    point isn’t to avoid gay sex, the gayness isn’t intolerable to
    them— e.g. observe the high hat Christians caught in various
    rest stops across our land— but even thought they’ve
    committed the act, it doesn’t affect their identity.

    My use of gay as an example is unfortunate because half of


    you will see “gay” as “bad,” but the projected impulse doesn’t
    have to be “bad”, merely incongruous to the desired identity
    that you are trying to solidify. If you doubt this, consider the
    sullen engineering student at a party, “I’m not like these
    superficial sorority girls with perfect smiles and condomless
    sex” who then perceives great happiness in these people.
    You could be happy, too, dude, if you weren’t so invested in
    not being happy. If you want a partial understanding of why
    19-21 Saudi/Egyptian terrorists could live in America and
    enjoy our strip clubs but still want to crumble our architecture,
    there you go.

    The article continues with a “nuanced” criticism of irony and


    the hipster mindset, and then towards the end she tries a
    reversal, but it’s a trick, not because it’s not genuine, it is, but
    precisely because it is genuine:

    Obviously, hipsters (male or female) produce a distinct


    irritation in me, one that until recently I could not
    explain. They provoke me, I realized, because they are,
    despite the distance from which I observe them, an
    amplified version of me.

    So true; totally wrong. When people “figure themselves out”


    and then applaud themselves for their “brutal self-honesty”,
    you can be sure it is further defense. The easiest way for a
    self-aware person to protect himself is to “figure out”
    something that is actually correct so that he stops there and
    doesn’t go any further, which is also the problem with most
    therapies. “I’m learning a lot about myself and my
    motivations.” No you’re not. “Figuring yourself out” not only
    fails, but is the defense itself. Stop doing it.
    She thinks she “realizes” hipsters are an amplified version of
    her, i.e. that she is projecting— which is in fact/duh correct,
    but never asks the question, “Why am I projecting? What do I
    benefit from this madness? How does the system benefit?”

    There are so many ways, let’s just take one. Is the result of her
    work product ironic? Yes. Then it’s in the service of the
    system, while she is able to affect a distance from “all this”
    she participates 100% in it.

    However much the NYT values her PhD, however much they
    value her intellect and opinions, it’s way more than what they
    paid her, which is nothing. The question is, why didn’t she
    demand to be paid? I’m not saying you have to do everything
    for money, god knows I write a lot of blog and drink very long
    rums and neither one have delivered profits commensurate
    with the labor. If she was promoting something of course I’d
    understand writing for free, but what can she do after writing
    for the Times except write for the Times again? See also
    Princeton, where you will pay them more to get the degree that
    they will then pay you less to use for them, in no other
    profession is learning how to do something more valuable than
    actually doing it. Is that ironic? Then she is able to affect a
    distance from “all this” while she participates 100% in it.
    Undoubtedly she’s thinking, “well, hell, I got an article in the
    Times!” as if that has some incalculable value, but that’s the
    trick. It doesn’t. It’s a scam.

    “I’m not a vicious capitalist, I don’t always have to get paid


    for what I do. I like to participate in the public debate.” I. I. I.
    Stop it, look around! This isn’t charity, the Times is a billion
    dollar corporation and Princeton is in actuality a gigantic
    hedge fund— why are you giving them your work for free?
    “That’s the system, I can’t change it.” Exactly.

    No different than the person who doesn’t ask for a raise


    because they’re nervous, “should I ask for 5% more?” and
    they agonize about it for a month, ten months. The point isn’t
    whether you deserve the extra money, the point is whether you
    deserve it more than the company, because if you don’t take
    the extra money home to your kids, the company takes it to
    theirs. Note that no one ever frames it this way, it is always
    about “making a case” or “explaining how you can both
    benefit.” Note also that in most cases the person you’d ask for
    a raise is a manager, one who has no investment in that money,
    it doesn’t come out of his pocket. Yet he is the biggest
    obstacle, he will put sugar in your gas tank to stop you from
    getting that raise. Is that ironic? Or totally the point?

    Glengarry Glen Ross is on Netflix, you should watch it a lot.


    The easy “critique of capitalism” is that “second prize is a set
    of steak knives” because that’s how little it costs to motivate
    you to work harder for them, and if that doesn’t work there’s
    always “third prize is you’re fired.” But the real wisdom which
    is not about capitalism but which is about narcissism comes
    from understanding that first prize isn’t a Cadillac Eldorado,
    you think Alec Baldwin needs a car? There is no first prize.
    Real closers don’t want the prize, they want to be the best,
    that’s why they will practice practice practice and don’t play
    the lottery. The car is a temptation only for people who do not
    know their own value, the value of their own work, who won’t
    lift a finger to advance themselves, who are motivated only by
    threats or by rewards, who would rather have the appearance
    of success than actual success. “I got an article in the Times!”
    celebrates the person whose brain is broken. “Alec Baldwin’s
    character is a raging narcissist!” Jesus are you stupid, Alec’s
    name is MacGuffin, that’s why he’s in Act I and never again
    yet propels the story forward. It is irrelevant whether Alec
    Baldwin has metal testicles or pathological grandiosity, what
    matters is that after years of C minus work, what finally gets
    those dummies fired up is First Prize or Third Prize, left to
    themselves they meander in mediocrity while deluding
    themselves that they are more than what they do. “I was
    number one in ‘87!” So was Alf. And the system knows this,
    which is why it lets Wampole call herself a professor but pays
    her like a TA–— and she’s upset at hipsters. Is that ironic?

    She’s criticizing— sorry, critiquing— hipsters for their


    defensive posture against society, and for not working, but,
    look, at least they are not working for free, like a Matrix
    battery propping up the very system that sucks the life out of
    them. “Well, it’s cool that I got an article in the Times, maybe
    I’ll get to write another one.” I know, I know, the temptation of
    a moment of celebrity was too great to resist, only a fool
    would pass it up. Meanwhile Princeton is happy to use her to
    market their anti-hipster brand to the demo that has the money
    to send their batteries to Princeton one day. However much
    Princeton values her article to the NYT, it is way more than
    they… never mind.

    The thing is, if I tie her to a chair and shine the heat lamp on
    her and ask her whose fault “all this” is, she’ll answer the
    Republicans. Since she’s a nuanced thinker she’ll probably say
    George Bush. And when she has to get a job at Rutgers
    because Princeton won’t give her tenure, she’ll blame the tax
    cuts or “an undercurrent of sexism in academia.” But she will
    save and save and save to send her own daughters to college
    one day, hey, if you send them to Rutgers they’ll generously
    give a 10% employee discount. Sweet!

    You gave the system you don’t like a spectacular blowjob, and
    then try to punish it by making it want you more. From the
    system’s perspective, not only did it still get blown, it liked it
    even more. In this analogy, the system is the system and you’re
    not.

    http://twitter.com/thelastpsych
    No Self-Respecting Woman
    Would Go Out Without
    Make Up
    January 14, 2013

    For some reason, one of the most emailed articles from the
    NYT was an article about whether women should or should
    not wear make up. “New York Times? Sounds progressive.”
    Yes.

    Seven people were asked their opinion in a column called


    “Room For Debate,” liars, there was no debate, all of them
    said “I guess so”, their main contribution was the hedge: “it’s a
    woman’s choice.” So while pretending this was some kind of
    debate with contrasting opinions, all of them had the same
    opinion, which should automatically signal to you it is the
    wrong one.
    When they say, “it’s a woman’s choice” what they mean is
    “it’s not a man’s choice, it is thoroughly stupid to wear make
    up just for men, the only acceptable reason is if you do it for
    yourself, if it makes you feel better about yourself.”

    Let me offer a contrary position, unpalatable but worth


    considering: the only appropriate time to wear make up is to
    look attractive to men. Or women, depending on which
    genitals you want to lick, hopefully it’s both. “Ugh, women are
    not objects.” Then why are you painting them? I’m not saying
    you have to look good for men, I’m saying that if wearing
    makeup not for men makes you feel better about yourself, you
    don’t have a strong self, and no, yelling won’t change this.
    Everyone knows you shouldn’t judge a book by its cover, now
    you’re saying the cover of the book influences how the book
    feels about itself?

    I am not doubting that in fact you do feel better about yourself,


    I am saying that that fact is both pathological and totally on
    purpose. Since this cognitive trick does help you feel better
    about yourself, by all means go ahead, but at what point will
    you stop pressuring other women to go along with it? When
    will you stop “requiring” it, like when you say, “oh, she’s so
    pretty even without makeup” as if the default was makeup?

    The fraud women now believe is that it is wrong to look good


    for men only, as an end in itself; the progressive delusion is
    that looking good for men is synonymous with
    submissiveness, so while you’re allowed to look good to men,
    it should always be secondary to looking good for yourself.
    This is madness. You are enhancing your outward appearance,
    which is great, but then you pretend it’s for internal reasons?

    How would you like to live in a world where men had to wear
    make up? “Oh, I love make up on a guy, especially eyeliner.”
    Of course you do, you’re having a stroke. Ask it this way: how
    would you like to be in a world where men said,” oh, I feel so
    much better about myself when I’m wearing makeup.” You’d
    run for the nearest totalitarian regime.
    The trick to the makeup debate is that it pretends to want to be
    free of male pressure, yet the pressure to look a certain way is
    actually much worse from women. So this result is that a
    “patriarchical”, controlling force, unacceptable if coming
    directly from men, is maintained by giving the whip to other
    women. No boss man would survive if he said, “ugh, you
    should put on some makeup, doll yourself up a little bit” but
    women say this to other women all the time— especially at
    work. “You look really tired,” says a woman in MAC
    Greensmoke to another who isn’t. Just once I wish the reply
    would be, “I am, your husband kept me up all night.” Not very
    progressive, but hilarious.

    The evolution from “enhances sexual attractiveness” to “doing


    it for yourself” is definitely a regressive step, and by
    regressive I here mean “regressing to age two”, but it’s the
    next step which reveals the presence of a neurosis: recruiting
    science as a justification for behavior: “Study finds makeup
    makes you appear more competent.” Can’t wait to read about
    that study in a Jonah Lehrer book. Ugh. So here’s the
    evolution of feminist theory, take notes: “I want to look better”
    to “I want to feel better about myself” to “I want people to
    think I am better.” Madness.

    The further clue that the problem is not gender but… you… is
    that you find this pseudoscience while you are browsing the
    internet, i.e. it is your entertainment, your free time; your
    leisure time is spent justifying a behavior you can’t not do.
    “But I wasn’t looking for those articles, I just stumbled on
    them.” Exactly.

    The reason the makeup debate is insoluble is that it’s not yours
    to solute. The choice to wear makeup is no choice at all, I
    know you think you came to it on your own but you live in
    America, you don’t make free choices here, freedom is a
    brand. Makeup is an $8B/yr industry, that’s face makeup
    alone, no way is it going to allow you to make a choice that
    doesn’t involve a credit card, fine, if you don’t like makeup
    here’s a remover for $30, just remember that you’re not doing
    it for men, you’re doing it for yourself.

    II.

    I had used all the porn on the internet, so I turn on the TV, and
    there’s a marionette called Diane Sawyer interviewing 20
    female Senators, the most in history, applauding and giggling
    as if cold fusion had finally been discovered. Of course it’s a
    “good thing” that women are Senators in as much as not
    allowing them to be Senators is the bad thing, but other than
    that, what does it mean? That women are finally brave enough
    to run, or America is brave enough to hire them? It’s not like
    the Capitol Building was turning them away, so why is this
    important? I knew I was being scammed because I was being
    told this was a historic accomplishment by the ABC Network.
    The ABC demo is not ever going to be a Senator, I would bet
    ten bazillion dollars they couldn’t even name one of their
    Senators and a gazillion bazillion dollars they have no real
    idea what Senators do, so why is this on prime time ABC?

    I think the answer is supposed to be, “it’s empowering to


    women”, but you should wonder: when more women enter a
    field, it means less men did, and if the men stopped going
    there, where did they go? Why did they leave? I assume they
    aren’t home with the kids, right?

    I don’t want to be cynical, but boy oh boy is it hard not to


    observe that at the very moment in our history when we have
    the most women in the Senate, Congress is perceived to be
    pathetic, bickering, easily manipulated and powerless, and I’ll
    risk the blowback and say that those are all stereotypes of
    women. Easy, HuffPo, I know it’s not causal, I am saying the
    reverse: that if some field keeps the trappings of power but
    loses actual power, women enter it in droves and men abandon
    it like the Roanoke Colony. Again we must ask the question: if
    power seeking men aren’t running for Senate, where did they
    go? Meanwhile all the lobbyists and Wall Street bankers are
    men, isn’t that odd? “Women aren’t as corrupt or money
    hungry.” Yes, that’s been my experience with women as well.
    This works in reverse, too, take a field traditionally XX-only,
    like nursing, and, huh, what do you know— at the time where
    nursing is more powerful than it has ever been, there are also
    more XY in it than ever. But who made it more powerful? It
    wasn’t nurses. And if you’re playing that game, ask if the
    reason “sexy nurses” as a fetish dropped out somewhere
    around the 90s had nothing to do with females finally getting
    control over their sexualization but exactly the opposite, men
    came in and unsexualized the joint. “I’m not gay.” Easy,
    Focker, no one was implying anything.

    I know to a woman it must feel good, “yay, I’m a Senator!”


    and I do not minimize the individual accomplishment of a
    woman becoming a Senator. But for everyone else, what is the
    significance? One of the Yay-Women senators suggested that
    the government would benefit from all the makeup because
    “women’s styles tend to be more collaborative,” and at the
    exact same moment she repeated the conventional wisdom’s
    horrendous banality she simultaneously got married to the
    head of a lobbying firm. That’s progress, I guess.

    The problem isn’t with women in the Senate, but rather its
    celebration, which these dummies blindly participate in. Is it
    putting on a face for the American public, the way the first
    face I see on Goldman Sachs’s website is a black woman? Is it
    cosmetic? She’s probably proud, she should be proud, that she
    made it to GS, but for the rest of blacks and women, what is
    the significance? It may be regressive to ask this, but it is
    illuminating: “hey…. why did they let so many of us in?”

    This is part of a larger, systemic problem with the way power


    has shifted not from Group A to Group B, but from ground up
    to top down, and top down works in a very specific way: it
    concedes the trappings of power while it retains the actual
    power.
    III.

    In this case, you are seeing a shift of power be repackaged as a


    gender battle. And it’s quite apparent that power is a
    generation or so ahead of you, so in 1990 a 40 year old who
    grew up around successful lawyers then says to his 5 year old,
    “daughter, you should become a lawyer!” and she probably at
    one point collaborates to decry the lack of female role models,
    and then by the time she graduates law school she discovers
    she’s a dime a dozen, power has been withdrawn, one step
    ahead; and at this rate I fully expect 2013’s Aspirational 14%
    to nudge their 5 year old daughters towards investment
    banking so they can be part of the big Women In Investment
    Banking conference of 2033. Don’t bother, it’ll be in Newark.

    I can’t predict the next field of power, I’m happy to hear your
    projections, the point for now is that while power moves ahead
    of you and your family, it leaves behind the appearance of a
    gender (or racial) struggle; and the immediate result of this is
    that people consider it a societal achievement that they are
    merely playing, even if what they are doing is ultimately
    meaningless. So while women (appropriately) fought for, and
    got, equal access to college educations— and now women
    even outnumber men in colleges— today we find that college
    is irrelevant. Huh. NB: what women did not fight for, and this
    is to my point, is the specific power of being taken seriously
    without a college education. “But how will the world know
    we’re equal?”

    The focus here, again, is why did/do women fight so much for
    what became irrelevant? Why does this happen all the time?
    More specifically, did they pursue it because they thought it
    had power, or did they pursue it because it had the trappings of
    power? I’m not being a jerk, it is a deadly serious question. If
    some dentist fires his hygenist because she’s too pretty the
    United States Of America goes to Defcon 1, but if Goldman
    Sachs doesn’t hire enough women some idiot at The Atlantic
    writes a fluff piece. “They apparently have a sexist culture
    there.” You know they rule the world, right?
    I know, I know, women get paid less then men. Sigh. There are
    a million reasons for this, but the most important is the
    simplest: some people want to get more money from the job,
    and some other people want the job to offer them more money,
    and they are not the same people. Typically the former is men
    and the latter is women, but the point isn’t gender but the
    mindset: the latter group wants the job to want to pay them
    more, they don’t want to have to have any input in deciding
    their own reimbursement. I have this conversation with
    women a lot, every time it goes exactly like this:

    Her: They only offered me $X.


    Me: Why didn’t you ask for more?
    Her: I don’t know… I was just happy to get the job.

    And I throw up my hands, nothing I say will convince this


    senator to try harder for herself. I have this same conversation
    with men as well, less frequently but not never, though the
    conversation is slightly different:

    Him: They only offered me $X.


    Me: Why didn’t you ask for more?
    Him: I don’t know… I was just happy to get the job.
    Me: What are you, a girl?

    Works every time.

    IV.

    Everything you need to know about how the system sees you
    is expressed in its purest way in ads. So, completely off topic,
    here’s an ad, relax, this has nothing to do with guns:
    I had never seen this ad, because the ad was not for me. The ad
    targets men who need a gun to feel like a real man, the gun
    validates their masculinity— or so the ordinary, pseudo-
    feminist deconstruction would go. Except that’s not what the
    ad says. It says, quite clearly, that the highest validator of
    masculinity isn’t the gun, it is the card.

    You’ve been trained to look at these things in terms of gender,


    forget it, the pathology of the generation is narcissism, the ad
    knows about, and works only on, a society eyeballs deep in
    narcissism, that requires its identity broadcast by branded
    objects but validated by other people. Because what this ad
    says, explicitly, is that owning the gun doesn’t make you a
    man; when you own the gun, some other omnipotent entity will
    declare you a man.
    I’m not saying that gun owners need to show their guns off,
    I’m saying this ad assumes that. There was a time where
    merely possessing the fetishized object was enough to self-
    identify (“I’m awesome, I’m having sex with a blonde”; “just
    having my 9mm inside my jacket makes me feel bad ass”), but
    this is no longer sufficient, it is no longer powerful enough to
    penetrate your thick skull, you have to be able to show it to
    someone else, to watch their eyes light up in recognition for
    you to know you have convinced them of who you are.

    Is it cosmetic? Note the logic has evolved from “you’ll feel


    better about yourself” to “other people will see you as more
    competent.”

    Forget about the gun/masculinity interaction, it is a red


    herring; the problem is the cycle of wanting outsiders to tell
    you who you are, which is why empty celebrity works just as
    well as accomplished celebrity, which is why you can’t tell if
    Kanye West is downgrading to Kim Kardashian or she is
    downgrading to him.

    But right on cue, the most deluded of women, not just a


    feminist but a self-proclaimed “feminist evangelist,” showed
    up and completely missed the point, so she changed what was
    a clear example of the generational pathology of narcissism,
    and repackaged it as a gender issue:
    “We?” As in, “we at Feministing?”

    If you follow that the consumer unconsciously understands


    that his masculinity is approved from the outside, by other
    people, then Valenti is the very person that the ad is arguing
    against: “these bitches think you’re not a man. We at
    Busmaster tell you differently. Who are you going to believe?”
    Hell, I’lI believe a Sleestak before I listen to Jessica Valenti,
    really, those are my only two choices? The ad had no effect on
    me; her tweet makes me want to join a militia.

    Note she doesn’t really want to discuss it, she assumes it’s
    self-explanatory, as if the very fact that masculinity and guns
    are related is itself bad, as if the solution was to uncouple the
    two. But what would happen next? The problem, as above,
    isn’t the gun but the need for external validation, which means
    if you take the gun away something else must replace it, and it
    won’t be what works for her, e.g. exposed brick and that great
    show Girls. “It’s great!” It’s horrendous.

    V.

    To understand exactly why “feminism” or whatever Valenti


    thinks she has re-invented has not only stalled, but is
    damaging to all humanity, all you need to do is go to the
    source. Totally at random, I went to Huffington Post Women.
    Let’s see what the feminists are up to, here are the top five
    articles:

    1. The Reason The Academy Passed On Kathryn Bigelow


    (answer: sexism.)

    2. Confessions Of A Mistress (protip: “Here’s the wisdom I can


    offer to mistresses out there: do not get too attached.”)

    3. Why You Should Be Nervous— And Yet Not— About Sunday


    Night (since the Golden Globes conflict with Girls, just DVR
    Girls, and anyway Lena Dunham will be at the Globes.)

    4. ‘Girls’ Star Talks Nudity And Season 2 (I refused to even


    click it)

    5. Meet The Woman Who’s Only Eating From Starbucks

    Look, it’s easy to make fun of these articles, my point isn’t


    that sometimes women read nonsense. The point here is that
    they are branded as for women, this is what the Huffington
    Post Women thinks of women, they suspect, apparently rightly,
    that women will respond better to these articles if they are told
    they are “For Women.”

    Here’s a quote from #5, the woman who is eating Starbucks


    for a year:
    So how can eating only one company’s products impact
    me, anybody? Well Mr. McDonald’s already proved that
    question years ago with his documentary and Mr. Subway
    did his take on the loosing weight portion of the food
    challenges too. But when I watched those guys doing
    their thing I asked myself “where are the WOMEN
    challenging themselves in the world?” “Where are the
    effects being shown on a woman’s culture? A woman’s
    family & children? A woman’s diet, weight, fashion,
    checkbook, community and world through challenges?”
    “Where is HER VOICE on how an international company
    is directly or indirectly impacting everything from her
    waistline to her bottom line and every other woman’s,
    man’s, child’s, societies and planets world with their
    presence?”

    What’s crazy about this crazy person is that she’s crazy, if she
    did this in the name of her own psychopathology we could
    happily ignore her, but she’s doing this for women, she’s
    saying it’s for women, when what you want to say is, “you
    know this makes people hate women, right?” Mr. McDonalds
    didn’t do it for men, or even as a man, he just did it, why do
    you have to drag the rest of the women into your delusions?

    But this is the kind of solidarity popularized by Lori Gottlieb


    and the rest— and I am asking, at what expense? Sites like
    Jezebel and Feministing are much, much worse than
    pornography, every article they write sets women back a week,
    do the math, they do such a disservice to women because they
    take their narcissism and repackage it as gender issues, and
    you’re locked into it. What if I don’t think gun control is a
    gender issue? What if watching Girls makes me want to make
    a snuff film? To use your impossible language, “where is my
    safe space to challenge your privilege?”

    My point isn’t that women don’t have legitimate gripes with


    the system, or that there isn’t sexism still around, my point is
    that most of what you think is “feminism” is really a work, a
    gimmick, a marketing scheme. It is straight up consumerism,
    repackaged as a gender issue. Case in point: season 1 and 2 of
    Girls.

    And most importantly of all: if this is what women’s solidarity


    is made of, how much support can they really expect from
    each other? Is this solidarity power, or the trappings of power?
    “Did you see Girls last night?” No, I’m sorry, I was being
    raped. “Oh, too bad. It was a good one.”

    VI.

    In Django Unchained, evil slaveowner Leonardo DiCaprio


    asks a question. Sorry, back up: why does everyone call him
    an evil slaveowner? As far as I can tell, he was a pretty
    average slaveowner, I’d even say he was “kind”, in the sense
    that all his slaves “like” him, and he rarely “tortures” anyone
    and by the use of quotes you can see I’m hedging, my point
    here is how quickly people have to broadcast their indignancy.
    “He’s evil.” So what you’re saying is you’re against slavery?
    Thanks for clarifying.

    This explains the near-universal anxiety over the movie’s


    frequent use of the word nigger, and someone asked Tarantino
    if he thought he had used it too much in the movie, and his
    response was perfect: “too much, in comparison to how much
    it was used back then?” Nigger, and the violence, was all
    anyone was upset about. Terry Gross, NPR’s mental
    Fleshlight, asked Tarantino her typically insightful and
    nuanced questions: “do you enjoy violent movies less after
    what happened at Sandy Hook?” Sigh. So there’s the Terry
    Gross checklist for reviewing Django: gun=bad and saying
    nigger=bad. Check and check. You know what no one thought
    badworthy? When the white guy asked to have a certain slave
    sent to his room to try out her ample vagina, and the prim
    white lady of the house happily escorted her up. “Go on, do
    what you’re told, girl.”

    I’d venture that Terry Gross and and the gang at HuffPoWo
    would rather be whipped than be— that’s rape, right?— but
    that scene didn’t light up their amygdalas, only hearing
    “nigger” did. I find that highly suspicious, or astoundingly
    obtuse, or both.

    Anyway, perfectly ordinary slaveowner DiCaprio asks a


    rhetorical question, a fundamental question, that has occurred
    to every 7th grade white boy and about 10% of 7th grade
    white girls, and the profound question he asked was: “Why
    don’t they just rise up?”

    Kneel down, Quentin Tarantino is a genius. That question


    should properly come from the mouth of the German dentist:
    this isn’t his country, he doesn’t really have an instinctive feel
    for the system, so it’s completely legitimate for a guy who
    doesn’t know the score to ask this question, which is why 7th
    grade boys ask it; they themselves haven’t yet felt the crushing
    weight of the system, so immediately you should ask, how
    early have girls been crushed that they don’t think to ask this?
    But Tarantino puts this question in the mouth of the power, it
    is spoken by the very lips of that system; because of course the
    reason they don’t rise up is that he— that system— taught
    them not to. When the system tells you what to do, you have
    no choice but to obey.

    If “the system tells you what to do” doesn’t seem very


    compelling, remember that the movie you are watching is
    Django UNCHAINED. Why did Django rise up? He went
    from whipped slave to stylish gunman in 15 minutes. How
    come Django was so quickly freed not just from physical
    slavery, but from the 40 years of repeated psychological
    oppression that still keeps every other slave in self-check? Did
    he swallow the Red Pill? How did he suddenly acquire the
    emotional courage to kill white people?

    “The dentist freed him.” So? Lots of free blacks in the South,
    no uprisings. “He’s ‘one in ten thousand’?” Everybody is 1 in
    10000, check a chart. “He got a gun?” Doesn’t help, even
    today there are gun owners all over America who feel that they
    aren’t free. No. You should read this next sentence, get
    yourself a drink, and consider your own slavery: the system
    told Django that he was allowed to. He was given a document
    that said he was a bounty hunter, and as an agent of the
    system, he was allowed to kill white people. That his new job
    happened to coincide with the trappings of power is 100% an
    accident, the system decided what he was worth and what he
    could do with his life. His powers were on loan, he wasn’t
    even a vassal, he was a tool.

    This is not to minimize the individual accomplishment of a


    Django becoming a free man. But for the other slaves, what is
    the significance?

    Of course Tarantino knew that the evil slaveowner’s question


    has a hidden, repressed dark side: DiCaprio is a third
    generation slave owner, he doesn’t own slaves because he
    hates blacks, he owns them because that’s the system; so
    powerful is that system that he spends his free time not on
    coke or hookers but on researching scientific justifications for
    the slavery— trying to rationalize what he is doing. That is not
    the behavior of a man at peace with himself, regardless of how
    much he thinks he likes white cake, it is the behavior of a man
    in conflict, who suspects he is not free; who realizes,
    somehow, that the fact that his job happens to coincide with
    the trappings of power is 100% an accident… do you see?
    “Why don’t they just rise up?” is revealed to be a symptom of
    the question that has been repressed: “why do the whites own
    slaves? Why don’t they just… stop?” And it never occurs to 7th
    graders to ask this question because they are too young, yet
    every adult thinks if he lived back then, he would have been
    the exception. 1 in 10000, I guess. And here we see how
    repression always leaves behind a signal of what’s been
    repressed— how else do you explain the modern need to add
    the qualifier “evil” to “slaveowner” if not for the deeply buried
    suspicion that, in fact, you would have been a slaveowner back
    then? “But at least I wouldn’t be evil.” Keep telling yourself
    that. And if some guy in a Tardis showed up and asked, what’s
    up with you and all the slaves, seems like a lot? You’d say
    what everybody says, “look wildman, don’t ask me, that’s just
    the system. Can’t change it. Want to rape a black chick?”
    IV.

    Speaking of no one being upset about rape, here’s a story,


    starts out bad and gets even worse in ways you won’t expect: a
    16 year old girl is passed out drunk at a party, she is then
    allegedly raped by a/two high school football players, and
    carried unconscious to other parties and displayed and/or
    raped, and apparently because the town has a “football
    culture” no arrests are made, it’s hushed up, the boys are
    protected, and I think to myself, oh, that’s weird, is that town
    still in 1986? True story: in 1986, at a mixer at the Delta
    Gamma sorority house, Lacoste Football Guy gets hard for 16
    year old sister of Benetton Girl, and in order to get her jeans
    off he hits her in the head with a lamp, so in order to keep her
    jeans on she kicks him in the mouth, and through the blood
    and fury he’s screaming he’ll sue her, do you know who my
    father is? NB: he went on to become a lawyer and no I am not
    making that up.

    “Ugh, even now, 25 years later, it’s still a hypermasculine rape


    culture.” Ha! No. Hypermasculine? Where are you, the
    Dominican? No, what’s amazing/obvious is how after 25 years
    of Diane Sawyer and makeup debates, not one other girl at
    this party came to the victim’s aid; not one girl saw what was
    happening at the party and simultaneously called 911 and
    Facetimed the crime; not one girl called all the women she
    knew and brought the wrath of Athena down on that town.
    Nope. Nothing. A lot of laughing and giggling though, turns
    out rape is funny, someone owes Daniel Tosh a huge apology.
    “Women’s styles tend to be more collaborative.” I can tell,
    they collaborated to keep their mouth shut. In 1986 the
    sorority girls also collaborated to blame the victim for for
    being so rough with Lacoste Guy: “How could you do that to
    him? His face is like, totally corroded.” Hey, come on, look
    how he was dressed, he was asking for it.

    “We need more women in power.” Wrong preposition,


    dummy, but anyway you have them. You have judges and
    prosecutors and twenty female senators, what has it gotten
    you? Your own ground floor women don’t protect each other,
    you know who had to come to this teen’s aid? Anonymous.
    Men.

    Of course I don’t know if the boys really did these things or


    not, ok? But if the reason the boys were protected was the
    “football culture,” that means people in the town were taught
    to protect them. And if the girls did nothing, it means they
    were taught to do nothing, and the people most responsible for
    that lesson was other women.

    “No, the town was corrupt, they swept these kinds of things
    under the rug for years.” If you’ve known for years the town
    isn’t going to help women, if you’ve known for years it’s a
    “hypermasculine rape culture,” wouldn’t that make women
    want to stick together more?

    It’s not like these teen girls were denied an education or had to
    endure sexual harrassment at work or had to go to Sweden to
    get abortions, if there was ever a generation that should feel
    most empowered it would be them, yet they— not just one of
    them; all of them— “knew”, somehow, that they could/should
    do nothing. Which means that they were taught that from
    somewhere, and the only place that it could have come was
    older women. “The other lesson is: makeup is a choice.”
    Today I learned nothing.

    There’s your female empowerment, there’s you feminist


    progress, catastrophically subverted from the top down, like
    it’s in an abusive relationship, satisfied with the house and the
    car and the 4/7 good days and simply doesn’t want to rock the
    boat so it expends frantic energy on what is ultimately
    nonsense. Every stupid parent teaches their girls not to get
    raped, duh, but have any mothers spent any time indoctrinating
    their daughters what to do if another woman is being raped?
    Have they made it a reflex to defend, to attack? “Isn’t that
    obvious?” Ask the town. “We need to support each other!”
    sure, as long as it’s from the safety of a computer monitor or a
    5K, yay women. Have you explicitly told your daughters that
    if a woman is passed out drunk and you see a Notre Dame Hat
    climbing over her couch, it is your responsibility to grab an
    aerosol can and a lighter and threaten Armageddon, or at the
    very least yell stop? “Well, that’s kind of dangerous.” Yeah,
    that’s kind of the point, but I grant you that it’s safer to giggle
    and let boys be boys. Do you want power, or the trappings of
    power? Somebody’s going to have it, you can’t make it vanish.
    I wasn’t at this particular rape, the town’s defense amazingly
    appears to be she was a slut and she was asking for it, and my
    point is: so what? Why didn’t the other women stop it
    anyway? Why didn’t they just rise up?

    http://twitter.com/thelastpsych
    Don’t Hate Her Because
    She’s Successful
    March 22, 2013

    the first thing you noticed is her great outfit


    and the first thing I noticed is she’s covering her wedding ring
    this is why you are anxious and I am Alone

    Today in the United States and the developed world,


    women are better off than ever before. But the blunt truth
    is that men still run the world…

    It is time for us to face the fact that our revolution has


    stalled. A truly equal world would be one where women
    ran half of our countries and companies and men ran half
    of our homes. The laws of economics and many studies
    of diversity tell us that if we tapped the entire pool of
    human resources and talent, our performance would
    improve.

    I.

    Sheryl Sandberg is the future ex-COO of Facebook, and while


    that sounds like enough of a resume to speak on women in the
    workplace, note that her advice on how to get ahead appears in
    Time Magazine. Oh, you thought that Sandberg’s book is news
    worthy in itself, how could you not do a story on this
    magnificence? No, this is a setup, the Time Magazine demo is
    never going to be COO of anything, as evidenced by the fact
    that they read Time Magazine. Much more importantly, they
    are not raising daughters who are going to be COO of
    anything. So why is this here?

    The first level breakdown is that this is what Time readers


    want, they want a warm glow and to be reassured that the
    reason they’re stuck living in Central Time is sexism. This
    demo likes to see a smart, pretty woman succeed in a man’s
    world, as long as “pretty” isn’t too pretty but “wearing a great
    outfit” and that man’s world isn’t overly manly, like IBM or
    General Dynamics, yawn, but an aspirational, Aeron chair
    “creative” place that doesn’t involve calculus or yelling,
    somewhere they suspect they could have worked had it not
    been for sexism and biological clocks. We all know Pinterest
    is for idiots. Hence Facebook.

    II.

    If you are still suspicious that Sandberg’s appearance in Time


    has nothing to do with her book or with women becoming
    COOs but is about something else, look through the newsstand
    for the other magazine in which Sandberg is prominently
    featured: Cosmo.
    the first thing you noticed is her great outfit
    and the first thing I noticed is she’s showing her wedding ring

    This is the mag she felt compelled to guest edit, an issue that
    also has “The Money, The Man, The Baby: Get What You
    Want,” by future Labor Secretary Kim Kardashian. No one
    reads Cosmo to become a COO, no one who reads Cosmo
    could become a COO, because— and I’m just guessing— they
    think the the secret formula for success is Dream Job + The
    Right Partner + Great Wardrobe = Yes I Can! Well, you can’t,
    not with those priorities. Each of those may be desirable, but
    when placed together as an equation it is revealed to be
    nothing but outward branding, and the consequence is that
    even if you get all three you will still be unsatisfied.

    For the past two weeks Sandberg was anywhere nothing useful
    is happening, and I’m going to include Facebook in that. Some
    cry-baby over at Jezebel was thrilled that Sandberg was
    featured all week on Access Hollywood, holy Christ, she
    thought this was a good thing. “Feminism is back in the
    mainstream in a big way,” she wrote, I assume in between
    quaaludes, “the women’s movement is actually moving.” How
    can you work in media and not understand media? The fact
    that feminism is in the mainstream means that it doesn’t exist,
    it is no longer real, in the same way that when you hear “gun
    control debate” it’s a lie and “fiscal cliff” is an easy to market,
    safe distraction from the structural problems that can never be
    named, here’s one: for any heterogeneous population, the
    expansion of a “welfare class” is logically inseparable from
    the entrenchment of an aristocracy, can’t have one without the
    other once you get bigger than 20M, ask Bismarck. “Does he
    write for Time?” No. But keep this in mind every time you
    hear how great it is Bill Gates is curing malaria after leaving
    us all with Windows.

    You might ask, well, how do we get women who read Cosmo
    and Jezebel to aspire to something greater? Your question is
    illogical. It’s not because Cosmo and Jezebel attract dumb
    women, no, not exactly, it’s that they teach their readers to
    want certain things over other things. They teach them how to
    want. What resists them? Nothing. Then who can unbrainwash
    them? No one. The person that should have was their mother,
    and they read Time.

    III.

    But other than getting them to buy magazines, why bother


    with making women feel good about themselves? Are they
    going to riot because men won’t let them be COOs? Placating
    the TV demographic whose only act of political violence was
    to Like the Kony video hardly seems urgently necessary.

    It’s not to make them feel good, and it certainly isn’t to inspire
    them to become COOs. It is what we drunks call
    “unconscious” and Sandberg herself is not aware of it. Don’t
    equate what Sandberg wants with what the system wants to
    use her for. If they did not overlap, you would never know the
    name Sheryl Sandberg; or, said the other, more scary way, the
    only reason you know the name of Sheryl Sandberg is because
    it represents a defense against change. Off topic, not really, a
    short joke by comic Greg Giraldo: “It’s so great that
    Americans will still vote for a white guy even if he’s a little
    black.” Defense against change.

    One of Sandberg’s three Time-approved points is that women


    “leave before they leave,” which means that instead of
    planning early to advance in their career, they plan early to
    leave their career. Here’s a very revealing excerpt, read it
    closely:

    But women rarely make one big decision to leave the


    workforce. Instead, they make a lot of small decisions
    along the way. A law associate might decide not to shoot
    for partner because someday she hopes to have a family.
    A sales rep might take a smaller territory or not apply for
    a management role…

    “So true!” Slow down. The trick is most employable women


    are at best at the “sales rep” level, not the lawyer level, but
    because of the juxtaposition you never think: why the hell
    would a sales rep want to be a manager? “Oh, because it’s a lot
    more work.” Is it a lot more money? “Well, no, it’s a little
    more money.” So you want me to work a lot more now for the
    possibility of eventually getting a job that pays only a little
    more money? “Yes, stupid, it’s called a promotion.” It sounds
    like a scam. “No, it’s a stepping stone to Nominal Vice
    President In Charge of Situations And Scenarios.” Does that
    pay more? “What are you, a communist? 401k matches 50%
    of the first 6%.” In other words 3%, ok, am I on a prank show?
    “Free GPS tracker in your phone and laptop.” Thank you Yaz,
    my forties are going to be great.

    Sandberg’s book is heralded as “the next great feminist


    manifesto”, by this logic the first one was TV Guide. Just
    because there’s a woman near it, doesn’t mean it’s about
    women. The feminism debate, labeled equivalently as “gender
    discrimination” or “women sabotage themselves”, is not about
    women, it is about LABOR COSTS, making working for
    something other than money admirable. If some women rise to
    COO that’s unintended consequences, what the system really
    wants is people, especially the still not maxed out women, to
    want to work harder for it, to be a producer/consumer for it, by
    making noble and desirable the long hours, “a seat at the
    table”— the kind of things that give away the majority of your
    high heeled, productive life in exchange for the trappings of
    power. This is one reason why while people think it’s cool if
    Zuckerberg wears a hoodie, women’s work attire is tightly
    controlled by women— being able to dress up for work is
    signaled to you as part of the appeal of work, a perk, which is
    why every picture of Sandberg is in a “great outfit.” It doesn’t
    matter that Sandberg does or doesn’t dress this way ordinarily,
    it only matters how her image can be repackaged to convey the
    correct message to you. Whatever Sandberg wants to say,
    whatever she thinks she means, is totally irrelevant to this
    process. The ability to run Facebook is insignificant next to the
    power of the Force.

    If you doubt this, observe that of all the advice Sandberg via
    Time gives to women, the single piece (in)conspicuously
    absent from the Time article is the most important: ask for
    more money. Duh. Ask for less hours. Ask for something real,
    that can affect your life, instead of the cosmetic, “trappings of
    power” gimmicks like titles or prestige— the very things that
    would appeal most to a narcissistic culture obsessed with
    broadcasting identity, requiring not just external but visible to
    others validations of their worth. NB: it’s not that Sandberg
    herself didn’t say ask for more money— she did, e.g. in her
    book and in the British “Americans are money hungry pigs”
    Guardian. But that advice cannot appear in Time. What the
    Time article made a big deal about was that she fought for
    pregnancy parking spots, that’s the progress, you go girl,
    Sandberg is also fighting for the right to cry at work, Jezebel
    was right, feminism is moving.

    Employers take note, Americans, especially American women,


    can be easily convinced to forgo money if it’s not enough
    money to be flaunted or if something else can be.

    The same should apply to men, the difference is working men


    have an Act I backstory: two generations ago and back the
    whole game for men was the money, the lifestyle, the
    house/wife/car— getting rich. I’m no fan of unions but they
    played it straight: if you’re going to sacrifice your whole life
    and lower back for the benefit of a faceless corporation then
    you’ve got to get paid. But young, aspirational women can be
    convinced that working longer, “a seat at the table”,
    “promotions” to management— these are worthy goals:
    Sandberg said so.

    Just because my posts have lots of typos doesn’t mean I’m


    lazy. I am not saying not to work hard, I am not saying not to
    run out the clock, I’m saying it has to be meaningful, it has to
    lead somewhere, it has to be for something, and if it doesn’t
    then at least it has to pay. Amazingly on purpose, in the
    cacophony of economic debates, it’s no longer acceptable to
    talk money. You can talk about unemployment vs.
    employment, class, titles, debt, growth, seats at table— but not
    money, unless they are actors or sports stars. If I told you
    Katniss was making $10M or $90M you wouldn’t know the
    difference, but try to get $1/hr more from your manager and
    you find out what a dollar is worth. “I’d like to see you take on
    more initiative,” says your manager, “then maybe we can
    come up with some solutions that are right for both of us.” I’m
    sorry, is a guy with a Blackberry and a Fox News app telling
    me I need to stay until 7 but I’m not worth $1/hr more?

    None of this has anything to do with feminism, stop saying


    that word, it’s meaningless. This trick applies to men, too, let’s
    go back to Zuckerberg and his hoodie: off of half a century of
    “the clothes make the man” and “don’t dress for the job you
    have, dress for the job you want”, the right to NOT have to get
    dressed up is sold to men as a perk, but look at the alchemy: it
    is 100% certain that if you think it’s wicked that your job has
    casual everydays, then you are smart, get paid way less than
    you are worth and, most importantly, you will never dare ask
    for more money. Eventually dressing down will be sold as
    aspirational for women, but don’t sweat it, wearing sneakers is
    a pro-feminist act, after all, they’re made almost exclusively
    by women.

    IV.

    “Ladies, conference room in ten minutes! We need to


    strategize!”

    This is a picture of a “Lean In,” which I assume is why they’re


    all wearing low cut tops. ZING. I can only imagine they are
    talking about the season finale of The Bachelor, because no
    legitimate business can be happening with blue pens and
    MacBook Pros, one of which isn’t even open. Unless this is a
    PR meeting? HR? Erotica book club? I give up. Some other
    observations: pretty women love beverages and smiling.

    My personal vote for Lean In valedictorian is the woman at the


    bottom left, I don’t know her life or her medication history but
    she has the diagnostic sign of her cuff pulled up over her wrist
    in what I call “the borderline sleeve,” that girl will have
    endlessly whipsawing emotions and a lot of enthusiastic ideas
    that will ultimately result in a something borrowed/something
    blue. Hope her future ex enjoys drama, he’s in for seven years
    of it.

    You’re going to try and counter that this is a staged publicity


    photo, but my rum makes me fearless against your rebuttals.
    During my two months of radio silence I’ve been writing a
    book of/on pornography, so I know it when I see it, and I see
    it. Main thing to observe about this girl-girl feature: all the
    chicks are white.
    Back up, wildman, the easy criticism to make is that there are
    no blacks in the picture, which is why you made it. Everyone
    knows that the presence of blacks in such pics is staged, yet
    we still notice it, still want it. Why? Even though we roll our
    eyes if a black woman is artificially included in the pic, why
    are we still satisfied by her presence, or uncomfortable her
    absence? Because we have no power to change the underlying
    reality. “Better than nothing.”

    This is a porno of a white woman’s workplace, no room for


    blacks in this fantasy, they don’t watch The Bachelor. Don’t
    confuse aspirational with desirable, Halle Berry is ass-
    slappingly hot, no one wants to be her. “If I worked at a
    female-friendly place like Facebook,” says anyone
    masturbating to this picture, “I’d totally have time to get my
    nails done.”

    No, the insightful criticism isn’t that they didn’t artificially


    include a black woman, it is that they artificially excluded
    Asian women— that this photo could only be made by actively
    denying a reality: among women, Asian women are
    proportionally overrepresented in successful positions,
    especially tech jobs, especially Silicon Valley, and yes, Apple
    Maps, India is in Asia. Putting this shot together is like staging
    an NBA publicity photo without any neck tattoos or handguns.
    “What?” When I was in my 3rd year of medical school and we
    all had to select our tax bracket, the Asian women went into
    surgery, ophthalmology, or the last two years of a PhD
    program, you know where the borderline sleeves went?
    Pediatrics, which I think is technically sublimation but I’m no
    psychiatrist. The logic was straightforward: they wanted kids,
    and, unlike surgery, pediatrics offered future doctor-moms a
    bit of flexibility, while the Asian women apparently didn’t
    worry about working late because their kids would be at violin
    till 9:30.

    This porno, for the Time et al demographic, cannot allow this


    bit of reality to be shown, because the moment you see
    Padmakshi or “Megan” at the table it is too real, it undermines
    the entire sexism thesis and suggests that something else may
    be going on, it’s like watching an awesome gangbang and
    suddenly noticing all the empty Oxycontin bottles and that
    they’re speaking Serbian. “That just makes it hotter!” I just
    logged your ip address. This doesn’t mean Asian women don’t
    experience sexual discrimination, it means that when an Asian
    woman succeeds, the other women in the office don’t get to
    experience sexual discrimination, so they’re left only with
    sexual harassment. Read it a couple of times, it’ll make sense
    and you won’t like it.

    V.

    Still not sold on the thesis that the system wants you to be a
    battery? Then you’re going to have a lot of trouble with this
    next part…… for the rest of your short life.

    The most important— her words— advice Sandberg has to


    offer women is… to choose your husband carefully. Think
    about this for a minute. I’ve fallen in love with some
    catastrophes in my life, I’ve drank a lot of rum, and I’m sure a
    lot of/all people say the same about me, but how on earth
    could I choose whom I fell in love with? The heart wants what
    it wants, even when what it wants is on Prozac. How could I
    select my love based on my career concerns, or is the logic
    that my soulless zombie skull would love anyone who agreed
    to do half the chores? The only person who can pull that off is
    a psychopath, and sure, you may indeed succeed in life, but at
    what cost? What are you good for? But the Time Magazine
    force vector doesn’t care about your human happiness, it most
    certainly doesn’t care about your caring about your partner’s
    happiness, it cares about your role as producer, and by
    producer I mean consumer. Eat up, it will have corn in it.

    Perhaps the logic is that I shouldn’t marry anyone except one


    who is compatible with my goals, good advice— except why,
    a priori, is one’s middle management career at General Motors
    more important than one’s marriage?
    “Half of all marriages end in divorce.” Yes, stupid, everyone
    says that, half of all marriages under 25 end in divorce, but
    wait till thirty and the deck is way more favorable, you have to
    learn how to count cards. But this isn’t some kind of failing of
    marriage itself, some structural defect in a system that’s been
    running for thousands of years, the problem isn’t marriage, the
    problem is you. You think the string of butcheries in your past
    are the fault of monogamy? As they say everywhere, the single
    commonality in all of your failed relationships is you. Time to
    get a cat.

    “No, she just means when you get married, to pick someone
    who supports your goals.” In other words, a business
    relationship? Arranged marriage, only this time by
    Match.com’s algorithm? “No, a marriage based not on passion
    but on mutual respect and shared values—” Stop, listen to
    what you are saying. Why would you want a man who agreed
    to this? Why would a man want a woman who thought like
    this?

    Keep in mind, her message is not for future COOs, her


    message is for the rest of you organ donors who need to be
    transitioned from 9 to 5 to 8 to 6, e.g. the Cosmo demo. The
    Time Magazine demo already gave up on love, after a decade
    and a half of a narcissistic marriage they only need to be
    convinced to work Saturdays or spend more. Either will do.

    The single greatest obstacle to turning women into fully


    productive members of the workforce, i.e. batteries, is not men
    obstructing them but their persistent belief in metaphysics. If
    the thing that is keeping women out of the underpaid labor
    force is “family”, then family must go, and if what pulls them
    towards family is love then love has to be a fantasy.

    I know what you’re thinking. You’re worldly, you’re cynical,


    your skeptical. You don’t go for all this love crap…. You’ve
    figured out that love was a construct pushed by the patriarchy
    to keep women tied to the home, to deny them orgasms with
    multiple penises and vaginas; to prevent them from getting
    jobs, money, power. Am I right? Ok, then let’s play by your
    rules, let’s say you’re right that love was used to keep women
    down— then what does today’s suppression of love signify?
    Could it be that the abandonment of love doesn’t also serve the
    system’s purpose? Or is only the former the trick, the latter a
    discovery made by your genius + sophistication + expert
    reading of human emotions?

    You think you’ve figured out that true love doesn’t exist, that
    it’s all been a kind of romantic lie sold by TV and the media,
    that real life isn’t like that; but what I am telling you is that
    you didn’t figure this out, you were TOLD this. Now,
    constantly, by every modern TV show, by Lori Gottlieb and
    the zombies at The Atlantic, by your friends, by your parents
    — the trick was to get you to think you figured it out on your
    own. Grey’s Anatomy is a terrible show but at least season one
    had the decency to be about having careless sex along the road
    to finding The One. You know where their passions lie now?
    Running a hospital. Yesterday’s episode featured eleven
    minutes of two young, superhot doctors orgasming over the
    new X-ray machine and how great it is for both efficiency and
    patient care, it’s almost as if the Disney Corp is doing its part
    to convince America that hospitals aren’t in it for the money,
    they’re warm and fuzzy places that are committed to helping
    patients with their fertility.

    The system’s ideal woman is the single mother, she’s produced


    with her uterus and is willing to go all in on
    production/consumption, she has no choice. I’m not saying she
    wants to be a single mother, I’m saying that’s what the system
    wants her to be. That’s feminism. You can get married too, as
    long as he’ll make it so you get in at 8.

    Unfortunately— and this is exactly the trick of it all— it


    sounds crazy to say, “wait for true love!”— it sounds
    regressive to say that pushing yourself at work might not be
    worth trading your family, but that’s the trick, the system has
    framed that question as binary, as if there were no other
    possibilities, no middle ground. The system has made it so that
    you can only choose one side, “aspire to be a COO!” or “don’t
    be a COO— you should be home with your kids!” It is a
    classic double bind, and you can’t ask: for the entirety of my
    life, these are the only two choices?

    Love is dying, the system is killing it. The only acceptable


    portrayal of fulfilled love is with vampires and BDSM
    billionaires, not because those men are great but because
    there’s no worry you’ll meet one, enjoy your little fantasy.
    Now back to work, whore, you need fulfillment.
    The Terrible, Awful Truth
    About SSDI
    April 5, 2013

    “wait— didn’t you do this post before?

    The email:

    The Simple Boring Reason Why Disability Insurance


    Exploded

    Ahem… just spot on stuff here…

    Sounds like a challenge.

    I don’t blame him. The idea that psychiatry and government


    are working together through the welfare system to patch holes
    in feudal America is hard to swallow, and when no less than
    The Washington Post explains it so concretely in a few
    PowerPoint ready graphs… it’s seductive, I sympathize.

    The Post article clearly explains that the explosion in the


    number of people receiving disability benefits is not really the
    fault of the economy; and, they will grudgingly admit, not the
    fault of “doctors [and applicants] conspiring to game the
    system somehow—” the default narrative of anti-corporate,
    pro-common sense This American Life, whose typical
    maneuver for depicting a complicated social process is to find
    an N of 1 living somewhere in Appalachia and imply that this
    nice but toothless baptist woman doesn’t know what’s good
    for her. “This week on This American Life, snark by Reductio
    Ad Absurdum, in four acts.”

    No, says the Post, the answer is more boring: people are
    getting older, and older people get more disabled.

    Pure common sense, no need for an appeal to “some other


    omnipotent entity.” Freakonomics would be proud . But I can
    do this drunk, ready, go.

    I.

    You have to start from first principles: what does the author
    want to be true? The Washington Post has a two part mission
    statement: 1. get you a higher SAT score or your money back;
    2. make sure nothing is Obama’s fault. I’m not saying
    anything is Obama’s fault, I’m saying that in 2008 they
    switched from “It’s Bush’s Fault” offense to “It’s Not Obama’s
    Fault” defense in hopes of keeping their last ten readers. Note
    that the Post’s site is called “WonkBlog,’ please also consider
    that anything branded with the word “wonk” is misdirection.

    The Post is making a bet that you won’t know the difference
    between SSDI and SSI, and you wouldn’t, no one does, it’s
    deliberately obfuscated and frequently conflated. They are
    totally different in terms of origin, budget and consequence,
    but both rely on “disability.” The only person who does know
    the difference is a guy actually on SSDI, so that when you ask
    him, “how long have you been on SSI?” he will freeze, pull
    out a knife, place it calmly on the table, and say, “listen lung
    transplant, I’m not on SSI, I’m on SSDI. I worked.”

    SSDI is “Social Security Disability Insurance.” It is what it


    says it is: you worked in the past, paid payroll taxes, “paid into
    the system,” and if you become disabled— not necessarily on
    the job, which is the requirement for collecting disability from
    the job, but for any reason— you can collect SSDI payments.

    The Post is explaining the trend in SSDI as the result of the


    aging population— not gaming the system, not the economy.

    The obvious retort to all this is, fine, so what? SSDI is


    meaningless, well, meaningful to you if you need it, but to the
    economy and to the progress of humanity it’s a wash. You’re
    telling me a guy pulled a 9 to 5 for a decade… and now
    “claims” he “can’t”? It’s not my ideal life plan, but if he
    decided at 45 to quit being a welder so he could downgrade by
    two thirds to the $15k a year baller lifestyle, well, I prefer my
    grog made of Zaya rum but I’m not going to begrduge this guy
    the well liquor if that’s the ship he wants to sail.

    What will sink the Earth into oblivion isn’t people who can no
    longer work, it is people who have never worked and will
    never have worked, who on the one hand will never pay into
    the system, on the other hand will never produce any output,
    and, thank you Zaphod, on the other hand will draw from it in
    a number of ways that perpetuate this draw. This is SSI, which
    stands not for “social security income” which would helpfully
    explain where it comes from, but “Supplemental Security
    Income,” which makes no sense, two of those words are lies.

    Some numbers are often useful to scare off the uninterested, so


    boo:

    Number of SSI recipients: 8M


    Average payment: $550/mo
    Total annual cost: $58B

    Number of SSDI recipients (ex-workers): 8M


    Average payment: $1100/mo
    Total annual cost: $120B. If you include family benefits, the
    total SSDI cost is $143B.

    “Hey, dummy, I thought you said the problem was SSI. 58 is


    more tinyer than 143.” Yes. My training in physics allows me
    to observe this as well, but the problem isn’t the money, the
    problem is the calendar.

    Since we like to defer our debts,here’s the future of America


    question: who is more likely to eventually go to work: the
    children of SSDI recipients, or the children of SSI recipients?
    The answer depends on whether there are class lines or
    multigenerational entrenchments of poverty in America, and
    there are, which means that while the kids of SSDI stand a
    chance, the kids of SSI are sunk. Fortunately, a lot of them are
    black, so there’s that.

    The welder who “gamed the system” at 45 at least caused his


    kid to observe him as a worker for the formative first 8 years
    of the kid’s life. It counts for something, it is not nothing.
    Possibilities exist. That guy may be a jerk, but he is not the
    problem.

    SSI is 100% a gimmick, but the gimmick is 100% hidden from


    you. The gimmick isn’t that poor people game the disability
    system to get cash payments, the gimmick is that the only way
    to deliver cash payments to poor people is through the
    pretense of disability, hence mental illness and pain disorders.
    Whether they are “disabled” or not is totally and completely
    irrelevant, poor people are going to get the money one way or
    another so that they don’t riot, but in order to prevent everyone
    else from rioting, deniability is created: “look, doctors—
    SCIENCE— said they are medically disabled, it’s out of our
    hands!” So your anger is safely diverted: “they’re gaming the
    system!” No. That is the system. If they were gaming it,
    someone would get caught. No one gets caught.

    “We need to create jobs.” There aren’t any to create. Robots


    and chinamen, that’s the future of unskilled labor. Sorry, I
    meant chinawomen. College won’t help either, you went to
    Barnard and you can’t find a job, what hope is there for the
    majority on SSI? Zero, not the way we’re doing it. TV tells
    them how to want, no one else is around to tell them
    otherwise. Here’s the advice you need to give your kid: either
    you find a knowledge based productive skill, from plumber to
    quantum programmer, or you will be living off the state,
    regardless of what company you think you’re working for.

    II.

    I know, the idea of people getting paid for nothing gives me


    the heebie jeebies as well, I’d want to shrug, too. But the point
    here is not whether poor people deserve living wages, the
    point, again, is that since this is precisely what they are
    getting, already and irrevocably, can we do it more efficiently,
    cheaply? Why do we have to go through all this bureaucracy
    that massively inflates the costs— for example, Medicaid (the
    poor have to first become “patients” and get meds to get
    disabled, after all)? Why not more efficiently deliver the
    “assistance”? Cut out the middlemen— send them directly to
    an ATM? I see how that might lead to an “entitlement culture”,
    but isn’t “disability culture” actually worse AND more
    expensive?

    But no one would stand for it. You, we, I, everyone, will
    gladly pay more in taxes or plunge deeper into galactic sized
    debt to not see the reality that some will get money just
    because, so that we can lie to ourselves that the “disability
    system” isn’t supposed to be used this way, they are gaming it.
    The problem is not economics, the problem is psychology.
    You’re paying extra for the deniability. Is it worth it?
    The Dove Sketches Beauty
    Scam
    May 8, 2013

    the only way to win is not to play


    “Dude, are you doing the Dove ad now? That was so April
    15th…?” Yes, I realize I missed the meme train, but it’s better
    to be right than part of the debate, especially when there is no
    debate, this is all a short con inside a 50+ year long con.
    Remember House Of Games? “It’s called a confidence game.
    Why, because you give me your confidence? No: because I
    give you mine.”

    “What’s with you and fin-de-Reagan David Mamet?” It’s not


    my fault Dove cast Joe Mantegna as the sketch artist, and
    anyway if you want to understand the world today, you have to
    understand how the Dumbest Generation of Narcissists In The
    History Of The World was educated. See also: 9 1/2 Weeks.

    Here’s how you run a short con, pay attention:


    Everyone likes to know the secrets of the game, and this scene
    certainly satisfies. Joe Mantagena shows a famous psychiatrist
    (played, tellingly, by David Mamet’s future ex-wife) how a
    short con is done, how it’s improvised, and he makes it look so
    easy. Really easy, except for the part where you have to
    connect with a perfect stranger and make them like you. Did
    you find yourself wondering if you had the skills to pull it off?
    Better watch it again, sucker.

    Quick test for a con: what questions does it not occur to you to
    ask? While you were memorizing the language and the pacing
    of the scam, you didn’t ask yourself, why didn’t Mantegna
    take that guy’s money at the end? Why did he let him off the
    hook? “He was just doing it as an example.” Oh, like when a
    guy says he’ll put in just the tip, “I want to see if it fits”? It’s
    not like the psychiatrist doesn’t know he’s a thief— that’s why
    they were there in the first place. So he purposely didn’t steal
    the money to make the psychiatrist feel at ease, feel closer to
    him. To earn her confidence by first giving her his. She’s the
    mark. The aborted short con is part of an unseen long con.

    But the genius of the scene is that while you, the viewer, are
    criticizing the stilted dialogue or the improbability of the
    success, “dude, that would never work in real life!” if you
    search your sclerotic heart you will find that you yourself felt
    good that Mantegna didn’t take that guy’s money, that he let
    him go. It endeared you to Joe, it made you feel more
    sympathetic to him, like he’s an ethical thief, like he’s Lawful
    Neutral. In other words, he’s given you his confidence….
    which means that the true mark is you.
    Women are their own worst beauty critics…. At Dove,
    we are committed to creating a world where beauty is a
    source of confidence, not anxiety… That’s why we
    decided to conduct a compelling social experiment that
    proves to women something very important: You are
    more beautiful than you think.

    “Oh my God,” you might say, “I know it’s just an ad, but it’s
    such a positive message.”

    If some street hustler challenges you to a game of three card


    monte you don’t need to bother to play, just hand him the
    money, not because you’re going to lose but because you owe
    him for the insight: he selected you. Whatever he saw in you
    everyone sees in you, from the dumb blonde at the bar to your
    elderly father you’ve dismissed as out of touch, the only
    person who doesn’t see it is you, which is why you fell for it.
    Even mirrors fail you. Hence a sketch.

    II.

    The gimmick that propels the Dove ad is a comparison


    between subjectivity and objectivity, though in this case
    objectivity is defined as however well Mantegna can use a
    charcoal pencil. Why not just use a photograph?

    Because when it comes to beauty, we all know photographs


    can be manipulated, especially in ads, especially by Dove. So
    the ad frees you from your cynicism and goes with a new
    standard of beauty, one that, like yoga or genetics, has been
    around for a long time AND you know very little about it; it
    hasn’t been over-critiqued, you haven’t watched it fail over
    and over, and thus seems pure, fantastical, true. The artist’s
    sketch. How can anything this lovingly and precisely created
    not be the real thing? And nothing makes a middle aged
    neurotic happier than 45 minutes alone in a loft with a good
    looking man who requires no sexual contact and just wants to
    listen to you talk about yourself, unless he’s also sketching you
    attentively in natural light. “Can I offer you a Pinot Grigio?”
    Slow down, Christian, you’re making me woozy. There is not
    enough quantitative easing in the universe to prop up this
    fantasy, but at $3000000000000 you can’t say America’s not
    committed to the attempt.

    The mistake in interpreting this ad is in assuming the ad is


    selling based on the women and their beauty. If that were true,
    it would be counterproductive: if they are naturally beautiful,
    if the problem is actually a psychological one, then they
    certainly don’t need any beauty products. A beauty ad operates
    by creating a gap between you and an ideal: by creating an
    anxiety that can only be mitigated by the product. But this ad
    reduces anxiety and avoids cynicism. Therefore, it is not a
    beauty products ad. It is selling something else. This is why
    there aren’t any products in the ad.

    Dove is telling you you don’t need to do anything to be


    beautiful, but it knows full well women must do something to
    themselves to feel good about themselves, and if they don’t
    need makeup then at least a moisturizing soap. All Dove needs
    to solidify this is to be recognized as an authority on beauty—
    real beauty, not fake, Photoshopped, eyeliner and pushup bras
    beauty.

    It is the sketch artist who is the most important character in the


    ad, the ad is selling him. That’s why he doesn’t just draw the
    sketches, he sticks around to chaperone these women to self-
    awareness. By the way he is depicted you understand that he
    knows beauty, inner and outer; he is part father, part lover,
    expert in what makes a woman valuable. For you to accept
    him, he can’t be married; but since in real life he is, they only
    show you the right hand— the part of him that almost
    autonomously draws beauty. He is an authority on appearance,
    he is the “other omnipotent entity” that decides whether “you
    are beautiful.”
    The ad lets the women become beautiful without selling them
    anything. It lets them win. It lets them win. It endears them
    and you to Dove, it makes you feel more sympathetic to Dove,
    like it’s an ethical beauty products company, like it’s Lawful
    Neutral. It gave these women its confidence; it gave you, the
    viewer, its confidence.

    And then— spoiler alert— it will screw you and take your
    money.

    III.

    That Dove wants you to think of it as the authority on beauty


    so it can sell you stuff makes sense, there’s nothing
    underhanded about it and hardly worth the exposition. The
    question is, why do they think this will work? What do they
    know about us that makes them think we want an authority on
    beauty— especially in an age where we loudly proclaim that
    we don’t want an authority on beauty, we don’t like authorities
    of any kind, we resist and resent being told what’s beautiful
    (or good or moral or worthwhile) and what’s not?

    You may feel your brain start trying to piece this together, but
    you should stop, there’s a twist: where did you see this ad? It
    wasn’t during an episode of The Mentalist on the assumption
    that you’re a 55 year old woman whose husband is “working
    late.” In fact… it’s not even playing anywhere. You didn’t
    stumble on it, you were sent to it, it was sent to you— it was
    selected for you to see. How did they know? Because if you’re
    watching it, it’s for you.

    Here you have an ad that was released into the Matrix, it is not
    selling a product but its own authority, and it is not targeting a
    physical demo, age/race/class, it is targeting something else
    that operates not on demography but virality. Are you
    susceptible? So while you are sure you most certainly don’t
    want an authority on beauty, the system decided that you, in
    fact, do very much want an authority on beauty. The question
    is, which of you is the rube?
    “But I hated the ad!” Oh, I know, for all the middlebrow
    acceptable reasons you think you came up with yourself. Not
    relevant. The con artists at Dove didn’t select these women to
    represent you because you are beautiful or ugly, any more than
    the street hustler selected you for your nice smile. They were
    selected because they represent a psychological type that
    transcends age/race/class, it is characterized by a kind of
    psychological laziness: on the one hand, they don’t want to
    have to conform to society’s impossible standards, but on the
    other hand they don’t want the existential terror of NOT
    conforming to some kind of standard. They want an objective
    bar to be changed to fit them— they want “some other
    omnipotent entity” to change it so that it remains both entirely
    valid yet still true for them, so that others have to accept it, and
    if you have no idea what I’m talking about look at your GPA:
    you know, and I know, that if college graded you based on the
    actual number of correct answers you generated, no curve,
    then you would have gotten an R. Somehow that R became an
    A. The question is, why bother? Why not either make grades
    rigorous and valid so we know exactly what they mean, or else
    do away with them entirely? Because in either case society
    and your head would implode from the existential vacuum.
    Instead, everyone has to get As AND the As have to be “valid”
    so you feel good enough to pay next year’s tuition,
    unfortunately leaving employers with no other choice but to
    look for other more reliable proxies of learning like race,
    gender, and physical appearance. Oh. Did you assume
    employers would be more influenced by the fixed grades than
    their own personal prejudices? “Wait a second, I graduated 4.0
    from State, and the guy you hired had a 3.2 from State— the
    only reason you didn’t hire me is because I’m a woman!” Ok,
    this is going to sound really, really weird: yeah. The part that’s
    going to really have you scratching your head is why did either
    of you need college when the job only requires a 9th grade
    education?

    Which is why those that yelled “Unilever owns Dove and


    Axe!” like it was an Alex Jones tweet, those who felt
    tricked/used/violated that Unilever has a sexist side to it, those
    who thought the ad was hypocritical or “anti-feminist” are still
    being duped, detecting hypocrisy is 100% the play of the rube,
    go ahead and yell indignantly as you continue to be fleeced.
    Figuring out the short con is part of the long con, see also
    House Of Games, for a non-spoiler example if the street
    hustler is shifting the cards and you think you’re able to follow
    them, then you’re still going to lose AND your pocket is being
    picked. “Can’t bluff someone who isn’t paying attention,”
    Mantegna told the shrink helpfully— he’s telling her the scam,
    no, she didn’t listen either. So let’s go to the places where
    people pay attention, go to the “intelligent” media outlets
    where all the suckers hang out, and observe the most common
    criticism about this Dove ad: it has no black women in it.
    Never mind it does, that’s a very telling criticism: why would
    you want black women in it? It’s not the Senate, it’s an ad, no,
    don’t you hang up on me, why do you want blacks in the ad?
    Because it would represent the diversity of beauty? Because
    without them, it sends black women the wrong message about
    society’s standards? Your answer is irrelevant, the important
    part is that whatever your answer, it is founded on the
    assumption that ads have the authority to set standards. Which
    is why, in your broken brain, the reflex is to complain about
    the contents of the ad, not assert the insignificance of ads. The
    con worked. Of course it worked: they selected you.

    “Well, not authority— power. You can’t deny their power is


    massive, but of course I’m not a stupid, I don’t think it’s
    legitimate.” I’m sorry, no, you are stupid. You’ll let it have
    power over you in exchange for the right to brag that you
    know its not legitimate.

    This is the same problem with people who want to ban


    Photoshopping in magazines or want bigger women to be
    featured in ads. You all have the internet, right? It seems crazy
    to worry about how beauty is portrayed on TV and ads when
    there are blonde billions (rated on a scale of one to ten) getting
    double penetrated literally underneath your gmail window, but
    that obsessive worry about what’s on TV or what’s in an ad is
    completely predicated on the assumption that the ad, the
    media, has all the power to decide what’s desirable. And
    therefore, of course, it does. But the important point is not that
    you believe this to be true, the point is that you want this to be
    true. You want it to be true that advertising sets the standard of
    beauty because in the insane calculus of your psychology you
    have a better chance of changing Dove than you have of
    changing yourself, turns out that’s true as well.

    Dove, et al sympathize with your powerlessness, so since you


    can’t get anywhere near those impossible standards, ads give
    you a chance of making some kind of progress: a little
    moisturizing soap and a positive message and maybe you get
    closer to the aspirational images of the women in the ad.
    “Those women are aspirational?” Of course: they’re happy,
    Dad told them they’re good. It feels like improvement, it feels
    like change, and I hope by now you understand it’s only a
    defense against change.

    The obvious retort is that ads are everywhere, you can’t ignore
    them. But there are rats in the ceiling of your favorite
    restaurant, and you ignore them no problem, you don’t even
    look up. That’s the real Matrix you make for yourself
    continuously, in analog, not digital— overestimate this,
    disavow that, a constant transduction of reality into a safe hue
    of green, until by the time you get to bed you’re physically
    exhausted but your brain can’t downshift. “I have insomnia.”
    Time for a Xanax. Yes, it’s Blue.

    “Everybody gets something out of every transaction,” said Joe,


    explaining why people want to be conned. That’s what ads do
    for you. They’ll let you complain that they are telling you
    what to want, as long as you let them tell you how to want.

    “Shouldn’t my parents have taught me how to want, instead of


    yelling at me about what to want?” You’d think that, let’s
    check in: have you shown this ad to your 14 year old daughter
    yet? Oh, you sent it to her on Facebook, that was helpful.
    What did you tell her about the ad? “Well, even though it’s an
    ad and they’re trying to sell you Dove soap, there’s a positive
    message in it.” No other ways to deliver positive messages?
    “Well, the ad is really well made, and it communicates the
    message more powerfully than I ever could.” But if the
    medium is the message, shouldn’t you NOT show her this ad?

    David Mamet has some excellent insights, but for practice


    what you preach wisdom you have to defer to a Wachowski
    sister: stop letting the Matrix tell you who you are.

    IV

    Did the way the sketching sessions were conducted remind


    you of anything? The women aren’t in yoga casual, no one’s
    wearing sneakers— they got a little dressed up for the
    appointment. Observe the way they talk about themselves,
    trying to find just the right words because, you know, their
    inner experience is very complicated; and the unfinished,
    hesitating haste with which they take their handbags and walk
    out at the end leaving the artist behind. The loft is certainly an
    inviting, comfortable setting, warm and safe, but it doesn’t
    belong to them. They know they are merely visitors in a
    shared space. That setting is exactly like therapy.

    You may think this is merely my (a psychiatrist’s/House Of


    Games viewer’s) biased perception of this, except that a)
    they’re in San Francisco, where the main output is
    crematorium roast coffee and cash-only psychiatry, and b):

    My father was emotionally very distant— and so was my


    mom. And I didn’t get the emotional comfort I needed…

    It’s been really clear to me over my life that I’ve made


    really bad choices, and that’s a reflection of my self
    esteem. I chose the wrong jobs, the wrong husbands…

    I use a toolbox of things I tell myself…. whenever I hear


    negative thoughts about myself, I remind myself I have to
    use what’s inside me, my authentic self, to feel good
    about how I am.

    This isn’t every woman I’ve ever been stuck next to on the A
    train who spotted me with a psych journal or a flask, this
    monologue is in the ad. Let’s find out why: anybody watching
    this ad in therapy? Anybody watching this ad ever fantasize
    about what it would be like being in therapy? What a
    coincidence.

    This woman is roots deep in therapy, she thinks about herself


    in the language of “insight oriented therapy,” how has this
    strategy worked out for her?
    Yikes, an Oscar Wilde novel. But the thing to notice here is
    not that this thinking has failed but that this thinking has
    BOTH failed AND she thinks it has worked amazingly well
    for everything else EXCEPT her perception of her physical
    appearance, her self-esteem; only in that one single area does
    she “have more work to do on myself.” If you ask her about
    her capacity for empathy or her social/political beliefs or her
    “values”— those aren’t evolving, those are evolved, they are
    unassailable. “I have a lot of love to give.” How do you know?

    I’m not picking on her, any woman who has to raise two kids
    on her own or with a husband has my unconditional support,
    but truth hurts, that’s how you know it’s true. The confidence
    with which she knows how her perception of self-esteem
    affects everything in life, “it couldn’t be more crucial” is not
    an insight, it is not wisdom gained from years of therapy: she
    has been conned, it is society’s long con so her pocket can be
    picked.

    The ad’s association to therapy here was probably not planned


    but it was inevitable, just as Mantegna selecting a psychiatrist
    and not an engineer or a cook or a stripper as the mark in
    House Of Games was inevitable. It is the only system of rules
    based on self-deception, it encourages the illusion of “self”
    separate from behavior. And as long as psychiatry uncritically
    elevates identity over behavior, it makes it— not the patients,
    it— an easy mark for con men with their own agenda: SSI, the
    justice system, gun control, schools, whatever. “It’s called a
    confidence game. Why, because you give me your confidence?
    No: because I give you mine.” Take a minute, think it through.

    Self esteem is sold to you as an inalienable right, not


    something to be earned; and if you don’t have self-esteem it’s
    because fake society made you feel bad about yourself. But
    fake society also made you feel good about yourself, it
    propped you up. The reason you got an A and not an R and
    believed it is because you actually believe you are an A kind
    of guy, Math, English, History, Science, PE, and Lunch
    notwithstanding. A, not R. But if everyone deserves it, it has
    no value. Which is why getting it is unsatisfying.
    Self-esteem is relative, advertising knows this, which is why it
    operates on comparisons between you and the aspirational
    people in the ad that seem better because they own the
    product. The Dove ad dispenses with the aspirational people
    and actually compares you to you. But that’s not you, it’s
    aspirational you, “wouldn’t it be great if people saw me in an
    idealized, sketchy kind of way?” But even as it does this, it
    pretends self-esteem is innate.

    One of the great insights of psychoanalysis is that you never


    really want an object, you only want the wanting, which
    means the solution is to set your sights on an impossible ideal
    and work hard to reach it. You won’t. That’s not just okay,
    that’s the point. It’s ok if you fantasize about knowing kung fu
    if you then try to actually learn kung fu, eventually you will
    understand you can never really know kung fu, and then you
    will die. And it will have been worth it.

    You can’t see it, but since this is America, the problem here is
    debt. Not credit card debt, though I suspect that’s substantial
    too, but self-esteem debt. They’re borrowing against their
    future accomplishments to feel good about themselves today,
    hoping they’ll be able to pay it back. Melinda’s 26, at that age
    some self-esteem debt is reasonable as long as you use it to
    hustle. But what happens if you overspend now and can’t pay
    it back by the time you’re 40? Look above. Time for therapy
    or a moisturizing soap. There’s not enough quantitative easing
    in the universe to prop up this fantasy, but you can’t say
    America’s not committed to the attempt.

    http://twitter.com/thelastpsych

    Luxury Branding The Future Leaders Of The World


    Still Alive
    July 6, 2013

    WHERE DID YOU GO?

    I flatter myself by thinking you are asking this question. I am


    writing a book of and about porn.

    IS IT ANY GOOD?

    Not sure. I am trying my best. It’s a lot of work, complicated


    by relentless self-doubt. The good news is I am drinking more.

    ALMOST DONE?

    Yes, guy who asks all the right questions.

    WILL YOU THEN RETURN TO THE BLOG?

    Yes. The blog is very good practice.

    IN THE MEANTIME, DO YOU RECOMMEND ANY OF


    YOUR OLD POSTS?

    No. Read at your own risk/tolerance, I distance myself from


    everything older than, say, the last four or five posts.
    Everything else is thinking out loud, work in progress. I could
    go back and try to revise the old posts, but there’s no point.
    Life is change, have to keep moving forward.

    IF YOU HAD TO PICK ONE OR TWO…?

    The Second Story of Echo and Narcissus and The Boy Who
    Cried Wolf.

    WHY A BOOK?
    I didn’t want to put a porn story on the blog, I felt there should
    be a buffer. Wait— are you asking me why I didn’t just shoot a
    sex tape? Huh.

    SO YOU WROTE AN ACTUAL PORN STORY?

    Yes.

    HARDCORE PORN?

    Yes.

    IS IT HETERONORMATIVE?

    Sigh.

    The book is in two parts. The first part is a straight up porn


    short story. There’s penis and vagina and lots of cum/ming. I
    have deliberately not written the story “well”, whatever that
    means, I am imitating the flow and style of that kind of story. I
    didn’t try to make it sensual or unusual; while it is hard core
    pornography it is a fairly vanilla story— boy vs. girl, no
    vampires, no one dies— obvious in its language and plot and
    etc. My goal wasn’t to elevate the genre but to photograph it. I
    did this so that you could assure yourself that there is nothing
    meaningful there, no symbolism— just explicit porn. And then
    to business.
    DO YOU TRY TO EXPLAIN THE PSYCHOLOGICAL
    MECHANISMS OF PORN?

    No. It’s not the deconstruction of a text, it is the interpretation


    of a dream. I make no attempt to explain what porn means in
    general, only what it means to you.

    HOW CAN YOU KNOW WHAT IT MEANS TO ME?

    The important thing is to say whatever comes to mind.


    Real Men Want To Drink
    Guinness, But Don’t Expect
    Them To Pay For It
    September 25, 2013

    the reason the bubbles go down is because of the drag created


    by the bubbles rising up the center.
    yeah, like a metaphor.

    Click this ad. It’s great, the internet told me so, it says it
    represents something good about humanity. You’re going to
    cry and feel good about the future and then consider ordering a
    Guinness. That is, unless you already like Guinness and then
    you’re going to have a totally different reaction, like switching
    to Belhaven.

    “The choices we make reveal the true nature of our


    character.”

    Yeah, we’re sheep. Message received. That wasn’t the


    message? Are you sure?

    According to social critics around the internet this ad is “such


    a refreshing change”, “great to see sensitivity and strength
    combined”, “promotes a new kind of masculinity.” I’d like to
    know what was wrong with the old masculinity? The one
    featured on Game Of Thrones? Was it too masculine?

    Before you applaud this ad for “breaking the mold of beer


    adverts” you would do well to remember that all ads are
    aspirational, not representational, and for sure not
    inspirational, i.e. the ad thinks this will work on the target
    demo because it describes an aspirational image for the demo,
    i.e. i.e. the ad has made several important assumptions about
    the kind of person who would like this ad— not the product,
    the ad— and you’re not going to like them. Still don’t see it?
    Take yourself back to 1990. What would this ad have looked
    like?

    In 1990, the ad would have shown the masculinity and


    heroism of the crippled guy: him, in his chair, keeping up with
    the bipeds, both physically and mentally, taking shots and
    landing zingers.

    Wheels (laughing):

    You still throwing bricks? What is this, a Masons’ convention?


    I got an idea, let’s just gather up all these bricks and build a
    shelter for the homeless so your mom has a place to live.

    Group (laughing):

    Oh no he didn’t just bring up your momma!

    Biped (laughing):

    Can someone sub in for Mr. Motherfucking March Of Dimes?


    He needs to take off for two hours to watch 60 Minutes.

    Group (laughing):

    Ooooohhhhhh! Snap! His momma looks like Morley Safer!

    Wheels (laughing, fouling a tree ent):

    Sorry, you either smoke or you get smoked. And you got
    SMOKED!

    Biped (laughing):

    Tree ent! Oh, that’s funny on two levels!!


    (Wheels shoots but is blocked by Biped)

    Biped (laughing):

    It’s true, white men can’t jump!

    (“good game”, high fives all around.)

    Voice Over:

    A real man doesn’t see limits. He doesn’t see disability. He


    takes on whatever life throws his way, sets up, and shoots for
    3. It’s not about the best trick shot, it’s about points on the
    board. And the way he handles the rebounds will define him as
    a man. Life is a team sport, and most people play to lose. For
    the winners, there’s Guinness.

    Then we’d pass the bong around and watch Simon & Simon
    reruns. I may not be remembering everything accurately, it
    was a long time ago.

    But this ad does the exact opposite: it shows a bunch of


    “men”— signaled by the modern exterrnal cues of tricep
    tattoos, wide gaits and carefully managed stubble— playing
    down to Davros’s level, not as a one time offering, but as a
    regular weekly game.

    That’s very sensitive, but, just curious, do these guys who grab
    a shower in the locker room have another weekly basketball
    game where they play standing up, or is this all it takes to
    satisfy their interest in recreational athletics? Because I can’t
    imagine anyone who actually likes playing basketball to be
    able to do it only this way. Perhaps their Cosmo girlfriends
    give them two evenings off a week for bro-ing?

    Get ready for a super-sexist comment that is nevertheless


    100% true, good thing my rum makes me impervious to your
    idiotic criticisms: reducing yourself because you think it’s a
    show of solidarity is a straight up chick thing to do, see also
    Slut Walks and crying excessively for the deceased. It was
    super-brave that Kellie Pickler shaved her head to support her
    friend with breast cancer, but what the hell was the point?
    “Breast cancer awareness!” Isn’t that what the implants are
    for?

    getting the message out

    The most generous interpretation of her “look at me” behavior


    would be, “I’m supporting my friend, showing that people can
    be beautiful even without hair, especially if they have a
    spectacular body and a national dance show, and a glam squad,
    and a wig, and are not on chemo.” Message received,
    oncology can bite me, I’m calling a stylist.
    I can hear the grumbling, so I’ll make a slight modification:
    only a woman would allow another person to reduce
    themselves in a show of support. When Joseph Gordon-Levitt
    improvised the head shaving scene in 50/50, Seth Rogen
    didn’t then grab the hedge clippers and say, “I’m not going to
    let my BFF feel bad about himself” because that would be,
    you know, ___________________. “Is it gay?” “No, no, is it
    retarded?” You’re both right. Everyone’s a winner!

    I could use this ad as a commentary about the wussification of


    America, “the guilt of privilege”, the Land Of Sensitivity
    Training, etc, etc, but that would be wrong and anyway I don’t
    have that kind of time. I started writing a porn book, this book
    has become my own personal nightmarish Hamlet, a scary real
    life example of what the “return of the repressed” looks like,
    and FYI it looks horrifying. Remember the scene in Ju-On
    where whatever the hell that ghost thing is materializes in the
    window, not to look at anyone specifically, but… only to
    reveal that it is watching?

    According to psychoanalysis, this is what turns me on.

    II.
    All of the psychologically necessary praise for this ad can be
    attributed to two things: 1) It’s for Guinness, which is already
    a kind of masculine product; 2) the woefully deluded premise
    that ads try to sell you on a product. Oh my God, what year is
    this? Stop it, this is WRONG.

    Ads do not try to sell you a product, is Mad Men canceled yet?
    On that now unwatchable soap opera Creative stays up all
    night eating chinese and trading tag lines, trying to capture the
    essence of the product. Essence of the product— for whom? In
    fairness, back then there was only one TV and one wallet per
    household, so demos tended to be a little more broad, by
    which I mean women. Fair enough, and not anymore. Now ads
    target a specific demographic, and tailor an aspirational
    message/image for that demo on which is piggybacked
    whatever product paid for the take out. THE PRODUCT IS
    IRRELEVANT. Write it down on a sticky note next to A-B-C,
    it will help.

    If the ad works you will consequently want the product no


    matter what it is, baaaaa, this is what I mean when I say ads
    teach you not what to want but how to want. You could use
    this exact same Guinness ad to sell something as unmasculine
    as guar gum flavored ice cream and it would work just as well,
    and I know this because
    While you wonder who copied what and why they bothered let
    me observe a key difference between this Indian ad and the
    American: in the Indian ad, everyone is handicapped, and the
    one biped joins in. His innate importance is signaled by his
    Iverson jersey, keep in mind this is 2006. That’s your
    metaphor for an aspirational, westernized, privileged but still
    socially conscious young man in India surrounded by… the
    rest of India.

    III.

    My interest here is not the tricks the ad uses to get you to like
    Guinness, but what the fact of the existence of such an ad says
    about American men today. It’s bad. It’s really, really bad.

    Let’s go back to the assumptions the ad makes about its target


    demo. What is the target demo? Think about this. Not who
    drinks Guinness already, this is not a “brand reinforcement”
    ad. Who are the people the ad is trying to attract? The ad
    doesn’t comment on Guinness drinkers, it is making
    assumptions about people who like the ad. Who is the ad
    trying to attract?
    “Is it paraplegics?” That’s a weird guess. “Is it basketball
    players?” I’m going to assume that’s code, no. “Is it 30
    something guys who play basketball and then go to bars to
    meet women?” No, that’s Heineken’s gimmick. Aspirational—
    look at the ad: who is not those men, but considers them
    masculine, sees something more masculine than themselves?

    It’s beta males. The best of men, except for actual men. What
    is a beta male? He is the kind of man who anxiously looks for
    something to identify him as a man, while doing nothing to
    become a man. For him, there’s Guinness.

    “Hold on. You’re saying that Guinness assumes if I like this ad


    I’m like, a… loser?” Yes. Or a girl. Tagline:

    Dedication.

    Loyalty.

    Friendship.

    I’m sorry, is this an ad for beer or golden retrievers? Why not


    “good nutrition” or “isn’t always yapping about her
    frenemies”? Just because the guy saying them sounds like a
    man doesn’t mean these words are branding for men. Usually
    “male” values are the things you have to teach or encourage
    people to do, like bravery, or sacrifice, or stoicism, where the
    default, the easier thing, is to not do those things. Dedication
    and friendship don’t code for men, they are too basic for men,
    they code simply for person, although women get associated
    with them because… not much more is expected of women.
    For whatever reason society has made the observation that
    women seem to be worse at friendship then men, and that
    reason is called TV, way to set the bar really really low,
    Shonda. “You’re… my… person.” Ugh, Jesus, someone
    Silkwood me. It’s not that these values are inferior, it’s that
    you can’t imagine someone else needs to praise them— or that
    any person alive or dead would feel good about themselves for
    having them— or would seek to be described this way. “I’m a
    good friend.” Of course you are, there’s no sacrifice involved,
    plus it gives you someone to talk at. This Guinness ad is for
    the demographic that aspires to positive experiences and
    pretend challenges buried in rhetorical cover so to avoid the
    guilt about its meaninglessness. “The cedar roasted asparagus
    has good chew. I don’t know how to enjoy it, so I’ll Instagram
    it.”

    Wheelchair b-ball is nice but it has nothing to do with being a


    man or masculinity, or females and femininity, or anything,
    and the point here is that the public’s desire to link it to
    masculinity is a sign of three very bad things: a) a pervasive
    sense of insecurity and inadequacy in many men which has a
    precise psychoanalytic characterization that I will not
    elaborate on here and which the ad reassures you is soooo not
    true, you loyal friend, you— you’re a real man; b) another
    example of the media teaching people how to want, how to
    think, in this case about themselves; c) the general public’s
    exhaustion with masculine men who don’t deliver on their
    masculinity, i.e. and e.g. getting the check.

    “I think your interpretation of the ad is wrong.” Maybe this is


    the Dexedrine talking, but I think you liked the ad. Do a
    system check: did you like the ad? “Well, I kinda liked the
    song.” Yeah. That’s why it was also in Grey’s Anatomy.

    IV.

    You may have heard that it’s hard to be a modern woman


    because of “the impossible expectations media sets”, but you
    should try it from the penis side. Not measuring up in America
    generates a distinct response in men, let’s see if I can elicit it
    in you. No? Wanna bet?

    Here’s an ad that is female analogue of the Guinness ad, i.e. it


    played on the same show and time. Let’s run the experiment.
    Storyboard: Raining. Pretty brunette in Iris & Ink trench and
    skirt sufficiently above the knee comes out of a Lean In and,
    oopsy, she has no umbrella. Oh my God, that’s so hysterical.
    So she runs to a passing salaryman and huddles underneath
    his. He’s surprised, obviously, the last half-Asian to come up
    on a white guy in the rain was The Ring and we all know how
    that ended. (Code for “Asian” by walking by a Chinese
    restaurant.) She gazes into his eyes. “We’re headed the same
    way, right?” she NLPs. “Yeah!” he responds, but five steps
    later you can see his pacemaker go off as she blue balls him
    for another umbrella that crosses their path, this time a
    basketball player’s. (Everybody still with me? Let’s keep
    going.) A few steps later, she froggers off towards the next
    passing guy, and when she settles in their eye contact lingers
    for longer than this married guy has had in a decade. “After
    you,” she says in some kind of way that means some kind of
    thing. Three more steps, and she dumps him and his thrifty tote
    bag for a luxury SUV. She closes the door, a sigh of relief. She
    made it.

    So? How do you feel? Here’s the tag line: “it’s all in how you
    get there.” Well, how did she get there?

    Here’s one interpretation: she’s a cunt, by which I mean a


    woman. The commercial represents a reality about women,
    hopping from guy to guy, taking, taking, taking. And that sigh
    at the end was what she really thinks of men. =choads.

    You’ll observe that this harpy never said thank you, she never
    even said excuse me. She just assumed it was ok, she was
    entitled, the world belongs to women, and when she got as far
    as his five and a half inches could take her, she was off to the
    next guy, black guys and homewrecking. Even better, she is
    proud of how she pulled it off, because getting to her car isn’t
    the only goal, learning how to manipulate emasculated men is
    just as important, note she never used a woman. The tag line
    reminds women that they shouldn’t feel to guilty about it, men
    are dispensable. As an aside, buy a Cadillac.

    That’s one interpretation, but the striking thing about the ad is


    how she explicitly did not slut her way from man to man. All
    she did was ask to use their umbrella— and got it. That’s the
    Female Power. What’s enraging isn’t that women are sluts, but
    that they are not sluts— that they are able to manipulate men,
    get what they want, without paying for it. That message to
    female viewers is what gets men angry.

    The problem with this analysis is that it assumes the message


    is for women only, as if women are the ones who buy
    themselves Cadillacs, and as if men would not be exposed to
    this commercial except by a wife who drags her husband over
    to it, “oooh, look at this great ad! I want a car!” But this ad
    was on at 4pm on ESPN, same time as the Guinness ad, for the
    specific male demographic that… is home watching ESPN at
    4pm, e.g. guys home at 2. What’s the aspirational message to
    those men? She’s exactly the kind of woman they wish was in
    love with them. “I want the kind of woman with max female
    power, that can get anything she wants, and that everyone
    wants, but no one can get— and she picked me.” See also
    female superheroes.

    Ok, but why does she need to manipulate men? What does the
    ad assume that women assume about men?

    There’s a gigantic error in the ad, yet to most people the ad is


    totally believable, like this is a hidden camera vid, this error is
    invisible to them; and if this error was corrected this ad would
    have never been possible. Do you see it? Why didn’t one of
    these “men” just walk her to her car? Three guys, not one
    thought of this? She’s under your umbrella and your natural
    instinct was not to protect, to help? So wrapped up in what it
    all means and power imbalances that you couldn’t just…
    behave? Ok, forget about chivalry— out of sheer selfishness, a
    hail mary longshot? Sure, no expectations, but what the hell,
    let’s see where it goes, maybe she’ll ask you out for a
    Guinness? Were you so insulted by her “entitlement” that you
    couldn’t just try? Or so flustered because a woman that you
    have stripped of her ordinary humanity and forced her to be a
    symbol of value chose to be near you, your brain couldn’t
    figure out what to do next? In which case her decision to leave
    you for another umbrella was astutely correct, odd how she
    and the commercial knew that. All men are good for is an
    umbrella because she cannot rely on men to act like… men.

    The point is not simply that those men should have walked her
    to her car, the point is that the ad knew with 100% certainty
    that it would not occur to any man watching to do this; that it
    would not occur to any woman watching that it’s weird no
    man thought to do this. Meanwhile, what did occur to men was
    that she’s a jerk.

    Look at it from your daughter’s perspective: should she date


    the guy who walks her to her car, or the guy who doesn’t walk
    her to her car? “You can’t judge based on that!” What else can
    I judge on? Didn’t you judge her based on her wanting to stay
    dry?

    “Hold on. You’re saying that Cadillac assumes if I hate this ad


    I’m like, a… loser?” Etc, and so forth. Love and hate are
    opposites for lovers, not ads, for ads the goal is to stimulate
    want through any emotion convenient.

    Tagline: Ladies, it’s all in how you get there, because you’re
    on your own.

    This is what the ad is telling women, and you, its foundational


    assumption: the public’s exhaustion with men who don’t
    deliver on their masculinity, their general loss of ambition,
    drive, respectfulness… and purpose; coupled with men’s
    haunting suspicion that their true worth— “in other people’s
    minds”— is signaled by women’s opinions of them, after all,
    money, jobs— all that is fake. Hence the need for something to
    redefine masculinity, to make it real.

    “Well, feminism has emasculated men.” Really? A girl did that


    to you?

    V.

    The Guinness ad proposes that what makes men men is that


    they don’t act like stereotypical men, if and only if they look
    like stereotypical men, otherwise they’re not men. That
    sentence is 100% correct, but it could only have been written
    by a madman. Reshoot that commercial using the cast of The
    Big Bang Theory and the entire aspirational message is
    obliterated. The mere fact that they took stereotypical-looking
    men to use as contrasts to “stereotypical men” means they
    themselves assume that “stereotypical men” are indeed the real
    men, everyone else is waiting to be labeled, by some other
    omnipotent entity, that they are close. And if this is confusing,
    just change “men” to “women.”

    It’s confusing because the Guinness ad is a mess of signals and


    symbols that you usually only see purposely mixed together
    for parody, like a Hooters waitress who also turns out to be
    really smart.
    Ok, she’s only smart at mixology and football, but to a guy
    watching ESPN at 4 in the afternoon, not coincidentally the
    same place/time the Guinness ad and Rainy Run were running,
    this signals as genius. The question is, why would the demo
    watching this want her to be smart ALSO? Look at her, what
    more do you want? Which is the same question as, why would
    the demo watching this want the Guinness guys to be “a new
    kind of masculinity”? What is the precise origin of the want?

    Look at the guy in the chair, gentlemen of 4pm football, that


    guy is aspirational you. I’m told Vitamin E is some kind of
    battalion leader, but the only reason she is talking to him is
    because she is smart, i.e. the fantasy for the viewer is that to
    talk to a girl like her he doesn’t have to be interesting,
    engaging, witty or cool, let alone young or attractive; she’s
    “smart” and likes “smart guys” so she’s happy to stick around
    and talk to “smart” guys about the things that interest them.
    Again, “smart” here carries the loosest possible definition so it
    can apply to 4pm Disney affiliates, but the point is no different
    than if she was solving for x. You don’t have to woo her on her
    terms (whatever they may be), she’s ready to meet you on
    yours.
    At this point you will no doubt think that the fantasy here is to
    be able to score a Hooters waitress or a 36-24-30 but this is
    neither true for you nor for the ad. The point for the ad isn’t
    her as physically attractive but her as a type— a Hooters
    Waitress— if she was thirty pounds heavier but still had the
    same attention to her appearance (makeup, etc), and adopted
    the style and mannerisms of hot girls then she would still
    cause that kind of approach anxiety, she would still be such a
    symbol, I’m pretty sure this is the entire gimmick of the
    Kardashians. I know this is going to sound like madness, but
    8/10 that approach anxiety is defensive, you think you want
    something you really do not want, that person is not for you, I
    don’t mean not good for you, I mean you do not really want
    this; but anyway the point here is that the ad mixes up the
    symbols as humor, to fool you into thinking that what’s
    humorous is that this type could play against type; but the
    horrifying, Ju-On reality is that the symbol ceases to be a
    symbol for you the moment she violates her own symbolism—
    the moment you get to know her— and then the want
    DISAPPEARS. Just like fear. If that ghost in the window so
    much as coughs like reality you will scale the wall and beat it
    the fuck out.

    And I know all this is true because the ads told me so, in order.
    You’re going to be infuriated at this blonde Hooters Waitress
    for only being attracted to chiseled abs and a commanding
    phallus, but even if she miraculously chose to come under
    your umbrella, you’d see suddenly she was only a brunette,
    huh, and you still wouldn’t do anything about it. And off she
    goes, a missed opportunity. And before that ignites your
    amygdala into a blinding self-hatred, you will remember that
    it’s all the cunt’s fault, and besides, never mind all these girls,
    the fact that you’re a good friend to your less fortunate friend
    is what makes you a man; but since you are not actually a
    good friend, indeed, you don’t even have any friends, well,
    this ad will signal to yourself that you are. Message received.

    As an aside, drink Guinness.


    How Does The Shutdown
    Relate To Me?
    September 25, 2013

    is Obama there?

    Everyone knows ads are propaganda, but what happens when


    you have an ad for propaganda? While you sip your first
    Guinness and try to figure out why China’s government can
    only ever shut down once, you can ponder this ad:
    The only reason you haven’t spit nitrogen bubbles on your
    screen is I haven’t shown you the other half of this
    outstandingly accurate abomination. You should get yourself a
    towel and another drink.

    I.

    Intelligent people like to tell each other that they aren’t liberal
    or conservative but independent; that Fox and MSNBC are
    biased and can’t be trusted, that partisanship, “special
    interests” and “lobbyists” have destroyed America; in essence,
    that they are not ideologues but practical, reasonable people
    who just want the system to do what’s right. Then you ask
    them what exactly “right” is, and the yelling starts.

    Intelligent people, like racists, are fluent in describing


    themselves in opposition to what they are not, but ask them to
    define themselves by what they are, tell you what they do
    believe in, and they’re lost. They have opinions on issues,
    sure, but ask for an overarching ideology and their face
    botoxes. Overarching ideology? Only people with manifestos
    have ideologies, not having an ideology is the whole point of
    being independent, the only thing they deal in is “facts” or
    “reality”, and gun to head if they believe in anything it’s
    “science.” Not physics or chemistry, but evolution. You know,
    whatever ideologues hate.

    I phrase it this way not to insult a group, but to show you how
    very easy it is to brand identify a group, because when a group
    becomes a demo it loses most of its freedom of action and
    becomes baa baa black sheep. Do you want to see the
    consequence? Turn on CNN.

    II.

    “The government shut down just shows that our government


    doesn’t function correctly!” That’s one interpretation, the other
    is that when a car starts to smoke, you pull over and fix it, you
    don’t keep going till it explodes, though I recognize the
    explosion makes for better TV. What you’re seeing is the
    ordinary back room realigning of interests and powers, but this
    time trying desperately to hide from a voyeuristic media that
    caters to a demographic, i.e. you, that believes that never more
    than three at a time colorful but poorly understood #issues will
    eventually get us to Mars. “We shouldn’t go to Mars.” You got
    your wish. Off topic, speaking of Mars, here’s an interesting
    thought: if things proceed as per y=mx+b, then the entire
    human race of the future interstellar diaspora will all be
    Chinese. Huh. What do you know, Star Trek was way off.

    Americans, by which I mean a populace propagandized to the


    Left or Right or Middle, cynically believe that “wanting to get
    re-elected” or arrogance or ideology is what’s to blame, as if
    500+ career Machiavellians are too stupid to know what an
    underemployed theater grad knows. “They should just do the
    right thing!” Who will let them? You?
    The shut down was the inevitable consequence of a
    government not permitted to compromise, smothered by the
    oppressive gaze of a kamikaze media that will kill itself and
    your country just to get a headline today. I’m starting to
    wonder if the reason it is always pretty white girls who get
    kidnapped is that the media is the one kidnapping them. And
    you blamed Bear Stearns for being too focused on short term
    profits? CNN’s time horizon is your next micturition. The
    media demands partisanship, conflict, opposing sides, but
    despite having 24 hours to fill will never, ever explain the
    interplay between complex issues, preferring to feature them
    in segments while hyping them to a crisis. Imagine trying to
    have sex always on camera, and always with a goat, and
    always with some know-it-all screaming at you, “get hard
    now! NOW! 8 seconds left! NOW! What’s wrong with you?!”
    Jesus, can I take a minute and do this privately?
    “Transparency!”

    If Senator X “makes a concession” the relevant media will


    proclaim him a loser and a coward, they don’t want
    representatives, they want cage fighters. There’s no reward for
    compromise and there’s no safe place to attempt it, either. This
    is 100% your fault, “I can’t believe how stupid these people
    are!” It’s great how you can’t find employment but have time
    to micromanage the U.S. Senate. #outrage

    If you want to know what political career disaster looks like,


    have an infinitely leggy ex-sorority girl in flesh toned Manolos
    sitting behind a glass table in perfect lighting announce to 50%
    of America that you were beat by an old woman from
    California or an old man from Ohio. “Ha ha, what a cuckold!
    Back to you, Kent.” You blame Congress? They are the ones
    who “don’t get it”? When a representative democracy gets
    crippled by what amounts to a 3x3 magic square, it’s not that
    they can’t figure out the solution, the solution is easy, the
    answer is 15 and the five is a gimme, we just need someone to
    dare allow himself to be filmed putting the 1 on the left or the
    right or the center so we can finish the other 13 numbers and
    go bomb Syria. “Wait, what? I don’t understand.” Yes, that’s
    my point exactly.

    III.

    I’m not saying the shutdown isn’t a real problem, only that if
    the news came out only in weekly format, this particular
    shutdown wouldn’t have happened. Or, said differently, if
    there was a government shut down at a time when the news
    came out only weekly, it would mean we were getting a new
    flag.

    All of what is now being subverted by the media has been


    detailed in The Process Of Government, you should read it.
    But you won’t, it has too many characters, and this is accurate
    no matter how you define characters. Come on, at least read
    Chapter XX, it’s online. Jesus, here. “Umm, It’s pretty
    boring.” I know, I know, you want to know how the news
    relates to you, and boy oh boy do I have the news network for
    you.

    “But that book was written in 1908. Based on what I’ve seen
    on Downton Abbey, things were a lot different then.”

    Well, yes, obviously, there had just been a massive leap


    forward in technology and industrialization, a booming
    economy fueling a wealth gap, temporarily course corrected
    by a financial panic “precipitated” by the failure of two
    overspeculating brokerage houses. There were also,
    simultaneously, great advances in progressive causes like
    worker’s rights and food quality, all on the background of
    decreasing importance of religion among educated whites in
    favor of science. Not physics or chemistry, but evolution.
    Tabloids were incomprehensibly popular, partisan media the
    norm. A loosening of conventional morality manifested as
    bored promiscuity, female bisexuality, and a flood of new porn
    the likes of which never existed before.

    “That does sound different. And awesome. What did their


    Millennial kids inherit, what did they experience over their
    adult lives, say 1929-1945?”
    I totally don’t know, Boardwalk Empire only goes up to 1924
    and Mad Men starts 1960.

    IV.

    The problem with blaming the shutdown on Congressional


    partisans is that the partisans on either side know exactly what
    they want. When there are specific things you want,
    compromise is usually possible.

    The public in the middle, however, don’t understand politics,


    only emotions given to them by TV, and so their beliefs are
    cobbled together in real time, improvised, as they get “more
    information.” One trending topic at a time, each vacuum
    sealed to prevent cross contamination. They don’t look at
    things historically, culturally, humanistically, or even selfishly,
    there exists no system for interpreting “the facts.”
    Compromise becomes impossible, as a simple example, when
    a “moderate” “thinks” there should be more restrictions on
    guns, they want gun owners to give up something they want
    very much— in exchange for nothing. “But it’s the right thing
    to do!” And the yelling starts, in HD.

    Worse, they proudly announce their lack of ideology by


    branding themselves as Independents— capital I, a thing, a
    demo. He willingly lessens his independence to become part
    of a group.

    The “independent” demo actually has all the textbook


    characteristics of a group most susceptible to propaganda,
    more correctly “pre-propaganda”, and by textbook I mean
    literally Propaganda.

    They consider themselves leaderless. They can have


    representatives, they can have “evangelists” but they have to
    believe that their conclusions are all their own, through
    individual reflection and objective consideration. Interestingly,
    and on purpose, they believe their brains can handle such an
    analysis, any analysis. This isn’t arrogance. They are told, by
    universities and the media, that their mind is prepared to do
    this heavy lifting as long as they are given just the right facts,
    filtered from the “noise.” “Where can we get the right facts, in
    a world of liars?” Good question, maybe the news?

    Commonly, independents have a single personal issue, say gun


    rights or abortion, but no personal experience with other
    issues, and lacking any subjective starting point, they therefore
    believe that ONLY objectivity will give them the truth. The
    less life experience they have the better; the less they’ve seen
    of the world, the fewer people they’ve argued with (in person,
    where it is real and has real consequences like punches), the
    less frequently their water balloon worldview is tested by
    people with pins, the more they will cling to the premise that
    “facts” are what’s important. In this way the one personal issue
    serves as a reference point which the propaganda exploits:
    “hey, gun advocates, did you know you like low corporate
    taxes?” I do? “Yes, because the people you hate are for raising
    them.” Consequently, raising corporate taxes is felt like an
    attack on the Second Amendment. “Liberals! Taking away our
    rights!”

    But sometimes the complexity of issues is just overwhelming,


    once in a while reality creeps in, and issues are discovered to
    be massively complicated, and anyway he has no power to do
    anything.

    No doubt this sounds depressing, he’s going to start drinking


    heavily, or become a cynic, or go the Hemingway. So the
    media=propaganda fosters his regression towards a much
    desired solution: total alienation. The media explains how
    things relate to him, and as long as he understands what’s
    going on, he feels empowered. He is given an ideology
    without even knowing it. Now he doesn’t actually have to do
    anything, indeed, it’s way the hell better if he does nothing.
    All that’s required is support, and through his support not only
    will “the right things” happen but he’ll share in the credit.

    You’ll counter that there are right leaning and left leaning
    independents, isn’t there a difference? but this misses the
    point: propaganda doesn’t try to get you to believe something,
    but to do something, and in this case it is to do nothing— it
    doesn’t matter what you choose to believe, as long as your
    outrage is done from inside your house.

    This is the whole gimmick of media, not polar but triangular,


    right, left, middle, mobilizing an army of assonauts to feel
    strongly enough about something that they don’t do anything.

    I already knew that “independent” was a group looking for


    representation, what I was surprised by is how fast
    “independent” became a mainstream brand demo. Here is page
    2, and 3, of Time Magazine:

    The first and most immediate observation is that Al Jazeera


    assumes its American target demo is stupid, very stupid,
    because here we have what is most certainly a college
    graduate who considers herself in need of unbiased, objective,
    independent news— yet she is still reading Time Magazine, as
    her main source of in depth news. Rana Foroohar balanced by
    Fareed Zakaria, two wrongs can make a right, and “it’s
    somewhere in the middle.” She has decided that the problem
    with her understanding of the world is that she just needs
    better intel. Yes, she will say intel, it sounds more objective.

    In order for the Time reader to have formed the quoted thought
    two other thoughts had to have occurred already, which in
    itself is astonishing, here they are: 1. She’s figured out that all
    American news is biased, she’s sick of the partisanship, after
    all, it doesn’t brand identify her. 2. She thinks that more
    objectivity is to be found at Al-Jazeera America.

    Why would she think this? Because she’s stupid? Actually,


    yes: the culture you know least about has all the answers,
    which is also why the Guinness ad hypermale in pre-season
    Special Olympics has chosen to tattoo gigantic Chinese
    characters on his arm to explain his ennui to himself. “It’s a
    chinese proverb, ‘That what doesn’t kill me make me
    stronger.’” I hope to God a bus tries to make you stronger. Off
    topic, as a sociological metric, you can track a chinese
    person’s first level of alienation from his culture by his
    branding himself with English-word tattoos; but you will
    know that all the chinese has been media powerwashed out of
    him when the he starts getting Chinese character tattoos. “It’s
    because I’m Chinese,” he’d explain, to which you would not
    dare reply, “yeah, I kinda figured.” To which he will then not
    reply, “I mean, I know I’m genetically Chinese, but I don’t
    really feel Chinese, but this signals that I’m part of a symbolic
    China more authentic than the actual China of my parents
    which I feel no real connection to, yet I know I’m supposed to
    feel the connection, it’s not like I can go around pretending I
    grew up on Waltzing Matilda.” To which you will not add,
    “It’s not entirely your fault, you didn’t live through a war like
    your parents and grandparents did, and anyway modern China
    resembles the U.S. far more than it does symbolic China.
    Technically, you’re alienated from your parents alienation, but
    neither are you connected to Americana either, the white
    girls/boys seem out of reach, there’s a frivolity you can’t really
    empathize with, jobs other than Law, Medicine, Science are
    unreal, and you feel like you’re always looking at everything
    from an outside that itself has no firm location.” And he’ll
    blink, confused, “truth be told, my only real association to
    chinese culture is my parents screaming at me that I’m not as
    good as ‘real’ Chinese. What can be done?” I don’t have an
    answer for you, the good news is that when you finally find
    the answer that works for you, your kids will be too old to
    care.

    Al-Jazeera America is trying to call itself “objective”, but right


    in the ad is the brand reveal: she doesn’t want objectivity, she
    wants subjectivity explained to her, she wants to know how
    the news relates to her. She wants to know: how can I, an
    organ donor in Sector 3, be part of the global community now
    that my husband is boring and my kids prefer their individual
    LCD screens? The media wants her to have an answer, after
    all, do you know how many Nielsen ratings that family
    generates, how individualized is the data? It’s not the quality
    of the news at AJA she likes, but how watching it makes her
    feel smart, unique. She’s not going to watch Fox, MSNBC and
    AJA, right? Only one of those, but AJA brands her as out of
    the mainstream, unique, open to other opinions. “I like to get
    my information from different sources.” I assume that includes
    twitter, 140 characters and an appeal to authority and you’re
    good to go at the Starbucks.

    V.

    To be clear, I’m not at all worried Al Jazeera is going to


    secretly convert this woman into a jihadist or spread
    misinformation and disinformation. I have no doubt Al Jazeera
    will be as objective as CNN, after all they took Soledad
    O’Brien from them to signal that very point.

    So when I say AJA is (pre-)propaganda, I don’t mean it won’t


    be accurate, I mean that it’s purpose is to prepare its demo for
    a certain way of life. Of course everything I’ve said applies to
    any American media— except that Al Jazeera offers
    something else the American networks don’t or can’t. If you
    want to know what Al Jazeera is really offering, take a look at
    its aspirational target demo:
    Not pictured is a white guy in a suit, because he already has
    media that’s for him, and it’s probably Fox, and the above four
    people hate it. That’s powerful branding in America: in
    opposition to what you hate.

    Women and minorities may not seem like an aspirational


    demo, but it is— not for actual women and minorities
    necessarily, but for people suffering from tremendous ennui
    who want to be part of a struggle, something bigger than
    themselves.

    They feel, without fully comprehending this to be true, that the


    only reason the American media is so partisan and loud and
    angry and urgent is because nothing really important is
    happening. Yes, there’s a countdown clock on CNN for Debt
    Ceiling Armageddon and I guess Kanye West is headed for the
    asylum but it’s all boy who cried wolf blitzer at this point. She
    heard, like you heard, that the NSA is monitoring us, and you
    know what? Meh. Though it was interesting when it was on
    The Good Wife. This isn’t to say things are going well, it is to
    say they are degrading boringly. Like the above woman’s
    marriage.

    This is what Al Jazeera promises her, not objectivity, but a


    connection to history. Our big crisis is… whether or we aren’t
    going to pay our short term debts. You think either of the four
    people above can get hyped about that? But over in the middle
    east history is happening, racial equality, women’s lib, the
    right to get an education, riots, ideological clashes— all that
    stuff is happening over there. Women are being stoned to
    death for seeing a penis, gay men, too, if you assume that at
    some point in some future these things will no longer be true,
    then you are saying that historical changes are afoot as the old
    ways are replaced, and by ways I mean men. The #OWS demo
    wants to see powerful men humbled before the t-shirted,
    tweeting masses, it allows them the fantasy that it could some
    day happen here, which it won’t because the propaganda
    worked.

    Propaganda doesn’t succeed because it is manipulative, it


    works because people WANT it, NEED it, it gives their life a
    direction and meaning and guards against change.

    Fans of AJA will probably attack me for being biased, but this
    accusation is silly. The whole point here is that the target demo
    for AJA is not smart, and I know this because no one smart
    would watch TV news. If you are watching TV news, then
    you’re not smart, this isn’t me saying this, this is TV news
    predicting this: no one smart would ever ask another person,
    let alone the news, to explain to them how the news relates to
    them. TV news thinks you’re as stupid as Time Magazine.

    If anything, Al-Jazeera isn’t the “Islamification” of the west, it


    is the westernization of the middle east. Al Jazeera reports in
    English, they have western values, and, most importantly,
    accept ads— western style ads, i.e aspirational, not
    representational. The neocons couldn’t have planned this
    better, someone should check to see if they didn’t. Two
    months of Al Jazeera and this woman will turn to her then
    deceased husband in a moment of big picture clarity and say,
    “you know, they’re not so different from us, they want the
    same things we want.” Yes. Why do you think that is?
    Evolution?

    The news for Americans, especially Independents, lacks


    meaning, direction, ideology— and they miss it, just like
    economically, they’ve been left behind. Now the news is
    artificial drama, just local crime stories blown up nationally, a
    natural disaster, the occasional Youtube video— where’s the
    Change, where are the upheavals, where are the riot police?
    We don’t have political riots here, we have high end sit ins
    near the Broadway Starbucks, and occasionally 20
    motorcycles will attack a minivan. “Is ‘motorcycle’ code?”
    That’s where we are right now, this is what the media has
    trained you for, detecting racism or hypocrisy or some other
    character flaw in the speaker as a proxy for the complexities of
    the issues so you don’t have to think. It is under these
    conditions that you expect John Boehner to “compromise” on
    something you don’t at all understand, and scream for his
    beheading if he doesn’t, all to the thrill of the media. “See!
    TLP is a right wing zealot!” See, you’re stupid. And boy oh
    boy do I have the news network for you.
    Hunger Games Catching
    Fire: Badass Body Count
    November 30, 2013

    sorry old man, I have a dress fitting to go to

    Number of people killed: 15


    Number of people Katniss kills: 1
    Number of times she is saved by someone else: 6
    Number of times she saves someone else: 0

    But boy oh boy, wasn’t she spectacular at practice, 9 targets in


    30 seconds, and then she strings up a mannequin. Take a bow.
    Badass.

    I.

    For context, here is why THG is a sexist fairy tale. It


    anticipates most of the criticisms.

    Except one. An insightful, even optimistic retort is that at least


    she’s not killing, at least she’s made the ethical choice to not
    kill anyone.

    But this insight is exactly what you are supposed to think, it is


    an illusion, and it is why my tally above is also a lie. She kills
    one person, but she is responsible for all of their deaths. From
    the very beginning of the Game it was immediately true that
    everyone but one got killed. From the very beginning, before
    anyone dies, you are guilty of everyone’s death.

    That’s the Game. It’s not like they went in there thinking, “I’m
    not going to kill anyone because I am planning to escape this
    Game.” No one backed up their pacifism with suicide.
    Katniss’s thinking is basically, “I’m not butcher, but I am
    going to try and survive.” The movie elevates her passivity
    into a moral act, which it isn’t, that’s the trick. This is a closed
    system. Whether she shoots them down herself or waits for the
    psychopath in the group to do it for her, it’s the same.

    What’s important is that this “choice” not to kill, and the


    personal feeling of morality it (falsely) gives you is how the
    system survives. Because you feel good about your choice, “at
    least I’m a good person,” you fight the system much less. You
    are less of a threat to the system because you are allowed to
    believe you’re a good person and they’re not. But you’re not.
    You killed 15 people. I counted them.

    The true criticism of the movie isn’t that it is too violent, but
    that it is not violent enough— it is Disney violence, and
    whenever you see the word Disney you should instead see
    “100% in the service of the existing social structure.” The
    movie presents “not murdering anyone” as if it were a moral
    option, as if it were true; so that you are not revolted by the
    fact that you did kill 15 people; so that you do not fight to
    change the system that forces you to kill 15 people.

    Just because the system tells you, “the other tributes are your
    enemy,” doesn’t mean it’s a factual statement, you have to
    answer the Thin Red Line question: “who’s doing this? Who’s
    killing us?”

    The Game is rigged to prevent all choice but allow the illusion
    of choice. There are Good Samaritan laws in place which
    protect you from liability if you give someone CPR in good
    faith but inadvertently crack a rib. But this is nonsense. The
    person motivated to offer CPR NEVER thinks about a future
    lawsuit, he just acts; or, in the reverse, the person who is
    nervous about lawsuits was never going to help anyway, and
    thank goodness he can blame it on lawyers. These laws have
    the perverse effect of allowing the us passive aggressive
    techonauts to observe events rather than intervene in events.
    “Come on, what am I going to do, you know the litigious
    world we live in, besides, we have paramedics for that.” So
    you’re telling me that, i.e. for example, my child got hit by a
    car on the street and instead of Airway-Breathing-Circulation
    your plan was to shift to Landscape mode? “Well…” You
    better burn off your fingerprints and move to Siberia.

    There’s going to be some who will respond with the obvious:


    “yes, but the fact is, not killing is better than killing— or do
    you think putting a gun to someone’s head is really the exact
    same as not doing that?” And some will counter-retort that it’s
    like war, if you send soldiers to fight you are responsible for
    their killings. Both arguments miss the point completely: NOT
    killing is better FOR HER, because then SHE doesn’t have to
    feel any guilt. But everyone dies ANYWAY. Not killing is
    entirely a selfish act, not a moral one, if my kid gets hit by a
    bus the driver at least did it by accident, you CHOSE to not
    help, you are WORSE, see also Steubenville. “But they did the
    rape!” But they did it for you to see, do you not get it?

    It looks like Katniss is free to make personal decisions, but no


    matter what her free brain decides, everyone around her dies
    as planned, huh, that’s odd. The only “free” choice, the only
    way to beat the Game, is not to play. If you really wanted to be
    a moral agent in such a terrible environment, you’d have to
    convince the other tributes to all agree not to fight each other,
    knowing full well that the soldiers will therefore come— that
    is the point of the maneuver, to expose the evil of the system
    instead of allowing them their deniability, “oh, we don’t kill
    anyone, the kids kill each other!” You have to sit there and
    Prisoner’s Dilemna the hell out of this and hope none of the
    other tributes breaks ranks and opens fire. It is the only anti-
    system choice short of revolution.

    The response that this maneuver puts the individual Districts


    in danger, too, is, unfortunately, part of the deal. The genius of
    the system is that it never puts everyone at risk, it presents
    them with a lie: only these Tributes are at risk. If the Districts
    themselves don’t want blowback, “we don’t want trouble”, if
    they “want” to maintain the status quo, they have to send
    people to participate. You don’t send a Theseus, you send a
    Katniss, which they did, hence another round of Hunger
    Games. She’ll look heroic, she’ll perform badassly, and
    nothing will change, which it didn’t, which is why even
    though she won the first movie there was a second movie.

    There’s going to be some of you who will be confused, “are


    you saying Suzanne Collins planned this? No way! You’ve
    totally misinterpreted—” No, no. Collins wrote the story, yet
    she is not aware herself of what she wrote; she couldn’t have
    written the story any other way than from a narcissistic
    perspective because that’s all she knows living in this world;
    or, to reverse it, had she known, had she written a different
    kind of story with a different kind of hero, it would never have
    been published, let alone made into movies, we’d be on
    Twilight 7.

    It’s here that I should SPOIL that the revolutionaries who do


    finally fight the system DON’T EVEN TELL HER ABOUT
    IT. Everyone around her is extraordinarily heroic and self-
    sacrificing, they literally drag her bad ass to the finish line at
    the cost of their own lives, so that she can survive as a symbol,
    and the rest of you dummies think she is the hero. Only a
    taught narcissistic psychology would SEE her as heroic when
    right in front of you and your eyeballs you can observe she is
    the least heroic of all. I’m not blaming you, this is the training
    we all got. The sleight of hand of such movies is that it
    presents an entirely different society (full totalitarianism) in
    the context of TODAY, in the context of narcissism as
    expected, as ok, so meaningless acts become exciting and
    meaningful acts are obscured. Huh, Mags blew herself up with
    poisoned gas. Ah well, she was old.

    But in totalitarianism, there are no individual acts— that’s the


    whole point of the totalitarian structure, that’s what it wants,
    what it wants you to become. Your acts appear personal and
    individualized but conform beautifully, they are no threat. It
    would NEVER occur to a real Hunger Games hero to show off
    for upper management, which is why no one else did it, that
    would be a meaningless act, only we today would applaud
    this, which we did, loudly. Badass. Not to go ancient history
    on you, but Achilles was the equivalent of a comic book
    superhero to young boys for two thousand years, it would
    never have occurred to any of them to applaud him for his
    trick shots. It wouldn’t have made sense. It doesn’t make
    sense. It is madness.

    There are some earnest attempts to apply Game Theory to the


    Hunger Games, what is the optimal solution? But
    unfortunately the people who do this are bad at math. Let me
    try to explain. If 2 tributes are to be randomly selected from a
    District of, say, 1000 people, then the probability of you being
    killed is…… 100%. You can double check me if you want, but
    the math is correct. And— and this is the point— the math
    becomes correct if and only if you think it isn’t.
    Randi Zuckerberg Thinks
    We Should Untangle Our
    Wired Lives
    January 25, 2014

    how hard could it be, none of those circles are actually


    connected

    Randi Zuckerberg is CEO of Zuckerberg Media, which,


    according to its 10-K, is an iphone. If you have no idea who
    she is, and you shouldn’t, then the answer to your one and
    only question is yes.

    In her considerable free time she wrote a book about social


    media. Here’s a question: why does a woman who epitomizes
    the online world need to write a hardback book? Could it be
    there’s no money in the online unless you actually own the
    online? I’m guessing that wasn’t in the book. Ok.

    I understand she gives a lot of interviews too, I’m sure they’re


    TEDy optimistic and unactionable, but she’s apparently an
    expert, shrug, here is her insight from six years of watching
    people work at Facebook: social media is a bad thing, unless
    it’s used responsibly, then it’s a good thing. Settle in for
    nuance and shades of grey, all 50 of them.

    She thinks it’s important to “find a balance” between plugged


    and unplugged life, a phrase you hear all over the plugged
    place but has suspiciously avoided scrutiny and is an example
    of media allowing you to debate the conclusions but forcing
    you to accept the form of the argument, in this case that a
    balance is what is desirable.

    I’m definitely not advocating a complete disconnect or


    complete unplug, that’s not realistic… But what I am
    thinking is that people, we’ve reached this point where
    we feel like we just need to be always on. Always
    answering emails 24/7 connected, and the pendulum
    needs to swing back a little bit for us to reclaim a bit of
    our own time…

    Someone is lying, time to figure out why. While she


    misdirected us with “pendulum” and “thinking” and “little bit”
    which are words vicious ideologues use to sound
    nonideological and “realistic”, she substituted the
    plugged/unplugged balance with work/home balance, don’t
    think I didn’t see it. Consequently, when someone/Randi tells
    you about the negatives of being too plugged in, they almost
    always blame work emails, as if the things that pay for your
    dinner are what distract you from dinner. Really? If I had to
    make a sexist yet 100% accurate prediction I’d say that it isn’t
    hers but her husband’s work emails that she can’t stand at
    dinner, I’m pretty sure that no husband has ever gotten away
    with telling his still Anne Taylored wife to put her phone
    away, “the senior partner will just have to wait, we’re about to
    say grace.” I’ll cover myself by saying that, indeed, wives do
    sometimes answer work emails at dinner, however and
    importantly if this is occurring you can be sure the wife is
    extremely, extremely bored with everything that happens after
    5pm, and this is compared to everything that happened before
    5pm which was also *yawns*. “Huh,” she soundboards as she
    one thumbs a text to anyone else, “Obama said that, you don’t
    say, pandering to the flavor profile demo, what are you gonna
    do.” I’ll be first to observe Obama has failed in every
    imaginable way, but Jesus, if that’s your dinner conversation,
    just Jesus. One of you should cheat just to force the eye
    contact.

    Email is a convenient scapegoat not just because “family time


    should be protected” but because it gets us out of inquiring
    what went wrong with our home life that we could ever be
    tempted by work emails, and the avoidance of this inquiry is
    highly suspicious, i.e. on purpose. “Honey,” she says putting
    down her Trader Joe’s summer salad, “I gotta take this.” Only
    in America does gotta substitute for wanna so we can avoid
    the guilt. #behavioralgenetics. You may recall
    industrialization/capitalism/Carousel of Progress’s great
    promise of fewer working hours, and for the most part this has
    come true, please observe what we have done with our
    increased leisure time: filled it back up with work. There was
    some consternation that evil capitalism had forced Target’s
    employees to work all day on Thanksgiving, “no respect for
    tradition or family time!” But how many of them wanted to be
    home on Thanksgiving? The customers sure didn’t, they were
    willing to camp out/throw down to get in a store what they
    coulda got easier/cheaper/faster from their Zuckerberg Medias.
    “But the store itself has the responsibility to respect tradition!”
    And only in America do we want the system to force us to do
    the right thing so we can take the credit.
    #behavioraleconomics
    One of our time’s great sociological questions is why we filled
    downtime back up with work, and the reason is it’s better than
    alcoholism. At some point during the Truman Administration
    home life became more stressful than work life, where
    stressful is defined either as hysterical drama or rheumatismy
    boredom, and by Reagan II the home was no longer a respite
    from modern society’s incessant demands to produce or at the
    very least a place to get a nap. Home became work, it became
    a work, and not coincidentally this parallels precisely the
    history of homework. (“But don’t you think kids get too much
    homework nowadays?” Sure, if you’re doing it for them, you
    have become so myopic about your kids’ possible trajectories
    that not only do you think faking their grades is their only
    hope, you think that will work.) Neither is there home cooking
    at home, Trader Joe’s does it cheesier and anyway it’s on TV.
    The XYs have long been resigned to this, hence their desire to
    “get an early start” or eat their lunch in their cars, while little
    girls were hooked on the potential of a fulfilling work and
    home life, or at least work or home life, now women are in on
    the reveal… and it is shaking their very souls. WTF. If home is
    stressful for adults, think about how bad it is for teens, all they
    want to do is hang out and talk about how phony everything is
    and instead they’re stuck upstairs with Snapchat while
    listening to their parents masturbate in separate rooms. Better
    than listening to them divorce, I guess.

    Part of the reason work and home keep mixing despite our
    professed desires is that that’s how Americans were taught to
    see an aspirational adult life. In every TV show and movie
    after Leave It To Beaver the gimmick has always been that the
    protagonist’s job and personal life overlap— doctors in love,
    CIA agents defending their family, late nights at the office
    trading zingers or abuse stories. While we no longer think we
    want the overlap, the shows reinforced the false psychology
    that a person is something, all the time and everywhere, and
    the backdrop world “sees” it, accepts it. This applies just as
    much to negative depictions of work/life overlap, e.g. the
    obsessed cop whose wife is now divorcing him because of the
    job: the point isn’t that the overlap is “good”, that’s not the
    aspiration; the point is that the structure of these depictions
    represents the fundamental narcissistic fantasy: a fixed and
    clear identity— a character— seen by a potential audience.
    This is why home is not relaxing: we are working to not let it
    be all that we are.

    Work, email, and Target’s hours, expand to fill the time


    available, by request. We took one look at the void and lack of
    interesting 5pm TV and started texting to anyone as fast as we
    could. The truth is we’re not overwhelmed by work emails, we
    just laid them on top to make it seem like we’re buried in
    work. Here’s your #OWS update: work doesn’t bleed over into
    home because capitalism is evil, work bleeds over to home
    because we have no idea what else to do at home, and thank
    God we can blame it on work. “But capitalism reduces human
    relations to market relationships.” Oh my god, feed Bobby for
    a second, I have to totally tweet that.

    II.

    Together with work emails, the social media evangelists will


    lump in porn and gaming, because those are seen by the
    person in the doorway as “bad.” Their inclusion in the
    plugged/unplugged balance is to get you to accept the form of
    the argument—that there is a moral balance: work emails,
    porn, gaming= time away from human relations= bad; while
    things like Facebook and texting are “used responsibly can
    connect us all”, these require a balance. “Balance” means “not
    at dinner”, though even this is nuanced, because while you
    shouldn’t check your Instagram during dinner, it’s perfectly
    acceptable to post to your Instagram during dinner, pretty sure
    that’s what it’s for. Here’s a foodie tip: the secret ingredient in
    every Instagramed delicacy is salt, and blowing the whites.

    The false dichotomy of “the balance” starts even earlier with


    reversing the direction of the vector of plugged/unplugged.
    “You need to unplug” assumes the default is plugged, but the
    vast majority of our response to the blinking blue light is a
    volitional search for anything else but now. It’s worth recalling
    that the phrase, “you need to unplug” came from The Matrix,
    and the phrase was important because it had an ironic second
    meaning: not “you need to stop drawing from the Matrix” but
    “you need to stop feeding it at the expense of your life.”

    “But the internet is soooooo distracting.” No, it’s not. A


    headline like, “When It Comes To Pubes, You Have The
    Following Options” feels like totallies but after ten thousand
    or so similar headlines, aren’t you wise to the bait and switch?
    I frequently get emails informing me that there are sexy
    singles available to chat right now, and I never click on them
    anymore. On some site I saw a story to the effect, “You’re not
    going to believe what a kitten and Miley Cyrus did at the
    AMAs!” Not believe what? That a Disney approved character-
    actor “won the internet” by pretending to sing a song written
    by the middle aged white guy who writes all of the 3:40s in
    front of a stage background of the hackest internet meme of all
    time— and together they cried like girls? “This. Is.
    Everything.” Yeah, I believe it.

    tell HarperCollins that women will like what you tell them to
    like, just get a boob to promote it

    Haters beware, clicking on a link because “I can’t believe a


    stupid person actually wrote such a a stupid article about a
    stupid thing” is 100% the exact same mental process, and
    anyway, the system doesn’t care about your motivations, so
    long as you act in the required direction.
    “OMG, you’re referencing something that happened like, three
    months ago?” But it was the top story at the time— so it
    wasn’t that important? You think you’ve forgotten about it
    because it’s pop culture stuff, but this is wrong, you’ve
    forgotten about it because you are conditioned for novelty, so
    all topics become forgettable, which, in the logic of the
    system, is sort of the point of the technology. “Come on, that’s
    just a bunch of BS, of course we can distinguish between pop
    crap and things that matter.” Yes, but when the dopamine falls,
    you won’t care. #SandyHook
    “So because social media is mostly a waste of time, we should
    shut it off and be more present in our offline relationships?”
    No, that’s what the internet paid Randi to tell you so that the
    default=plugged. This standard criticism of social media and
    texting is backwards: it doesn’t detract from real life
    relationships, it represents a much desired break from them.
    Having to be with someone, especially someone you’re not
    having sex with, especially someone you’re not having sex
    with anymore, is very, very hard; having people see you,
    especially when you’re not amidst the symbols that you
    believe form your “real” identity— say, a hedge fund trader
    who has to be home with the kids or a pretty girl in a sweats at
    a supermarket— this is a kind of exposure far more
    embarassing than any selfie. What if they confuse that as the
    real you? You can see a version of this in married couples who
    talk to each other, joke, eat, raise kids, do couples stuff, but
    don’t make eye contact. Avoiding eye contact is a way of
    keeping reserved a part of yourself, to yourself. “I’m here,”
    you whisper to yourself, “but I’m not going to let this all
    overtake me, I’m more than this.” This message is strictly
    internal, after all, you may not be looking at them but they can
    still see you. Avoiding eye contact is avoiding a full on Sartre
    moment, the “scrutinous gaze” of the other. “Umm, first of all,
    scrutinous isn’t a word, second of all, Sartre called it ‘the
    look’.” Um, hello? My eyes are up here.
    What the couple should have done to avoid this calamity is
    formed a shared identity, “this is us”. But how were they going
    to do this? Everything conspires to drive them apart, hell, even
    a big tent TV show would be a shared hour but media loves
    multiple Nielsen boxes so just go buy yourself another
    flatscreen and watch your own targeted ads. On the other hand,
    when TV ignores demography and tries to make a show for all
    audiences, you get Laverne & Shirley, and you get it for eight
    seasons, so I admit there’s no easy solution. “What about not
    watching TV?” Hush your crazy mouth, telling America not to
    watch a Disney network is a non-starter, and for clarification
    ESPN= (0.5)Disney; the Princesses, Thors, ABC, the theme
    parks— all that combined is merely the other half. Now you
    know what’s a stake. The NFL’s been handing out traumatic
    brain injuries for decades, but the moment Disney decided it
    needed the women that was the end of lockerroom hijinx. But
    until it completes the NFL’s rebranding as a kinder, bully-free,
    concussionless game, complete with engagement rings and Us
    Weekly‘s “Ten Hunkiest White Or Articulate Quarterbacks”,
    it’s going to have to keep broadcasting Nashville. Please don’t
    make the mistake of assuming that the NFL wants female
    viewers, it couldn’t care less, the ad dollars from beer and
    trans fats and cars are plenty. What the NFL/Disney needs is to
    reduce the tension between females and males over all that’s
    spent on it: merchandise, tickets, time, men would gladly
    watch all the commercials on Sundays if women didn’t drag
    them to baby showers and home repairs. Sports are male
    expenses that women reluctantly accept, but there’s always a
    ceiling and if women were more into the experience then that
    ceiling could go up, way up. The key is to rebrand the NFL not
    as a man‘s game but as America‘s game, thus reducing the
    barriers to consumption.
    (“You know, you could use an editor.” You could use some
    free association, it may help you see unconscious connections
    which drive your life. “I find that weed helps.” Amateur.)
    The only shared identity these couples pull off nowadays is
    “the kids”, which is why they can make eye contact easily
    when they talk about them. But relationship experts have
    analyzed today’s marital difficulties completely backwards:
    rather than trying to find some common connection amidst the
    the turbulent waters of life, they are actually struggling against
    the current of the relationship to keep themselves private. This
    is what they practiced for two or three decades, how can they
    unlearn the skills? They fought so many years to be seen as
    individuals, “be true to yourself”, a few years past the
    exploratory segment of the relationship and a shared mental
    space becomes suffocating. So for them, plugging in gives
    them some privacy, a micro-break from shared reality, under
    the rhetorical cover of “connecting with others.”
    But why do we need “the balance?” What does it replace, what
    went missing? The very thing Holden Caufield hated:
    “phoniness”, protocol and ritual for seemingly no purpose.
    Politeness is fine, but why do I have to make small talk? Why
    do I have to pretend to care about the weather? Why, after a
    decade of marriage, should dinner be a regular review of the
    somewhat boring goings-ons of “the day”? Because that
    formality is freeing, it allows self-conscious physical bodies to
    get used to standing next to each other without having to be
    acting, this includes husbands and wives. When dinner is a
    controlled process with “manners” and expected topics of
    shared conversation and start and end times, as boring as it
    may get, it is boring, not you. Women are especially sensitive
    to this absence of convention, this is one reason for the
    popularity of Downton Abbey, not to mention alcohol and
    iphones at dinner. It is against this background of “phony”
    convention that teens can productively “rebel” and find their
    own individuality against a status quo; fighting against an
    emotionally illogical, arbitrary, unpredictable structure results
    in learning the opposite lesson, “whatever gets me through the
    day…” Without this structure to social activities, when the
    “natural” conversation stops being interesting— and it will,
    even if most of you weren’t bad at it— it would be a judgment
    about your relationship, about you. And you’ll beg St. Jobs to
    blink a path to safety because otherwise you have to sit there
    with no existential support.
    Texting and social media’s slowness gives them their power
    for this purpose. You read a text, and it lingers, it keeps your
    attention because it’s all there is; and then you respond with a
    piece of your real self, and wait for a response… what’s
    happening is time travel— while you are on pause, the rest of
    not-your life goes faster. It is far more efficient at killing time
    than a phone call.

    III.

    What no one will ever say out loud for fear of being labeled -
    ist is that “finding a balance” is something only women are
    encouraged to do. For men it is supposed to be binary, on or
    off. “Honey,” the wife says without making eye contact,
    “please put your phone away.” —But it’s the senior partner.
    “He can wait, we’re about to say grace.”
    Unlike men, women, as a group, are constantly being
    reminded by the media that social media is a necessary use of
    time— just find a balance. To be precise: it is not marketed as
    a diversion, or useful, or helpful or fun— it’s necessary to their
    existence. The danger is branded as “excess.” And this
    coincides their role as the primary consumers and
    consumables, which is why Randi’s stupendously uninsightful
    book is being heralded wherever online women congregate.
    The book itself isn’t meant to be read, it can’t be read, it can
    only be hurled. It is a MacGuffin; her interviews aren’t
    promotions for the book, the book is an excuse for the
    interviews. No, of course she doesn’t know this. I’m sure she
    thinks she’s talented and smart and fiercely independent (two
    fingers to the sky!), but getting her to televangelize about
    finding a balance (=the default is plugged) to her demo of
    underachieving credit card applicants is what suits the suits.
    “How come Facebook’s board has so few women?” ask the
    very women who would rather use it than run it. Randi also
    wrote a children’s picture book about a child who is obsessed
    with her ipad but “learns to unplug once in a while”, tellingly
    even though Randi has a son she wrote the book about a girl—
    a girl she named after the internet. Get it? Because she can’t.
    However, not all women are the target demo of Randi’s lip
    synching, the CEO of General Dynamics is a woman, I think
    she has a higher security clearance than the entire Senate, and
    I know for a fact she builds alien spaceships, why not
    interview her about how she uses social media to promote her
    brand and make connections and break ceilings? Because
    there’s no Like button for hard work or triple integrals, which
    is doubly interesting because calculus was invented to make
    hard work easier. “I just don’t get math.” Can’t do math if you
    weren’t taught to think logically, and logic is tough on kids’
    self esteems and makes them way less submissive, easier just
    to put on a video. “They’re obsessed with the Wiggles.” And
    apple juice, whose fault is that? So instead of “if you do the
    same amount of hard work as everyone else, you should end
    up in the exact same boat as everyone else, and it will sink
    because none of you know anything about boats,” we get
    Randi Zuckerberg, a lot, who tells us about the occupational
    hazards of posting baby pictures:

    First yawn? Adorbs. Facebook it. First hiccups?


    Obviously all my friends want to see that. Snoozing in a
    park? OMG, soooo cute! Who wouldn’t want to see baby
    photos 50 times a day?

    I soon found out. I had some pretty honest co-workers,


    and one day one of them decided to give it to me straight.
    “Randi,” she said, “Asher is adorable, but you can’t keep
    posting a zillion baby photos. You have a professional
    reputation to uphold.”

    I just got the bends. What the hell kind of profession could she
    have had that she’s on Facebook all day and then the only
    criticism she gets is that her pics are of babies? Observe that
    the discussants are both women. Who does woman B believe
    will judge Randi harshly for her baby pictures? Men?
    All this worry about baby pictures vs professionalism exists in
    the minds of women, not men, which is why this was in
    HuffPo, using the atemporal logic of narcissism: if baby
    pictures can sabotage a woman’s professional reputation,
    therefore she has a professional reputation. Men are irrelevant
    to this discussion, a man would never bother to tell Randi
    anything because the minute a professional man sees a
    professional woman’s baby pictures, she’s moved from Bcc: to
    cc:. A Cosmo-feminist will hashtag this as evidence of
    inherent sexism, but you may want to wait a few paragraphs
    before you hit RT.
    The easy “male” criticism is to say that too many baby
    pictures reveals her head isn’t in the game, she’s not focused
    on capitalism and destroying the competition so her boss can
    make more money. “Wait, what?” Don’t overthink it, it’s a
    magic trick, you’re being permitted to debate the
    consequences because you’ve unknowingly accepted the form
    of the argument.
    It’s not that babies are more interesting to women than men, it
    is that baby pictures are more interesting to women than men.
    Men would rather look at a picture of a used condom than a
    baby, this is a scientific fact. They get that the baby is precious
    to you, but there is nothing otherwise in a picture to connect
    to. Furthermore, showing a baby picture to a man is an
    aggressive act because it demands a reaction, you showing
    him a picture of your baby is entirely for your benefit and not
    at all for his, it is a dare, in much the same way as a woman on
    a first date telling you she doesn’t play games is a dare, a dare
    you shouldn’t take, trust me on this, overpay the check in cash
    and run. I’ll grant that there is some level of bonding that
    occurs between women over baby pictures, worth exploring
    later, but not for men: men will only (and rarely) show photos
    of their children doing something, the activity is what
    represents the kid as kid and them as a parent. Showing a man
    a baby picture is equivalent to showing a woman a picture of
    his car. “A #baby is more important than a car, dontcha
    think?” Yes, but a picture of a baby isn’t more important than a
    picture of a car. “Yeah, but—” I know. Logic is mean.

    In the world where the media postulates social media as an


    absolute requirement of the modern era— the era where
    everything is fetishized— no one is permitted to make the
    distinction between a value and the picture of a value, they are
    made equivalent, so daring to criticize Randi’s baby pictures is
    made to sound like misogyny or misobaby. It’s not. I love food
    but if you ask me to look at a picture of a food I will poison
    your toothpaste. Be careful: the point is not that a woman
    shouldn’t post her baby pictures, the point is that the system
    cannot profit from her baby except as a photo, so that in order
    to get them to do it more— to be online more— the system
    teaches them to overvalue the photo; and this must necessarily
    be at the expense of the object itself. #porn.
    And here again you glimpse the long con: a power struggle
    packaged as a gender war.
    Usually you imagine “sexism” as a pervasive institutional
    power directed top down against you, oppressing you with
    sexist jokes or heels at work, but it’s much more illuminating
    to understand sexism as just another tool to increase
    consumption. An obvious example: it costs women more to
    dress professionally, even though they get paid less. But
    sexism can be run in the reverse, too, for women’s “benefit.”
    Example: We say things like “the public has a ravenous hunger
    for celebrity photos,” but this is demonstrably untrue,
    paparazzi pics are almost entirely a product for the female
    demo, no man wants to see a picture of any of the Kates or
    their babies or their homes. However you will never hear this
    said out loud in the media, they will tell you (and you will
    parrot) that the greedy force that creates the paparazzi is
    “America” or “the public’s obsession with celebrity”— men
    are lumped in with women. Men’s relationship to celebrity
    after teenage years is completely different, the pictures matter
    much less than “information”— a pic of Lebron is worth way
    less than his stats. But the easy money is in digital photos,
    monetizing envy has very low fixed costs and great margins,
    and nothing can be permitted to threaten the money, so when
    Princess Di is driven off the road we blame the paparazzi; but
    then, in a surprising admission of guilt, the media comes out
    and accepts some responsibility— although in a very specific
    way: “the media has succumbed to the ravenous demands of
    the public‘s infatuation with glamour and wealth.” Because if
    everyone— not just women, but everyone— wants this, then
    women have less guilt about wanting it and men get the sense
    nothing can really be done to change it. Do you understand the
    infrastructure that is necessary to cause people to disavow
    something that they know with total clarity, just to keep the
    money flowing? The moment male America decides out loud
    that we’re harassing actors and actresses not for “our” prurient
    interest but for women’s prurient interest only, to the media’s
    financial benefit, they will require an open carry permit for
    telephoto lenses; tell them gays also like Us Weekly and they
    will repeal the First Amendment. Believe it. The system
    repackages a female product as a “public” product to get it
    past the hairy misogynists who hate women’s media because it
    doesn’t wisely use a ball, and if a couple of celebrities have to
    be harassed or die for their ballless entertainment, whatevs,
    there’s no reasonable right to privacy on the street or on a
    beach. The consumers are women, the rest of you pad the
    numbers. “It’s hard for me to tell what side you’re on here.”
    Sides: the form of the argument you’ve been trained to accept.
    Still not convinced? Swap out “America’s celebrity culture”
    with “America’s gun culture” and “male America” with
    “Senator” and see which Amendment gets repealed. “Now I’m
    totally confused what side you’re on.” Jesus. Just Jesus.
    It’s right about here that I should again remind everyone that
    for five decades we’ve been repeatedly assured that men are
    visual creatures. Time to rewrite the evo psych texts to support
    the new economy.

    –
    Part 2 here
    Who Can Know How Much
    Randi Zuckerberg Is Worth?
    March 1, 2014

    cue hatred

    Part 1 here
    IV.

    Off topic: Randi strongly believes Facebook has a legitimate


    place in the business world, and this makes me think Facebook
    is finished. I realize this is a speculative trade to make. The
    usual anxiety about Facebook’s future is that teenagers aren’t
    interested in it, but the more relevant demo here is adult men,
    especially the ones in suits. Facebook runs 60/40 women to
    men. In the language of self-aggrandizing social media, that’s
    a tipping point. 5% more estrogen and Facebook will be
    perceived as a women’s site and no guy will want any part of it
    except for guys you will want no part of. Hush yourself, you
    have your sexism backwards: The instant a woman notices a
    man flipping through Facebook and one eyebrow goes up, you
    can head to your car and beat the stadium traffic, the game is
    as good as over. That’s what happened to Myspace. It tipping
    pointed into “unemployed/some high school” and The Ruling
    Class had to sell it to Ima Holla Achoo for 20x less than they
    bought it. Now it looks like Windows Mobile, which is
    demographically appropriate.

    Lose the men and you’ve lost Big Business, and at some size
    point a technology needs Big Business to want it, which makes
    Pinterest more valuable than Instagram and WhatsApp
    completely worthless. This is the story of Blackberry. The
    conventional wisdom is that people didn’t like their emails in
    monochrome and preferred the sleek and sexy iphones, but
    you probably remember all the business casual salarymen
    proudly carrying around two phones like some bourgeois
    Frenchman with a dignified wife and a touch sensitive
    mistress, a couple years in a guy’s going to get to thinking,
    “what am I, a Mormon, how did I end up with two wives?”
    When Business was henpecked into supporting the iphone,
    Blackberry went sadly into menopause and defiantly into
    Africa. Plausible deniability requires that I do not explain how
    layered a joke that is.

    V.
    I want to believe that Randi Zuckerberg is delusional, that
    because she is so wealthy and famous she sincerely believes if
    you take a MacBook Pro to a Panera and start a mommy blog
    or a particle accelerator, follow your passion, you should be a
    TEDx speaker in no time, but don’t forget it’s hard work,
    money isn’t everything, and take time out to unplug!
    But this person was at Davos. Now I’m confused, was the
    invite Mark + 1? That’s the easy criticism to make, that she’s
    famous only because of her brother, but nepotism only gets
    you so far, Mark has a much more intelligent wife who just
    graduated medical school and no one is interested in her, and
    when the media has no other choice but to acknowledge her
    they do this:

    I know, I know, it’s probably photoshopped. Still.


    So on the one hand the media has no idea what to do with an
    Asian physician except depict her as a borderline psychopath
    on Grey’s Anatomy, on the other hand they are excited to
    interview a lunatic who broadcasts the appearance of
    excessive action— frantic activity as a defense against
    impotence— that’s what the demo wants, and if you’ve been
    paying attention you will understand the translation: since the
    target demo has no idea what to learn from the experience of
    an Asian woman who despite marrying the Powerball became
    a physician anyway, you get Davos updates from a woman
    who plurals adjectives. This isn’t a criticism of her, it’s a
    criticism of you: what do you expect to gain from all the haste,
    the energy, the “finding ways to be creative?” Unlocking
    creativity is the third biggest swindle perpetrated by
    managment consultants, after open floor plans and managment
    consulting. Creativity was never the problem, the problem was
    always the math.
    Randi probably read her book herself and I don’t doubt that it
    took months to come up with the phrase “dot complicated”,
    after which she needed a vacation, but she doesn’t understand
    why she wrote the words she did, what forces were acting on
    her, and what these forces wanted from her that she was
    elevated to celebrity status. Consequently, her demo doesn’t
    understand either: they think she’s an idiot. This woman went
    to the World Economic Forum, which you probably think is
    irrelevant and you’d be right, but grant that they are at least
    pretending they are relevant; yet they still allowed her in,
    knowing full well if anyone found out it could completely
    obliterate their legitimacy. Why take such a gamble, to what
    possible benefit? Look, if Scarlett Johansson is going then at
    least you can say Scarlett Johansson is coming, I totally get it,
    but putting Randi Zuckerberg on the brochure should be brand
    annihilation.

    for the sake of this premise, pretend she came to the 2014 Davos
    “I’m pretty sure that’s Charlize Theron, not Scarlett
    Johansson.” And I’m pretty sure they’re the same person, and
    just because now she’s Rachel Maddow doesn’t mean she’s
    serious. “But she did actually do serious humanitarian work.”
    Yes, great, how about that. Is there a blonder picture we can
    use for the flier?
    It’s probably very frustrating for whoever that woman is to try
    being anything other than whatever she is because no one will
    see her as anything but that, but this is the nature of the trade
    off: you spend your life trying to be seen as something, then if
    you happen to succeed then you will not want to be only that
    anymore, you are really something else. But the world and/or
    your girlfriend won’t listen. This is especially hard if you
    simply age out of it, you want to move on with new ideas but
    the jerk in the supermarket wants you to be the person from
    ‘99, which means that the jerk in the supermarket still is the
    person from ‘99 and can’t understand how calendars work.
    “You changed!” he hisses with disgust because you fail to
    normalize his cortical sclerosis. Sigh. You can’t punch him,
    there are witnesses. There are always witnesses, and they will
    all be from ‘99.
    VI.
    You would be forgiven for thinking Randi was at Davos
    merely because she’s rich, but consider that Warren Buffett
    was not there. He’s a capitalist, not a globalizer, so his brand
    doesn’t synergize, in fact, he is the competition. “No, he
    knows Davos is irrelevant!” So why does he go on CNBC?
    Buffett is a CNBC favorite, but what’s so remarkable about his
    appearances is that while he is branded as a sober “buy and
    hold” investor, he is only ever asked about short term trends:
    are we at a bottom, what will the Fed do tomorrow, etc. Why?
    You know what he’s going to say: “You want to buy good
    companies when they’re undervalued,” he’ll intone over a
    cheeseburger, callously unaware that there are only 7 minutes
    until the close. —What about Facebook?! Buy at 57?! “Oh, I
    don’t know anything about those new fangled tech stocks, I
    liked Wrigley’s as a child, I understand the company, it offers
    durable competitive advantage.” —Oh, Uncle Warren, you’re
    so out of touch! (But the rest of you understand Facebook, you
    liked it as a child, doesn’t it offer competitive advantage…?)
    What does Watch Us With The Sound Down And Feel Like
    You’re Active need him for? It’s not his words, it’s him, he’s
    the draw, he is the aspirational image of the demo of 35-54yo
    hopefuls: “Someday I’ll be old, but when I am, I’ll have
    become rich through the market.” So keep trading.
    And here I have to go back over something. The harder part of
    the psychology is that the demo doesn’t want to become full
    time traders, either at home all day or on Wall Street— that
    part must remain a fantasy— because then it would be a job
    and it wouldn’t count; it has to be a side gig, then their success
    wasn’t their “work self” but their “real” self; no one else can
    claim a sliver of that success— not the liberals with their
    “‘entrepreneurs’ just pretend they don’t benefit from public
    services!” or the wives with their “behind every good man…!”
    or the echoes of their father yelling, “you need to apply to
    Sperry Rand, now there’s a company you can put in forty
    years with!” It all happened in their head, no one else can
    share the credit, it is 100% a consequence of their personal
    value. Bonus: if they fail, it can be quickly discounted as
    merely a hobby— that wasn’t, after all, their real self.
    The mistake is in thinking this has anything to do with the
    money. It’s said that most at home traders fail, but this is
    incorrect: they fail at making money, but they are successful at
    feeling like a trader. That is the goal; the money is secondary,
    which is why they fail at making it. The buy/hold/reinvest the
    dividends strategy of Buffet is totally opposite to what’s
    desired, because the strategy does not involve market timing
    or status updates, it is on autopilot, and there’s no “i” in
    autopilot. Well, there’s one, but it doesn’t stand out.
    The trading activity itself— the frantic activity— keeps the
    rest of reality away. You’re not your job— you’re something
    else. You’re not your family, you’re more than that. Things
    have the potential of possibly happening someday, and no
    work will have been necessary to accomplish it. Just you wait.
    But even that’s not true. The hardest part of the psychology is
    that feeling like a trader isn’t the final goal. Turn CNBC back
    on, there’s Buffett, and oh, look, there’s Peter Schiff. Peter
    Schiff is another CNBC favorite, and his presence is even
    more incongruous until you understand it isn’t. Whatever your
    opinion of his opinions—
    debt/inflation/government/armageddon— his are more
    political than financial or macroeconomic rather than technical
    and anyway they are 100% long term opinions. He may tell
    you to buy gold for the coming collapse, but you have a few
    years to open a position. So why is he there? “Because he’s
    right!” No— why is he on Fast Money?
    Here is the unspoken fantasy that explains the presence of
    Warren Buffett and Peter Schiff on CNBC: “Someday I’ll be
    old, but when I am, I’ll have become rich through the market.
    And then people will want to interview me.”
    VII.
    Swap out the demo, and this is Randi Zuckerberg. She
    believes she is worth all her money, she believes she is more
    than Mark’s sister, she believes she has valuable opinions.
    Anyone who disagrees is a hater. You’re just jealous. “No,
    she’s a fool!” Then how come she’s so rich?
    Those who are enraged by her are actually suffering from the
    same delusion she is, which is why her target demo as seen by
    Davos includes her haters. The standard criticism of her is that
    she didn’t really do anything to deserve her money— “she got
    rich because of her brother”— but this is a profound disavowal
    of the reality: she got rich because of timing— even though
    her job at Facebook was trivial, she was there from the
    beginning and got paid in stock options. What’s interesting is
    that no one makes this criticism of her, because that’s what her
    haters believe is supposed to happen to them. She timed the
    market the way you’re supposed to; what she did that makes
    her hatable, therefore, is that she had inside information.
    I don’t begrudge anyone the good fortune of right place/right
    time, take your money and run, but first drop a knee and be
    humbled before God reflecting soberly on the knowledge that
    you didn’t deserve it. I love getting paid, do whatever you can
    do to get paid, but do not let the money whisper to you that
    you are worth it, it will be lying and you will believe it. You
    hold a fetish of value and not actual value. But even her haters
    want the money to mean retroactively they were already
    deserving of it, this kind of fortune has bypassed reality testing
    and instead creates a new reality, it uses the truth in order to
    lie: of course I’m not rich because of my work product, duh,
    you can’t measure a human being’s value based on his labor.
    I’m rich because that’s what I’m worth. “Isn’t that specious
    reasoning?” Oh, dear, sweet, earnest, Lisa, I want to buy your
    rock.
    And so the hatred of her, like all hate, is revealed to be a
    defense. To her haters Randi is a buffoon, a step above
    relationship expert, she is too glaringly undeserving of that
    money; Randi is an obscene counterexample to the logic that
    the payout mirrors value and self worth. She is a narcissistic
    injury for everyone else. So she’s disparaged in a specific way:
    she doesn’t deserve all that money because she got it from her
    brother.
    VIII.
    Not coincidentally, this is the narrative of Davos to the demo
    that, unlike Randi, will never, ever, ever be rich; but to whom
    Randi represents a possibility of it: with globalism comes the
    possibility of a lifestyle independent of your work product,
    and, more deeply, that your self-worth will finally be
    recognized by the world that is happy to pay you just for your
    individuality. Why wouldn’t it? Your baby pictures are
    adorable.
    To be clear, it’s not a lifestyle that could be independent of
    your work product— it has to specifically be independent of
    your work product, otherwise its based on something other
    than you and thus wouldn’t count. This is why one cannot
    profit from “nepotism” and “inside information”. Those are
    bad. That they are, in fact, actually bad is besides the point:
    they are the exemptions which prove you are worth your
    money.
    It’s probably unnecessary to point out that this increase in
    lifestyle is built on the increased work product of whoever will
    do it for 30 cents an hour, and anyway it is a red herring. The
    real attraction for us isn’t just the lifestyle, but that it
    systematizes— it makes normal— not ever wondering: how
    come we have more lifestyle when we didn’t do more work?
    How did that happen? In 2008 it was 1933 and six years later
    it’s 1999, what kind of bananastown calendar is this?

    no caption is possible

    Confused, I run through my checklist: was there a war? No.


    Did they invent a new technology? No. Was cold fusion
    discovered? No. Did the aliens come? Don’t look at me like
    that, did they come? Then nothing could possibly explain how
    we are all worth twice what we were worth in 2009, or even
    30% more than we were worth in 2007. “But stock prices
    aren’t based on our worth.” Then what do they reflect? Our
    productivity? Our innovation? A bet on our future prospects? I
    ask you again: Did the aliens come?
    And hence Globalism— the brand, not the particulars— is
    attractive because it is the physical manifestation of the logic
    of disavowal we already use for everything else. “I don’t know
    how it happened, but it makes sense. After all, I am worth it.”
    Economics mirrors psychology, as it always must.
    So Randi goes to Davos, never once asking why they would
    want her there? Convincing her demo of underproducing
    hyperconsumers that capitalism— controlling capital— is
    pointless and mean, but globalism— doublespoken as
    “progress”, “human rights”, “everything is connected”— that
    is a noble cause. Remember that the “culture” she thinks she
    speaks for, including those that hate her— “the startup
    culture”— is premised on starting a business in order to sell
    the business to someone else. Of course the idea is to get rich
    — which sounds like capitalism, if you’re retarded, but
    observe the message that is being taught: that the necessary
    correlate to getting rich is to give all the capital to someone
    else. The power is traded for the fetish of power. That’s not
    capitalism, it is madness, and apparently Davos and Randi
    think women especially will heart it. It’ll work for a handful of
    well publicized people pictured above the caption, “$100
    billion! You could be next!”— followed immediately by a
    story about how worthless the business turned out to be, so of
    course the goal for you is to sell out ASAP; but the vast
    majority who have aligned their psychology with this vector
    will pursue an impossible fantasy at the expense of their labor
    and their lives. If you don’t believe me, believe Lori Gottlieb.
    This logic recommended to her to drop out of Stanford
    medical school to join Kibu.com, and now she’s a relationship
    expert.
    “But capitalism exploits the worker.” I’ll take my chances,
    because when you get a taste of the money but no access to the
    capital, you are easily seduced by Globalism— the brand, not
    the particulars. Hence the Hollywood stars, hence Buffett’s
    grandson, hence Randi Zuckerberg, all who act like they
    belong there. They do.
    Every time you hear the word globalism, you should hear three
    things: 1. wealth uncoupled from work product. 2. Lifestyle as
    a reflection of your personal self-worth. 3. You give up control
    of the capital, and by capital I mean you. “Do I still get paid?”
    Sure, but you have to promise to spend more than what we
    pay. “How will that work?” Don’t worry, Visa will explain it
    all to you.
    IX.
    It is no coincidence that social media, “everything is
    connected” (the default is plugged), is a vivid metaphor for
    globalism, even as so many social media vaginalists think they
    are against globalism if it is defined as Wall Street.
    Propaganda doesn’t care about your motivations, so long as
    you act in the required direction.
    When social media is branded to men as a positive, the
    gimmick is that it magnifies their power, e.g. “the hive mind.”
    This brand is reinforced even when it is depicted as bad, e.g.
    men’s increased power to stalk, harass, or bully people. On the
    other hand, when social media is branded to women with
    interests and passions but no math skills it’s for “finding
    support” or “community”; nothing powerful is expected to
    occur there, it’s a place to feel safe, “connect” and “have a
    conversation.” Those are not accidents, and they have nothing
    to do with biology, they are the result of market research and
    50 years of very, very bad parenting.

    But my generation came of age in a world with social


    networks… we understand that the business leaders of the
    future will be three-dimensional personalities whose
    lives, interests, hobbies and passions outside of work are
    documented and on display.
    We should embrace this new world. The answer isn’t
    fewer baby pictures; it’s more baby pictures. It’s not that I
    should post less; it’s that everyone else should post more.
    Let’s change what it means to be professional in the
    Internet age. The time when your personal identity was a
    secret to your colleagues is over and done. And that is a
    good thing.

    This is a woman who hates everything. I know that seems


    unbelievable given that she adorbs baby pics and is always
    shown smiling in lipstick three shades too bright for her
    hematocrit, but don’t be fooled, her hate is transmogrified by
    money and fame and class buffers so it doesn’t action the same
    way it does for Al Qaeda, but if she had a commercial pilot’s
    license she would hit you with it.

    Think seriously about what she (thinks she) wants: acceptance


    of her individuality— by work. Not for her work product—
    there is none; but for her individuality, by work.
    First question: which work? Not the job you have, it’s real, and
    it’s boring. It is a future “career”, the fantasy environment seen
    on TV dramas where all of life takes place.
    Second question: why work? Men are not being taught to want
    their job to value them, in fact, men want as little to do with
    their jobs as possible. Randi and the globalism party bus are
    teaching women to want “careers”— more precisely, to want
    to draw more of their identity from their careers. The perk of
    taking your work home with you isn’t more money, it’s
    acceptance of your individuality. Also you get to have to shop
    at Ann Taylor. Before you seize on this as a biological flaw in
    women’s character, let me remind you that they want work to
    accept their individuality because their family and
    relationships have failed them in this regard. The only place
    they feel… happy?— is when they are at work or plugged in.
    “I know The Bachelor is mindless TV, but I just like it.” Keeps
    your husband out of the room, anyway. How great is it to be
    alone?
    Third question: what are the consequences of Randi’s utopian
    fantasy of your job valuing you as an individual for everyone
    else at work?
    She believes her authentic self, via Facebook, should be
    accepted everywhere, home and work, so the suits should just
    shut their greed vacuums and embrace her baby pictures, her
    individuality— after all, that’s why they hired her, right?
    That sounds laudable— except that she’s lying. Ok, I have to
    pretend not to be sickened by her baby pictures, will she Like
    me live-posting My Summertime Threesomes? Huh. So now
    individuality has an asterisk: since Facebook should be on at
    work, everyone’s Facebook should be nonthreatening, not
    mean, safe— work appropriate.
    “Well, stupid, just don’t put naked pics on Facebook.” Fair
    enough, but whereas before it was my poorly thought out
    choice, now it is not allowed by work.
    “Well, Facebook shouldn’t be on at work.” Duh, of course it
    won’t be on at work, no company would allow Facebook to be
    on at work, there’s work to be done. So “ok at work” really
    means “if work saw it” and “Facebook” really means “the
    internet.”
    “Well don’t put naked pics—” You’re focused on the wrong
    side of the equation. Why should I be careful of my internet
    behavior? It’s not because it can hurt me, it’s because it can
    hurt the company. What Randi doesn’t realize she was used to
    say is that your internet life better be work acceptable since
    there’s much more at stake there than at home.
    If threesomes are’t your thing, try a 2nd Amendment Fan Page
    or 10 Things I Hate About Senators and see if your job
    supports your individuality. See how close to the edge you can
    get before Facebook itself censors you. It is tempting to see
    this as a “war on men” because Randi tests as a genetic
    female, or a war on conservatives because Randi sounds like a
    “capitalism with a human face”-progressive who ran pass
    interference for the DNC in 2008, but I hope you can see that
    the force would equally oppose anything that was slightly
    outside of the mainstream. Randi needs the job to tell her she
    is valuable, and the job wants frictionless employees. The war
    isn’t on men or women, it is on individual freedom, it is
    regression to the mean by suppressing the mean, where mean
    is defined by its deviation from SFW, according to W.
    Since work has encroached on your home life at your request,
    since you’ve conflated plugged/unplugged with work/home,
    then

    “The time when your personal identity is a secret to your


    colleagues is over and done. And that’s a good thing.”

    It’s good for the company, anyway. You may be surprised to


    discover that the more replaceable you are to the company, the
    higher standards you are held to, that’s what happens when
    you don’t control the capital. Rather than fostering
    individuality and creativity, Randi is telling the organ donors
    to sanitize their internet presence so that it doesn’t affect the
    people who are profiting from your work. Consolation is you
    get to post your baby pics and work has to accept it.
    X.
    In the absence of a big payday, the only things left that can
    value us are the job, and the media. Regularly someone says
    something “offensive” in the media and the media punishes or
    fires him, and we debate whether that was justified or not. The
    debate entirely avoids the most important point: the media
    company punished the guy in media. They could have fired
    him privately, the way you would have gotten fired from your
    job if you started YZing all your coworkers. Not only do they
    publicly fire him, they force the guy to make a public apology
    first— and then fire him anyway. Who benefits? The offended
    victim?

    But as much as we say we hate their power to judge us, we


    want them to have this power— who else is going to have it?
    If they have this much power to destroy a person, then how
    much more significant is a RT? How great would it be if they
    acknowledged my worth? With no power, what other chance
    do I have? In the fantastical words of Marshall McLuhan,
    “there is no sweeter praise than the gaze of a tyrant, especially
    if it’s in HD.”
    This is what we want judging us, this is the calendar we’re
    using. Something external that can value us at 1999 levels
    while the real world is pricing us at 2008 levels. My face is in
    my hands and I wonder how anyone could be asked to raise a
    girl in such a world? Recently a female cardiologist with a
    “difficult” 10 year old daughter who had been well trained to
    want things but not control things asked me if I had read “the
    study in the New York Times”— !?!?!?!?!?— that said that
    people with the same surname, over generations, continued to
    achieve the same level of wealth, showing “therefore” that
    genetic factors were more important than the home
    environment in determining social mobility, isn’t that probably
    true? Having to do this sober I asked her, “But didn’t you
    change your surname 11 years ago? Or are you betting she can
    just upgrade hers?” What else could I say? If you read it, it’s
    for you?
    True Detective’s Detective
    March 8, 2014

    taking part in a particular pleasure


    [Pastabagel and I have emailed about the show. Some
    excerpts of his]:
    In Episode 3, the preacher says to Cohle, “Compassion is
    ethics, detective” when he departs the trailer leaving the
    reformed pedophile Burt in distress. Cohle replies “Yes, it is.”

    But if Time was created so things could become, and if acting


    out of the interest of others is compassion, then we should
    assume that Cohle is “becoming”, changing into something
    else. But what?

    Cohle asks in Ep. 5 “Why should I live on in history?” It’s an


    odd line, especially when in episode 1 he tells Marty that he
    “lacks the constitution for suicide.” But he also meditates on
    the cross (as an atheist), “contemplates that moment in the
    garden, of allowing your own crucifixion.” But by 2012,
    Cohle has changed. He’s resigned himself to ending his own
    life, but only after settling this debt- doing what he owes. One
    last act of compassion before giving up the only thing he has.
    His life. And once he’s willing to do that, then he can do all
    the things in his life that require selflessness, courage, etc (i.e.
    things that require faith). You have to accept the infinite so
    you can make the right moves in the finite.

    And when he does this, when he resigns himself not to his fate
    but to his eternity of endlessly repeating, at that moment he
    will actually have faith, because that’s when he proves he
    believes in the eternal. Only after doing this last good thing
    does he believe that he could stand the idea of an eternity of
    rerunning his life, because he knows at the end, he’s fulfilled
    it. “Nothing is fulfilled—until the end.”

    According to Kierkegaard, this resignation to the eternal is


    crucial. Kierkegaard was not an atheist but a diehard Christian.
    He believed that when a man resigns himself to the eternal, to
    existing in eternity, and gives up everything that ties him to
    this world then he becomes a “knight of faith” capable of great
    Christian acts (like the self-sacrifice that is almost certainly
    coming in ep. 8). When Kierkegaard wrote about a Knight of
    Faith, he contrasted the Knight of Faith to the mere Knight of
    Infinite, the “God botherer”—a phrase used twice in the show.
    What did Kierkegaard say the Knight of Faith looked like?
    Like this:

    Why, he looks like a tax-collector!” However, it is the


    man after all. I draw closer to him, watching his least
    movements to see whether there might not be visible a
    little heterogeneous fractional telegraphic message from
    the infinite, a glance, a look, a gesture, a note of sadness,
    a smile, which betrayed the infinite in its heterogeneity
    with the finite. No! I examine his figure from tip to toe to
    see if there might not be a cranny through which the
    infinite was peeping. No! He is solid through and
    through. His tread? It is vigorous, belonging entirely to
    finiteness; no smartly dressed townsman who walks out
    to Fresberg on a Sunday afternoon treads the ground
    more firmly, he belongs entirely to the world, no
    Philistine more so. One can discover nothing of that aloof
    and superior nature whereby one recognizes the knight of
    the infinite. He takes delight in everything, and whenever
    one sees him taking part in a particular pleasure, he does
    it with the persistence which is the mark of the earthly
    man whose soul is absorbed in such things. He tends to
    his work. So when one looks at him one might suppose
    that he was a clerk who had lost his soul in an intricate
    system of book-keeping, so precise is he.

    [Here I said that the reference was clear, but that Cohle did not
    look like this at all, that he appeared much more like the
    knight of inifinite resignation, the “tragic hero.”]

    The point is that the writer is taking the concept and running
    with it. If we’ve already spotted Kierkegaard, Schopenhauer
    and Nietzsche, then we are firmly entrenched in the existential
    project, and we should expect to find references from other
    existentialists also. And we do. The preacher in 2002 tells us
    that God is dead (“only nearness is silence”). Ep 3 Marty asks
    Cohle the question from Dostoyevsky, “You know what people
    would do without God, it would be an orgy of murder and
    debauchery.” Would it? Existentialists say no. Do we have
    Sartre? Why yes, we do. There’s angst and despair all over the
    place. And the angst is brought on by the burden of freedom,
    not the absence of it.

    Think how often Cohle ruminations on suicide echo Camus’s


    formulation of suicide as the fundamental question of
    philosophy in the Myth of Sisyphus (a guy endlessly pushing a
    rock up a hill, over and over, repetition, cyclical.) But Camus
    answers it in the negative, faced with a meaningless world,
    you embrace the absurd and revolt, not commit suicide. And
    isn’t what they are doing now a revolt? Kidnapping cops,
    burglarizing the houses of the most powerful figures in the
    state? If this group has been kidnapping kids, if they held
    power for generations in the state, if they are plugged in all all
    levels, then isn’t acting against them so deliberately a revolt
    against power?

    And if they are embracing revolt, if they are not embracing


    suicide (but are willing to make a sacrifice, is there a
    difference?) then they have embraced the absurd, and are on
    their way to the teleological moment (“Teleos de Lorca,
    Franciscan mystic”—a made-up guy that invokes Francis of
    Assisi a second time, reminds us of the teleological stakes, and
    re-invokes mysticism to bridge us from the ethical paradigm of
    the characters to the Continental philosophy started by Bataille
    (who was derogatorily called a mystic by Sartre, all in one
    shot, how is that for economy of storytelling, take that Cormac
    McCarthy)).

    Revolt: “Fuck this world,” Cohle says. Remember how he says


    it? Not in anger, almost off-handedly, like he’s passing on the
    offer of a free lunch. No anger, no big explosion. Just…
    resignation. But he only gets around to trying to screw it 10
    years after he says it. And in 2012, it’s jumper cable time. No
    institutional rules. And no masked perversion of the
    established rules. (I’m a cop who’s job is to uphold the law,
    and therefore I’m the one who can break it). Rather than
    commit literal suicide, they commit it metaphorically, by
    giving up and saying goodbye to everything to take on the
    very institution that defined their identity.

    And if it is a revolt, then we invoke all the ideas of consistent


    with revolution? Do we push out of the existential angst of the
    50’s into the revolution of the 60’s and beyond? The “present”
    in the show is 2012? Will we get a postmodern postmortem, an
    aftermath 2 years later set in 2014? And by then, how much
    more of the landscape will be swallowed by Carcosa, the
    corrupting refinery towers that loom in the back of every scene
    in the show?
    Ten Extra Seconds Would
    Have Saved True Detective’s
    Finale
    March 10, 2014

    what could it mean?

    You just watched a historical TV moment: never before has


    the audience for a show been smarter than its writer. I submit
    as second evidence the season finale for The Bachelor that was
    on yesterday, for three hours, drawing ten million “people”.
    Just remember that the next time some dummy from The New
    Yorker complains that TV has a woman problem.
    The Whitman’s Sampler that was True Detective’s finale is
    beyond discussion, literally, because what we now know is
    that no discussion was necessary. All the references, all the
    philosophical subtext, all the weirdness— turns out it was
    topping after topping, “does this make you watch? How about
    this?” Remember when the one character who turns out to be
    irrelevant says, “YOU’RE IN CARCOSA NOW,” do you
    know what that meant? Nothing. The writer once read a story
    that had the word Carcosa in it but since his cat was already
    named Chuckles he used it in a TV script. “It’s a reference to
    —” I know what it’s a reference to. Why is it a reference?
    Does it mean anything? Did “acolyte” or “metapsychotic”?
    We see Errol shifting fluidly between several accents. Here is
    the show I thought I was watching: is this is a 1 Corinthians 14
    “speaking in tongues”? Maybe coupled with the aluminum and
    ash reference it suggests Errol is Baal and Carcosa is Hell?
    Here is the show I was actually watching: though not
    mentioned ever in the show ever, he did that because the
    accident that caused his scars also made it hard for him to talk
    in his normal voice.
    Meditate on that.
    The writer googled Chekhov’s Gun, laughed mightily and
    roared, “you’re not the boss of me!” I’m confused, so the
    killer’s ears were green because he painted houses with his
    ears? The point isn’t that this explanation is stupid, the point is
    he didn’t need to have green ears.
    I don’t care about “tying up loose ends” or sterile Judeo-
    Christian undercurrents, I have ABC for that. I care only about
    internal consistency. If you’re going to make a show about, for
    example, zombies that is worth watching, at some point a
    character must say, “look, the only thing we know with 100%
    certainty is that every single one of us will eventually but
    unpredictably become a zombie, so we probably need to
    devote, oh, I don’t know, 100% of our energy to dealing with
    that certainty.” Once you ask that question you are lead, for
    example, towards a sci-fi show about forced physical isolation
    where the only contact we have with each other is digital, but
    because of the lack of physical contact paranoia sets in, and
    suddenly every interaction becomes an implied Turing Test.
    Would you watch that show? Because without that question
    you have four seasons of Denial Lets Us Pretend The Old
    Rules Still Apply.
    A show about applied philosophy in the form of a crime drama
    sounded intriguing. All of True Detective’s existential despair,
    posed as, “how do you solve a series of murders when humans
    are a mistake anyway?” — well? It’s finally solved
    incoherently with an appeal to the Old Testament. Oh, so God
    exists after all? That would have been helpful to know up
    front, because I thought we were in Schopenhauer’s “time is a
    flat circle” universe. But whirlwinds are cool, too.
    So through some kind of faith, Cohle loses both his nihilism
    and… his interest in pursuing child killers? “We got ours.” Oh,
    we’re done then. Time for a sandwhich.
    “I don’t sleep, I just dream.” Turns out that doesn’t mean
    anything either, but if you’re 16 feel free to lay it on the artsy
    girls. You’ll think they’ll think you’re mysterious.
    II.
    I’m sure everyone has their own idea of how it should have
    ended. But as an exercise how could you take the finale that
    was aired and fix it using only an additional 10 seconds? You
    can’t change anything else.
    Could you have kept it true to the show’s original promise,
    such that “pessimist” Cohle is both redeemed AND still true to
    who he is? Could you have rendered a closing scene so
    diabolically duplicitous that, on the one hand, most of the
    characters are saved/happy, while the world’s bleak necessity
    of a tragic hero (since that’s all he was, after all) becomes
    unescapable? That we all live semi-peacefully only because of
    the sacrifice of a few loners in a garden, coming out one by
    one to allow their own crucifixion?
    “Compassion is ethics.” Yes it is. How do you take Nietzsche’s
    nihilism and make it compassionate? Yet not sappy? If you
    accept that the theme of the show is that life has absolutely no
    meaning and therefore it is up to you to give it meaning, how
    do you take the mess that is episode 8 and say that?
    Could it be done in ten extra seconds?
    At the end they optimistically talk about stars and daughters
    and life energies, and Marty smiles upon Cohle and Cohle
    smiles upon the universe, and Marty, having learned the true
    meaning of Christmas, skips off to go get the car.
    Cohle sits alone in the wheelchair, watching him. The emotion
    in his face disappears. His face hardens. He takes a long drag
    from the cigarette.
    “But I lied for your salvation.”
    Cut to black.
    Credits.
    The Maintenance Of
    Certification Exam As Fetish
    April 29, 2014

    no need to wait for the receipt

    (I had reworked an old post for a psychiatry trade journal,


    which I would happily have linked you to, except that page 2 is
    behind a login wall. So here is the version I submitted before
    the editors edited it, slightly longer with more typos. I am
    posting this because of the new lawsuit against the American
    Board of Medical Specialties.)
    The mission of the American Board of Psychiatry and
    Neurology’s Maintenance of Certification (MOC) Program is

    to advance the clinical practice of psychiatry and


    neurology by promoting the highest evidence-based
    guidelines and standards to ensure excellence in all areas
    of care and practice improvement.
    That’s what the website says, I have no reason to believe they
    are not earnest. But far from succeeding, the program does the
    exact opposite. We have come to a moment of truth in
    psychiatry, and we are all going to fail. By which I mean pass.
    We can start with the 200 question certification exam. The
    most obvious clue that there was something suspicious going
    on with the test was that there were no questions about Xanax.
    How do you measure “excellence in all areas of care and
    practice” without asking about the most commonly prescribed
    medication in America, let alone psychiatry? Meanwhile there
    were several questions about pimozide, a medication which
    appears to be prescribed exclusively by psychiatrists who want
    to brag about prescribing it. I was repeatedly assessed on my
    competence in Dialectical Behavioral Therapy, but was not
    asked to display my knowledge of SSI. You might retort that
    SSI isn’t really psychiatry, but then why is so much of my time
    spent on it? The only thing I spend more time on is Xanax.
    But though the missing Xanax was a clue, the insidious
    problem with the exam was not the content. To see the bad
    faith obscured by the questions, put aside the usual college
    freshman complaints of, “why do we need to know about
    pimozide?” and ask instead, “what happens if I get the
    question wrong? What happens if I get them all wrong?” The
    answer is nothing. There are no consequences for failing this
    test, at all. First, 99% of the applicants pass, I assume the other
    1% forgot to bring two forms of ID. Second, even if you fail,
    you can take it again and again, as many times as you feel it’s
    worth the $1500. Third: there were a thousand easy ways to
    cheat, here are three: I could have walked out of the building
    on an unsupervised “break”; I could have Godfathered an ipad
    to the back of a toilet; or I could just picked up the phone and
    called everyone. Who was going to stop me? There is more
    security at a pregnancy test, which made me wonder if how
    easy it was to cheat wasn’t… on purpose. The retort is that
    doctors are expected to behave honorably, but the honorable
    ones were going to pass anyway. Those in danger of failing—
    the very people the test should detect— would be most
    tempted to cheat. Doesn’t the ease of cheating render the test
    unreliable? If the test is unreliable and 99% pass, why have a
    test at all? Which reveals the gimmick: the point of the test
    isn’t to measure competence, but to convey the impression that
    competence was measured. The point of the test is to say that a
    test was given— and nothing else.
    The question is, to whom are we saying this? It is as if
    psychiatry was in denial about its ordinary reality and was
    trying to create a different identity through the test itself. A
    psychiatry where there are right and wrong answers. Where
    pimozide and Dialectical Behavioral Therapy happens, a lot.
    Let me anticipate your retorts: that the questions are carefully
    constructed for their validity; that the test itself “incentivizes”
    learning; that not everyone prescribes Xanax; that if I’m such
    a smartypants, what system would I use? If these are your
    replies, you have missed my point: a flawed system isn’t better
    than no system at all, it is worse than no system at all, because
    at least with no system we are forced to be accountable to
    ourselves for our education. “Not everyone will be so
    dedicated.” Correct, but now those same undedicated people
    get an official blessing of their ignorance. Who doesn’t walk
    out of even this ridiculously meaningless exam not feeling
    smart, accomplished, up to date? And who would dare, after
    passing, to criticize the exam that warmed his ego?
    In addition to the test, the Board also requires a nauseating
    number of CME credits, but these CMEs are an even worse
    affront to learning. The only thing that CMEs guarantee is that
    money was spent on buying them, $80 and no questions asked
    is all it takes, which is even sillier than it sounds since I could
    go to a number of websites which offer instant and unlimited
    free CMEs, so long as I skip the long text and just take the
    post-test, which I can take as many times as I want. I can get 1
    CME every 25-50 seconds, depending on my ability to click
    “b”.
    The retort is that the system is predicated on a certain level of
    honor, that physicians shouldn’t cheat. Fair enough, but if
    you’re trusting them to be honest in revealing what they learn,
    why not simply trust that they’re going to learn it? Because the
    point isn’t the education. The CME exists to say that there is
    CME; the CME exists to say there is oversight.
    To clarify: the important criticism here is not that the
    multimillion dollar CME industry is a gigantic money making
    scam, something on the level of the 15th century sale of
    indulgences, because to say that would be actually to defend
    that very system: the money is a diversion, a patsy, what is
    corrupt about CME isn’t the money but, as the default
    mechanism for continuing education, it subverts its own
    purpose. It reduces the interest in actual education so that it
    can pretend that it explicitly monitors it. If you have a minute
    to spend on your “education,” the system pushes you towards
    CME. “Why not do both?” Why do both, who can do both?
    There are only 24 hours in a day. In other words, the system
    doesn’t just fail, it forces failure.
    Last year there was a large cheating scandal at Harvard, over a
    hundred students were accused of plagiarism in a government
    class, and amidst the usual self-aggrandizing criticisms of the
    college kids as entitled, lazy, or stupid, what no one wondered
    is why, in an introductory survey course predicated on
    institutionalized grade inflation and no wrong answers, did the
    students feel compelled to cheat when they were all going to
    get As anyway? The terrifying answer is that they weren’t
    cheating to get the right answer, there was no right answer,
    they were forced to cheat to concoct the answer the professor
    wanted— because that’s the system. Meanwhile, while they
    were spending their time “cheating”, what real learning could
    be done? None. So– why bother with an exam at all? Why not
    just offer the course and give everyone an A anyway? Because
    the purpose of the test is to say a test was given, to prove to
    some hypothetically gullible entity that learning occurred—
    and to prove it to ourselves. Which is why our reflex was to
    criticize the kids, not the system: we are products of that
    system, to criticize the reliability, let alone validity, of that
    system would be to open ourselves to scrutiny, to deprive us of
    a core part of our own identity. “Things were a lot more
    rigorous when I went to college.” First of all, they weren’t.
    Second, even if they were, why, when you got to be in charge,
    did you change the system to this?
    Seen this way, these tests, whether Harvard government exams
    or MOC exams, are nothing more than fetishes: a substitute for
    something missing which saves us from confronting the full
    impact of its absence. In less abstract terms, these tests allow
    us to believe NOT that we learned something, NOT that we
    know something— but that there is something to know. Since
    there is nothing new to learn, therefore there must be a test.
    The logic of a 10 year MOC exam is to keep us up to date, so
    it’s fair to ask: what in psychiatry has changed in ten years,
    what are the major advances? Depakote was discovered to be
    the default maintenance mood stabilizer despite no evidence
    supporting this, but that fell into disuse at a time oddly
    coinciding with its patent expiration, which is suspicious but
    I’m no epidemiologist. Anyway, it wasn’t on the test.
    Anything else? A few new medicines have come out, though
    none of them appeared on the test either. There’s money to be
    made on the west coast using giant magnets, (fortunately) also
    not on the test. So? Was the ABPN worried I’d forget how to
    use MAOIs? I’m never going to use them, I have enough
    problems monitoring Xanax. The astonishing truth is that
    despite millions of dollars and hundreds of academic careers
    psychiatry has made no progress in almost 20 years, let alone
    ten, a claim no other medical specialty can make, and the truth
    which cannot be spoken out loud. Hence an exam.
    Are you prepared to look inside yourself? When a nurse
    practitioner asks you what about your board exam is difficult,
    what will you say? Take a minute, it’s important. “Well, it has
    neurology in it.” Note carefully that the psychiatry questions
    aren’t “harder,” the appeal here isn’t to a higher level of
    expertise in psychiatry, but an expertise in something else,
    something “more” than psychiatry, and it is this link that
    symbolizes our status as “experts.” Older psychiatrists will be
    quick to assert that “clinical judgment” counts for a lot, and I
    don’t disagree, but it’s probably not testable, and it most
    certainly wasn’t tested. So what does $1500 buy you?
    “Existential support.” I hope it was worth it.
    What makes the MOC not just a bad exam but evidence of a
    pathology is that though college kids have no idea what
    they’re up against, that the system works against their
    education, psychiatry is the very discipline that articulated
    these defense mechanisms. It should know better, it is
    supposed to know better; which means that we are either
    unable to see what we are doing or believe that we are
    somehow exempt from this. But here we are, spending time
    and money on cosmetics and pageantry to pretend that we are
    learning, to pretend that we are being measured, all the while
    slinging random neurochemicals + Xanax based on an a
    suspect but billable logic in the hope that something sticks and
    no one notices. Frantic activity as a defense against impotence.
    There is a term for that, but you can bet your career it won’t be
    on the test. Pass.
    Who Bullies The Bullies?
    May 3, 2014

    but they’re welcome to buy an iphone

    Pacific Standard. Get it? It’s like The Atlantic, but it’s Pacific.
    Totally different. So unlike The Atlantic, it will “attack the
    conventional wisdom from a west coast perspective.” That’s a
    quote. “But didn’t the editors come from The Atlantic?” Yes.
    “So what’s the diff? Does west coast imply the writers will be
    better looking?” The women will be, unless they write about
    gender issues, then they will appear gendered. The men will
    look wise if they’re crushing on social science, or tough and
    no-nonsense if they’re hating on Republicans. Don’t worry,
    pics of the writers will be included to suggest an appeal to
    authority. “Hold on, is the owner of this magazine Sara Miller
    McCune? The same woman who is responsible for those
    atrocious SAGE journals like Psychological Science and
    Evolutionary Perspectives On Human Development that
    charge CV padding post-docs a few hundred dollars to publish
    linkbait like “Ovulating Women Prefer Men With Large
    Sneakers”, that Malcolm Gladwell and media outlets like
    Pacific Standard then cross promote as valid science?” Yes,
    but I’m sure it’s a coincidence. “This magazine sounds
    terrible.” Duh.
    This cover story details #young #vulnerable #feminist writer
    Amanda Hess’s frustration with disinterested male law
    enforcement when, after writing an article about receiving rape
    threats from a troll, she received rape threats from a troll. I
    sympathize, though in my experience what’s even more
    frightening than a guy telling you he’s going to rape you is a
    guy not telling you he’s going to rape you.
    There’s a big push for “women’s safety” online, for getting rid
    of trolls and cyberbullies and cyberstalkers, not coincidentally
    another one of Randi Zuckerberg’s pet causes; and while these
    are all legitimate worries someone should take a minute and
    ask why, when mustached men have been stalking women
    since the days of Whitecastle yet no systemic changes have
    been effected, the moment women feel threatened from the
    safety of their LCD screens America opens the nuclear
    briefcase. No one finds that suspicious?

    In fact, regular stalking is barely ever mentioned in media, no


    matter how many times the guy was laying under her new
    boyfriend’s front porch on Wednesday nights after Organic
    Chemistry class, what drives the article is “and then he stalked
    her on Facebook!”
    Here’s just a sampling of the noxious online commentary
    directed at other women in recent years. To Alyssa
    Royse, a sex and relationships blogger, for saying that she
    hated The Dark Knight: “you are clearly retarded, i hope
    someone shoots then rapes you.” To Kathy Sierra, a
    technology writer, for blogging about software, coding,
    and design: “i hope someone slits your throat and cums
    down your gob.” To Lindy West, a writer at the women’s
    website Jezebel, for critiquing a comedian’s rape joke: “I
    just want to rape her with a traffic cone.” To Rebecca
    Watson, an atheist commentator, for blogging about
    sexism in the skeptic community: “If I lived in Boston I’d
    put a bullet in your brain.” To Catherine Mayer, a
    journalist at Time magazine, for no particular reason: “A
    BOMB HAS BEEN PLACED OUTSIDE YOUR HOME.
    IT WILL GO OFF AT EXACTLY 10:47 PM ON A
    TIMER AND TRIGGER DESTROYING
    EVERYTHING.”

    As the recipient of not zero decapitation emails I admit it does


    make you curious about whether or not you can buy an
    alligator, but while you’re arming your windows like a Saw
    movie you should contemplate the difference between what
    should be done and why it appears something should be done.

    I.

    The force for this change isn’t coming from safety or ethics.
    Neither is it activism. If you see any group advocating
    influentially for change in a media they don’t own or control,
    you can double down and split the 10s, the dealer is holding
    status and quo. No change is possible on someone else’s dime,
    and if what looks like a supermodel approaches you with a
    microphone and a camera crew, you should run like she’s
    Johnny Carcosa. On occasion what the activists think they
    want may happen coincidentally to align with what the system
    wants, and from that moment on they will be lead to believe
    they are making a difference, which means they’re making
    money for someone else. “Your writing is so muddled.” Sorry.
    Were you better persuaded by the concise prose of Amanda
    Hess?

    Her article seems to be about what could be done to stop


    anonymous trolls from terrorizing and threatening women.
    How about prosecuting them, since terroristic threats is
    already a crime? Unfortunately, as Hess discovers, the police
    don’t care much about online stalking, which is consistent
    since they don’t care about IRL stalking either. But never
    mind, it’s not the problem: misogyny is the problem, amplified
    1000x by online anonymity. Anonymity makes the internet
    mean and gives trolls= men too much power. This is the subtle
    shift: what starts out as “misogyny is bad” becomes
    “anonymity facilitates misogyny.”

    Keeping in mind that actual stalking has never been dealt with
    in any significant way ever, the desire of a few female writers
    to curb online anonymity wouldn’t be enough to get an @
    mention, except that this happens to coincide with what the
    media wants, and now we have the two vectors summing to
    form a public health crisis. “Cyberbullying is a huge
    problem!” Yes, but not because it is hurtful, HA! no one cares
    about your feelings— but because criticism makes women
    want to be more private— and the privacy of the women is
    bad. The women have to be online, they do most of the
    clicking and receive most of the clicks. Anonymous
    cyberbullying is a barrier to increasing consumption, it’s gotta
    go.

    II.

    You may at this point roll your eyes epileptically and retort,
    “well, who cares ‘what the system wants’, the fact is
    anonymity does embolden the lunatics, shouldn’t we try to
    restrict it?” Great question, too bad it’s irrelevant. You’ve
    taken the bait and put all your energy into accepting the form
    of the argument. The issue isn’t whether we should abolish
    online anonymity, since this will never happen. For every
    American senator trying to curb anonymity there’s going to be
    a Scandinavian cyberpirate who will come up with a
    workaround, and only one of them knows how to code.
    Besides, there’s no power in abolishing anonymity, the power
    is in giving everyone the pretense of anonymity while secretly
    retaining the PGP keys to the kingdom.

    To understand what’s really happening, start from basics: if


    you’re reading it, it’s for you. I assume you’re not a cyberbully
    or a stalker. So do you have any power to abolish anonymity?

    If Hess has made you wonder, hmm, maybe unrestricted


    anonymity is bad because it gives trolls too much power, then
    the system has successfully used her for its true purpose:
    brand it as bad, to you. She is unwittingly teaching the demo
    of this article, e.g. women in their 20s with no actual power
    looking to establish themselves, who are the very people who
    should embrace anonymity, not to want this: only rapists and
    too-weak-to-try rapists want to be anonymous. Smart women
    write clickable articles about their sexuality for nothing,
    because what good are you if you can’t make someone else
    money? Interesting to observe that the article’s single
    suggested solution to cyberharassment is to reframe a criminal
    problem into a civil rights issue using a logic so
    preposterously adolescent that if you laid this on your Dad
    when you were 16 he’d backhand slap you right out of the glee
    club: “it discourages women from writing and earning a living
    online.” Earning a living? From who, Gawker? Most of the
    women writing on the internet are writing for someone else
    who pays them next to nothing. None of them control the
    capital, none of them get paid 1/1000 of what they bring in for
    the media company. You know what they do get? They get to
    be valued by work, and in gratitude they are going to the front
    lines to fight for the media company’s right to pay them less.
    And the indoctrination has worked, the less Asperger’s a
    woman is, the more she’ll hate writing anonymously. Don’t
    get angry at me, they did a study, and I think it explains why
    women don’t want to write for The Economist. In the reverse,
    put a pic in your byline and you improve your female
    audience; put a pic of a female in your byline and you’ve
    maximized ROI, everyone will click on a pic of a chick. This
    is economic and psychologic universe in which Hess finds
    herself.
    “But you can’t use a pen name at places like The New Yorker.
    You know they pay their top staff writers $100k a year?”
    Jesus. a) yes you can; b) listen to me: if those swindlers are
    willing to pay you $100k, then you could probably get $200k
    yourself, and if you can’t get $200k yourself then you aren’t
    worth their $100k either and they will eventually notice. When
    they pay you that much they’re not paying you to write for
    them, they’re paying you not to write for anyone else, that’s
    called controlling the capital.
    “So your solution is that she should use pseudonym? Isn’t that
    blaming the victim?” No, not her— you. You should use a
    pseudonym. You aren’t writing for Gawker, you just use the
    internet, comment on things, etc. Why should you use your
    real name? “Why shouldn’t I?” I’m sorry, I wasn’t precise:
    why are you being encouraged to use your real name? Again,
    the question of whether anonymity emboldens trolls is not the
    force of that article, it isn’t about their behavior, it is about
    yours.
    “But merely ‘branding anonymity as bad’ isn’t going to stop
    the cyberbullying misogynists.” You are correct, which is why
    the spokesperson for this crisis is Amanda Hess. No one is
    trying to stop cyberbullies, there’s no point, they don’t shop
    and no one wants to look at them. Hess has entirely
    misunderstood what the medium wants. The whole game is to
    get women— not the cyberbullies, not criminals, but the
    consumers— to voluntarily give up all of their privacy, while
    paying lip service to privacy at home— knowing full well
    women that women will pay money not to have the kind of
    privacy they have at home. Voluntarily exposing yourself
    makes you a targetable consumer and targetable consumable.
    Is it worth it?
    III.
    All of this is for the benefit of the media, which is why I know
    with 100% certainty that nothing will change. Because she
    wrote that article, because some people camped in Zuccotti
    Park, the energy for activity was discharged. And the media
    got all the profits.
    What Hess didn’t realize is that while she was fumbling
    impotently with the cops, the media company that she worked
    for could have crushed the troll if it was worth it to them. Did
    you have this thought? If not, it’s not your fault, some people
    are trained not to have it while others were trained to have it
    immediately. Which are you? If the founder of Religions For
    New Atheists Sara Miller McCune herself had received an
    electronic rape threat from some Fox News stenographer in a
    Kentucky man cave, you think she’s dialing 911? From her
    apartment? She would have waited until she got to the office,
    waved her hands like in Minority Report and her lawyers
    would have midnight Seal Team Sixed him while he was
    overhand jacking it to interracial porn. Do you know what
    Hess’s employers did for her? No, I’m serious do you know? It
    can’t be nothing, right? That would be Bananastown. It was
    nothing? Really?
    Maybe hypotheticals aren’t your bag, ok, here’s a true story:
    “Amy” received a couple of voice messages from a
    “customer” she met at work who wanted to put something in
    her vagina. These messages were not violent, in so far as
    forcing your fantasies of consensual sex into an unwilling
    girl’s ear is considered not violent, but of course they creeped
    her out. There’s one other crucial piece of information needed
    to understand this story: her harasser probably had large
    sneakers. I’ll give you all a minute to catch up.
    Every woman has some version of this story, with one
    important difference: Amy was a medical student, which
    meant a lot of money went into her and a lot of money was
    expected of her. One (1) phone call from the Dean to a phone
    number that was not 911 and that guy was evaporated. Two
    cops located him minding his own business, and because he
    defended himself with the magic words— and you should
    write these down, they’re gold— “it’s a public street, I have a
    right to be here”— he was jailed for eight months for
    harassment and resisting arrest— pre-trial. Pre means without.
    Of course his case was ultimately dismissed. Does that matter?
    Please observe a) Amy herself didn’t have to do anything to
    effect any of this, she was mostly unaware of the results, the
    system was on autopilot; b) he was jailed not for what he did
    but for whom he did it to, had Amy been a 1040EZ at the
    Footlocker we’d say she was asking for it. “But it isn’t fair that
    her protection money should get her concierge policing while
    the rest of us have to make due with socialized law
    enforcement.” Was it fair that he did eight months because he
    couldn’t afford bail, is it fair that he didn’t know that it wasn’t
    fair? On the other hand, was he a dangerous nut, should he
    have been punished? Of course. Was he operating from a
    perspective of institutionalized sexism, patriarchal thinking,
    misogyny? Sure, #whatevs. Sometimes the structural
    imbalances go your way, and sometimes they don’t, better
    figure out who makes the scales.
    After Hess got the runaround, she spent a lot of time trying to
    get a protection order, a force slightly less compelling than
    wind. Why didn’t she just call the Mayor? “Hi. I work for the
    city paper, the one that caters to voting Democrats and men
    looking for Russian companionship. I’m doing a story about
    police apathy regarding sexual violence from a first person
    perspective, by which I mean your perspective. Comment?”
    That would have solved her problem, but more importantly it
    would have forced her to think about WHY that solved her
    problem. What is the difference between a “woman” who is
    threatened and a “reporter” or “medical student” who is
    threatened? Why is it more bad to attack a journalist than a
    woman? Think about that, it has not always been so. The
    former is an attack on the system, so the system must respond;
    the latter is an attack on a woman, so ––––––––––––-. And so
    it goes.
    But Hess preferred to see misogyny on the internet, so instead
    we get another trending article about how the problem has a
    penis. This coincides perfectly with the media’s desire to
    frame it as a gender war because that makes for good clicking.
    Let’s summarize the media’s thesis via unwitting Hess: 1.
    cyberharassment is a women’s issue, never mind the men who
    are harassed. 2. The appropriate way to handle women’s issues
    is not necessarily to solve them but to discuss them in the
    media. “It’s called awareness.” We are all aware. Are you
    aware of how much you made for Pacific Standard at your
    expense and to no avail?
    IV.

    Hess is fighting the battles of 50 years ago because she was


    told to fight them by people who profit from the fight, and as a
    bonus it gets her out of any self-criticism. Oh, Sheryl
    Sandberg thinks Silicon Valley can be a boys’ club? Was that
    why she manned up and sold us out to the NSA? Curious that
    she didn’t accuse the NSA of being a boys’ club. Perhaps real
    power transcends gender? More curious/on purpose is that she
    and the boosters at Wired are more horrified about NSA
    spying, despite there being an explicit terms of service
    agreement with them that what it finds without a warrant is
    inadmissible, but Google monitoring my sexts for their
    commercial benefit is SAGE approved behavioral economics.
    Google buying Boston Dynamics is better than DARPA
    having it, is that the game we’re playing now? If I had to put
    my chips and my children against an 8 year rotation of civil
    service nincompoops vs. some nerd with an open marriage
    who spent $15M on a “bachelor pad” so he could score chicks
    of questionable emotional stability, I’m going with the group
    my private sector lawyers have an outside chance of pwoning.
    “But how cool is that guy that he could spend $15M on
    scoring chicks!” You’re looking at it backwards, the only way
    he could score chicks was by spending $15M, and now that
    guy owns cybernauts. Power corrupts, but absolute power
    doesn’t exist, so for everything else, there’s Mastercard.
    What Hess and others fail to see is that this kind of
    postgraduate sexismology— Hess’s “ability” to see it— is
    encouraged because it favors the status quo. It is a tool for
    maintaining an economic and psychological disavowal
    favorable to Gen X and older— men and women. Their
    collective psychology has caused to be a machine that is
    calibrated to ensure their life is not disrupted— at the expense
    of everyone under 30, you guys waste your life Banning Bossy
    and make sure you pay back all of your student loans, sorry
    about the future but the SLEEP/CONSUME machine from
    They Live has to keep running.
    Here’s a “class struggle” example: name one Wall Street type
    who went to jail post 2008, everyone picks Bernie Madoff.
    Now name one person you know who was harmed by Bernie
    Madoff. That’s weird. Note he didn’t cause the crash, his
    criminal empire was a “victim” of the crash. What got him
    jailed was stealing from the wrong people— that the media
    coded as either “celebrities” or “pension funds”. Look
    carefully at the result: you got a distraction to label as evil so
    you don’t have to feel any guilt about overusing your credit
    card; the rich guys get (some of) their money back; and the
    media makes millions of dollars engaging you in a
    “conversation.” “But he was symptomatic of Wall Street
    excesses.” Way to treat the symptoms. Hence the most
    important result: nothing changed. The whole thing is a
    defense against change, for the system and for you. Still have
    that credit card at max?
    Radical political action, radical as in “outside the frame”
    radical, the kind self-aggrandizing #OWS is incapable of,
    would be to demand Bernie Madoff be released, so that
    everyone would have to watch him in restaurants and hookers,
    an unignorable signal to the system and to yourself that things
    are not right. Not to settle for symbolism and scapegoats. But
    the media won’t let this happen, they thrive on symbolism and
    scapegoats; and you won’t let it happen as long as you can get
    an iphone.
    So the system encourages women like Hess to “critique the
    patriarchy” or “bring awareness” because it stands no chance
    of moving the money, let alone the power, and also the media
    gets a cut. Meanwhile men all over the place are left
    questioning why their opportunities are just as limited but their
    answer can’t be a glass ceiling. “Maybe it’s reverse sexism!”
    Maybe your media is no different than her media, we’ll see
    what kind of sexism there is when the robots replace all of
    you. What is both obscene and astonishing in its power is that
    this distraction is foisted on Millennials by other Millennials,
    they’re fighting for the other team, precisely because the
    immensely hard work of work can be avoided by hoping the
    problem is sexism. Hess is frantically fighting against—
    whom? Cyberbullies? Frat guys? Stand up comedians? What
    are the results she expects from this fight? The fight is a
    symptom of neurosis, frantic energy as a defense against
    impotence, frantic energy as a defense against change. “Why
    am I in the top 20% of intelligence but I’m running the register
    at a store whose products I can’t afford?” Because trolls are
    preventing women from earning a living online? “So it’s
    Reddit’s fault!”
    V.
    There should be no controversy: a guy should never tell a girl
    he’s going to rape her, online or not, kidding or not. I get that
    he’s probably not serious, but there should be no instinct at all
    to defend such a jerk, and yet–— and yet that is precisely the
    instinct many people get. Men who have never wanted to
    threaten anyone read Hess’s story and side with the troll. And
    Hess will agree: it is a massive number of people. So they’re
    all misogynist jerks, too? No other explanation?
    Yet a typical such “misogynist” probably has a wife and
    daughters whom he loves in a more equal way than sexists in
    the Whig party did. He is aware his daughter is a girl, he wants
    the best for her, he’d be thrilled if she became President, do
    you think he doesn’t want her to have power/money/influence,
    more than any man? And of course he wouldn’t want his
    daughter to receive such rape threats, but what’s important is
    that he believes she wouldn’t— she wouldn’t deserve them.
    There is plenty of existing sexism and [insert lip service here].
    I do not deny or minimize it, the point here is to identify the
    self-imposed kind of oppression, instead of top down it is
    bottom up: impotence. All of these choices, all of these
    products, all of that sex, all of that power— why not me?
    The troll and Hess have this feeling of impotence, which Hess
    easily finds to be the fault of patriarchy, which she uses
    interchangeably with class, except when that class is Sarah
    Miller McCune, then it’s just patriarchy. The troll thinks the
    source of his impotence is “militant feminism”, which also
    explains why he’s not worrying about his daughter. She’s not a
    woman, she’s a person, i.e. like all American parents, he’s
    raising her like a boy: school x 16, sports x 12, violin x 6, and
    for everything else there’s LCDs. I don’t know why he thinks
    his daughter will fare any better through the same machine
    that is failing his son, but I guess it’s worth a shot. Of course,
    he probably won’t be too happy if she becomes a “feminist”;
    e.g. living with a teenage Zosia Mamet drove David Mamet to
    the Republican Party. I’m going to go ahead and protect
    myself by saying that’s a joke.
    So in order to explain their otherwise irrational feeling of
    impotence, they pull from any of the media-approved
    categories of blame, depending on your news network: sexism,
    racism, feminism. The central importance of the media in
    soliciting their anger is totally lost on the older “activists” who
    still believe that the -ism is the primary force. They’re enraged
    that a white Princeton student would dare to write that white
    privledge doesn’t exist; they never wonder why they read it.
    They are at a loss to explain why the very same trolls who
    want to “rape” feminist bloggers are even more enraged that
    women in Saudi Arabia are forced to wear burqas. So do
    misogynists hate Arab men more than American women? Is
    there a hate hierarchy? Yet the media is unsurprisingly
    ambivalent about the burqa, the feminism risks an assertion of
    cultural priviledge so they’d just as soon not get involved. And
    to hell with George Bush who made us have to.
    There was a time not long ago when the dumbest people in the
    world were polacks. Do you see any dumb polacks around
    today? What happened? “Awareness?” Do you think we all
    just learned “poles are just like us?” You think it was…
    education? Pole empowerment? Tolerance? The question is
    not how did we learn to get over that prejudice, but rather what
    purpose did it serve in the first place, why was it the preferred
    expression of hate of that time?
    VI.
    Hess had a chance to wonder about this, but the media’s
    keyword list and her own personal psychology converge to
    make her prefer to see sexism. Against these force vectors she
    is powerless. The medium is the message, she just puts her
    byline at the top. Hess even looked for a “woman problem” at
    The Economist which I thought was going to be that there
    weren’t enough women there because she cited the statistic
    that 77% of the writers are men, except that she then lamented
    that since there are no bylines you couldn’t tell which ones
    were the men and the women, which was also bad. But she
    had something else in mind:

    In many ways, the magazine suffers from the same


    woman problem that plagues libertarianism more widely.
    The Economist‘s central belief in “free trade and free
    markets” informs its one-size-fits all approach to its
    readership—the idea that women might actually want to
    consume news differently than men doesn’t fit into this
    theoretically level global playing field.

    Women consume news differently. True? Let’s find out:

    When I lived with a boyfriend who subscribed to The


    Economist, I’d pick up the magazine occasionally,
    scanning the table of contents for the odd piece that
    appealed to me—a dissection of the racial dynamics of
    American marriage, for example, or a takedown of U.S.
    sex offender laws. Typically, though, I’d flip straight to
    the book reviews, a space I discerned as a little more
    inclusive than the front of the book. I recently asked that
    guy whether the contents of the magazine ever struck him
    as particularly masculine, too. “It’s called The
    Economist,” he replied. “It’s like Maxim for nerds.”

    Lord have mercy.


    First of all, Maxim is already for nerds, who else would want
    to look at glamour shots of still dressed women only women
    have heard of? This month is Sophia Bush and Olympic figure
    skater Tara Lipinski, yum, time to get your hard on. “Oh I
    loved her with Johnny Weir covering Sochi!” Can’t say
    Maxim doesn’t know its demographic.
    this is what women are told men want; this is how women are told how to want

    So for him to think Maxim isn’t for nerds means he thinks it’s
    for Dude-Bros, i.e. large genitaled males who get to rape all
    the drunk chicks at the Delta house. Which means he’s an easy
    mark for branding, and which, I am willing to bet $10M, is
    why he tells his guy friends about Maxim but shows his
    girlfriend he subscribes to The Economist. Don’t worry,
    Amanda, he only reads the book reviews, too. Stab in the dark,
    here’s a guess at his character sketch: a smart underachiever,
    proud he’s “not some frat jerk”, he knows he’s supposed to be
    interested in topics not related to him but finds his
    concentration isn’t up to the task— so he reassures himself
    with the trappings/magazines of intelligence. “Would Adderall
    help me do more work and less porn?” No, but it will help you
    write a book of porn and you will be terrified at what you
    learn. His favorite way to consume news is to forgo primary
    sources in favor of skimming two paragraph dissections
    written by others who also forwent the primary sources.
    Unmotivated, unthreatening and unrelevant, publicly not
    drawing from the system according to his need but privately
    disavowing a lack of contribution back to the system
    according to his ability. “But the system is corrupt.” $100M
    says there’s a vaporizer nearby.
    Second of all: hell yeah, dissections and takedowns, thank you
    for your consideration.
    Third of all: observe that she asked him about The Economist
    after they had broken up. Her ex was her go-to guy when she
    had a question about masculinity, and magazines. Does she
    know any other men? Has she interacted with any men without
    the polarized glasses of stereotype, prejudice and fear? Is
    every guy only either a love interest or a Dude-Bro?
    Fourth: she misunderstood/completely understood his answer
    about whether the magazine was particularly masculine: “It’s
    called The Economist.” Uh oh. If I ask, “Is Cosmo Magazine
    particularly feminine?” and you reply, “Duh, stupid, it’s called
    Cosmo, any more feminine and it would have a tailbone
    tattoo,” then you are implying not only that the magazine is
    feminine, but that I should have been able to infer that because
    cosmos are feminine. To him, The Economist is masculine is
    because economics is intrinsically masculine— and she
    implicitly accepts this. Now who’s the sexist? Whose
    theoretical daughters have a better chance of learning
    economics? Of course she’d say any women can learn
    economics, yay women, but her daughters would be learning a
    masculine discipline, see also math, which I predict she’s bad
    at. The barrier is in herself, sexism is merely her projection of
    it.
    So while she pretends that it is the male perspective she
    doesn’t like, it is evident that it’s the contents themselves that
    she objects to. They’re boring, but that can’t be related to
    intellectual curiosity because she’s a thinker. So it has to be the
    “male perspective”. But didn’t the same male perspective
    write the takedowns and dissections? Books, sex,
    relationships; those are “inclusive to women”. What happens
    when you don’t sign up for NATO— that’s masculine. But is
    it? Really? I agree that most of the articles in The Economist
    are boring and don’t “relate” to my lifestyle as an alcoholic,
    but I force myself to go through them like social studies
    homework, and most of the women who do the same are doing
    it as the same. The articles aren’t supposed to be interesting to
    me, they are supposed to be important and I force myself to be
    interested.
    However, the point isn’t that she should read The Economist,
    the point here is that she saw sexism, which means she didn’t
    notice this:

    UNWITTINGLY, perhaps, Vladimir Putin is playing


    Cupid to America’s Mars and Europe’s Venus. … “I have
    not felt this good about transatlantic relations in a long
    time,” whispers one senior European politician.

    WTF, why would anyone whisper this? Is Putin standing right


    there? The Economist does this all the time, citing unnamed
    sources while alluding to their power and significance. Of
    course the easy critique to make, and even this one Hess was
    not allowed to formulate, is that in this way The Economist
    conveys the impression that it has personal access to the levers
    of power, the way Us Weekly recasts publicists as “sources
    close to Kim Kardashian”, shrinking the gap between the
    magazine and the sources and artificially widening the
    distance between Kardashian and us. She becomes more
    important and less accessible— except through Us Weekly.
    But this critique is backwards, it assumes the magazine is
    trying to trick its audience, this is wrong, the audience is using
    the magazine to trick itself. The audience wants this distance.
    It wants heroes, celebrities, people with power— it wants an
    upper class— and it wants them inaccessible. Envy? No, that’s
    advertising, this is the “news.” This is what happens when a
    whole generation’s narcissism is threatened with injury—
    since everything is possible, why aren’t you enjoying
    everything?— the personality structure becomes
    overwhelmingly defensive. “If I were Kim Kardashian, then I
    would be able to do X!” is NOT envy, flip it over and read the
    redacted obverse: “Only Kim Kardsahians can do X —
    therefore it’s not my fault that I can’t!”
    The Economist demo appears to want this same defense. The
    real trick of The Economist is that as a magazine of
    “libertarianism” [sic], its belief in “free trade and free
    markets” requires as axiomatic that these are not real. The
    Invisible Hand is actually attached to a benevolent class of
    gentlemen capitalists who have the money, the connections,
    and the information to best mold the world. You don’t know
    these people, but fortunately The Economist does. Their motto,
    inscribed in runes over a blue moongate on Jekyll Island, is,
    “Be content to bind them by laws of trade. You have always
    done it. And let this be your reason.”
    Why would the The Economist‘s rich and powerful demo want
    to be ruled? Because they aren’t powerful, only rich, all that
    time getting rich did not translate to any power, only the
    trappings of power. So they’ve postulated a fantasy power
    structure/NBA owners that explains why they can’t enjoy their
    lives as they think they should— to absolve themselves of the
    guilt they feel for having money/intellect/opportunities and
    NOT being able to do anything with it except spend it on the
    system-wide approved gimmicks: Trading Up, college
    educations, the National Bank of S&P 500.
    And you say, boo hoo for the rich. That’s your media approved
    classism talking. Does $200k/yr have more in common with
    $50k/yr or $1M/yr? What do your TV commercials tell you?
    Don’t think about where the lines are drawn, think about who
    draws the lines.
    Hess yells about a world of masculine power because she has
    the power to yell at it. But of course her power is limited only
    to yelling, she is impotent against a troll who yells at her. But
    her mistake is in thinking he has the power. No one has it, the
    system doesn’t allow it. Even the mighty Economist demo
    feels impotent. Are they all delusional? This is the true critique
    of the system, not simply that one group reliably oppresses
    another; but that the entire system is based on creating a lack.
    This lack is not a bottomless hole that nothing could ever fill,
    but a tiny, strangely shaped divot in your soul into which
    nothing could ever fit: not money, not sex, not stuff, not
    relationships. Nothing “takes.” Nothing counts. Nothing is
    ever right. Only novelty works, until it wears off.
    This lack of power— not power to rule the world, but
    existential power— what is the purpose of my life? What is
    this all for? I get that I’m supposed to use my Visa a lot, but is
    that it? Shouldn’t I be able to do more than this? Everything is
    possible, but nothing is attainable. Nothing tells them what is
    valuable; worse, everything assures them that nothing could be
    more valuable. That the media is the primary way the system
    teaches you how to want should have been obvious to Hess,
    she works for it, but for that same reason it was invisible to
    her.
    You shouldn’t be surprised that the only sane response to this
    impotence is neurosis, for which of course the system provides
    a psychiatric treatment that couldn’t possibly work. “I need an
    Ambien, I can’t sleep.” But where did you hear that you
    needed to sleep?
    VII.
    If you’re a guy, you probably don’t realize the awesome
    pressure on women to let themselves get looked at: to reveal
    themselves online, to post a pic, to give everyone your
    attention, to stop what you’re doing and give the other your
    self, even if they want to yell at you. “Hey lady, I hate you!”
    And yet that same pressure tells women they are valueless
    unless they are public. Madness.
    The system is illogical, the things you want cannot actually
    coexist, but you dare not attack the system that promises
    everything, therefore something else must be blamed. As a
    basic example, Hess probably wants all the benefits of
    socialism and all the brand products of capitalism. When she
    can’t have it, obviously the problem is misogyny.
    Another example: Donald Sterling.
    everyone hates two of these: fat cats, america, virgins

    Here’s a transcript of an illegal recording not done by the NSA


    that therefore everyone is ok with, consistent with our new
    standard of conduct: it is not illegal to make an illegal
    recording as long as it is given to the media and they profit
    from it and we can use it to rationalize our lives. Got it. Now I
    know you think you know what he said, but this time pay
    attention because he leaked a state secret:

    You can sleep with them, you can bring them in, you can
    do whatever you want. The little I ask you is not to
    promote it on [Instagram] and not to bring them to my
    games…. Don’t put him [Magic Johnson] on an
    Instagram for the world to have to see so they have to call
    me… Yeah, it bothers me a lot that you want to broadcast
    that you’re associating with black people. Do you have
    to?…You’re supposed to be a delicate white or a delicate
    Latina girl.

    Here’s a question: who is THEY who have to call him? Why is


    a gazillionaire 3 years from God’s judgment worried about
    They? And why would They care what his girlfriend does?
    The implication is that They are even more racist than he is,
    which should blow your mind when you consider They are
    about to pretend to try to take his team away from him and
    give him $600M.
    But the other possibility— which coexists with the first— is
    that They don’t exist, not in any coordinated way: They are
    you, the public, far more dangerously racist than he is because
    his racism is overt and yours is disavowed. What he is worried
    about is that you will see a picture of “a delicate white or
    Latina” girl next to a guy with large sneakers and… film your
    own conclusions.
    Some clueless TV types have deduced that she set him up.
    Duh. Then they tried to figure out why he hooked up with such
    a manipulative harpy, and I therefore know with 100%
    certainty that to them having a hot young girlfriend is an
    unattainable fantasy. But he didn’t have a choice: his superego
    required it, as a condition of his identity he is obligated to have
    a mistress, a miss-stress— a girlfriend who is way more
    headache than any wife he was “bored” with. Since everything
    is possible, he is obligated to enjoy— and if it isn’t enjoyable
    there must be something preventing it, and that obstruction has
    to be her fault, or They’s fault, what it can’t be is his fault.
    He’s 80, his sexuality is… on the decline. If he can’t enjoy sex
    someone else has to enjoy it for him, in his place: no, not the
    black guy, but her— she is doing the enjoying for him. Being
    cuckolded— that’s what this is, right?— is fine, it works for
    him, as long as he isn’t humiliated in public. “It’s ok if They
    see me as a racist because I AM a racist, I accept it as part of
    my identity, there’s no shame in it; but if They think I’m not
    satisfying her, or worse— if they think I’m a cuckold— if they
    don’t see me the way I want to be seen–-”
    “If only you were the girl I thought you were!” he said,
    paraphrased. But of course she was the girl you thought she
    was— she picked you. When you pick a woman for certain
    reasons, you are also picking the kind of woman who wants to
    be picked for those reasons. You may even have succeeded in
    tricking her that you like her for other reasons, but this is
    irrelevant: you like the kind of girl who likes the kind of guy
    who pretends to like women for other reasons……. But in any
    event, his desires were illogical, they can’t actually coexist, so
    it must be They’s fault.
    It is heartwarming to think of the backlash against Sterling as a
    new intolerance of racism, and I’m told his case is important
    to society because he’s famous and rich, but his money doesn’t
    come with any power. So while you are all glowing in self-
    righteousness because you outed another racist rich guy,
    consider that you will never hear a recording of the head of
    Goldman Sachs making racist statements. “Maybe he’s more
    progressive?” Hmm. Or maybe power won’t allow it, power
    won’t even allow you to think about it. The more likely
    explanation— remember, basketball is a TV show on The
    Disney Channel the outcome of which couldn’t be less
    relevant to humanity— is that it is projection, it represents
    frantic activity as a defense against change. “I’m not a racist—
    because THAT’s a racist!”
    –

    1Bbu9uvaNMWmAGj6sPF3edaA4u1wY2DLtZ

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