Tuesday, December 31, 2013

America's Polygamous Future

Wall Street Journal

When the Supreme Court paved the way for universal recognition of same-sex marriage last June, opponents predicted that polygamy would be next. They didn't realize how quickly this would happen.
Less than six months after the high court issued a pair of decisions expanding access to gay marriage and its benefits, a federal judge in Utah has ruled unconstitutional key parts of a Utah bigamy law that makes polygamous cohabitation a crime. The law had been challenged by 44-year-old Kody Brown and his four wives, who, together with their 17 children, star in the reality-TV show "Sister Wives." The Browns, who used to live in Lehi, Utah (they have since moved to Las Vegas), belong to one of several breakaway Mormon sects that practice plural marriage. (The mainstream Church of the Latter-day Saints formally abandoned polygamy in 1890, shortly before Utah became a state). An estimated 40,000 residents of Utah live in polygamous households.
To be sure, the court ruling, by U.S. District Judge Clark Waddoups, does not legalize polygamous marriage or even invalidate Utah's bigamy law in its entirety. All 50 states have antibigamy laws on their books. But Utah's law, apparently uniquely, forbids plural marriages entered into via multiple marriage licenses and also applies to a married person who "cohabits with another person."
The typical practice for breakaway Mormon men, including Kody Brown, is to enter into only one legally recognized marriage but to take on additional "sister wives" in "spiritual" unions sanctified by religious ceremonies. Such unions are technically adulterous, but since the state of Utah does not prosecute adultery, Judge Waddoups said there was no "rational basis" for Utah's criminal law to distinguish between plain old adulterous cohabitation and informal polygamy entered into for religious reasons.
His ruling thus affects only so-called "fundamentalist" Mormons. However, the decision becomes precedent elsewhere, then it may apply to an estimated 50,000 to 100,000 Muslims in the U.S. who are in similar polygamous arrangements that they believe are permitted by the Quran.
"Polyandry"—one woman with multiple husbands—is extremely rare. It seems to exist only among isolated Amazonian hunter-gatherer tribes and in parts of rural Tibet...
Polygamy invariably favors "alpha" males who can beat down the competition for available women and maintain a lock on the affections of the women themselves. The women also have to be willing to sacrifice being the only object of attention of their spouse or lover for the glory of being an object of his attention at all.
The evolutionary psychologist Geoffrey Miller, in his 2000 book "The Mating Mind," described polygyny as a kind of default setting for human societies, and indeed primate societies as well. "[M]ating in our species has always been moderately polygynous," Mr. Miller wrote. He pointed out that women crave powerful, charismatic, often sexually promiscuous men—the most successful hunters and herdsmen, conqueror-kings such as Charlemagne and Genghis Khan, politicians, rock stars, and even sociopaths such as Charles Manson —because women instinctively reach out to men strong enough to protect them and the vulnerable offspring they bear.
And, as those evolutionary psychologists say, it is more advantageous for a woman to have half, a third, or even a fourth of a prime male specimen, than 100% of a loser. She wants her offspring to inherit those alpha male traits and thereby have enhanced chances for survival and reproduction.

And, by the way, we already have polygamy in the United States. What do you call a man who sires three sets of children by three different women? Well, the biologists would call him polygamous, but we just call him a twice-divorced guy with child support and alimony payments.


Monday, December 30, 2013

College libraries

The Atlantic

A simple test -- just look at the two photos below.

Do they look like someplace you would just LOVE to spend some serious time in?


Then do everyone a favor and don't go to college.

Sunday, December 29, 2013

To his Coy Mistress -- Andrew Marvell (1621-1678)

Had we but world enough, and time,
This coyness, lady, were no crime.
We would sit down and think which way
To walk, and pass our long love's day;
Thou by the Indian Ganges' side
Shouldst rubies find; I by the tide
Of Humber would complain. I would
Love you ten years before the Flood;
And you should, if you please, refuse
Till the conversion of the Jews.
My vegetable love should grow
Vaster than empires, and more slow.
An hundred years should go to praise
Thine eyes, and on thy forehead gaze;
Two hundred to adore each breast,
But thirty thousand to the rest;
An age at least to every part,
And the last age should show your heart.
For, lady, you deserve this state,
Nor would I love at lower rate.

But at my back I always hear
Time's winged chariot hurrying near;
And yonder all before us lie
Deserts of vast eternity.
Thy beauty shall no more be found,
Nor, in thy marble vault, shall sound
My echoing song; then worms shall try
That long preserv'd virginity,
And your quaint honour turn to dust,
And into ashes all my lust.
The grave's a fine and private place,
But none I think do there embrace.

Now therefore, while the youthful hue
Sits on thy skin like morning dew,
And while thy willing soul transpires
At every pore with instant fires,
Now let us sport us while we may;
And now, like am'rous birds of prey,
Rather at once our time devour,
Than languish in his slow-chapp'd power.
Let us roll all our strength, and all
Our sweetness, up into one ball;
And tear our pleasures with rough strife
Thorough the iron gates of life.
Thus, though we cannot make our sun
Stand still, yet we will make him run.

Saturday, December 28, 2013

I Bombed Korea -- Cake (1994)

I bombed Korea every night.
My engine sang into the salty sky.
I didn't know if I would live or die.

I bombed Korea every night.
I bombed Korea every night.
I bombed Korea every night.

Red flowers bursting down below us.
Those people didn't even know us.
We didn't know if we would live or die.
We didn't know if it was wrong or right.

I bombed Korea every night.

And so I sit here at this bar.
I'm not a hero.
I'm not a movie star.
I've got my beer.
I've got my stories to tell,
But they won't tell you what it's like in hell.

Red flowers bursting down below us.
Those people didn't even know us.
We didn't know if we would live or die.
We didn't know if it was wrong or right.
We didn't know if we would live or die.

I bombed Korea every night.

Friday, December 27, 2013

Is ADHD overdiagnosed?

New York Times

[R]ecent data from the Centers for Disease Control and Prevention show that the diagnosis had been made in 15 percent of high school-age children, and that the number of children on medication for the disorder had soared to 3.5 million from 600,000 in 1990. He questioned the rising rates of diagnosis and called them “a national disaster of dangerous proportions.”
“The numbers make it look like an epidemic. Well, it’s not. It’s preposterous,” Dr. Conners, a psychologist and professor emeritus at Duke University, said in a subsequent interview. “This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”       
The rise of A.D.H.D. diagnoses and prescriptions for stimulants over the years coincided with a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents. With the children’s market booming, the industry is now employing similar marketing techniques as it focuses on adult A.D.H.D., which could become even more profitable.
Few dispute that classic A.D.H.D., historically estimated to affect 5 percent of children, is a legitimate disability that impedes success at school, work and personal life. Medication often assuages the severe impulsiveness and inability to concentrate, allowing a person’s underlying drive and intelligence to emerge.
But even some of the field’s longtime advocates say the zeal to find and treat every A.D.H.D. child has led to too many people with scant symptoms receiving the diagnosis and medication.

Thursday, December 26, 2013

Antipsychotic medications used to control behavior in poor children?

 Consumer Reports

The number of children taking powerful antipsychotic drugs has nearly tripled over the last 10 to 15 years, according to recent research. The increase comes not because of an epidemic of schizophrenia or other forms of serious mental illness in children, but because doctors are increasingly prescribing the drugs to treat behavior problems, a use not approved by the Food and Drug Administration (FDA). And a disproportionate number of those prescriptions are written for poor and minority children, some as young as age 2.

Doctors are prescribing antipsychotics even though there’s minimal evidence that the drugs help kids for approved uses, much less the unapproved ones, such as behavioral problems. And to make matters worse, the little research there is suggests the drugs can cause troubling side effects, including weight gain, high cholesterol, and an increased risk of type-2 diabetes.

Doctors can legally—and commonly do—write prescriptions for any medication they see fit to treat a condition. (See here for more details on off-label prescribing)

But overuse of antipsychotic drugs has become worrisome enough that the American Psychiatric Association recently announced that doctors should not routinely prescribe the drugs as first-line treatment to children and adolescents for any reason other than psychotic disorders such as schizophrenia or severe tic disorders. The association is so concerned that it chose to include this issue as part of Choosing Wisely, an initiative in which Consumer Reports has jointed the ABIM Foundation and national medical societies to identify tests and treatments to question.

Antipsychotic drugs do have a place in psychiatric treatment, even in children and teens. They can help manage disabling symptoms caused by severe mental illness or developmental disorders. But for many kids taking the drugs, the benefits probably don’t outweigh the risks.

“What’s not known about the long-term effects is very troubling,” Christopher Bellonci, M.D., assistant professor at Tufts University School of Medicine in Boston, said. “The younger you go, the more you can affect the developing brain.”

So, what’s behind the antipsychotic boom? Our investigation, based on an analysis by the American Society of Health-System Pharmacists, uncovered several factors, including overly aggressive drug marketing and a lack of access to quality mental health care. Caught in the middle are families who often have insufficient resources to deal with complex emotional, psychological, and behavioral problems.

“There’s a societal trend to look for the quick fix, the magic bullet that will correct disruptive behaviors,” David Rubin, M.D., associate professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, said. “But for those looking for a quick solution to escalating behaviors at home, the hard truth is there is unlikely to be a quick fix.”

The rise of antipsychotic drug use

Certain antipsychotic drugs have been approved by the FDA to treat schizophrenia and bipolar disorder in adolescents and teens, as well as extreme irritability in children 5 and older with autism who could be a danger to themselves and others. (See the table below for a summary).

But the majority of kids prescribed antipsychotic drugs don’t take them for one of those reasons. Schizophrenia is rarely diagnosed until adulthood, for example. Bipolar disorder is estimated to affect less than 3 percent of teens, according to the National Institute of Mental Health, but the exact prevalence is unknown because of its difficulty to diagnose in children. That’s partly because the symptoms are less clear and may overlap with other conditions such as ADHD. And while about one in 110 children have some form of autistic disorder, only about 30 percent are affected by the aggressive impulse behavior antipsychotic drugs have been approved to treat.

Table 1. Antipsychotic Medications and Their Approved Uses

Brand Name (generic name)FDA-approved uses for children
Abilify (aripiprazole)Approved for use by adolescents with schizophrenia, adolescents with bipolar disorder mixed or manic episodes, and irritability associated with autism.
Clozaril, Fazaclo (clozapine)None
Saphris (asenapine)None
Fanapt (iloperidone)None
Zyprexa, Zyprexa Zydis (olanzapine)Approved for use by adolescents with schizophrenia, and adolescents with bipolar disorder mixed or manic episodes.
Invega (paliperidone)None
Seroquel, Seroquel XR (quetiapine)Approved for use in treatment of children with manic episodes in bipolar disorder, and adolescents with schizophrenia.
Risperdal (risperidone)Approved for use by adolescents with schizophrenia, adolescents with bipolar disorder mixed or manic episodes, and for irritability associated with autism.
Geodon (ziprasidone)None

Over the last decade or so, doctors have increasingly prescribed the drugs for “off-label” uses, particularly in ADHD and disruptive behavior disorder, a broad diagnosis that encompasses a range of behaviors from attacking other children to temper tantrums and defying authority.

Those disorders affect a much larger pool of children. About 10 percent of kids aged 3 to 17 are affected by either behavior problems or ADHD.

Increasingly, kids are prescribed antipsychotic medications at their pediatrician’s office, rather than by a psychiatrist. The number of prescriptions for the drugs written by pediatricians has increased steadily over the last several years and is up nearly 25 percent since 2006.

“What started out as a treatment with some level of evidence for a small sub-group of youth with significant development disabilities, for example, has been extended to cognitively normal kids without any strong evidence,” Rubin said.
Two studies provide a window on just how much things have changed. In the first, researchers looked at prescribing practices from 2005 to 2009 and those of a decade earlier. Results, published online Aug. 6, 2012, by the Archives of General Psychiatry showed that antipsychotic use increased about 85 percent in children and adolescents—at a much higher rate than in adults—and that the drugs are now used very differently in younger patients. For example, in adults, doctors prescribe antipsychotic drugs mostly for bipolar disorder, depression, or schizophrenia and more often to women; in children and adolescents, the drugs are most commonly prescribed to treat disruptive behavior disorder in boys.

Another analysis found that antipsychotic prescriptions for children age 2 to 5 doubled between 2001 and 2007. Most of the children were 4- and 5-year-old boys, with ADHD and disruptive behavior disorder among the most frequent diagnoses.

Behind the trend

Use of all psychiatric drugs has increased in children, not just antipsychotic drugs. One reason is a growing awareness of mental health problems in kids and an honest desire to treat them. But the system is not always set up to provide the best care.

For one thing, an approach that combines nondrug measures such as parent training and cognitive behavior therapy with medication if necessary may work best. But many kids taking antipsychotic drugs have never seen a mental health professional. “Use is really high among kids in the Medicaid system where decent non-drug services may be difficult to find,” says Rubin, who also points out that even kids with private insurance often don’t have coverage for psychiatric care or counseling.
And it doesn’t help that drug companies might overhype the benefits of the drugs while playing down the risks.

Antipsychotics have become huge moneymakers for the drug industry. In 2003, annual U.S. sales of the drugs were estimated at $2.8 billion; by 2011, that number had risen to $18.2 billion. That huge growth was driven in part by one company—Janssen Pharmaceuticals— and its aggressive promotion of off-label uses in children and elderly patients, relying on marketing tactics that according to the federal government, crossed legal and ethical lines.

In November, Janssen Pharmaceuticals and two other subsidiaries of the behemoth drug manufacturer Johnson & Johnson agreed to pay more than $2.2 billion to settle criminal and civil claims stemming from deceptive marketing of the antipsychotics risperidone (Risperdal) and other products. According to claims made by the U.S. Department of Justice, the companies marketed two antipsychotics for uses that were never proved safe and effective using tactics that allegedly included downplaying serious risks and paying kickbacks to physicians and pharmacies for prescribing and promoting the drugs.

Important questions

There’s been little official research into the use of antipsychotic drugs in kids, particularly off-label uses of the drugs. But, in effect, widespread off-label use of the drugs means that many kids are involved in a sort of large, poorly controlled experiment. That has left a lot of questions, even some basic ones, unanswered:
Do they help? Even for approved uses, the evidence is limited to a few short-term studies; it’s still unclear how well the drugs work and whether they remain effective over the long-term. All total, studies of the drugs have involved fewer than 3,000 children, most followed for eight weeks or less.
Are they safe? Newer antipsychotic drugs are turning out to carry more risk than initially thought. “The atypical versions were thought to be safer (than older antipsychotic drugs), but we are seeing a different set of side effects,” Bellonci said.

One of the most common side effects is weight gain. Studies lasting six to eight weeks show that children and teens can gain an average of 2 to 9 pounds, depending on the drug, and current research suggests that weight gain may continue as long as children take the drugs. In addition, some antipsychotic drugs can adversely affect cholesterol and increase blood sugar levels and their risk of type-2 diabetes.

Although the newer antipsychotic medications used commonly today are less likely to cause movement disorders than older versions of the drugs, some studies have found that kids taking certain drugs are still at slightly higher risk of abnormal body movements, including muscle twitches, tremors, and spasms than those receiving a placebo.
What happens when drugs are combined? Even less is known about what happens when kids take two or more of the drugs at the same time, something that doctors often prescribe. For example, in one study of a large Medicaid program, 7 percent to 8 percent of children and adolescents treated with antipsychotic drugs received two or more of the drugs for an average of about six months. And in the preschool study cited earlier, nearly 80 percent of children prescribed antipsychotic drugs were taking one or more additional psychiatric drugs.
How do they work? The exact mechanism is not well understood. Scientists know that antipsychotic drugs affect neurotransmitters, brain chemicals that play important roles in behavior and cognition, as well as sleep, mood, attention, memory and learning. This might be how the drugs reduce psychotic symptoms, such as hallucinations, delusions, disorganized thinking, and agitation as well as the tendency to hurt oneself or others.

A cautious approach

Although there may be a place for limited off-label use of antipsychotic drugs in children, the group of kids who could benefit needs to be better defined and the drugs should be more carefully managed than they often are today.

“In the end, what I’m bothered most by is those who would say we have to do it this way because we don’t have enough mental-health resources," said Helen Egger, M.D., Chief of Child and Family Mental Health and Developmental Neuroscience in the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center in Durham, North Carolina. "That’s not good enough. The answers on how best to use these drugs will come from instituting evidence-based standards of care.”

Eggers and others advocate for a multifaceted approach to behavioral, emotional, and developmental issues, in which medications, if used at all, would comprise only one part of treatment. While there is no cookie-cutter formula for families dealing with complex and often very difficult issues, following steps outlined below can help people navigate the health care system and get the best possible care for their child.


Tuesday, December 24, 2013

Monday, December 23, 2013

Why Professors Should Be Like Preachers

The Atlantic Monthly

Futurism is a hazardous sport, but this Tyler Cowen fellow seems like he might actually be good at it. In this brief passage, he manages to point out the weakness of MOOCs and to reiterate the value of "high-touch" services.
At a good teaching school, a professor is expected to run the class and, sometimes, have a small group of students over to his house for dinner. As the former function becomes less important, due to competition from online content, the latter function will predominate. The computer program cannot host a chatty, informal dinner in the same manner. We could think of the forthcoming educational model as professor as impresario. In some important ways, we would be returning to the original model of face-to-face education as practiced in ancient Greek symposia and meetings by the agora.
It will become increasingly apparent how much of current education is driven by human weakness, namely the inability of most students to simply sit down and try to learn something on their own. It’s a common claim that you can’t replace professors with Nobel-quality YouTube lectures, because the professor, and perhaps also the classroom setting, is required to motivate most of the students. Fair enough, but let’s take this seriously. The professor is then a motivator first and foremost. Let’s hire good motivators. Let’s teach our professors how to motivate. Let’s judge them on that basis. Let’s treat professors more like athletics coaches, personal therapists, and preachers, because that is what they will evolve to be.

—From Average Is Over: Powering America Beyond the Age of the Great Stagnation, by Tyler Cowen (published in September by Dutton)

Sunday, December 22, 2013

The Bloody Sire -- Robinson Jeffers (1940)

It is not bad. Let them play.

Let the guns bark and the bombing-plane

Speak his prodigious blasphemies.

It is not bad, it is high time,

Stark violence is still the sire of all the world’s values.

What but the wolf’s tooth whittled so fine

The fleet limbs of the antelope?

What but fear winged the birds, and hunger

Jewelled with such eyes the great goshawk’s head?

Violence has been the sire of all the world’s values.

Who would remember Helen’s face

Lacking the terrible halo of spears?

Who formed Christ but Herod and Caesar,

The cruel and bloody victories of Caesar?

Violence, the bloody sire of all the world’s values.

Never weep, let them play,

Old violence is not too old to beget new values.

Saturday, December 21, 2013

Brandy -- Looking Glass

There's a port on a western bay
And it serves a hundred ships a day
Lonely sailors pass the time away
And talk about their homes

And there's a girl in this harbor town
And she works layin' whiskey down
They say "Brandy, fetch another round"
She serves them whiskey and wine

The sailors say "Brandy, you're a fine girl" (you're a fine girl)
"What a good wife you would be" (such a fine girl)
"Yeah your eyes could steal a sailor from the sea"

Brandy wears a braided chain
Made of finest silver from the North of Spain
A locket that bears the name
Of the man that Brandy loves

He came on a summer's day
Bringin' gifts from far away
But he made it clear he couldn't stay
No harbor was his home

The sailor said " Brandy, you're a fine girl" (you're a fine girl)
"What a good wife you would be" (such a fine girl)
"But my life, my lover, my lady is the sea"

Yeah, Brandy used to watch his eyes
When he told his sailor stories
She could feel the ocean foam rise
She saw its ragin' glory
But he had always told the truth, lord, he was an honest man
And Brandy does her best to understand

At night when the bars close down
Brandy walks through a silent town
And loves a man who's not around
She still can hear him say

She hears him say " Brandy, you're a fine girl" (you're a fine girl)
"What a good wife you would be" (such a fine girl)
"But my life, my lover, my lady is the sea"

Friday, December 20, 2013

Using Music to Elicit Autobiographical Memories in Brain Injured Patients

Science Daily

After a serious head injury (wear a helmet, kids!) some patients can have difficulty recalling even autobiographical memories. In many rehab facilities, therapists use an Autobiographical Memory Interview to help patients recall their past. It includes questions like, "Who were some of your friends when you were in grade school?" The study that follows played hit songs from the patients' pasts and then asked them if those songs brought back any memories.
Baird and Samson played extracts from 'Billboard Hot 100' number-one songs in random order to five patients. The songs, taken from the whole of the patient's lifespan from age five, were also played to five control subjects with no brain injury. All were asked to record how familiar they were with a given song, whether they liked it, and what memories it invoked.
Doctors Baird and Samson found that the frequency of recorded MEAMs was similar for patients (38%-71%) and controls (48%-71%). Only one of the four ABI ["acquired brain injury"] patients recorded no MEAMs. In fact, the highest number of MEAMs in the whole group was recorded by one of the ABI patients. In all those studied, the majority of MEAMs were of a person, people or a life period and were typically positive. Songs that evoked a memory were noted as more familiar and more liked than those that did not.
As a potential tool for helping patients regain their memories, Baird and Samson conclude that: "Music was more efficient at evoking autobiographical memories than verbal prompts of the Autobiographical Memory Interview (AMI) across each life period, with a higher percentage of MEAMs for each life period compared with AMI scores."
Notice that the study included only FOUR patients with brain injury, and for ONE of them, the music technique didn't work at all. Just goes to show that even in scientific publishing, if you've got a hot hook, you don't need much else.

It interesting to think about what music was playing on the car radio when you were 5, 10, 15, and 20 years old, and what impact those songs might still have on you today. Perhaps not coincidentally, one of the songs I have posted to this blog, as well as the one that I had been planning to post on Saturday, were hits when I was between 4 and 5 years old.

Here's the link to the Billboard Hot 100 archive, in case you want to play this game.

Thursday, December 19, 2013

Vaccine for PTSD?

Discovery News
Medical researchers say they have discovered a possible “vaccine” for post-traumatic stress disorder that could protect soldiers in battle by regulating one of the body’s own hormones.
Scientists at the Massachusetts Institute of Technology report in a new paper that ghrelin, a hormone produced during stressful situations, primes the brain for PTSD. They believe that by controlling ghrelin, they can also prevent the formation of PTSD after traumatic events.
“You would get a shot, and for a year it would lower your ghrelin levels,” said Ki Gossens, assistant professor of brain and cognitive sciences at MIT, and an author of the paper in the journal Molecular Psychiatry, which is appearing this week. “When you were deployed and exposed to the stress of combat, your ghrelin levels would go up and the vaccine would combat that. That should reduce the incidence of PTSD. Right now, we don’t have anything to prevent it.”
Easy there, Ki. First of all, it's not at all certain that PTSD is simply a "fear-based" or "stress-related" disorder. You don't develop PTSD just because you have been in a stressful environment for an extended period. As far as I know, no one has ever presented evidence that elevated ghrelin levels are a risk factor for PTSD (i.e., that you can predict which soldiers will develop PTSD by measuring their in-theater ghrelin levels).

Secondly, are you sure you want to prevent PTSD? What do we call people who are exposed to horror and don't experience it as horror? Oh yeah, psychopaths. Richard Gabriel discussed this nightmarish "fearless soldiers" business a couple of decades ago.

Scientists had previously known that ghrelin makes you hungrier and dubbed it the “hunger hormone.” It was the target of research by drug companies who wanted a cure for obesity, but none of that work was successful. However, Gossens said her group has found that ghrelin also may make people more susceptible to PTSD.
During their experiments, the researchers found that when rats were given a drug to stimulate ghrelin levels in the blood, they became much more susceptible to fear than normal rats. By blocking the receptors on the cells that interact with ghrelin, the researchers reduced fear to normal levels in the chronically stressed rats.
Gossens said that ghrelin operates alongside the brain’s other “fight or flight” neurochemical system, which is controlled by the hormones cortisol and adrenaline. That signaling route is known as the hypothalamus-pituatary-adrenal pathway, or HPA.
“What we are suggesting is that the ghrelin pathway operates in parallel,” Gossens said. “We think the emotional disorders (such as PTSD) following trauma exposure are the result of elevated ghrelin rather than HPA. It gives us a completely new set of targets to treat PTSD.”
Gossens believes that since many ghrelin-related anti-obesity drugs have already passed federal human safety trials, it would give them a leg up on developing some kind of vaccine for PTSD. However at least one researcher said blocking ghrelin might have harmful side effects.
“As to the ‘vaccination’ issue, it is premature to talk about that and probably also not a good idea,” said Bruce McEwen, director of the neuroendocrinology laboratory at Rockefeller University in New York in an e-mail. “Ghrelin is a hormone and also a neuromodulator that stimulates appetite and also enhances aspects of cognitive function. A systemic vaccination might not even work and could ... make people anorectic and impair other aspects of physiology by blocking good actions of ghrelin.”
He meant "anorexic" (with diminished appetitite), which is how you feel after you take an anorectic.[Persons with anorexia nervosa are not actually anorexic, because they actually are hungry but they resist the urge to eat. It is depressed persons who are more likely to be anorexic.]

So, you do a rat study (one that you really have to use your imagination in order to relate it in any way to combat trauma), you get it published in Molecular Psychiatry, you issue a press release and shoot off you mouth to a reporter, and now people are going around saying, "I heard there's a new vaccine for PTSD." Yup, that's pretty much what happens every day.

You know what the vaccine for PTSD is?


Wednesday, December 18, 2013

Freud on drone warfare


Perhaps in a whimsical mood, Sigmund Freud cited some unusual evidence for the aggressive impulse he found in mankind. In his essay “Reflections on War and Death,” he writes that French philosopher Jean-Jacques Rousseau “asks the reader what he would do if without leaving Paris he could kill, with great profit to himself, an old mandarin in Peking by a mere act of his will. Rousseau implies that he would not give much for the life of the dignitary.” Imagine if great numbers could so exercise their will. What violence would be unleashed, how many prostrate bodies around the globe who never knew what hit them. Ecstasy!
And so it has come to pass. With the will to do it, the United States—that is, the White House—can now eliminate undesirables anywhere in the world by means of the unmanned aerial vehicle, or drone, with over 2,300 remote executions so far. A case in point was the assassination last September of a U.S. citizen, suspected terrorist Anwar al-Awlaki, as he was driving in Yemen. This was accomplished with less oversight than capture and extradition would have required—paperwork and negotiations avoided. Clean.
Attorney General Eric Holder says execution by drone is not assassination if the victim is threatening the state. It may not be due process as provided by the U.S. Constitution, but it’s “judicial process” as decided by the White House. Holder offers only scant details on the targets—classified, you know—but rest assured they have been painstakingly selected, and we are at war, though not, to be sure, in Yemen. That country, we’re told, at least partially approves of these attacks.
Pakistanis have complained that too many civilians are killed in American drone strikes. At a recent meeting with President Obama, Pakistani Prime Minister Yousef Raza Gilani demanded that drone attacks stop in Pakistan. No way, responded Obama. They’re needed to wipe out terror.
That’s what they all say, notes Freud, a congenital skeptic. Acts of violence are usually given some justification, deserved or not, to relieve the conscience. In this regard, he quotes Shakespeare’s Falstaff, who says that when excuses for any doubtful action are needed, reasons are “as plenty as blackberries.” Pick away. And drones can continue to pick away without impediment.

Read the rest...

Tuesday, December 17, 2013

Lobotomizing veterans

Really great investigative reporting by the Wall Street Journal:

Between April 1, 1947, and Sept. 30, 1950, VA doctors lobotomized 1,464 veterans at 50 hospitals authorized to perform the surgery, according to agency documents rediscovered by the Journal. Scores of records from 22 of those hospitals list another 466 lobotomies performed outside that time period, bringing the total documented operations to 1,930. Gaps in the records suggest that hundreds of additional operations likely took place at other VA facilities. The vast majority of the patients were men, although some female veterans underwent VA lobotomies, as well.
Lobotomies faded from use after the first major antipsychotic drug, Thorazine, hit the market in the mid-1950s...

Notice that the procedure often seemed to work, and it may have even been beneficial for the veteran prominently featured in the story. But for his lobotomy, he might have been institutionalized his entire life. We might assume that antipsychotics would have helped him, but we cannot know that. (And, of course, the folks performing the lobotomies could not have know that the advent of antipsychotics was coming in less than a decade.)

Not that treating war trauma with antipsychotics is a good thing, mind you. Remember that Thorazine was first marketed as a "chemical lobotomy," i.e. yielding all the positive effects of lobotomy without the hassles of surgery.

The real issue here, of course, is how many thousands of men were driven mad by their war experiences.

Monday, December 16, 2013

Was James Bond an alcoholic?

Read the entire "study," which appears in the Christmas edition of BMJ (formerly, the British Medical Journal). Best quote:

Bond is noted to have several drinks, enough to put him well over this limit and then drive. In Goldfinger, for example, he drinks 18 units while having drinks and dinner with Auric Goldfinger before then driving home. In Casino Royale he drinks over 39 units before engaging in a high speed car chase, losing control, and spending 14 days in hospital. We hope that this was a salutatory lesson.


Objective To quantify James Bond’s consumption of alcohol as detailed in the series of novels by Ian Fleming.

Design Retrospective literature review.

Setting The study authors’ homes, in a comfy chair.

Participants Commander James Bond, 007; Mr Ian Lancaster Fleming.

Main outcome measures Weekly alcohol consumption by Commander Bond.

Methods All 14 James Bond books were read by two of the authors. Contemporaneous notes were taken detailing every alcoholic drink taken. Predefined alcohol unit levels were used to calculate consumption. Days when Bond was unable to consume alcohol (such as through incarceration) were noted.

Results After exclusion of days when Bond was unable to drink, his weekly alcohol consumption was 92 units a week, over four times the recommended amount. His maximum daily consumption was 49.8 units. He had only 12.5 alcohol free days out of 87.5 days on which he was able to drink.

Conclusions James Bond’s level of alcohol intake puts him at high risk of multiple alcohol related diseases and an early death. The level of functioning as displayed in the books is inconsistent with the physical, mental, and indeed sexual functioning expected from someone drinking this much alcohol. We advise an immediate referral for further assessment and treatment, a reduction in alcohol consumption to safe levels, and suspect that the famous catchphrase “shaken, not stirred” could be because of alcohol induced tremor affecting his hands.


Sunday, December 15, 2013

In Memory of Sigmund Freud -- W.H. Auden

When there are so many we shall have to mourn,
when grief has been made so public, and exposed
     to the critique of a whole epoch
   the frailty of our conscience and anguish,

of whom shall we speak? For every day they die
among us, those who were doing us some good,
     who knew it was never enough but
   hoped to improve a little by living.

Such was this doctor: still at eighty he wished
to think of our life from whose unruliness
     so many plausible young futures
   with threats or flattery ask obedience,

but his wish was denied him: he closed his eyes
upon that last picture, common to us all,
     of problems like relatives gathered
   puzzled and jealous about our dying. 

For about him till the very end were still
those he had studied, the fauna of the night,
     and shades that still waited to enter
   the bright circle of his recognition

turned elsewhere with their disappointment as he
was taken away from his life interest
     to go back to the earth in London,
   an important Jew who died in exile.

Only Hate was happy, hoping to augment
his practice now, and his dingy clientele
     who think they can be cured by killing
   and covering the garden with ashes.

They are still alive, but in a world he changed
simply by looking back with no false regrets;
     all he did was to remember
   like the old and be honest like children.

He wasn't clever at all: he merely told
the unhappy Present to recite the Past
     like a poetry lesson till sooner
   or later it faltered at the line where

long ago the accusations had begun,
and suddenly knew by whom it had been judged,
     how rich life had been and how silly,
   and was life-forgiven and more humble,

able to approach the Future as a friend
without a wardrobe of excuses, without
     a set mask of rectitude or an 
   embarrassing over-familiar gesture.

No wonder the ancient cultures of conceit
in his technique of unsettlement foresaw
     the fall of princes, the collapse of
   their lucrative patterns of frustration:

if he succeeded, why, the Generalised Life
would become impossible, the monolith
     of State be broken and prevented
   the co-operation of avengers.

Of course they called on God, but he went his way
down among the lost people like Dante, down
     to the stinking fosse where the injured
   lead the ugly life of the rejected,

and showed us what evil is, not, as we thought,
deeds that must be punished, but our lack of faith,
     our dishonest mood of denial,
   the concupiscence of the oppressor.

If some traces of the autocratic pose,
the paternal strictness he distrusted, still
     clung to his utterance and features,
   it was a protective coloration

for one who'd lived among enemies so long:
if often he was wrong and, at times, absurd,
     to us he is no more a person
   now but a whole climate of opinion

under whom we conduct our different lives:
Like weather he can only hinder or help,
     the proud can still be proud but find it
   a little harder, the tyrant tries to

make do with him but doesn't care for him much:
he quietly surrounds all our habits of growth
     and extends, till the tired in even
   the remotest miserable duchy

have felt the change in their bones and are cheered
till the child, unlucky in his little State,
     some hearth where freedom is excluded,
   a hive whose honey is fear and worry,

feels calmer now and somehow assured of escape,
while, as they lie in the grass of our neglect, 
     so many long-forgotten objects
   revealed by his undiscouraged shining

are returned to us and made precious again;
games we had thought we must drop as we grew up,
     little noises we dared not laugh at,
   faces we made when no one was looking.

But he wishes us more than this. To be free
is often to be lonely. He would unite
     the unequal moieties fractured
   by our own well-meaning sense of justice,

would restore to the larger the wit and will 
the smaller possesses but can only use
     for arid disputes, would give back to
   the son the mother's richness of feeling:

but he would have us remember most of all 
to be enthusiastic over the night,
     not only for the sense of wonder
   it alone has to offer, but also

because it needs our love. With large sad eyes
its delectable creatures look up and beg
     us dumbly to ask them to follow:
   they are exiles who long for the future

that lives in our power, they too would rejoice
if allowed to serve enlightenment like him,
     even to bear our cry of 'Judas', 
   as he did and all must bear who serve it.

One rational voice is dumb. Over his grave
the household of Impulse mourns one dearly loved:
     sad is Eros, builder of cities,
   and weeping anarchic Aphrodite.

Saturday, December 14, 2013

Tangled up in Blue (live, 1974) -- Bob Dylan

Early one mornin’ the sun was shinin’
I was layin’ in bed
Wond’rin’ if she’d changed at all
If her hair was still red

Her folks they said our lives together
Sure was gonna be rough
They never did like Mama’s homemade dress
Papa’s bankbook wasn’t big enough

And I was standin’ on the side of the road
Rain fallin’ on my shoes
Heading out for the East Coast
Lord knows I’ve paid some dues gettin’ through

Tangled up in blue

She was married when we first met
Soon to be divorced
I helped her out of a jam, I guess
But I used a little too much force

We drove that car as far as we could
Abandoned it out West
Split up on a dark sad night
Both agreeing it was best

She turned around to look at me
As I was walkin’ away
I heard her say over my shoulder
“We’ll meet again someday on the avenue”
Tangled up in blue

I had a job in the great north woods
Working as a cook for a spell
But I never did like it all that much
And one day the ax just fell

So I drifted down to New Orleans
Where I happened to be employed
Workin’ for a while on a fishin’ boat
Right outside of Delacroix

But all the while I was alone
The past was close behind
I seen a lot of women
But she never escaped my mind, and I just grew

Tangled up in blue

She was workin’ in a topless place
And I stopped in for a beer
I just kept lookin’ at the side of her face
In the spotlight so clear

And later on as the crowd thinned out
I’s just about to do the same
She was standing there in back of my chair
Said to me, “Don’t I know your name?”

I muttered somethin’ underneath my breath
She studied the lines on my face
I must admit I felt a little uneasy
When she bent down to tie the laces of my shoe

Tangled up in blue

She lit a burner on the stove
And offered me a pipe
“I thought you’d never say hello,” she said
“You look like the silent type”

Then she opened up a book of poems
And handed it to me
Written by an Italian poet
From the thirteenth century

And every one of them words rang true
And glowed like burnin’ coal
Pourin’ off of every page
Like it was written in my soul from me to you

Tangled up in blue

I lived with them on Montague Street
In a basement down the stairs
There was music in the caf├ęs at night
And revolution in the air

Then he started into dealing with slaves
And something inside of him died
She had to sell everything she owned
And froze up inside

And when finally the bottom fell out
I became withdrawn
The only thing I knew how to do
Was to keep on keepin’ on like a bird that flew

Tangled up in blue

So now I’m goin’ back again
I got to get to her somehow
All the people we used to know
They’re an illusion to me now

Some are mathematicians
Some are carpenters’ wives
Don’t know how it all got started
I don’t know what they’re doin’ with their lives

But me, I’m still on the road
Headin’ for another joint
We always did feel the same
We just saw it from a different point of view

Tangled up in blue

Friday, December 13, 2013

Friday movie quote: "You know, former SAS types with easy smiles and expensive watches...Rolex?"

This scene is a brilliant display of "street" personality assessment, the sort of thing most intelligent people could do but don't, because they are too self-absorbed and don't pay attention to other people.

Daniel Craig's James Bond in Casino Royale is an exquisite portrayal of the psychopathic personality.

Thursday, December 12, 2013

Montaigne on unwilling students

"You still can't discuss the differences between objective and projective psychological tests?"

From Gilbert Highet's brilliant book, The Art of Teaching:

The real job for which teachers are trained and paid is to help the young to learn. It should not be necessary also to make them learn....Of course there has always been resistance to school discipline and reluctance to learn hard and boring things. Scarcely anyone learns the multiplication table for fun....But it seems to me that resistance [to learning] was not shown by entire classes of youths and girls, year after year, until education ceased to be a privilege sought after by the the few and became a compulsion inflicted on everyone....If [education] is surrounded and sanctioned by disciplines, [students] come to hate it. If it is made easy and delightful, they don't take it seriously....For this problem I see no solution except the radical one of declaring such numskulls unfit for education in book-work, and devising trade-schools, outdoor schools like the CCC camps, and domestic schools, to occupy their strong hands until they grow up. (Montaigne, who was a mild enough man and devoted to kindness as an educational ideal, had no solution either. He said that if a boy refused to learn or proved quite incapable of it, "his tutor should strangle him, if there are no witnesses, or else he should be apprenticed to a pastry-cook in some good town.")


Wednesday, December 11, 2013

"They act bright, they know the reference, they're credentialed."

Peggy Noonan

"Here I will say something harsh, and it’s connected to the thing about words but also images.
From what I have seen the administration is full of young people who’ve seen the movie but not read the book. They act bright, they know the reference, they’re credentialed. But they’ve only seen the movie about, say, the Cuban missile crisis, and then they get into a foreign-policy question and they’re seeing movies in their heads. They haven’t read the histories, the texts, which carry more information, more texture, data and subtlety, and different points of view. They’ve only seen the movie—the Cubans had the missiles and Jack said “Not another war” and Bobby said “Pearl Harbor in reverse” and dreadful old Curtis LeMay chomped his cigar and said “We can fry a million of ‘em by this afternoon, Mr. President.” Grrr, grrr, good guys beat bad guys.

"Let's bomb those Cubans back to the Stone Age."

It’s as if history isn’t real to them. They run around tweeting, all of them, even those in substantial positions. “Darfur government inadequate. Genocide unacceptable.” They share their feelings – that happens to be one of the things they seem to think is real, what they feel. “Unjust treatment of women—scourge that hurts my heart.” This is the dialogue to the movies in their heads. There’s a sense that they’re all freelancing, not really part of anything coherent.
For four years I have been told, by those who’ve worked in the administration and those who’ve visited it as volunteers or contractors, that the Obama White House isn’t organized. It’s just full of chatter. Meetings don’t begin on time, there’s no agenda, the list of those invited seems to expand and contract at somebody’s whim. There is a tendency to speak of how a problem will look and how its appearance should be handled, as opposed to what the problem is and should be done about it. People speak airily, without point. They scroll down, see a call that has to be returned, pop out and then in again.

It does not sound like a professional operation. And this is both typical of White Houses and yet on some level extreme. People have always had meetings to arrange meetings, but the lack of focus, the lack of point, the sense that they are operating within accepted levels of incoherence—this all sounds, actually, peculiar.
And when you apply this to the ObamaCare debacle, suddenly it seems to make sense. The White House is so unformed and chaotic that they probably didn’t ignore the problem, they probably held a million meetings on it. People probably said things like, “We’re experiencing some technological challenges but we’re sure we’ll be up by October,” and other people said, “Yes, it’s important we launch strong,” and others said, “The Republicans will have a field day if we’re not.” And then everyone went to their next meeting. And no one did anything. And the president went off and made speeches.
Because the doing isn’t that important, the talking is."

Tuesday, December 10, 2013

First person accounts of mental illness

These are from the syllabus of Dr. Aaron Pincus' Penn State seminar, Madness in the First Person (Fall 2009):

1. An Unquiet Mind: A Memoir of Moods and Madness, Kay Redfield Jamison. Bipolar disorder (manic-depressive illness).

2. Drinking: A Love Story, Caroline Knapp. Alcoholism.

3. Wasted: A Memoir of Anorexia and Bulimia, Marya Hornbacher. Eating disorders.

4. First Person Plural: My Life as a Multiple, Cameron West. Dissociative Identity Disorder.

5. The Quiet Room: A Journey out of the Torment of Madness, Lori Schiller & Amanda Bennett. Schizophrenia.

6. Students in the seminar also read Am I Okay?: A Layman's Guide to the Psychiatrist's Bible by Allan Frances and Michael First.

I've only read the first book on the list, but I would gladly read any of these over any weekend.

Monday, December 9, 2013

Pearl Harbor Day, a look back, and forward

Pearl Harbor, as seen from an attacking Japanese aircraft, December 7, 1941
It's often good fun and sometimes revealing to divide American history into distinct periods of uniform length. In working on my forthcoming book on American migrations, internal and immigrant, it occurred to me that you could do this using the American-sounding interval of 76 years, just a few years more than the biblical lifespan of three score and ten.

It was 76 years from Washington's First Inaugural in 1789 to Lincoln's Second Inaugural in 1865. It was 76 years from the surrender at Appomattox Courthouse in 1865 to the attack at Pearl Harbor in 1941.

Going backward, it was 76 years from the First Inaugural in 1789 to the Treaty of Utrecht in 1713, which settled one of the British-French colonial wars. And going 76 years back from Utrecht takes you to 1637, when the Virginia and Massachusetts Bay colonies were just getting organized.
As for our times, we are now 72 years away from Pearl Harbor. The current 76-year interval ends in December 2017.
Each of these 76-year periods can be depicted as a distinct unit. In the Colonial years up to 1713, very small numbers of colonists established separate cultures that have persisted to our times.

The story is brilliantly told in David Hackett Fischer's "Albion's Seed." For a more downbeat version, read the recent "The Barbarous Years" by the nonagenarian Bernard Bailyn.

From 1713 to 1789, the Colonies were peopled by much larger numbers of motley and often involuntary settlers -- slaves, indentured servants, the unruly Scots-Irish on the Appalachian frontier.
For how this society became dissatisfied with the Colonial status quo, read Bailyn's "The Ideological Origins of the American Revolution."

From 1789 to 1865, Americans sought their manifest destiny by expanding across the continent. They made great technological advances but were faced with the irreconcilable issue of slavery in the territories.

For dueling accounts of the period, read the pro-Andrew Jackson Democrat Sean Wilentz's "The Rise of American Democracy" and the pro-Henry Clay Whig Daniel Walker Howe's "What Hath God Wrought." Both are sparklingly written and full of offbeat insights and brilliant apercus.

The 1865-to-1941 period saw a vast efflorescence of market capitalism, European immigration and rising standards of living. For descriptions of how economic change reshaped the nation and its government, read Morton Keller's "Affairs of State" and "Regulating a New Society."

The 70-plus years since 1941 have seen a vast increase in the welfare safety net and governance by cooperation among big units -- big government, big business, big labor -- that began in the New Deal and gained steam in and after World War II. I immodestly offer my own "Our Country: The Shaping of America from Roosevelt to Reagan."

The original arrangements in each 76-year period became unworkable and unraveled toward its end. Eighteenth-century Americans rejected the Colonial status quo and launched a revolution, then established a constitutional republic.

Nineteenth-century Americans went to war over expansion of slavery. Early-20th-century Americans grappled with the collapse of the private-sector economy in the Depression of the 1930s.

We are seeing something like this again today. The welfare state arrangements that once seemed solid are on the path to unsustainability. Entitlement programs -- Social Security, Medicare, Medicaid -- are threatening to gobble up the whole government and much of the private sector, as well.

Lifetime employment by one big company represented by one big union is a thing of the past. People who counted on corporate or public-sector pensions are seeing them default.

Looking back, we are as far away in time today from victory in World War II in 1945 as Americans were at the time of the Dred Scott decision from the First Inaugural.

We are as far away in time today from passage of the Social Security in 1935 as Americans then were from the launching of post-Civil War Reconstruction.

File:The USS Arizona (BB-39) burning after the Japanese attack on Pearl Harbor - NARA 195617 - Edit.jpg

Nevertheless our current president and most politicians of his party seem determined to continue the current welfare state arrangements -- historian Walter Russell Mead calls this the blue-state model -- into the indefinite future.

Some leaders of the other party are advancing ideas for adapting a system that worked reasonably well in an industrial age dominated by seemingly eternal big units into something that can prove workable in an information age experiencing continual change and upheaval wrought by innovations in the market economy.

The current 76-year period is nearing its end. What will come next?

Sunday, December 8, 2013

Porphyria's Lover -- Robert Browning (1812-1889)


The rain set early in to-night,
The sullen wind was soon awake,
It tore the elm-tops down for spite,
And did its worst to vex the lake:
I listened with heart fit to break.
When glided in Porphyria; straight
She shut the cold out and the storm,
And kneeled and made the cheerless grate
Blaze up, and all the cottage warm;
Which done, she rose, and from her form
Withdrew the dripping cloak and shawl,
And laid her soiled gloves by, untied
Her hat and let the damp hair fall,
And, last, she sat down by my side
And called me. When no voice replied,
She put my arm about her waist,
And made her smooth white shoulder bare,
And all her yellow hair displaced,
And, stooping, made my cheek lie there,
And spread, o'er all, her yellow hair,
Murmuring how she loved me — she
Too weak, for all her heart's endeavour,
To set its struggling passion free
From pride, and vainer ties dissever,
And give herself to me for ever.
But passion sometimes would prevail,
Nor could to-night's gay feast restrain
A sudden thought of one so pale
For love of her, and all in vain:
So, she was come through wind and rain.
Be sure I looked up at her eyes
Happy and proud; at last I knew
Porphyria worshipped me; surprise
Made my heart swell, and still it grew
While I debated what to do.
That moment she was mine, mine, fair,
Perfectly pure and good: I found
A thing to do, and all her hair
In one long yellow string I wound
Three times her little throat around,
And strangled her. No pain felt she;
I am quite sure she felt no pain.
As a shut bud that holds a bee,
I warily oped her lids: again
Laughed the blue eyes without a stain.
And I untightened next the tress
About her neck; her cheek once more
Blushed bright beneath my burning kiss:
I propped her head up as before,
Only, this time my shoulder bore
Her head, which droops upon it still:
The smiling rosy little head,
So glad it has its utmost will,
That all it scorned at once is fled,
And I, its love, am gained instead!
Porphyria's love: she guessed not how
Her darling one wish would be heard.
And thus we sit together now,
And all night long we have not stirred,
And yet God has not said a word!

Friday, December 6, 2013

Friday movie quote: "You're not a weak sister, Mr. President. You're a criminally weak sister."

Burt Lancaster is formidable in this role. Hollywood legend has it that JFK was enthusastic about the making of this 1963 movie, even sanctioning the filming of the opening riot scene in front of the White House.

Not that Kennedy ever thought that members of the military would ever organize against the head of state. Oh wait, maybe he did. It would have been pretty hard for him to miss the fact that in August 1962, members of the French army tried to assassinate President Charles de Gaulle.

Seven Days in May is a very good movie -- but Day of the Jackal...ah, magnifique! The books from which the movies were made are also quite good.