Maggie's Farm

That's the view of Dr. Alan Frances, and I tend to agree. However, I never liked the DSM 4 either. 

Psychiatry's New Diagnostic Manual: "Don't Buy It. Don't Use It. Don't Teach
It."

Related, from Dr. McHugh: DSM-5: A Manual Run Amok - It's time for psychiatry to drop its field guide and try to
learn about mental ills

Salt is one of those things that drive dietary cranks, control-freaks, and ignorant do-gooders nuts.

There really is no reason for that. Most of us docs have been saying this for years and I have made this point here in the past. Salt is an absolutely necessary nutrient for all animals, and very low levels of sodium chloride can make you sick or dead.

The average, normal human body contains around 50 quarts of salt water.

The reason people used to advise "low-salt" diet is because excess dietary sodium is a bad idea for people with kidney failure and congestive heart failure, and people with uncontrolled high blood pressure (with its associated higher risks of heart attack and stroke).

However, salt does not cause those things.

Significantly-high blood pressure is easily dealt with these days. Heart failure will likely kill you in time regardless of what you do (barring a heart transplant), but it is treatable with medicines and some salt restriction.

The new study from the CDC: No Benefit in Salt Restriction.

The American Heart Association is not up to date on the topic: Sodium is Your enemy.

If you have high blood pressure, get it under reasonable control with your doctor. If you have organ failure (eg kidney or heart failure), or have some other ailment, do whatever your doc says. If you're healthy, enjoy your salt. It makes food taste better.

One recipe tip: I always season a salad with salt and pepper. It makes rabbit food taste almost good. Don't get me on the topic of whether green salad is "healthy." (It's neither healthy nor unhealthy. It's just filler.)

Readers know that we do not approve of using mental health terms as ad hominems against those with whom we have honest disagreements on political, or other, topics. I have been guilty of sometimes opining that "big, benign government types" are indulging in infantile fantasies of ideal parents, and I should not do that.

World-views differ, as do views of human nature. It makes life interesting and interestingly-contentious.`

Still, once you get past the insulting title this is a good post: On the Arrested Development of the Left:

At some point, one needs to grow up. The fact is, the human quest for salvation, whether personal or social, cannot be left to the reckoning of children. Given the perilous condition to which progressivist utopianism is taking our country, its pubescent psychology deserves to be even more carefully scrutinized. The soft-focus, Pollyanna attitude of the left, which has come to be known as the therapeutic perspective on the world, is often accompanied by unmitigated savagery. Even if the assault on culture is not physical but legislative, its effects are almost universally devastating. The historical register shows that the effort to improve the world by revolutionary violence or by comprehensive and indiscriminate cultural revisionism — therapy gone wild — is practically guaranteed to cause far more misery than it attempts to alleviate.

Addressing the tough realities of the real world, and the depressing limits of one's own self, are the best vitamins.

Mr. Solway references Rieff's challenging book, The Triumph of the Therapeutic: Uses of Faith after Freud.

I've mentioned here several times that the DSM is no "bible" for me or for most of my colleagues. We rarely find our patients in there, or human beings, for that matter. When the premise is wrong (that surface symptoms and complaints lead directly back to a neuro-chemical abnormality), then the entire endeavor is only useful for completing insurance forms (with a handful of partial exceptions).

A few relevant and interesting links:

- The Real Problems With Psychiatry - A psychotherapist contends that the DSM, psychiatry's "bible" that defines all mental illness, is not scientific but a product of unscrupulous politics and bureaucracy.

Not to mention the pharmaceutical industry. Always question Authority!

- Psychiatry’s Guide Is Out of Touch With Science, Experts Say in the NYT via 1 Boring Old Man's Groundhog Day

- How Scientific Is Psychiatry?

Like many fields of endeavor, good Psychiatry is part art, part science, but mixed with much life experience, much interpersonal experience, and as much painful self-knowledge as the doc him- or herself can handle to "sharpen the scalpel" as it were. We are called upon to be experts in real life, relationships, religion, the brain, the mind, the body, and the soul. It's a tall order which is why it is often termed "the impossible profession."

Readers know that I have trademarked the term "psycho-utopianism" to refer to the naive and reductionistic notion that, if all our our chemicals and all of our neurons were straightened out, and if we docs could fix it all by a cookbook, we'd all be some kind of "normal" and some kind of moral and some kind of "happy" of a serene, bourgeois sort. It ain't never gonna happen, and it's for the best that it cannot.

It would not be human, and it would not be real life. I recently was referred an evaluation for depression. Patient fit the DSM perfectly, but it didn't "smell right" to me so I took a chance and ordered her a total body MRI. She had an undiagnosed gastric cancer.

Executive decision-making is a skill. Good executive decision-making seems to be a talent. These are neither skills nor talents that I was blessed with, but that's probably just as well. I've never been much of a leader, and never a good follower either. My major life decisions have always made me nauseous. Medicine has been the right field for me. Independent work, endlessly interesting, and cautious, careful, conservative decision-making comes easily to me.

From Harvard Biz School, "While elevated narcissism and self-promotion has been shown to result in quicker promotion early in one's career, its negative impacts are revealed in positions of higher authority."

As in the sports world, in the biz world, if you cannot produce winning decisions consistently and with integrity, you will eventually go down. It's rough out there. I hear all of the stories and all of the excuses, but the most talented and honest do pretty well and never make excuses for their disappointments. Competition is a big part of life, and an exciting part of it.

Reflections of a Medical Ex-Practitioner - The glow of the personal relationship with patients is being extinguished:

 When I graduated from medical school in 1962, the profession of medicine was for many graduates an opportunity to provide care—as distinguished from, though aligned with, treatment—and to provide it to individuals, not to populations or governmentally specified groups. Young doctors hoped to establish an independent business, enjoy lifelong intellectual excitement as knowledge and therapies expanded, and have an income sufficient to live decently and support a family. There have always been some who entered medicine, as with any vocation, to maximize income. Yet most of us who came into the profession in the early 1960s had modest financial aspirations and substantial social commitment...

There is no "should". This foolish and, I think, exhibitionistic piece in the WSJ, How Often Should Married Couples Have Sex?, has been getting attention all over. I don't think it is very illuminating. Sexual frustration, however, does make both guys and gals cranky, and tends to make them want to look elsewhere for their instinctual romantic and sensual drives (which normal people do anyway, but even more so).

In my professional opinion, younger guys seem to be OK and relatively calm with sex twice daily. They are monkeys. Older fellows seem to get by with anywhere from daily to 3-4 times/week, depending on how hard and long they work at their jobs. Women are an entirely different topic, but my general advice to women is to remove the TV from the bedroom. Not to worry ladies - they will put it back in our bedrooms 24 hrs/day when we're demented widows in the nursing home. We can catch up with our shows and movies then. Carpe diem.

Apropos of the topic, I saw that Glenn Reynolds linked this book: Lube Jobs: A Woman's Guide to Great Maintenance Sex. Library journal commented about it, "Most people spend the largest part of their adulthood slogging through committed relationships, and they need books like this." 

Good cozy marital snuggles can make up for a lot of troubles. But "slogging"? If you're slogging, it's your own darn fault. I have patients deep into their 70s and 80s with quite satisfying and jolly sex lives even when they know far more than they want to know about their spouses, and when their equipment is not what it once was. We are, in part, biological beings.

Have Americans lost the sense of evil? I don't really think so. Some say that, nowadays, the cognoscenti can only use the word ironically, but I don't agree with that entirely either. After all, I have read too much vitriol from the Left directed towards people like me, labeling us (non-ironically) as evil.

In other words, I think "evil" has been secularized or politicized. At the same time, attempts are made to psycho-babbleize it away.

Without writing an opus on the topic, I'll make just a few points about evil (from a non-religious standpoint). Evil thoughts and impulses exist in everyone, to varying degrees, whether consciously or unconsciously. It never appears in pure form. 

A normal human conscience, along with social pressures, fear, a desire not to be destructive, etc. permit most of us to live without enacting very many evil deeds. Some people, in denial of their own dark sides, project evil into others. Some people attempt to deny the existence of evil anywhere. Some people try to erase the presence of evil by what we call "identification with the aggressor", of which the Stockholm Syndrome is an extreme example.

To look upon evil, wherever it is and however banal it may appear on the surface, is frightening. In the movies it can be exciting, but in real life it is deeply scary. Thus thoughts like this: St. Louis U. student asks, “Why don’t we talk about evil anymore?” and this: Why Does Evil Make Liberals Stupid? A quote from that:

This piece in The Atlantic is a good exemplar of the mushy liberal commentary that has proliferated in recent days. Authored by one Megan Garber, it is titled: “The Boston Bombers Were Muslim: So?” Before taking a close look at Ms. Garber’s article, let’s advise The Atlantic not to put away that headline. It could come in handy so often. “The Cole Bombers Were Muslim: So?” “The Embassy Bombers Were Muslim: So?” “The First World Trade Center Bombers Were Muslim: So?” “The September 11 Bombers Were Muslim: So?” “The Madrid Bombers Were Muslim: So?” “The London Bombers Were Muslim: So?” “The Shoebomber Was Muslim: So?” The Underwear Bomber Was Muslim: So?” “The Fort Hood Shooter Was Muslim: So?” “The Beslan Child-Murderers Were Muslim: So?” “The Times Square Bomber Was Muslim: So?”

And this one:  Jihad Will Not Be Wished Away - But willful blindness remains the order of the day.

I am sorry to say that Mukasey has it right:  Make No Mistake, It Was Jihad - Let's hope the administration gets over its reluctance to recognize attacks on the U.S. for what they are.

All sorts of things can help unleash the cruelty and destructiveness in people, but I won't get into all of that now because I only want to mention one of the things: communal support of evil. If only 7% of Muslims are inclined to active Jihad, that's 100 million people. That's no mob - that's a large nation of killers and would-be killers of infidels and they are all on the same page.

Jihadists believe the West is evil. "Submit or die." They are convinced of their virtuousness, but they are as wrong as can be because all that we in the West want is to be left alone and to truly "coexist" peacefully.

Here's an interesting 1996 book by Columbia Prof Andrew Delblanco: The Death of Satan: How Americans Have Lost the Sense of Evil

I have been saving two links about Tallis' 2011 book, Aping Mankind: Neuromania, Darwinitis and the Misrepresentation of Humanity, until I found time to say something interesting about the ideas. I could not add anything, as it turned out, because Mark Signorelli says it so well in his review.

Tallis, a neurologist (and amateur and impressive philosopher) wrote the book as a critique of biological and evolutionary reductionism. 

Here's a brief review from the WSJ.One quote:

 In his vigorously argued "Aping Mankind," Raymond Tallis takes on what he calls "neuromania" (the belief that we are our physical brains and nothing more) and "Darwinitis" (the insistence that our consciousness can be reduced to evolutionary terms) in a robust defense of the unique nature of human consciousness. Mr. Tallis, a doctor and researcher in clinical neuroscience, believes that most contemporary accounts of human consciousness fail to understand the lived experience of individual minds. Reducing man to simply another animal in a real sense de-humanizes us, with disastrous effects in areas from social policy to the interpretation of art and literature, which the author touches on in engaging asides.

Aping Mankind is negative research. While most popular-science writers attempt to weave compelling stories from the latest neuroscience experiments to explain 'why we are the way we are', Tallis attempts to show why these stories simply cannot be true. If you are skeptical of media--and scientific journal--headlines such as "Researchers discover the location of love in the brain", then you may enjoy Aping Mankind. In this work Tallis exposes the odd proclivity of scholars, from biologists to literary critics, to anthropomorphize pieces of matter while simultaneously dehumanizing human beings. In effect we are systematically transferring our humanity to matter, and this may not be good for our health--just like vitamins.

Returning to Signorelli's impressive review which opens like this:

I can recall very clearly the moment at which the spread of Darwinian ideology became a matter of concern for me. Previously, I had been acquainted with such ideology, and recognized it as but one more strain of fashionable cant, promoted by a set of persons quite obviously unfamiliar with elementary philosophical reasoning. Having attended college in the late twentieth century, I, like many of my generation, simply became accustomed to dwelling in an intellectual atmosphere poisoned by noxious dogmas, whether deconstructionist, multi-cultural, or what have you; Darwinism was evidently just such another doctrine, and so I took no great alarm at its prevalence. That changed one evening when, surfing idly across the internet, I came across the late Denis Dutton’s article on “Aesthetics and Evolutionary Psychology” in the Oxford Handbook of Aesthetics, an article which proposed the advantages of applying evolutionary theory to our inquiries regarding the arts and literature. This was the first time I had encountered Darwinism in such a context, and when I looked into the matter subsequently, I found that Dutton was by no means alone in his project; quite a body of literature had amassed by that point, purporting to offer evolutionary accounts of poetry, dance, and painting, among other things. Now I became alarmed, and greatly so. Literature (understood in the broad sense of learning, or letters) has been everything to me, the source of all my consolation, and all my self-understanding. To see it threatened by this dirty little creed, with its invariable tendency to degrade whatever comes under its purview, was deeply worrying to me. So I began writing against it, with that same defensive urgency that motivates a man to fight for kin and country.

I am a big fan of AA as a help with addiction and as a method for personal growth and maturity.

It's not the only way, but it might be the best way for those who have trouble with it. Recently, people have recommended two books by Allen Carr:

The Easy Way to Stop Drinking

Allen Carr's Easyway to Stop Smoking

It's been far too long since I studied, or used statistics other than to read medical journal articles. Everybody talks about Bayesian Statistics nowadays. They are the new old thing, almost 100 years older than Fisher Statistics (Fisher was an interesting fellow).

In my youth, I learned to be always skeptical about any research results, but I am told that running data through Bayesian methods is a good test of data.

Can somebody explain the concept to me in simple English? I don't intend to use it, just to get the ideas (I can do the math, but I want something conceptual for starters.) Most Liberal Arts students learned basic Stats in college, the p and the t-test, etc., but the Bayesian is new to me.

Reading Buzz Bissinger's confession, My Gucci Addiction, I would have to seriously consider the Bipolar possibility were I his doctor:

In the past few years, I've bought eighty-one leather jackets. Dozens of boots and leather gloves. I've purchased pants that cost $5,000. I own a $22,000 coat. This winter I took a tour of Milan's Fashion Week (all expenses paid by Gucci, in appreciation of my many, many purchases), where I spent tens of thousands more and began to seriously grapple, once and for all, with a compulsion that could cost me more than just my life savings. My name is Buzz Bissinger. I am 58 years old, the best-selling author of 'Friday Night Lights,' father of three, husband. And I am a shopaholic.

Not everybody who does crazy things has a diagnosis, but unless Mr. Bissinger has inherited $100 million, somebody ought to try to stop him before he blows himself up. It does not sound like his wife is likely to do that.

I saw a nice lady for consultation a few years ago. She was distraught, wanted help in rebuilding her life and her emotional strength. Her husband, age 54, had, after an evening of good sex with her, informed her that he had realized that he was gay, and needed to leave her to pursue a gay life style because he did not want to deceive her or betray her.

They cried together and held eachother. She cried for two weeks. After that, she began having panic attacks. He moved out, and the legal aspects of the divorce proceedings had been easy and mutually agreeable.

Six months had gone by and she still felt shattered. The reality of her life had been exploded. I told her that grief takes at least a year.  Mind you, this was a sophisticated urban woman who had once been in the fashion business and who assured me she could readily identify gay guys at a distance. He had always been a loving, sexy, loyal husband with no hyper-macho ways, and no stereotypical gay interests or mannerisms. Good father, too. He worked in finance.

In the six months apart, she told me that he had seemed to transform himself from an ordinary fellow into a flamboyantly gay man who drinks too much, dyes his hair, spends weekends in Provincetown and weeknights in gay bars. He told her it took him 40 years "to find his inner fag." He says he'll love her forever, support her and the kids, but now has found his real self and feels happier than he ever had.

I thought to myself "That was a real gay marriage." I also wondered whether he was Bipolar, but it didn't matter because it was over and her challenge was to write what I term "a new chapter."

I had seen this a number of times before, in mid-life men and in women too. I can't say I understand it. Nobody really does, but I do understand the grief. Agonizing. I also understand the horror of wondering whether much of one's life has been fraudulently-lived in a fake reality.

In my line of work, I encounter plenty of people who live in fake realities of their own construction, but it's not ordinarily about sexual matters. It's usually about other things. I carry the burden of a thousand stories in my soul, but don't feel sorry for me. It's a privilege, and I get paid to carry them.

(nb: real details of this story are totally altered and combined - fake but true)

If psychotherapists "screw up" their children any more than anybody else, I haven't seen the data. (My own kids, BTW, are perfect.) Biggest issue with parenting these days? Trying to be friends with the young. They can be pals when they grow up and achieve independence but, until then, make your own friends.

It's a perennial topic, however. If therapist-types do, I think it comes from being over-attentive, over-protective, overly-empathic, and not respecting kids' resilience and adaptability.  How Therapists Screw Up their Children.

It's important for therapist-types to put their work hat on before work, and to take it off after work.

This on parenting is related: Please Do Not Adjust Your Child

Unlike, it seems, some or many of the young women in Medicine today (50%), I never had any interest in being anybody's employee.

The Doctor Won't See You Now. He's Clocked Out. ObamaCare is pushing physicians into becoming hospital employees. The results aren't encouraging.

My freedom in practice is to see people anytime I want or can, to work whatever hours I want to, to follow no imposed treatment protocols, to set my own fees and to provide as much charity as I wish, and to help anybody I chose to.

Nobody tells me what to do or how to do it. Maybe I'm a dinosaur. I'll see patients on a Saturday or Sunday if need be.

A quote from the article:

Once they work for hospitals, physicians change their behavior in two principal ways. Often they see fewer patients and perform fewer timely procedures. Continuity of care also declines, since a physician's responsibilities end when his shift is over. This means reduced incentives for doctors to cover weekend calls, see patients in the ER, squeeze in an office visit, or take phone calls rather than turfing them to nurses. It also means physicians no longer take the time to give detailed sign-offs as they pass care of patients to other doctors who cover for them on nights, weekends and days off.

Most hospitals exacerbate these strains by measuring the productivity of the physician practices they purchase in "Relative Value Units." This is a formula that Medicare already uses to set doctor-payment rates. RVUs are supposed to measure how much time and physical effort a doctor requires to perform different clinical endeavors.

Amateur addicts always have an excuse, but those who are honest with themselves will admit that it just makes them feel good and that they have addictive tendencies.

There's a Reason That Addicts Say Yes to Drugs.

Emerson College's Insurer Will Cover Transgender Student's Transition Surgery.

These people who seem to believe they are the spawn of aliens, animals inside a human body, boys who believe they are girls, and all the other sorts of silly fantasy lives that people put on display today, are people with only the slightest grip on reality.

I would never claim that we shrinks and psychoanalysts have the power to change such unfortunate fantasies/delusions, but seeing other physicians collude with such fantasies disturbs me more than a little bit.

Many rightly criticize Psychiatry for over-pathologizing human variation, but normalizing total weirdness is another matter. Strange is strange, and nobody should be afraid to say so in fear of the Thought Police.

He has a new book out, about what he learned from the Harvard lifetime study. He is delightful. The podcast is here.

Why we have our best ideas in the shower: The science of creativity.

I always figured that it's because there were no distractions, same as driving alone with the radio off (which I recommend).

I entirely agree with the comment:

Wakes and funerals already exist to serve the immediate needs for mourning and recognition of the loss. Participation in normalizing rituals is probably far more helpful than therapy in the immediate aftermath of a such a loss.

We all agree that human monogamy is not "natural" in any animal sense. It's a stretch.  If marriage matters to you, and you've been married over a year or ten, this could a pretty useful talk, and takes the topic further and more intelligently than the supermarket magazines ever will.

Just one of the secrets seems to be experiencing one's spouse in different situations and seeing them being effective or impressive in different ways - socially, professionally, intellectually, adventurously, morally, humorously, physically, talent-gifted, etc. We can never know everything about another person and it is much easier to become familiar with a spouse's flaws than with their varied strengths, many of which may be hidden from us.

For one example, when on occasion I have barged into my husband when he is deep in prayer, I do see him with new eyes. For another, when I see him regaling people with wacky stories at a party.

The secrets to desire in a long-term relationship:

As the man says, "their definitions expel me and, in fact, most mental health professionals."

I like to claim that the DSM is an Obsessional Disorder.

Daniel Greenfield asks the question Who Needs The Family?

That's easy for me to answer: I do, and I always did. A person without family, tribe, and community is a person adrift, a lone wolf, a lost soul. Governments have nothing to do with it. He says of socialist schemes:

    The state replaced the family. It told men and women that they no longer needed to make permanent commitments to each or to their parents and children. So long as they paid their taxes, the state would bear the burden of their commitments. And so men and women gave up on each other, parents gave up on their children and children gave up on their parents, the family fell apart and now the state that took its place is also falling apart.

    A building cannot be built on nothing...

At best, the merger of
romantic love and marriage is relatively recent and relatively localized.

We have posted in the past about the history of romance being converted into covenant marriage. Marriage has always been in transition, and, for better or worse, it is in transition now.

As I have said countless times here, I don't know how people can run an orderly, complicated, and productive life without a committed partner, much less create a family with all of the things family entails - finances, traditions, social life, stability, values and religion, disciplines, etc. The very wealthy always could do that, but not otherwise.

I never forget the story of how Thomas Lincoln (Abe's father, a prosperous and prominent Kentucky farmer and real-estate investor at the time) hopped on his wagon and drove to the nearest city, leaving the kids in charge of themselves, to quickly fetch a new wife after Nancy died. I believe he fetched the first widow he could find, Sarah.

Today, he would be arrested for leaving the kids on their own.

I have made the case here, in the past, that PTSD is not so much a disease or "disorder," but a normal variant in response to disturbing events. The mental health field, these days, is pathologizing everything and everybody.

I have seen persistent PTSD complaints in all sorts of people, far more civilians than military. Life affects us deeply, and can shatter us, unless we are heavily armored or lacking in emotional response. I have seen them in sudden announcements to divorce, spousal death, deaths of a child, job loss, fatal car crashes, young police officers, and witnesses to the 9-11 jumpers.

We Westerners live in a mostly safe world, insulated from so much of the pain, distress, and horror which were routine in past generations. An ordinary snowfall, or a loss of electric power, is now a really big deal, a tragedy. We are so safe and comfortable that we have lost the tools to cope with tough situations, scenes of horror, and painful memories. These things do, indeed, change us. Comfort and safety have made us innocent, in a way. Police and doctors deal with these things routinely, and develop thick skins, professional distance.

I read this today: Government Can Do More to Treat Veterans with PTSD. The number of returning veterans afflicted with Post Traumatic Stress Disorder has reached crisis proportions.

By government, they mean the VA. "Qualifying" for disability is a terrible idea. Getting into life is the best plan, whether one wants to or not. No matter what happens, it's best to buck up and get on with it.

There is no treatment, no cure, for being human. There is no cure for PTSD complaints other than the old-fashioned "tincture of time." Entrepreneurs out there sell cures which are snake oil. All we Psychiatrists really have to offer these people is care, emotional support, help with substance abuse, and, if they wish, emotion-blunting medicines. There is no magic cure for life's horrors and misfortunes other than alcohol and drugs, and they tend to make things worse in the end.

Some psychoanalysts like Kohut and Kernberg have theoretical ideas about it. Sometimes I think that the word, and whatever idea exists behind the idea, is a sociocultural construct more than anything else.

That is not to say that we are not individuals with our own personality tendencies.

Here's an essay: The Self in Self-Help - We have no idea what a self is. So how can we fix it?

As I have often said, there is no useful general definition of happiness. Unhappiness and misery are much more easily defined.

Do all people need a sense of mission or purpose to be "happy" - other than the basic mission of survival and comfort? I very much doubt it. The wonderful psychiatrist Victor Frankl was indeed sustained by his search for meaning in the camps, but that is far from ordinary life and he was far from an ordinary man.

Here's Emily Esfahani Smith's There's More to Life Than Being Happy. I am not sure what I think about that report.

For me, contentment is a good, loyal husband, a good love life, good work, enjoyable if sometimes difficult kids, good friends and good acquaintances, exciting hobbies and sports, integrity and a clean conscience, a dog, a relationship with God, and books to read. Changing the world is a fool's errand for crazy people and narcissists who do not want to focus on the substance of their own brief lives. Can't do without them, though. Part of the fabric.

Mass killings, and serial killings, are in decline. Murder overall, in fact, is in decline except for in some (Blue) cities like Chicago and Detroit which nobody seems to get excited about very much. 

Everybody is seeking scapegoats for mass killing, especially when it's white suburban kids instead of the slow mass murder of inner city black kids, and everybody hops onto the hobby horse they want to ride. Movies and video games, firearms, bomb ingredients, the mentally ill, etc.

The problem is that these mass events are so rare as to be utterly upredictable. We cannot put an armed guard at the door of every classroom. And trust me, you cannot lock up, indefinitely, every paranoid or angry person who has thoughts of killing people. You'd have to lock up half the commenters at Daily Kos. Thoughts about killing, like thoughts of suicide, are very common.

Furthermore, mass killers like Timothy McVeigh and serial killers like Ted Bundy were not even mentally ill in any usual sense. Evil, not ill. Not to mention Nidal Hasan, the Fort Hood killer. A military Psychiatrist, no less (and a presumed Jihadist). Or the 9-11 killers.

Terrible events are black swans and probably not preventable. Dangerous people rarely seek help with their problems anyway, and criminals ignore laws. Nobody who is hell-bent on mass killing is likely to tell anyone.

From the NYT yesterday,  Focus on Mental Health Laws to Curb Violence Is Unfair, Some Say.

Here is Top 10 Myths About Mass Shootings

As I have mentioned here before, I don't know how it is possible to run a complex household effectively without two or more adults in it. We know that marriage has seen a marked decline in the lower socioeconomic strata, thus contributing to a vicious circle of poverty, malfunction and dependency. From what I have read, marriage is still going strong in the middle and upper-middle strata. I suspect that is because middle class people desire a coherent, orderly, busy life which is enriching to everybody in the family - and one reason why divorce is so traumatic: it's not just about money, it's about structure.

From Exodus from Marriage:

“The scale of marital breakdown in the West since 1960 has no historical precedent and seems unique,” the distinguished historian Lawrence Stone said a few years ago. “At no time in history, with the possible exception of Imperial Rome, has the institution of marriage been more problematic than it is today.”

You know you are reaching true adulthood when you read articles about The Kids These Days and end up grimacing. We have posted about the hooking-up culture in the past, about "friends with benefits," and about how the youth are mating randomly and promiscuously like rabbits in the woods and yet are spared the reputational problem which would have occurred when I was 20.

The example from The New York Times is about girls: The End of Courtship?

Voyeurism is fun, but tacky. From what I see in life, which is quite a lot, it seems to me that these stories are the exception rather than the rule. From what I see, the average middle-class American girl avoids casual sexual encounters and wants to be treated respectfully if not lovingly. There is a bell curve, and the left tail of the curve is sociopathic.

So much for the girls. For the 20's guys, there is no doubt that it has gotten very easy to get lucky in the bars these days, if that is how one chooses to live. The modern trends of feminism are great for the guys: they get much more sex and sexual variety without committment, and the women make their own money. Unless you feel that relationships are a serious matter and that using others is a form of low life, that is.

Elizabeth Wurtzel wrote a much-commented-about essay (about herself, of course, in whom she seems excessively interested) last week, Elizabeth Wurtzel Confronts Her One-Night Stand of a Life.

There are some grim aspects to her report from the front lines of the follow-your-impulses approach to life, but, in the end, I have to comment that I think it's just great that, in America, there is the freedom and opportunity to construct a life any way one chooses.

As long as I do not have to end up supporting it, that is. Despite all of her opportunities, I fear we all may end up supporting her in her old age, if she achieves it. True bohemians are supposed to die young-ish, of TB, cirrhosis, drug overdose, AIDS, broken heart, or other such romantic maladies:

I have written about the illusion of a state of Happiness in the past here. In doing so, I have always pointed out that it's a term without a meaningful definition. However, it has always seemed to me that happiness implies, for some, an imaginary infantile state in which all wants and needs are met rather than the state of stress, difficulty, and challenge which many of us seek.

For a simple example, I have a friend who never feels "happier" than when struggling for hours in a fruitless effort to master a Chopin piano piece.

Transient joys and delights certainly occur, as can periods of contentment with their implication of acceptance of, or resignation to, the limits of reality.

Leszek Kołakowski poses the question Is God Happy? (h/t Althouse) as a way to reflecting about the human capacity for happiness. He says:

Happiness is something we can imagine but not experience. If we imagine that hell and purgatory are no longer in operation and that all human beings, every single one without exception, have been saved by God and are now enjoying celestial bliss, lacking nothing, perfectly satisfied, without pain or death, then we can imagine that their happiness is real and that the sorrows and suffering of the past have been forgotten. Such a condition can be imagined, but it has never been seen. It has never been seen.

Kolakowski clearly adopts the definition of happiness to which I alluded earlier, ie, the serene absence of any disturbing thoughts or feelings. Sounds more like a mindless beach vacation to me than something anybody would aspire to for more than a few days. Sounds like heroin.

Regarding the question re God's happiness, it's an absurd question. God is not human.

Readers know my interest in the workings of the human conscience and the structures of human morals. The (our) devils are relentless in pursuit of the low-life, the dark side.

Hawkins at Pajamas: Here ... are a few signposts that will alert you to stop, pause, and take stock to make sure you’re not on that gentle slope.

How's that for a catchy end-of-holiday-season header? (Metazoans is the new name for the Animalia Kingdom - those creatures with differentiated tissues like sponges, earthworms, and people.)

I have been attempting to familiarize myself a little with the rapidly-expanding science of Epigenetics lately. When I took pre-med Genetics, it was a marginal topic. Now that the fundamental workings of DNA are fairly well understood, epigenetics has become a hot field ("epi" because it's the things - heritable things - that effect cell-differentiation, growth and development, etc. on top of the basic DNA template, but are affected by the environment). Shades of Lamarck.

Epigenetics is interesting partly because it's one of the ways that a metazoan species can be affected by environmental influences during growth and development. Molecular tools for shaping the final product. The complexity of metazoans (as contrasted with fungi, bacteria, and protozoans, for example) requires complex epigenetic processes. Heritable things which switch on or switch off gene expression.

Here's the simplest short piece I could find: What Is Epigenetics? Easy to follow if you ever took intro Bio.

The wiki entry is actually a good intro, but tough sledding unless you had a decent college education or are a bio reader.

Over the next few decades, we can expect interesting new discoveries about how epigenetic processes affect human psychology.

I have spared our readers all of the more technical and experimental things I've been reading. If I can interest one person in the topic, great.

I've been preaching this since long before Gary Taubes' books came out. That's because I have a colleague who studies the physiology of insulin. From what I know, Taubes is right. A quote re Dietary Incorrectness at Powerline:

Taubes disputes the connection between dietary fat and high cholesterol. He challenges the thesis that dietary fat is detrimental to our health. He rejects a balanced diet. He advocates a high-fat diet. He opposes dieting. He doesn’t object to exercise, but he asserts that it makes you hungry. It’s almost funny. He is the dietary equivalent of politically incorrect.

Taubes is a serious science reporter, not a crank. As I say here ad nauseum, and as Taubes explains, if you want to get trim, quit the carbs. None. That includes fruit, which isn't any good for you anyway. It's just sugar. As the man says, after 14 days off all carbs they will not appeal to you so much anymore. (There is an addiction-like quality to carbs.) And if you want to be fit, youthful, sexy, intelligent, and vigorous, then exercise or do physical work too. If you want to lower your triglycerides, get better genes or take Lipitor.

It's not complicated. It's a free country, food is cheap and exercise is free. Do what you want to achieve the goals you desire. Don't tell me it's hard to do, because everything in life is hard to do except eating, surfing the net, and watching TV.

They feel they must for PR, grandstanding, or as a power grab, but it won't matter in the end. From my readings about the Newtown nightmare, the killer was a distinctly odd, fairly bright but low-functioning kid, maybe autism spectrum or childhood schizophrenia spectrum, schizoid, or something like that. A harmless oddball. Some colleagues of mine have suspected a psychotic break, but I doubt it. Wired a bit wrong from the beginning I suspect, but this is not uncommon at all. Everybody has a loose wire and it's a matter of degree.

As the over-stressed parents of such kids learn, there are no cures for these problems. Often, no effective treatments either other than zombifying them with antipsychotic medicines. Sometimes a residential placement with lots of support can be useful but not curative in any way - and would need to be voluntarily undertaken. The killer's family had plenty of money, access to all of the resources that a wealthy family in wealthy and treatment-rich Connecticut and his devoted mother could provide, but nothing much could be done because there was little to do.

Not only is help limited in power, the humbling fact is that mental health professionals are essentially unable to predict either violent, homicidal or suicidal behavior except in the most acute situations. We try, often over-react, but these are black swan events which are unpredictable by definition. We cannot lock up every unusual, isolated kid who enjoys war games any more than we can lock up every angst-ridden teen with thoughts of suicide. And if we could, for how long? Kellerman writes about deinstitutionalization but that's not what this is about. Angry and unhappy people are everywhere.

Furthermore, many if not most people who could use a hand from mental health professionals have little interest in pursuing that. Interestingly, the ACLU recently blocked a Connecticut law which would have made outpatient treatment mandatory for some patients. Not that mandatory "treatment" can do much good. That's why people needing help slip through the cracks: they don't want it.

The sanest, least hysterical essay I have read on the topic is from Megan McArdle: There's Little We Can Do to Prevent Another Massacre. One quote from her excellent piece:

Unlike many libertarians, I am fine with a ban on automatic weapons. But no need to hop over to Change.org to start a petition to ban them; machine guns have been illegal in the United States since 1934, and since the 1980s, it has been illegal to manufacture and sell any automatic weapon. Apparently unbeknownst to Twitter, we have also already made it illegal for the mentally ill to buy or have guns, and have background checks aimed at prevented just that.

But beyond the strange calls to make serial killers pray more and outlaw things that are already illegal, the most interesting thing is how generic they were. As soon as Newtown happened, people reached into a mental basket already full of "ways to stop school shootings" and pulled out a few of their favorite items. They did not stop to find out whether those causes had actually obtained in this case.

It's the age-old "something must be done," but, as Megan points out, bad cases make bad law. The only consoling fact is that mass murder has been declining in the US since 1929. Guns have little to do with it. People determined to wreak havoc can do it in many sorts of ways, from making bombs to driving cars or airplanes into buildings, and do so across the world. The US has no monopoly on killing sprees, contra Michael Moore. If one looks around the world, it can seem as if civil behavior, as Americans understand it, is the abnormal.

Gun laws? Bomb laws? Other criminal laws? Evil-doers ignore and bypass laws while honest people end up having their freedoms limited by them. Naturally, when dramatic events happen in the world - 9/11, crash of housing bubble, mass murders, storms, etc., the pols and "advocates" and rent-seekers jump avidly onto their favorite hobby-horses and ride them for all it's worth for their own reasons. People want to assign blame on anything, it seems, other than, in this case, the seemingly demonic perpetrator.

As cold as it may sound today, crushing tragedy is part of the human condition and has always been. No "mental health system" or politician or policy will change that unless we all decide to live in a prison camp. We do believe in being armed, though, to minimize the odds of becoming a victim. That's why we have lightning rods on our roof, too.

In the meantime, we all mentally re-live the nightmare in our minds and wish it to be undone, to go away, to not be real, to be impossible.

Latest update: Killer's mom was attempting to get him committed to hospital

I am pleased that we posted on Father Rohr this morning. I have no interest in posting on the topic of dramatic mass murders on this site, because I have already said all I have to say about it already on previous postings.

Dramatic or undramatic, evil is pervasive. There is not a single human heart without some. We read about guns, mental illness, government policy, a bad culture, inattentive parents and others, etc. These are all distractions. The relevant topic is human evil in all of its forms. We do not like to think about that.

Believe it or not, I saw a headline saying "Gun kills 26 in Connecticut."

A planet without humans would be a planet without good and evil. The utopian narrative goes something like this: "If everybody is properly served, controlled, treated, drugged,  provided for, etc etc, horrible things might be eliminated from the world." That thought is truly crazy and is the reason we have trademarked the term "psycho-utopianism" on this website.

A simple jump rope is possibly the best cardio exercise device one can own. It is also the cheapest and most portable.

Jumping rope will burn also 11 calories per minute (more than anything else) while offering almost total body fitness. If you have the fitness and endurance to jump rope for half an hour, you can burn off one candy bar or one donut but few people could go that long even if they wanted to. At a very fast pace, maybe a donut in less than half an hour. However, nobody I've seen can go that long.

At my gym, it's mainly men who jump. Amazon has all sorts of jump ropes. Many people like the beaded ones and the weighted ones.

Done properly on the toes, it's a low-impact exercise. Most people seem to jump in 30-second to three- or six- minute stints. It is demanding for people over 25.

 Here's 3 Benefits of Jump Rope Fitness

10-Minute Jump Rope Cardio Workout

Jumping rope for boxers

If you google jump rope exercise you will find hundreds of articles about technique and the benefits.

Dr. Helen discusses the recovering adult teenager Tucker Max: American Immaturity: How We Grow Up After We Grow Old.

Her post reads a bit like an old fogey complaining about "these kids today," but she is talking about adult-aged kids, not real teenagers. Some of the comments are interesting. I am convinced that difficult realities and challenges are what creates adults.

Here.

I learned a lot about ADD and ADHD at a recent conference. I am slowly coming around to thinking that it's something worth looking for and paying attention to. There are a number of complicated issues surrounding the diagnosis which I will not get into now.

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

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

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

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

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

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

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

and

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

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

Call it Psychopathy or Sociopathy or just "bad people," people with predatorial instincts are all around us. Overwhelming most are non-violent, but what Dr X points out is that psychopathy is a matter of degree.

Most people who worry about being bad or evil, are not especially so. Sociopathic people rarely recognize their inner bad, and often think highly of themselves. Significant degrees of sociopathy can be found in people in all walks of life, not just in penitentiaries (in which few penitents are to be found). I knew a brilliant, charismatic Psychologist with abundant psychopathic traits who probably helped more people than I ever will with his charm, warmth, and wisdom. He had enough self-awareness to keep himself out of serious trouble but he had some close calls.

Dr X pointed out this piece at Smithsonian: The Pros to Being a Psychopath - In a new book, Oxford research psychologist Kevin Dutton argues that psychopaths are poised to perform well under pressure. Not sure I agree, but an interesting topic.

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

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

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

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

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

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

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

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

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

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

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

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

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

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