Just a Quick Quote from Eminem

August 16, 2010 at 4:51 am | Posted in Uncategorized | Leave a comment

Heard on my Pandora station this morning: “I feel like I’m walking a tightrope without a circus act.” Eminem, “Rock Bottom,” The Slim Shady LP

The good news: I had an extraordinary day climbing yesterday, cruising up a couple of walls that would have defeated my utterly when I took it back up again last month. On the advice of my much more experienced climbing partner, I’ve confined myself to relatively easy walls for the last couple of weeks so that I could focus on technique. That helped immensely. It’s natural to improve in bursts rather than steadily, but it still felt strange to find myself moving with such decision and ease.

Neutral news: Today I’ll be doing my interim review at work. I’m a bit anxious, of course, but I always like having an opportunity to get feedback on my performance.

Free Will Moment

July 23, 2010 at 1:02 pm | Posted in Uncategorized | Leave a comment

I found this New York Times blog post interesting, and I submitted the following comment:

I don’t see why (iv) above must be true — that is, that we must have chosen how we are in order to be held responsible for the actions that follow from that being. In fact, it’s commonplace and probably morally necessary to hold ourselves responsible for actions and states that we did not explicitly choose.

This concerns me because I am manic-depressive, and though I didn’t choose to be that way, I have remarkable latitude >and< responsibility with regard to my actions (though perhaps not to the extent that a person with no mental illness has). No one would seriously argue that, since I haven't chosen my mental state at any point in my adult life, I can't be held responsible for anything that I do. Or, to look at a more specific instance: If I suspect that my medication is making me dangerously ill — perhaps even exacerbating my illness — I may go off my medication. If, as a result, I have a manic episode and, say, steal your car or seduce your husband, it seems to me that I could (and should) be held responsible for my actions, even though I didn't choose to be manic, or to experience side effects from my medication. I acted according to my best judgment; as it turns out, I still hurt people. Did I have free will? Even the most minute examination of the circumstances will not prove that I did or didn't. Am I responsible? Following David Jones above, I would say that, yes, I am.

My point is this: It's fruitless to try to reason out free will and responsibility without considering the specific circumstances in which we find ourselves, and acknowledging that we cannot predict the results of our actions.

Love to all.

Not Now — I am Hypnotizing the Chickens

April 27, 2010 at 3:44 am | Posted in Uncategorized | Leave a comment

Chickens.  Lots of chickens.

The poor things don't even have their own cubicles!

I kept cracking up as I read this New York Times piece on the use of PowerPoint in the military. Who knew that there was such an apt phrase for the act of dazzling and boring a credulous audience into submission?

On a slightly more serious note, if you’d like to start your day with the lash of indignation, you have only to read this exercise in arrogance by psychiatrist Daniel Carlat, who is proud that he now spends a few moments talking to his patients before whipping out his prescription pad even though doing so reduces his profits slightly. Be still my heart. I’m fascinated by how he pairs an unquestioning faith in the psychiatric Diagnostic and Statistical Manual with a cheerful willingness to slap a patient with fiercely addictive uppers and downers without apparently mentioning the substantial long-term risks. Even more interesting — and, frankly, discouraging — is how many of the comments praise him for for his insight. If this is an example of refreshing modesty, then our standards for psychiatrists must be very low indeed.

I have been considering what the heck to do with this blog now that I am apparently not bipolar. I don’t really see closing up shop, and he idea of launching a campaign against the psychiatric establishment makes me more weary than an hour of PowerPoint. I have a lot — a lot — to say about the evils of the 21st Century, so don’t be surprised if I hare off in that direction.

Guest Post: The Health Care Bill Might Not Be As Trivial As I Thought

April 5, 2010 at 3:45 am | Posted in Uncategorized | Leave a comment

A lawyer friend recently sent me the following and gave me permission to publish it here as a guest post:

The health care bill is very, very complex. Wrapping one’s fingers around the health care costs of employers, the government costs of subsidies and tax breaks, the societal benefit of low-income citizens having access to health care, including the economic savings as a result of prevention, early detection, and quicker treatments that allows people to get back to work, the savings of hospitals who will have fewer patients who can’t pay, the additional revenue of new taxes, changes in medicaid, the potential changes in insurance premiums and costs, as well as the economic efficiency and new jobs created from allowing people to spend their money on homes and cars and vacations instead of health care- and comparing that to the cost of doing nothing- is next to impossible. I have a degree in economics, and I have no clue what the costs and trade-offs are going to be. But I do know it’s complex.

Who likes things complicated? Nobody. So Republicans, to their credit, have done a fantastic job of manipulating the debate. The “debate” became one about death panels, big government, socialized medicine, and huge tax increases. These things are easier to understand. As a result, people turned strongly against a health care bill that will benefit many of them. Republicans have scored major points by opposing and blocking anything and everything. Sadly, it seems likely that some Democrats may lose their seat in congress because they wanted their constituents to have better access to health care.

I am sending this to you, because you know more about health care than I do, and you have a blog. People who care about the welfare of others and favor health care need to share our thoughts with the world.

Here is HR-3950 in condensed version:

1. Tens of millions of Americans who didn’t have health insurance before will now have access to affordable coverage.

2. The biggest part of this program will be paid for by closing a tax loophole that only the super-rich could exploit, and by taxing the profits the super-rich reap by letting their wealth earn interest for them.

3. Insurance companies will no longer be allowed to massively raise premiums and co-payments while denying claims simply to boost their profits.

4. Families with good insurance will have an easier time keeping that insurance, even if they change jobs or even change states.

5. Because families will have more choices of insurance, they will be able to pick a plan that saves them money.

6. Most middle-class families will spend less of their money on health care, freeing them to spend it on houses, cars, vacations or big-screen TVs, giving a boost to the economy and creating new jobs.

Interesting. I guess I had lost perspective and come to think that (without seeing the new law) the reform that passed was no reform at all.

Love to all. I’ll be off for the next four days, but will take up my pen again on Friday.

Briefly Noted

March 17, 2010 at 12:49 am | Posted in Uncategorized | Leave a comment

I started my intensive outpatient program last week, and it’s, um, intensive. On Monday I was away from home between 6:00 a.m. and 8:30 p.m. I’ll be posting less here, then, since I really need to preserve my energy and attention. My apologies.

In other news, I’m taking two meds that are notorious weight gainers. I’m constantly hungry, and I’ve put on seven pounds so far. The gentlemen of my acquaintance seem pleased, and I like what I’m seeing. I was getting a little gaunt. It’s easier to pull off extremes of thin before your 40th birthday. I figure I’ve got at least another 10 lbs to go before I need to throw on the brakes.

That’s all.

Love to all.

OK, So I’m Easily Amused

March 9, 2010 at 6:33 pm | Posted in Uncategorized | 1 Comment

If you take a look at the picture that leads off this story in The New York Times about the “immense subtlety and beauty” of Alexander McQueen’s final designs, you, too, may snicker, “Hmm. Apparently a use of the word ‘subtle’ that I’ve never before encountered.”

That’s all. I just had to share that.

I apologize, too, for the dismayingly fragmented nature of this morning’s post. Oops.

Western Civilization Continues to End

March 2, 2010 at 5:07 am | Posted in Uncategorized | Leave a comment

So the other day when I went to visit our IT people about a hardware order, the guy assigned to our program said, “Yes, I wonder whom is responsible for ordering that?” I found this attempt at gentility strangely winning.

I Hereby Declare My Review of Crazy Like Us Complete

February 17, 2010 at 2:26 am | Posted in Uncategorized | Leave a comment

Cross draped in purple

Have a happy Lent! Or, more appropriately, a repentant one. I'm going to try to make it to Mass for an imposition of ashes.

Then there’s this: According to this survey, 60 percent of Americans believe that universities and colleges are run like businesses, and this is not a compliment. I heartily agree, and wonder what rock the other 40 percent live under. At the same time, I don’t feel tremendous sympathy for the public. That’s what you get when students and parents campaign to turn higher education into vocational training by getting rid of such luxuries as composition.

Well, that should settle their hash.

Book Review Continued: Crazy Like Us

February 15, 2010 at 3:28 am | Posted in Uncategorized | 3 Comments

The cover of Watters' bookYesterday I began a review of Ethan Watters’ Crazy Like Us. I’ll try to conclude today.

Watters’ initial chapter, which concerns the spread of anorexia in Hong Kong, failed to convince me, not, I think because it’s poorly researched, but because the book has a cumulative effect. As I worked my way through his case studies — PTSD in Sri Lanka following the tsunami, schizophrenia in Zanzibar, and depression in Japan — I found myself coming to accept his argument, bold as it is, for two reasons. First, it’s well-argued and researched; second, it squares neatly with my own experience in the mental health system. In this review I’ll often refer to the latter, since I think it puts me in a unique position to evaluate Watters’ work.

Each chapter details a truly appalling abuse of professional and economic power. It’s not an exaggeration to say that his description of hundreds of slavering therapists and researchers descending on post-tsunami Sri Lanka shocked me. I’m familiar with psychiatric and therapeutic abuses, but I had no idea that they exist on a huge international scale; I’ve always said you can never be cynical enough about Big Pharma, and clearly I haven’t been.

Narrative and anecdote appeal to me, and the details the author furnishes dovetailed with my own adventures in diagnosis. For instance, I’ve always felt that Post-Traumatic Stress Disorder has many of the hallmarks of a socially transmitted moral panic. This is the case even though I displayed classic symptoms for roughly seven years after having been raped. I’ve felt skeptical about my own diagnosis because, eerily, all but one of my psychiatrists has interrogated me about the possibility that I’ve suffered childhood sexual assault, and only reluctantly accepted that I haven’t. Typically they dismiss the actual rape, preferring to spend session after session hunting the chimera of incestuous gropings.

It’s long been established, most notably in the New York Review of Books, that supposedly therapeutic techniques popular in the 80’s and 90’s convinced countless patients that they’d suffered everything from incest to ritual satanic abuse; the diagnosis of PTSD grew in part out of just these techniques. I’ve witnessed these psychological abuses myself. In a therapy group I attended in the early 90’s, a woman became wholly convinced that a beloved uncle had fondled her repeatedly even though she couldn’t remember a single incident. Far from acting intentionally or out of spite, the victim was horrified at the very idea that her uncle, who had just died, could have done such a thing. Though she’d discovered the abuse during a highly suspect group process of “rebirthing,” during the months that I belonged to the group, she never doubted that it had happened. It saddens me deeply to think of the damage that these almost certainly manufactured memories must have caused her and her family.

Following that experience, I’m not at all surprised that self-styled and mostly well-meaning American PTSD counselors imposed their own model of trauma on Sri Lankans, undermining the more suitable style of coping that they learned from their own culture. Article after article in The Times and elsewhere attests to the international spread of PTSD; the consequences may be debatable, but the fact of its growth is not.

The third and fourth chapters, which concern schizophrenia in Zanzibar and “The Mega-Marketing of Depression in Japan” deal with diseases that Western medicine considers to be purely biological. Watters demonstrates convincingly that though the most devastating mental illnesses transcend culture, their expression and treatment vary to an extent that took me by surprise. When you think about it, though, it makes sense that sufferers in different cultures should experience widely different psychotic delusions, and that their families and society should understand them as, say, spirit possession rather than the expression of a broken brain. Western psychiatric history holds that the former belief is much more stigmatizing than the latter, but Watters demonstrates through anecdote and research studies that the opposite is true; people who attribute mental illnesses to genetic causes fear and shun the mentally ill more than their counterparts who hold to earlier models.

Given our perverse health care system, our recent romance with a medical model of mental functioning condemns many people to lives that ought to appall us. As David A. Karp demonstrates in The Burden of Sympathy, which I reviewed in this space, American families with mentally ill members receive no meaningful social or financial help from either public or private sources. Without extensive family support, seriously mentally ill people in America risk ending up either homeless or imprisoned. In my case, with my family’s support, I earned a Ph.D., hold a demanding job, and own a home (and, no, they didn’t buy the latter for me); I would not have been able to house myself or hold a job for all these years without their help.

You may ask, What about psych drugs? Surely the benefits of American medical treatment outweigh the risks of our fragmented culture, at least for those who can afford it. More than one shrink has told me with a mystified air that the prognosis of Third World mental patients is much better than that of their most privileged American peers. In other words, even if it’s factually true that genetics and brain chemistry cause schizophrenia and bipolar disorder, we’re unable to turn our scientific understanding into treatments that work.

More on that later, though. I’ll return to the issues Watters raises in Crazy Like Us tomorrow.

Briefly noted: The longest hypomanic stretch in my life may be ending. Every day for the last 10 days I’ve been dreading the return of my depression and hoping that I’ve finally recovered the real Dr. RandR. I wish so much that I could shed the drooping self that irks me so and claim my feisty, temperamental pre-Klonopin existence. I am trying to tamp down hope, since I know perfectly well that mania is marked by a sense that you’ve morphed into your better, true self. In the meantime, I’m savoring this thrilling clarity of thought and sense of the incandescent web that interconnects words.

Previews of the DSM-V and Ethan Watters’ Crazy Like Us

February 10, 2010 at 5:04 am | Posted in Uncategorized | Leave a comment

This morning The New York Times published a short but intriguing look at the draft fifth edition of the Diagnostic and Statistical Manual. Since this tome is the worldwide standard for psychiatric diagnoses, psychiatrists, insurance companies, and Big Pharma all have huge stakes in the final version. The DSM determines who’s sick and who’s well, and whether insurance will cover treatment costs.

The biggest criticism of the forthcoming edition mirrors earlier complaints: The diagnoses have little objective basis, and many seem more aimed at enforcing normalcy and creating new drug markets than at isolating and alleviating human misery. Surely I’m not the only one who finds the definition of “hypersexuality” to be baggy, given that most of us, men in particular, spend much of their lives from adolescence on thinking obsessively about sex and plotting to get more.

Speaking of the DSM, I’ve started reading Crazy Like Us, the book that inspired an article in The New York Times (linked in this space) that investigates claims that the U.S. is exporting its categories of mental illness at a dangerous rate. It’s intriguing, but I’m finding the argument less persuasive than I thought I would. I’ll certainly review it for you-all.

The comments on <a href="“>a blog article in The New York Times supports my assertion yesterday that the Internet poses much the same risk as television. I don’t own a television, and I’m beginning to think that I’d better limit Idiot Box II.

Scary thought: I wonder if cutting my Internet time would improve my depression? It’s worth looking into, certainly.

I’m going to get off and get ready for work. While there yesterday, I logged no fewer than 10 hours and 45 online minutes yesterday, which brought me to almost 14 hours on the day. Sheer madness.

Love to all.

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