Curiosity Over Pride (FYI: To comment, send an e-mail to

Friday, April 2, 2010

The Most Fabulous Object In The World

(The title of this post pays homage to the great movie "Time Bandits")

Our recent discussions involving consciousness got me curious about what other people have thought up so far. So I type "theories of consciousness" into Google. As always, wikipedia popped up close to the top and lured me in with a nice summary of the situation.

Under the Evolutionary Biology section I found this:

Budiansky, by contrast, limits consciousness to humans, proposing that human consciousness may have evolved as an adaptation to anticipate and counter social strategems of other humans, predators, and prey.[38] Alternatively, it has been argued that the recursive circuitry underwriting consciousness is much more primitive, having evolved initially in premammalian species because it improves the capacity for interaction with both social and natural environments by providing an energy-saving "neutral" gear in an otherwise energy-expensive motor output machine

This is alluring. Adaptation loves energy-saving devices. Elsewhere in the wiki someone posited that consciousness wasn't needed until "culture" came about (I interpret this as group selection literally guiding physical changes).

Another section brought up Julian Jaynes' The Origin of Consciousness in the Breakdown of the Bicameral Mind. I've never read this book, but I keep coming across it. Smart people have heralded it and then denounced it. Its weird. But could it fit with the Stroke of Insight author's experience? I may have to breakdown and buy the weird thing. Stolen sentences include:

Subjective conscious mind is an analog of what is called the real world. It is built up like a vocabulary or lexical field whose terms are all metaphors or analogs of behavior in the physical world. Its reality is of the same order as mathematics. It allows us to shortcut behavioral processes and arrive at more adequate decisions. Like mathematics, it is an operator rather than a repository. And it is intimately bound up with volition and decision.
...and page 65...

It operates by way of analogy, by way of constructing an analog space with an analog "I" that can observe that space, and move metaphorically in it.
...and perhaps most tellingly, page 66...

there is nothing in consciousness that is not an analog of something that was in behavior first.

Really, what is the use of all the other wonders of the world if we don't have a conscious to admire them with? Hence, it is The Most Fabulous Object In The World.


Dr John said...

Dink, can you clarify what you mean by the consciousness? i.e. "self awareness"?

Debra said...

But it doesn't manage to do what the magiquest thing in the world does...
Nice post. I shall comment in more detail after my dinner party.

Dink said...

"Dink, can you clarify what you mean by the consciousness? i.e. "self awareness"?"

Welllllll... (squirming, eyes shifting side to side). Thats, uh, tricky. Its perception of something. Like sensation is perception of a physical stimulus, consciousness is a perception of some sort of fluent mental calculations.

Have you come across some definitions that you like? I'm desperately in need of knowledge, you know ;)

Dr John said...

NO. That is the problem. We talk of consciousness when we really have not even agreed on what that means. Certainly we can infer from observation and comparative anatomy primitive life can be said to sense physical stimuli and react to it. This process becomes increasingly complex until you reach humans at the top of the food chain. We give these perceptions meanings and we create symbols to represent them and we have an understanding of our mortality and future and ultimately death. But is that consciousness? If so which is required for a being to be "conscious"? When we are asleep we lose that sense but we are not thought to be "unconscious" as we can be brought out of it. Clearly other animals than man have some sense of self awareness and planning ability but we do not see them as self aware in the sense we humans are. But do we really know? The process of "consciousness" whatever that is runs on a continuum. We squirm(me too) when we artificially try to define what it is by carving it into pieces at the joint so to speak. I have read a fair bit about this subject and I am not sure I am really any closer to understanding even what the real questions are?

Thai said...

Oh oh oh oh oh, no fair!!! Such great chat and I'm away armed with only an I phone and am trying to reconnect with family I haven't seen in at least a year.

Briefly, we will not get agreement on consciousness because it is against the laws of physics to get agreement: think Godel's incompletness theorem per Street Dog (Dr. John, he's our resident Cal Tech Opthalmologist who has been missing for a while, which is sad as I miss his wit).

... Anyway, try to define "energy", I dare you. ;-)
It usually starts with some variant of the ability to do work, and as I'm sure JP will attest, that is where you usually notice the entrance to the rabbit hole (hence FYI Dr. John, my fractal rabbit icon ;-) though in truth it should have a bazooka in it but I couldn't find such an icon.

... By the way, this is where Deb usually rejects universalism on totalitarian grounds. ;-)

Oh, and before I forget- easy to do from this atheist's perspective- happy Good Friday all!

Thai said...

In fact, even getting precise linguistic agreement on ANY word in ANY language is impossible (or any "string" of words, etc...) as any linguist worth 2 cents will certainly attest, it is just our brain tends to ignore this little issue.

In fact, I'm a firm "believer" that the Heisenburg uncertaintity principle is scale invariant and that it is like Godel's incompleteness theorm, itrying to define anything is just an endless excercise in matroiska dolls- e.g "this statement is false". ;-)

Thai said...


matryoshka dolls

e.g. Information structures "nested" in information structures.

consciousness is an inormation structure. ;-)

Debra said...

When you get back, Thai, I will try to expose one of the most interesting postulats of structural linguistic theory : the tripartite (trinitarian...) nature of what we call the "signifiant", which for simplicity's sake I will call "the word".
De Saussure postulates that our linguistic systems ARE NOT in relation to the physical world, of course.
They are closed systems, our linguistic systems.
So... when we are talking about consciousness, we are STILL talking about words..
Any theorization, or perception of "consciousness" is done through the linguistic medium.
And of course, the structure of the medium MUST affect the nature of the theory...

Thai said...

Anyone who thinks linguistic systems are "different" than the physical world needs to come up with a new way of thinking IMO.

As my "proof", all I can say is I have watched with my own eyes as a neutral third party observer two people physically fight after one spoke insults against another. Somehow that "non-physical" word was able to stimulate the physical mechanics of the other person and yet a third neutral observer (myself) watched this pass.

I cannot see how something which is not part of the physical world- e.g. a word insult and all the information contained in it- can "stimulate" the physical world if there is no connection between that which is non physical in a word and that which is. And if there is a connection between the two, then they are really one and the same at some level.

And, I and my mechanics and optics were connected to this word the other person spoke as I then physically reacted accordingly (ducked for cover, etc...)

Thai said...

Dr. John, there is a fair bit out there on consciousness and Bose Einstein condensates. Do you not agree with these theories? I would love your 2 cent opinion as well coming at it from an erector set mindset like Dink and I and a colleague involved in neuro sciences on a daily basis.

Deb, why say linguistics is a closed system? I can't link on my iPhone or I would but I'm skeptical.

Debra said...

Thai... relax. Have fun.
Can't this wait until you get back and I do a post on it (in part, or somebody else does a post...) ??
What I don't agree with in what you say is that it is on the same level.
I think it is important, essential that it be on a DIFFERENT LEVEL.
Zero sums becomes... zero products, maybe.
But I don't agree with the sums bit.
And I have discovered that the most difficult things to understand are the ones that take the simplest forms.
And I STILL maintain that we have not really explored the metaphysical implications of the four basic operations, and WHAT MAKES THEM DIFFERENT.
And I think that we invent theories/perceptions to match the mathematics that we invent.
But... what PROOF do we have of any of this, given that the very idea of proof is culturally arbitrary ?
Do you understand ?
For language, sound is energy, for sure, so for speaking you can certainly evoke the element of physical energy, but what about for written language ?
What is material in written language ? The ink on the page ? Is that energy ?
Where are you seeing it ??
In our reactions to the printed word ?
Sure, there is energy involved in feeling emotion, for example.
Enough for now.
I hope you are having fun...

Debra said...

One of the greatest challenges we have as human beings is intricating language, the linguistic system to our physical bodies.
This does NOT come naturally, in my book.
There are varying degrees of what I call "incarnation".
Each and every one of us does this, achieves this in a different fashion.
And we are constantly working on it.
From birth to the grave.

Dink said...

" no fair!!! Such great chat and I'm away armed with only an I phone"

LOL! I'm fairly terrified by what's going to happen when Thai returns. He'll have the pent up energy of about 47 nuclear reactors!

"NO. That is the problem. We talk of consciousness when we really have not even agreed on what that means..... I have read a fair bit about this subject and I am not sure I am really any closer to understanding even what the real questions are?"

I sense that this has been a quest of yours for some years. Sorry that I do not have answers, but I can offer conpanionship on your search.

First, Buddha said (approximately) do not believe anything any one says (including him) unless it makes sense to you. So we'll have that as a guiding principle.

Linguistics is an element, neural structure is an element, and I suppose particle physics is an element. But to start at the most basic level, what can we assess/observe about consciousness?

It feels like a verbal narrative streaming across my attention that I'm just passively listening to and occassionally acting upon physically. Which is weird because this implies a speaker and an observer function operating at the same time. Moreover, the mind is likely far more than just these two independent functions, yet they integrate seemlessly to feel like one cohesive unit. Is it seemless at birth or does it later melt together? I'm actually rather disturbed by it all so I'll go out to lunch now.

Let me know your observations/descriptions!

Thai said...

Dink, I'm as eager as you to read Dr. John's response

Dr John said...

To say I am involved in the neurosciences on a daily basis Thai would be to imply that a man who shovels shit for a living is involved in the study of intestinal flora.Most days I would liken my job to an over paid hall monitor on the psychiatric unit. Whatever limited knowledge I have it is far removed from the practice of psychiatry. The field is brain dead and such ideas are not even taught in training. I just had to re-test for boards. There was not one question on this subject. Do you know any psychiatrists? My lord...I really do not understand Bose-Einstein condensates as they apply to consciousness. From a quantum perspective are these not thought to occur at only or near absolute zero? God your story connecting linguistics with the physical world made me cry with laughter. Dink I am ignorant. Most of my reading has been in philosophy on this issue and debates about what it even is as apposed to materialistic theory on it. It is interesting but I am not sure I am one bit closer to having any idea what is going on. ugh

Thai said...

I completely agree there is a whole "jobs" aspect to the mental health world, but I'll never agree to anything less than you psychiatrists are goddam heroes and pay a very heavy price for what you do.

I don't know how to help you reconcile the nihilistic reality of the world/universe/everything with the simultaneous construction of false realities we ask you to build to help people move through this journey we call life- if I can I surely will try- but that does not lessen you and your work one bit IMO.

As far as my reality goes, there is simply cooperation and you are very definitely part of the glue that creates it so I tip my stethescope to you.

When I get back to a real computer I'll post on Boze-Einstein.

... Perhaps we can write an article for one of your psych journals if you concur?

Trust me, the EM (Emergency Medicine) community is not interested.

Dink said...

".Most days I would liken my job to an over paid hall monitor on the psychiatric unit."

I can see how it could be discouraging, but it a way that makes it all the more heroic. Noble, in a French Foreign Legion sort of way. You've got unreliable weapons (meds), you're fighting a powerful enemy of which little is known (the human mind), and the patient has free will to disregard your advice. The odds are stacked against you and still you fight. You should get one of the cool foreign legion hats (that shield the back of your neck from sunburn).

I do know a psych ARNP (they can prescribe meds in the state of WA). The meds (if the pt actually takes them) have wretched side effects. The pts often self-medicate to complicate the picture. The bipolars in the manic phase are having a great time and don't want your help; the paranoid assume you're murdering them. Very tough. Semper fi, soldier.

Dr John said...

Thai,thank you for your support. I have given up on reconciliation of any kind when it comes to my field. My attempts to do so almost cost me my family and sanity. Psychiatric practice is unbearably difficult for anyone with a conscious and half a brain. The dialectic is completely reversed from the rest of medical practice for the most part. Pts are hostile, uncooperative and abusive or often regressed and ambivalent about their existence and what you have to offer. They are often coerced into contact with you and lie and obfuscate. I am expected to be mind reader, policeman and Nostradamas rolled into one. Psychiatric constructs are virtually useles and the field has no predictive power or validity. I process social dysfunction. I do not practice medicine. There are rare exceptions but not many. The only up side is that "in the land of the blind the one eyed man is king". Anyone who can speak to normal family drs or the ER and help them navigate their way through the huge numbers of problems that present themselves as "psychiatric issues" is a God. I have immense self loathing professionally but I am loved in my institution. I am the "Cleaner" from Pulp Fiction. I roam the halls sweeping up problems whisking them away to my locked psychiatric unit or just kicking them out of the hospital.Staff do not care what's wrong with them when I come or what I do with them after they go, only that I relieve them of their problem. I have accepted my place and make a very good living. I am hoarding my pennies and getting my kids schooled and watching the clock. I hope to return to school this summer to get my Masters in Philosophy and a teaching degree so I can go teach high school kids what I had to learn on my own.It will be a few years but that is my plan. I very much look forward to your next post on B-E condensates and I would love to collaborate in some way with you in writing a paper if possible. John

Dr John said...

Dink, how well do you know the APRN. Is she like me a total cynic or still drinking the psych Kool-Aid?

Thai said...

Back home on my my Mac!

Well, if your saving you nickels and biding time, you'll definitely want to read up on some of the sites we all first met in- as I'm sure your aware, we live in interesting times (literally, like once every 75-100 years at a minimum).

If you are not careful, you could work in a job you hate and then see all your life savings confiscated. It is clear this will happen to someone.

Think of some of the people we see daily who also maintain a facade of "normalcy", hold down a job, etc... and vote.

As for reconciliation causing any threat to things you hold dear, that would be bad indeed.

Yet I refuse to concur with you that the scientists who look at computer software are less "real" than those who look at the same computer's hardware. One can seem more tangible at times than the other, I'll grant you that, but this is really more an artifact of human perceptual systems than anything else.

And I rest my case
re: "psychiatrists are goddamn heroes and pay a very heavy price for what you do."

I listen to this nonsense re: physicians are paid too much all the time.

And yet when the big political battle happens (yet one more time), what do "they" decide to do?

And I think all here will attest I said over and over that I didn't think spending more money on health care would help things.

But does anyone listen?

Nope, they spent more money anyway. So forgive me while I don't lose any sleep over you and I getting paid more.

You can lead a horse to water but you can't make him drink. ;-)

Debra said...

Doctor John, I admire your decision to get a philosophy degree and teach kids in high school.
I totally understand this (I think...)
I think that this is why I wanted to invite you on this blog. A kindred spirit, can you believe it ?
YOU may not believe it, but i do.
Except that I'm into literature, not philo, even if I have a linguistics degree, and can hold an intelligent conversation on the structure of language, no mean feat.
I am sorry that you are so... disenchanted with what you do, nonetheless.
It does not make your life any easier, this disenchantment.
What about.. private practice ?
My husband is very very happy in private practice.
He does what he pleases, and no one is looking over his shoulder (for the time being...).
He gets tremendous satisfaction out of his work without prescribing meds, by the way.
And he can SEE the people getting better.
At a certain level, most of you can't believe me when I say this, but I see people getting better when they realize that they are NOT TOTALLY RESPONSIBLE for what has happened to them.
But... ironically enough, most people DON'T WANT TO BELIEVE THAT THEY ARE NOT TOTALLY RESPONSIBLE (when they are not whining or wanking about being victims, and this happens a lot too...) because this means that they are not in total control of their existence.
And most everybody I know/see these days wants to feel in total control of his/her existence.
Against all reason. Because it's OBVIOUS that we are not in total control.

Dr John said...

Thai, I most assuredly am trying to educate myself in matters of finance. I have been reading the posts and comments on Sudden Dept.I am very grateful for any and all education you and the others can provide me. I know at times I tend to speak about work with broad brush strokes and I do not believe that as you say those who look at "computer software are less real than those who look at its hardware" in all fields. The problem for me runs very deep into the core of my personal belief system and how even the practice of psychiatry fits into it. Forcing people to accept anything just because it covers my ass and is the standard of care is reprehensible but I do it anyway at times. You cannot escape it in psychiatry. I just do not have the energy to deal with such resistance on a daily basis.
Debra I do run a small private practice.I would say this is the most satisfying part of my work. I see opiod addicts and prescribe a drug called suboxone. At the same time I talk to them about the problems they have in their life and how they contribute to their drug use. Some do really get better I think. Many stop using other drugs but want little else from me but the pills. Many are still stuck in the same patterns of lying and manipulation and play this out with me as well. As I have said on Carlat, I am highly skeptical of almost allpsychiatric/psychological special knowledge.
I plan on doing a post on this but I am getting increasingly concerned that although almost all of these people are functionally improved on the medication but they are getting locked into it and I will never get them off.I also detest the rigid dogma of CD Tx programs that I am surrounded by and often must alter my approach in order to manage my "risk" and give the impression I am following a certain standard of care.
I guess Debra you are right. Deep down I am addicted to erector sets.

Thai said...

Re: "Forcing people to accept anything just because it covers my ass and is the standard of care is reprehensible but I do it anyway at times. You cannot escape it in psychiatry. I just do not have the energy to deal with such resistance on a daily basis."


We physicians are as trapped by the system as anyone else.

That's one of the reason I liken what is going on in health care to a bubble, and it will keep on going until people finally realize the tooth fairy doesn't exist or the system collapses from its own debt.

Given the level of debate by all sides of the health care discussion, I suspect this bubble has a few more years left until it forces some degree of bankruptcy.

FYI- You won't find any investment advice on Sudden Debt- it is not that kind of site. JP says he is doing well so if he shows back up, perhaps he'll give you some. ;-)

He is really hear to tease me as I do like to go out of my way to make a fool of myself on SD.

I am fascinated by investing but fundamentally will not let myself do it; I hand it over to someone else as I wouldn't sleep at night if I did and I'm sure every decision I'd make would be the wrong one. Instead I just found someone who I believe I can trust.

So for me, reading the daily in's and out's of our economic mess is more like watching NCAA Basketball- all just wonderful sport.

PS- I realize this annoys those who really are there because they think there is wisdom on the site but the more I read, the more I am convinced that priests would be more helpful to our current mess than economists are.

Think of them as having as much legitimacy as psychiatrists. ;-)

... Though they do have their own version of the conservation of energy, namely "there is no free lunch" and once you realize this, they are a lot easier to understand.

PPS- this is/was the best post I ever read on what happened. At least for me, after reading it, it did become much easier to understand how credit cycles happen, how they are independent of words like "public" or "private" or "business", how they are as old as humanity, and how they will continue until the end of time.

It was particularly helpful (at least to me) in understanding how everything is the same as it was before, any yet why everyone can still be so pessimistic and lose their marbles, etc...

For they do deal with what I think of has the "hubs" (like network hubs) of society- trust.

Oh, and one last point to quickly get you up to speed: the sum of the parts equals the whole, and this is true regardless of whether the whole is also more than the the sum of its parts. This little detail is important to keep in mind when you read linguistic modifiers to terms people write like debt, spending, etc... because TOTAL debt is not the same as public debt which is not the same as private debt. Yet total debt is made up of the other two, etc...

Thai said...

Remember, that in this tale, you and I are Alice... I'm assuming you are Alice just like me from your statement "I am hoarding my pennies and getting my kids schooled and watching the clock."

Remember, Alice lost biggest of all in this story once it all settled out.

There is a reason the rich get richer- unless they don't- beyond the simple fact that the laws of physics says this must be so.

You and I are the one's who stand to get killed the most in all of this.

For your patients want not only your time, they also want your savings and remember, they vote. And they are mentally ill so for people like Okie this is a"free hall pass" and you just have to accept it without complaint. ;-)

The tragedy of the commons is playing out on a really grand social scale right now. In the end, the collective is going to do what it is going to do and there is nothing either you or I can do about it other than try to take cover when the bullets fly.

We live in interesting time.

Dr John said...

Great posts Thai. We are Alice. After many years of having someone manage my money and escape with "usury and murder" in the words of Cato I do it myself. I am no expert but have done much better on my own. I read a very simple book called "The Smartest Investment Book You'll Ever Read" by D Solin. It basically teaches you how to use index funds for long term investing and how to limit your risks. I was lucky enough to have pulled almost all my money out of the market when it was at nearly 14k on mostly a hunch. I waited for it to bottom out at around 6k and began reinvesting and have done very well. The problem as you so clearly point out is that this is a closed system and tricks like that can only be done for so long before it all collapses in on itself. I am hoping to survive and prosper in the current cycle long enough to shelter what I have for the "end of days". I am buying gold and stocking up on can goods an shotgun shells.(nervous laughter on my part)

Debra said...

It's funny, but we are having a discussion about money on my loony forum.
I inherited a nice chunk of portfolio from my mother at her death.
I am not going to go into all the really complicated shit that transpires when you inherit stocks/bonds/cash as an expatriate, and I will let you GUESS how much that has pained my ass.
As times passes, I am... losing more and more interest in money.
I am dropping out of the game. Outside of trying to find ways to GET AROUND the money problem (and no, I am NOT psychopathic...).
Don't tell me about how SOMEBODY ELSE is going to pay for this, Thai, because if you think so, you don't know my loony self very well.
I will honestly try to limit to a maximum just how much SOMEBODY ELSE HAS TO PAY.
This makes me sad, because I tend to think that WE (collectively) could be doing much more to make money... MEANINGFUL, and being meaningful does NOT MEAN making money into a graven idol. Far from it.
On a graver, related note, I had a discussion with one of my older friends a couple of years ago.
We evoked the idea of going up into the mountains and lying down in the snow when the time came.
And we both ended up DYING WITH LAUGHTER as we realized that THIS TOO could be painful..
Any way you look at it, there is no good solution for the kids... A long drawn out decline in a nursing home/lying down in the snow/disappearing ?
Is there a good way to gracefully bow out ?
No, I am not (inordinately) depressed.
Just the effects of a lifetime of living with death, in one form or another.
Those American retirement plans...
Pulling the petals on a daisy, yes for the 401k, no for the 401k..
What SENSE does a 401k make for me OVER HERE ??
You get the picture, now ?
You understand why I occasionally feel a little.. MUTINOUS and AGRESSIVE ?
End of sob story.
So, are you home now, Thai ?
For good ? Vacation over ?

Debra said...

It's funny, Thai.
I am sending you over to Carlat to take a look at the recent reaction I got to a rather doomsday comment about the relationship between propaganda and advertising, and there is somebody who came out of it REALLY INSPIRED, REALLY GALVANIZED to do something about the negative effects of propaganda/advertising that are sapping our ability to have FAITH in anything or anyone.
Funny how that works, huh ?
So... let's not give in TOO MUCH to depression while convincing ourselves that we are being.. REALISTS..

Dr John said...

Debra, can you give me your definition of the word "faith"? I see you use this word a lot but never know what you mean by it.

Thai said...

I know you asked Deb but I thought I'd add my own 2 cents

I don't think science can remain honest to itself and eliminate religion/faith. In fact, the National Academy of Sciences has basically said just this.

They are simply different ways of processing information.

I say I'm an atheist only to simplify my own position on religion as atheism comes closest to the way the average person would think/talk about religion imo.

But understand this, I clearly read almost daily how all scientific research/literature is confirming that everything is connected to everything else- indeed, if everything were not connected to everything else, then the conservation of energy could not be true- so there are a great many ways in which I agree with people of "faith" AND I am not religious as the average person defines religion.

Fundamentally my religion is science.

As for Deb's word "faith", I think you'll find it has a lot of overlap with my words "cooperation" and "trust".

Thai said...

Oops typo

I say I'm an atheist only to simplify my own position on religion as atheism comes closest to the way the average person would think/talk/describe my views on religion.

I certainly have no anthropomorphic religious beliefs.

Thai said...

Deb, I'm going to stay out of the Carlat debate if you don't mind. I find the idea of trusting the shrinks over the drug companies most amusing.

There is a tremendous amount of misconceptions on this kind of stuff and while there is a ton Carlat says I agree with, there is a bit I do not.

I think I'll do a post on the how the pharm critics are making the classic "life is lived forwards but understood backwards" error so prevalent in society today.

Thai said...

And the problem with gold is that it is a 50/50 bet.

If we print, and have an inflationary credit crunch depression, gold is the best place to be and you'll have hit it out of the park. If we keep borrowing but then either eventually stop due to the high interest rates or default such that we have a deflationary credit crunch depression, your gold will be wipe out.

But personally, I think we will see a lot more of this. Watch the news for things like declining divorce, birth rates, lower miles driven or flown, reversal of the obesity epidemic, etc...

In a world/economy/universe where everything is related to everything else, I think your psychiatrist's gut on what people will be willing to forgo first will do you quite well.

Having seen more victims of domestic violence return to their "beater" when really faced with certain choices than I can possible remember, I have learned over the years that people have a tendency to say one thing yet do another and your gut is often a pretty good predictor of what they will do.

And re: guns

Remember, the decline of violence is a fractal phenomenon.

Thai said...

And Deb, yes, I had a great time, thanks for asking

Re: "Don't tell me about how SOMEBODY ELSE is going to pay for this, Thai, because if you think so, you don't know my loony self very well."

No Deb, I think I know you a bit by now and I'm quite sure you would have no problem having me pay for it either. ;-)

Dr John said...

Thai, that Pinker video is gold! I have never understood the irrational calls to primitivism I hear people make, none of who actually practice it.People get slack jaw when I discuss declining crime data from the FBI. This is much more compelling.I do see the gold issue as a 50/50. It has not been part of my investment strategy until recently and only as a hedge, along with my .357 a .38 with laser sight and my 12 gauge Remington. With your interest in economics and keen insights I am surprised you do not manage your own $$ and someone else's for that matter.

Thai said...

As I said, I find this fascinating (well not guns- yuck! I see there influence already enough in my line of work).

But for me, economics, investing it first and foremost a hobby, just like people follow sports.

My only real foray into "investing" is as an evaluator of other's investing prowess as I am my group's retirement plan trust officer.

I am strictly an observer as others watch politics, etc...

Thai said...

It let's me be much less passionate about the subject.

If I'm worried about the result, the same paradox you guys debate over at Carlat begins to take place.

Debra said...

No, Thai, the guy was saying that he realized that HE TOO could be involved in "propaganda", and stick stuff in his waiting room like brochures for activities, or exercise groups, for ways to meet people, along with the stuff that the drug companies put out.
Stuff the HE believes in.
By faith I mean the capacity to engage oneself in something that one believes in, and work toward it.
For a long time we have been confusing faith with the belief or not in the existence of God.
Faith is NOT about believing in God.
It is about personal engagement towards bringing something about in relation to one's fellow man.
This is a little vague, I know, but faith is what allows you to get up in the morning and GO THROUGH EVERYDAY with a sense of meaning, and NOT a sense of hopeless boredom.
And it does not drop into your mouth.
You gotta work at it. And sometimes it's hard.
On the upcoming financial bottom out...
I do not really think that we are going to see our retirement, but maybe I am unduly pessimistic.
I think that the best investment we can make for the future is.. learning how to think and use our hands.
Sounds wacky, right ?
Maybe this thinking is not right for my generation which will manage to squeak through.
But for my kids ??
YOUR kids ??
Hmmm... the party's over, I think.

Thai said...

But think of the externalization it will now cause to the patient (interestingly I noticed one of the commenter did hit on the issue of externalities).

For the patient gets a brochure saying "drug is good", but they also get a lesson from the spy said "drug not so good".

Who are they to trust?

Should the trust no one?

Perhaps they trust spy, but now the do not trust drug company.

Is this good?

Is spy trustworthy while drug company is not?

Thai said...

By the way, Dink, I forgot to say I agree. It is the most fabulous object in the world and if we had to lop off parts of our body, I suspect the very last we would allow depart.

Dr John said...

So it sounds like you are saying faith to you is some kind of combination of hope and optimism that drives you to do good each day on your behalf and on the behalf of others. I think all those people putting out drug pamphlets in the waiting room would say they are doing that if you ask them? I do not think we live in an age where people look to each other to provide that kind of (faith). It has been replaced by pills and Iphones. I would agree with both of you however as it appears you believe that kind age is coming.

Thai said...

Sort of yes and sort of no.

My problem is I realize I can come off a bit wacky and I really don't mean to be. I am certainly not into mysticism.

I think it kind of depends on how you look at things (PS, I put my first post up on consciousness but it is only an intro to the subject).

Take the example is the sum of the parts a reductionist compilation of its parts, or is it a whole and similarly part of something bigger?

I would say it is both and simply matters how you want to look at things.

At some level, I don't think things ever real change, only our perception of them instead changes.

Thai said...

Once upon a time, you must have been very optimistic about psychiatry, no?

I seriously doubt psychiatry changed, rather your view of it.

Dr John said...

I think I agree mostly with you but how do we tell if things are changing our its just our perception? Either way our perception is of change. I do not think in my case psych changed nearly as much as I did. I chose psych as the path of least resistance to be dead honest. At the point I had to choose my primary talents and interests were in neurology. I was married however and not sure I would be able to survive the rigors of training.
Psychiatry at that time was pumped full of reductionist propaganda and the claim that we were looking right down the sights at a complete revolution in our understanding of such "neuropsychiatric disorders"(sarcastic emphasis on NEURO).
Like a young girl who goes into marriage with a man who she knows has a h/o philandering but ignores it and hopes for the best, I chose psychiatry.
At first I really did buy into it. The more people resisted the harder I tried. After some time someone tried to blame me for something else someone did that was very, very bad. People cannot do worse things than this and I barely even new this person who did this horrible thing. I had no way of explaining any of it. After sinking into a deep abyss, I decided to try to find out what other smart people said about such problems so I started reading philosophy. That lead me to study the history of philosophy and of course science and critical thinking.
Mind you at no time in 20 years of education had I ever learned any of this. As I began to actually learn how to think I realized there was no real thought in psychiatry at all. That has not been an easy realization.
I do not mean I am incapable of helping people just that really nothing I learned in my training helps me much with that. Training may help you learn to sit longer with people you hate but that is about it.
If at some point along my journey someone had grabbed me and shook me and pointed these things out, I am sure I would have changed paths. At this point inertia carries me on. Yes Thai. I think Psychiatry has not changed much. I certainly have.

Dink said...

How can I be this far behind in comments already!! Semper fi, semper fi...

BTW, Dr J and JP, to get to the comment section of Thai's most recent post you have to click on the title. This happens with Okie's posts sometimes too.

(I am still about 25 comments behind so please forgive the backtracking of subject)

The "cleaner" in Pulp Fiction was Winston Wolf ;)

I could be completely off base here, but perhaps your angst stems from not being able to "cure" the patient. Well, your care may be palliative, but it is still worth doing.

I have a sister-in-law who is a special ed elementary school teacher. She loves her kids, but the parents can be impossible. No one wants to believe that their six year old has reached their developmental peak. I guess the analogy here is that you make the situation the best it can be given the circumstances, not the best it can possibly be for someone who doesn't have the illness.

Faith= Belief without evidence. In the case of science, there are many cases where we don't actually work out the math ourselves, but we probably could if we had the time. In the case of religion, you don't get the option of questioning or experimentation.

Though religion is cool in a way. All the unfairness gets remedied. No one really dies. Some one is in control which would be comforting.

Re: finance- Man, is that ever a rabbit hole! Following the train wreck back to some Rothschild in the 1700s is fun. But I don't believe in a cabal currently orchestrating the world economy; its too much of a cluster@%^* to have possibly been planned.

Thai said...

Re: "its too much of a cluster@%^* to have possibly been planned."



Dr John said...

My angst with psychiatry is much deeper than my powerlessness Dink. If it was that I could deal with it. It is because in a general sense I believe psychiatry as it currently exists is evil. I am not saying all are harmed and I believe some even made well but on the whole it does more harm than good. I will likely post on this but Thai said something back about "12 step TX not working".
And I thought fair enough but what are they so supposed to work for? I do see some of them giving some people a framework for elevating themselves and re-framing their struggle. I see this with religion to. So does it work? No in my mind not if working means eternal exclusive salvation or an understanding of how all the crazy pieces of hx or the world fit nicely together in God's big plan. But none the less I see religious belief helping people deal with pain. Both AA and religion can cause lots too. There is no redeeming consistent philosophy in psychiatry that is clearly found that can be found in AA or some religion. If people get it from psychiatry they get it from some individuals personal philosophy not psych training. Psychiatry has created philosophies that supposedly help its practitioners understand people. That is very debatable. Even if you buy into it that knowledge does not lead to specific interventions. With the medicalisation of life in the past 20 years psychiatry has created and sold mass dysfunction. It is about creating need for itself not about making anyone well. I do not believe everyone that practices psychiatry is evil but we all do things for self interest that we firmly believe are meeting the needs of others. I have no self deception left in me. Most all pts who make their way to psychiatry would be better off if it never existed. Not all are clearly harmed but at best they are deceived and poorer for it in so many ways.

Thai said...

I know this may sound wrong but at some level, I think people need to be permitted to take their own life and we not be held responsible if they do.

Understand I truly hope no one ever does take their own life, and I honestly do not think many people would if we permitted it, but our inability to predict who will and will not kill themselves coupled with our fear of litigation that we as physicians will be held liable if someone does kill themselves coupled with the societal problems of drug dependency and homelessness is crushing to mental health system and preventing us from helping the few who really could be helped.

Whether or not 12 step programs do work, and I'm very skeptical that the do, I completely agree with you that we are not helping a lot of people yet we are creating a lot of dependency, and are spending a lot of resources that could go to much better uses.

But this is not something that any "one" person or group can do as it is the result of our collective behaviors- as I say, the tragedy of the commons. It requires changing the mindset of physicians, patients, the legal system, regulators, etc... and until all these change, the bubble will continue.

Dr John said...

I do not think that thought is at all bad Thai. In many ways I greatly admire pre-westernized Japanese culture. Suicide was a noble act. Now I will not go quit so far to endorse it but I understand the act of suicide. It is horrific in part because of how it is looked on in the west. I have made it clear to everyone who knows me that at some point if I have no hope for any quality of life I would, if available seek someone to help end my suffering.I also respect seeing the act of suicide in the way Albert Camus did in his work "The Myth of Sisyphus" Life is ABSURD and suicide is an act of trying to reconcile that absurdity.I do not think Camus was talking about dying with no hope of relief or recovery though.

So much of what I see on a day to day basis is nothing at all I have any expertise in or in fact is a "medical" problem at all. What astounds me is that thinking is so concrete I will see broke homeless, loners living on the edge of existence placed on multiple psychotropics for "depression" after being admitted. How can people pretend that that act has any value. I have said to many that if the goal was just to help people the hospital would do far more good running a homeless shelter or a jobs program with their money. I do not think 12 step programs "work" anymore than any other rigid closed system of belief works. Eventually people will be faced with something that the system will not explain and they will break down. The bubble will continue.

Thai said...

The problem with ideas like suicide as a release from severe suffering (say the Kavorkian ideal) is I have found this to be more typical of my actual experience when it comes to end of life wishes.

Everyone says "don't do all that stuff for me" until they actually face death head on, and then a lot of them really do change their mind and want everything done.

I have no answer for this dilemma as it is real. AND I know the national academy of sciences say 45,000 people/year die of lack of health coverage AND 1/3 of all monies are spend in the last 6 months of life AND America has a 10% account deficit with the rest of the nation and is borrowing like there is no tomorrow in order to maintain this account deficit.

As you say, if the bubble plays on, it will be the unstoppable force hitting the immovable object- something has to give but your guess is as good as mine as to what.

But in the more specific case of suicide as a presenting complaint to the ED for mentally ill patients, I probably commit 2 patients per shift against their will to psychiatric wards for suicidal threats, yet I'm often skeptical that a number of these patients truly are suicidal, but instead say all the right things to get a hot meal and warm bed for a few nights as they sober up before their next drug/alcohol binge. And I see a lot of them back in my ED a few weeks to months later with exactly the same complaint.

And beleive me, I would love to help them out, but I have no alternative resources to offer them and of course, in the endless catch-22 paradox of mental illness, if the system did provide resources for them, a kind of "if you build it, they will come" dilemma would soon materialize.

All I can say as way of innocence is I didn't create our health care system, and if I could change it, I would.

And yet I do love our system. It has its really really fine points as well.

Debra said...

Lots of stuff in this comment section since I last posted to talk about.
I think that probably the big "problem" that people who are practicing psychiatry in the States are confronted with is this constant that we always observe in human society.
What started out as a great idea, discovered by an individual (or a group of individuals) in his OWN PERSONAL SEARCH for meaning, and trying to understand human suffering and alleviate it, tends to take on the... aspect, the structure of an institution.
This is not limited to psychiatry.
We are animals who create institutions.
To... transmit what we think we know. To try to transmit what we believe in (an impossible, but necessary dream... an ... illusion, if you like).
And the institutions pick up momentum. And they become corrupt, and corrupt us. At a certain point in time they are working to maintain themselves PRIMARILY, and NOT to fulfill their original mission.
You really should take a look at what happened on Carlat.
I am pretty mystified.
HOW, WHY did this guy ALL OF A SUDDEN get inspired by what I said about Adolf Hitler, and propaganda ??
Because... I was there at the right time to say something that HE WAS JUST READY TO DISCOVER ?
As an individual ? As a psychiatrist ?
Why not ?
There never WAS a golden age of humanity.
Of democracy.
But... our INFANTILE (not a judgment, careful...) DESIRE for there to HAVE ALREADY BEEN a golden age seriously gets in the way of our trying to work (hard work... not for shirkers) to CREATE THAT GOLDEN WORLD IN THE FUTURE.
On whatever level we are cut out best to do it.
Me, I do it at an individual level. Face to face with individuals, and here with you on this blog. And on my loony forum. With people who are asking themselves the same questions that YOU are asking YOURSELVES. Maybe their vocabulary is not as sophisticated. Maybe they don't have as much money, or as much book larnin. But that doesn't stop them from asking themselves the SAME QUESTIONS.
That's what I'm.. GOOD AT. (I hope...)
And I DON'T agree with Camus.
The world is NOT ABSURD.
The world is as absurd... as you SEE it. As you WANT to see it, in my book.
You DO have free will in HOW you see your world.
WHEN you start observing, and seeing it.
Cutting through your... prejudices, whoops, constants.

Dr John said...

I agree Thai/Debra that maybe what started out as a noble effort has turned into an self perpetuating institution. One concept that organized psychiatry seems totally blind to is how it feeds this. I wrote a section on this in my first paper but it had to be trimmed do to length.
I am not a big fan of George Soros but I read his last book which had a very philosophical slant. In it he talks of the concept of "reflexivity". This concept implies that investor analysis and modeling activities actually serve to change the markets, rather than just "mirror" them. This is exactly what psychiatry does by interacting with pts and promoting illness behavior. Thai you see those people showing up in the ER because we give them roles to play.They take on the role of being "mentally ill" because the forces in medicine and psychiatry drive this. If we turned our back on all of this and the "suicidality" people would figure out some other way to survive. There is no evidence that psychiatric TX reduces suicide rates at all. There is no evidence that in pt psych TX reduces suicide yet you are forced to probate people in support of this myth and the roles which have been created for us.Who even decided reducing suicide should be a primary objective of health care expenditure? Even if it did it is too costly for what society gets in return.

Debra said...

Not create that golden world in the future.
Create it in the PRESENT.
That golden world is FOR THE PRESENT.
And this is what the financial mess is about. Trying to create a golden world in the future..
Agreed on the roles, Doctor John.
Also agreed that... WHERE would the psychiatrists BE if the patients were not "playing" those roles ??
Not feeling useful... (For many of them...)
What is TX ?
Treatment ?
Weird acronym for treatment....
Suicide ? The way we "treat" suicidal behavior is an example of our current zero risk think...
Check out what I wrote in the jungle on zero risk.
Thai and I do NOT agree about risk taking, apparently...

Thai said...

I have wondered if psychiatric treatment altered suicidality, but never actually looked it up. Thanks

I definitely know we can't predict who will or won't kill themselves and we have spent a ton of resources trying to do just that. Physician ability to predict the future is very poor and so we simply do more and more in the hope it helps the odds (in many instances the evidence says it does not- some examples:
1. Getting a WBC (blood test) is MORE likely to lead to misdiagnosis and predicting whether someone has appendicitis or not
2. Having a cardiac stress test done yesterday is of zero clinical value in determining whether someone who has chest pain today in your emergency department should be sent home. It is not even worth knowing whether it happened.

Deb, I agree that risk is part of our very existence but I think it is one of those "levels" or aspect discussions, and it kind of depends what level you are talking about or what the aspect is you bring into the discussion. We could spend hours discussing which types of risk we do and do not agree with each other on and it would hate hours trying to figure out all the issues which create the aspect we bring into the discussion itself to see if we really are agreeing or disagreeing.

But I do think there is one or more than one part of our brain that involved in the concept of "self preservation" for whatever we are doing at a given moment and it tries to do its job very to protect the body from harm- e.g. protect from harm at a great many levels and this is what gets tough.

But like any form of attention, when this/these neural structure's attentions is/are on one thing, it (or another) neural structures attention is not on something else. And if tries to be on two things, then each individual attention is weaker than it would be if it were on just one... except I suspect there are probably a few unique individuals who have more structures like this than everyone else or their structures operate in parallel as opposed to serial.

And to make it more complicated, these structures are "non-linear" so some focus intensely on protection (say are 200% average), while others are less intense (say 50%).

There are so many moving parts and so many levels it becomes impossible to follow

Debra said...

That's why I play the piano, Thai.
(One of the reasons, at least.. Not the major one, certainly...)
And am bilingual.
The.. both/and vs the either/or mindset...
My theory.

Dr John said...

Yes "TX" is treatment. It is a U.S. medical abbreviation. You know I realize what I am really getting paid for in the hospital is not to get people well. Oh that is what we all pretend but no one who has been doing what I have for long could say that was the job with a straight face. I get paid to endure risk and be the lightening rod when it strikes. I am always waiting for the shoe to drop like Ford waiting for Pintos to explode. It's built into the system. It is so sad. All my notes have nothing to do with what is actually happening or what I even believe is happening at the time with pts. Everyone is dictated with only one thought in mind. How will a malpractice attorney look at this? I try to pretend every encounter I have will end up in a suicide. I craft my artificial silly DX to reduce risk. Hardly anyone gets a DX of "Major Depression" from me. This buy its very nature implies a treatable "biologic" entity that can be fixed and when the pt ends up dead I have failed. They all get "substance abuse" "personality disorders" or something like that.I am not saying I do not try to do my best with people but gone are the days when you can actually put what you want in a record.I think I am the only psychiatrist I know who still uses the term "malingering". The whole thing is a pathetic charade but I do have a nice piano and some good shoes to show for it.

Debra said...

HA !!!
I KNEW we were soul brothers.... ;-)
What is this dealie with the X factor ?
What's with all the little XXXXX's everywhere ?
This is a NEW DEVELOPMENT for me.
I don't particularly care for "malingering" diagnoses though... The proverbial... glass half full/glass half empty phenomenon.
We are not yet to the point of seeing the bogeyman lawyer everywhere over here.
It MAY be coming, but let's hope not.
It sounds rather sordid.
But... do you REALLY HAVE TO PRACTICE this way because of the bogeyman lawyers ??
Isn't there supposed to be something out there called... FREE WILL ?
Those people aren't malingering and YOU don't have to practice this way...
Who knows ?
What kind of shoes ??

Dr John said...

I do use a lot of X's Debra. everything in American medicine ends with an X. I have been blamed by lawyers for bad outcomes 3 times. None went to court and all were dismissed but it effects you deeply. At least it does if you give a shit and try your best to help people. It makes you bitter and defensive. I do believe in free will. But I also realize "a wise man/woman understands the world he lives in." I do not mean malingering always in a nasty way. I mean if you are poor and hungry and have no home you need to be crazy NOT to pretend your crazy to get someplace to stay. None the less there is a lot of abuse of the system and I believe it is human nature for people to have a desire to be cared for if they can. Damn I wish someone would take care of me. I am all for care for everyone but we all should have to do something in exchange. These people ARE malingering and I do have to practice this way. How many lawsuits have you faced? If the answer is none talk to me after number 3.At some point it becomes self preservation. As far as shoes I am addicted to Prada. I have four pairs of loafers and 1 pair of boots. Always looking for more. I also love Zegna suits.

Debra said...

So... I guess that we are living in different universes.
When I came BACK to the U.S. of A. two years ago, I thought it looked like a hopeless, sordid place to be, with all those... shopping malls with Targets going up in place of REAL business, REAL occupations, REAL work for human beings.
Prada shoes ? Zegna suits ? Don't know. I hope you look.. GREAT in them.
You have reassured me about malingering.
A LITTLE bit...
I plugged Philip Slater's "The Pursuit of Loneliness" in the jungle a while ago, and this plug still stands.
A book written in golden age of the '70's when lots of excellent stuff was coming out.
Slater points out that we have conflicting desires (yep, Freud knew all about conflicting desires...) : to be "autonomous' (yuck, hate that word...) AND to be dependant.
And when we go into DEEP DENIAL about our need for dependance, well... unpleasant things start happening.
I think that the social body is in DEEP DENIAL about our need for dependance.
DEEP DENIAL of the fact that we are born dependant and remain dependant all through life.
DEEP DENIAL that it is precisely BECAUSE OF our dependance that we enter into any kind of relation, which of course includes.. ECONOMIC RELATION and EXCHANGE.
We are dumb shit animals, sometimes.
We can be really obtuse...
Specially when we don't like ourselves.

Debra said...

Just read your link about Dr Pardi, the woman who did not want palliative care...
This story brings up very complex issues.
My mother had breast cancer at a time when the life expectancy was around 5%..
She went through several painful surgeries, and was horribly mutilated by them.
The IDEA of a doctor saying to a patient, "ok, you have this much time to live", or "you're going to die" is anathema to me. (One of my mom's doctors tried saying something along these lines, and she threw him out of the room, and never saw him again..)
Because... doctors SHOULD NOT say things like this. They have no business saying things like this, because.. they don't KNOW this.
Against all odds my mother lived more than twenty years after her bout with cancer, and died of a heart attack.
There was one REALLY IMPORTANT difference between my mom and Dr Pardi...
My mother was a deeply religious woman.
And she DID NOT FEEL like she WAS, or HAD TO BE "in control".
"Being in control" is a REAL problem.
It is probably our BIGGEST problem these days, collectively AND individually.
This goes back to what I said in the last comment here about dependancy.
Dr Pardi was a frightened little girl trying to maintain control at all costs. ALONE.
She had been LIVING that way for a long long time.
MAYBE... this is in part responsible for her death.
Who knows ? NOT the doctors, at any rate.

Dr John said...

Wow, I hope at some point we can post more on this issue. I agree with Debra however and I am disgusted with Drs telling people they will die in a certain amount of time. I think much of this is perpetuated by what is the TOTAL myth of Kubler-Ross and her stages of dying. This is a horrendous pile of bullshit and I see so much harm done to people by those who somehow think that it is their job to get people to "come to grips with death". This woman's story is a wonderful tale of that pathetic hypocrisy. Thai, I think you are right. I spend a lot of time thinking about death. It is part of the Stoic philosophy I practice. You know what? I have no idea what I will do until I get there. I hope I die a fast clean death. John

Debra said...

It's strange.
I DON'T spend a lot of time thinking about death because... death is a familiar companion to me.
It is not something that I think ABOUT.
Like... an object.
When I feel fully alive, it is against the backdrop of my mortality, and I know this.
I don't know what I would do if I found out I had cancer.
One of my friends refused a colostomy several years ago when the docs told her that she would DIE without it.
She's still HERE... And doing fine, I should add.
What I DO know is that there was a time when I thought that the years I spent in psychoanalysis were some kind of... INSURANCE POLICY against my getting cancer like Mom.
After my last crisis, I now am living life with no cute safety net like that.
And.. doing fine, too. For the time being.

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