Welcome Doctor John !!!!

This is a big moment for me...

I am pleased to announce the arrival of a NEW PERSON (well, at least a new person who has grabbed the micro...) to our saloon.

A transfuge from another blog.

Papieren, bitte ?

No, just kidding. You don't need a passport to join us here on this blog (one of the advantages that comes along with (as a result of ??) the jettisonning of all barriers to the transfer of capital, I guess...).

Over here on my loony forum (up and running again, DIFFERENT FROM BEFORE, but still a hell of an experiment in democracy), we stick up a photo of a red carpet being rolled down a magnificent staircase that looks like it could be in a palace...

Here on this blog, where we are all "normal"... we are not quite as civilized as my friends on my loony forum. (Or we WOULD be able to stick up photos of red carpets, don't ask me, I am a total loser with computers.)

But that's ok. I'm still pretty excited that somebody new has decided to push the door.

For however long it lasts...

One little teaser on the responsibilities of the individual in a group effort.

At a certain point it becomes hubris to assign TOO MUCH responsibility to the individual.

Hubris, like that little castration problem that Freud mentioned as being the ultimate obstacle involved in analytic work at the end of the cure. Like... I'M the EXCEPTION to all the rules.

Dink will appreciate, I'm sure.

Welcome on board, Doctor John.

The Problem With High Fructose Corn Syrup

A new study out from Princeton University lends new evidence that High Fructose Corn Syrup leads to inordinate weight gain.

A Princeton University research team has demonstrated that all sweeteners are not equal when it comes to weight gain: Rats with access to high-fructose corn syrup gained significantly more weight than those with access to table sugar, even when their overall caloric intake was the same.

In addition to causing significant weight gain in lab animals, long-term consumption of high-fructose corn syrup also led to abnormal increases in body fat, especially in the abdomen, and a rise in circulating blood fats called triglycerides. The researchers say the work sheds light on the factors contributing to obesity trends in the United States.

"Some people have claimed that high-fructose corn syrup is no different than other sweeteners when it comes to weight gain and obesity, but our results make it clear that this just isn't true, at least under the conditions of our tests," said psychology professor Bart Hoebel, who specializes in the neuroscience of appetite, weight and sugar addiction. "When rats are drinking high-fructose corn syrup at levels well below those in soda pop, they're becoming obese -- every single one, across the board. Even when rats are fed a high-fat diet, you don't see this; they don't all gain extra weight."

And, of course, what is the solution that is given to us? Here, just take these medications. Lose weight. Eat less. Exercise more.

What bothers me is that there is this meme all throughout the American culture that states that everything is personal responsibility. Further, that business interests have no responsibility to provide healthy foods -- or any other products -- that are safe for use by the ultimate consumer or user. We have been heading back -- for many years now -- to the rule that had been abandoned because of its inequities and harshness: caveat emptor.

The rule had been abandoned long ago because it was decided that sellers were in a far better position to know the hidden dangers in their products. Eventually, the legal theory of products liability came to be.

In the United States today, we are facing an obesity epidemic. While I try to eat only organic food, sometimes it is not available. And what about when I decide to go out to eat? Do I have the choices to eat and drink foods that don't contain this additive? It is not just in Coca-Cola and other soft drinks; it is in ketchup and candy and even "healthy" fruit drinks.

We are told that we don't exercise enough. OK, that's true enough. But what about the community's / society's responsibility to provide parks and streets which make exercise available? The point I am making here has to do with how our cities are predominantly designed for cars as opposed to walking.

Doesn't anyone recognize that the obligation to provide healthy choices is more than just a personal responsibility, but also a -- for lack of a better word -- a corporate one?

My lilies...

Dinky, you're going to have to put yourself on hold for this post, if you don't like the.. associative way that I write....

This post is a response to Hell's response to my response in the jungle.

Well, really, only partly, because I intended to write this post anyway, but Hell's response can be tied right into this post, and I am counting on HIM (at least...) to understand why.

This morning I went out into the garden and started poking around a little bit. (I am a dilettante gardener at the very best. Thank God (lol) that I don't have to feed my family with the garden because we just MIGHT starve to death if we had to depend on my gardening skills...)

Two days ago the earth smelled that humous smell of things waking up seriously. Mother Earth shaking off the winter definitely. The ball has stopped twitching. It has gained momentum. It is.. rolling well now.

And I took a close look at that flower bed when, on a cold day in November, I carefully dug 15 holes (hard work...) and lovingly placed 15 rather large sized lily bulbs in place, taking care to replace the soil above them so there would be no air bubbles, no useless space. And then I stuck dried leaves over the bed to protect my.. babies from the cold winter that was coming up, and watered them.

They stayed cosy warm (for bulbs) under there in the earth for more than four months, and... I didn't resort to sophisticated technology, or sonars to make sure that they were doing fine.

I just... TRUSTED that those little bulbs knew their stuff, and that whatever allowed those little bulbs to know their stuff (no names, now, please...) was looking out for them ok. (Some people would say that they KNEW those bulbs would come up, but... that is rather.. PRESUMPTIOUS in my book, saying that you KNOW, when really it is a question of FAITH.)

And guess what ? After 4 months now of cold, and quiet, the first shoots have broken the soil !!

Talk about a miracle.

Boy... am I ever a proud mother of those bulbs !! Isn't it great to see a miracle at work ??

In case you were wondering... That was a parable.

It is a parable for the metaphysical underpinnings of investment.

You know, that operation whereby OVER TIME, something that you have put into the ground, NOT KNOWING WHETHER IT WOULD PAN OUT OR NOT, but that you WORKED FOR, that you WATERED AND NURTURED, OVER TIME would PRODUCE.

Sounds pretty corny in our slick world, doesn't it ?

But...

Buyer beware. Those are just WORDS above. But THOSE WORDS are firmly anchored to ancestral processes that inscribe us in NATURE AND TIME, as LIVING BEINGS.

This, by the way, is what the Ancien Regime was founded on.

YOU may think that the Ancien Regime was a pile of shit that enslaved the citizens.

But... the Ancien Regime was ALSO a complex theological and metaphysical system that had carefully thought out man's place AND his RELATION to his environment, nature.

And this SYSTEM gave us... a particular idea of time, duration, (for Thai, the time that is modeled on the processes of pregnancy and digestion).

Something which the relative destruction of the Ancien Regime HAS NOT GIVEN US.

And that is why this CRISIS before us is a crisis, NOT JUST OF FIAT MONEY.

It is a METAPHYSICAL CRISIS, which interrogates our TIME, our PLACE, WHO WE ARE.

Don't get me wrong. There is no tragedy involved. Because we have become TOO BOURGEOIS for tragedy. (That may change rapidly, as the middle class disappears from the scene...)

Where are you, Joe ?

YOU should be reading me here. I think you understand this...

The Butterfly effect, Part III... The collective is not of one mind

... This is Chapter III in a multi-chapter series. If you happen to be coming to this tale in the middle, please begin here, with Part I.

So we left with the idea that in order to statistically find small effects from treatments, very large study populations are often required. Further, in the issue of tPA for stroke in 2000, 7 studies showed no benefit but an 8th and larger study did. And on the basis of this single but more "powerful" study, tPA was approved by FDA.

Further, as I asked you earlier to walk in the shoes of an emergency physician trained to interpret data and studies such as these, you should immediately recognize that the success of tPA in NINDS only suggested that the absolute benefit of tPA for stroke was probably quite small. For if there was a benefit to using tPA, still the benefit couldn't be very large or it likely would have surfaced in the seven earlier but smaller studies. The fact that it took a very large study (powered with enough patients) to find it suggested from the beginning that the effect was not very important.

Later in this post I will share with you the actual statistical outcomes of what happens to patients who are given tPA for stroke. You can decide for yourself whether we were justified in looking at the issue this way back in 2000.


Still, NINDS was a glimmer of hope.

So I now want you to shift your viewpoint from just mine- a single emergency physician- to the entire emergency medicine physician collective. And if you were unaware, the collective medical mind is anything but unified, and this disunity exists for very good reason. For the right thing to do is rarely obvious and we all have learned that statistics can be just that: statistics. Effects witnessed today in one or more studies often vanish under closer scrutiny as we come to learn we were fooled yet again by randomness.

Many physicians in the collective are cautious when new drugs are approved, especially when prevailing data suggests a drug's benefit is small. And as I said earlier, you can decide for yourself whether these physicians were justified in being conservative when I share what we now know 10 years later.

So the approval of tPA by FDA, as any physician with 2 neurons could have predicted, led to a fracturing of the collective medical mind as some physicians (myself amongst them) decided to give tPA to their patients while others opted for caution and took a watch and wait approach. I will not bore you with the details of these disagreements, though they legendary amongst my peers, but let me say they were quite robust.

But here is the key point of this entire post, all the while this debate was happening, the simple fact remained that the FDA's decision to approve tPA for stroke was akin to a butterfly flapping its wings. And while emergency medicine physicians debated these issues within the confines of their own private little world with what they thought were well defined boundaries, a lot of other people in the health care system were also effected by the ripple created by the butterfly's flap. And these other people, working in their own private worlds both outside and unbeknown-st to the emergency medicine community, were also taking notice of the ripple. And this ripple was beginning to make them stir and make worlds suddenly collide.

I shall end Chapter III here and will discuss the beginnings of these boundary collisions in Chapter IV as I have time to write it. But before I proceed, I want to make one last point re: tPA and stroke. Please understand that tPA can only be used on 2% of stroke patients. Sadly, it cannot be used on the other 98% or it will harm them for reasons I will not go into in the interest of time.

Please remember this 2% figure as you continue reading future chapters.


And, as I promised, I will now share what we now know about the cost-benefit of tPA in stroke. Looking at tPA from the perspective of a patient with a stroke, sadly this is what I tell my patients and families all too often:

1. If you have a stroke and DO NOT get tPA, you have a 40% chance you will have a good recovery within 3 months
2. If you have a stroke and receive tPA, you have a 52% chance for a good recovery within 3 months- this means there is a 1 in 8 chance the drug will benefit you if you receive it and a 7 in 8 chance it will not
3. If tPA is used, you have a 1 in 16 chance of developing a hemorrhage in your brain (6% absolute chance of hemorrhage related to tPA)
4. Despite the increased chance of bleeding, there is no evidence tPA make any difference before 3 months.
5. Your risk of death from stroke is approximately the same whether you receive tPA or not.

In other words, if an emergency physician treats 100 stroke patients who meet tPA criteria, e.g.- arrive within 3 hr, and have no absolute or relative contraindications, 12 will have absolute benefit and 6 will have a serious intracranial hemorrhage. And 2 patients will have minimal or no deficit for every 1 patient that gets a hemorrhage. We help a few patients (1 in 8) but we harm slightly fewer. It is not zero-sum, but some definitely lose as a few more win.

So I ask you, is this a wonderful drug?

And having shared this data with you, I have a few questions for you:

1. Is tPA a big deal?
2. Do you feel there is a lot of benefit for the risk?
3. If you had a stroke and qualified for tPA, would you take it?
4. Was the suggestion that the benefit was small in 2000 subsequently proved correct?
4. Were the physicians who took a cautious approach justified knowing what we know now?

The Butterfly Effect Part II

... This is Chapter II in a multi-chapter series. If you happen to be coming to this tale in the middle, please begin here, with Part I.


In order to frame this story, we must play a game called walk in another man's shoes. For understanding this tragedy of the commons tale requires we look at the story from several different perspectives, or viewpoints, simultaneously.

The first perspective I want to share is the one which introduced me to our tale- my own. And to examine this tale from my perspective, e.g. that of a typical emergency physician, a small understanding of both the statistics of tPA's efficacy for stroke and the history of how we came to understand these statistics is in order. I will try to simplify as much as possible.

In 1995, the year I completed my residency, the state of our knowledge was such that seven studies, including three major studies with names like ECASS, ECASS2 and ATLANTIS, showed no benefit in using tPA for stroke when compared against placebo. However, as we all know, statistics are a rabbit hole with no end and the story of tPA in stroke proved no exception to this rule... Though it did validate another rule of mine which I have come to call Thai's Alice in Wonderland rule of medical advice which goes something like "if something is controversial it is also not important; for if it were important, it would not be controversial". However physicians may differ in opinion, we almost all desire similar outcomes for our patients.

Remember that in order to observe a small effect in a large group of people, you need to study a very large number of people. Studying a small number of people can easily miss a small effect. The 7 prior studies were performed on a reasonable number of patients, but the argument was always lingering in the background that the studies to date had simply not been "powered" enough (which is medical speak for enrolling enough patients) to see tPA's effect. And so, "powered" with enough power to overcome all prevailing studies, a 1995 study titled NINDS overturned all prevailing wisdom as it showed a benefit to tPA on select stroke patients.

This is where we come to the part of the story where the butterfly flaps its wings. For on the basis of NINDS, in 2000, the FDA approved tPA for use in stroke and things got very interesting.

We come to the end of Chapter II. When you are ready, please progress to Chapter III.

The Butterfly Effect Part I

Forgive me for posting again on health care, but a few things have it on my mind of late. Probably most significantly, the congressional vote on HCR is approaching, yet I was also delighted to learn that my specialty society has decided to remain neutral on the HCR plan... As Winston Churchill once quipped: "You can always count on Americans to do the right thing - after they've tried everything else", so too can the same be said of ACEP, my specialty society... At least most of the time. ;-)

We physicians are simply not disinterested observers and I commend ACEP in recognizing this, even it they do not actually recognize this.

Anyway, I want to share a particular tale about events I have been witnessing for many years. And while I realize my interpretations on these events may be very far from a complete 360 degree picture of the truth, still they are as I saw them and therefore an honest attempt to tell a tale the best I can without resorting to extensive research and fact checking. Perhaps someone else (a journalist?) will one day pick up this story and flesh out my obvious omissions and errors. I would clearly be curious to read a fuller account.

My story is about a common tragedy which affects our collective- stroke- and how a glimmer of hope appeared against this curse. But how this glimmer of hope set off an unforeseen butterfly effect which has become my personal parable of the tragedy of the commons mess we call our health care system. This particular story is perhaps most relevant to my home state of Maryland; yet I somehow sense its lessons are illustrative of what has befallen medicine in general. And how complexity can simply beget more complexity, yet more complexity is not always for the positive of anyone involved. A classic tragedy of the commons saga if ever there was one.


A little background may be helpful: strokes are caused by an interruption of blood flow to part of the brain leading to brain tissue death. They are the second most common cause of death and major cause of disability worldwide. They are a VERY big problem for us all.

Further our developed world is seeing more and more strokes as we age and the effects of all these Five Guy's cheeseburger's begin to take their toll on our collective BMI.

Enter a glimmer of hope: a thrombolytic known as tPA.

To simplify things greatly, think of thrombolytics such as tPA as the medical equivalent of Drano. Physicians use thrombolytics to open clogged arteries. tPA is manufactured by Genentech and according to the company's 2008 annual report, thrombolytics brought Genenetech revenues of $275 million for all clinical indications- certainly no chump change but similarly no "blockbusters", to use a little pharm lingo.

... FWIW, the people at Genenetech are entitled to every single dime of that money imo so do not misunderstand where I am going.

In fact, I will stop the Chapter I of my tale here. When you are ready, proceed to Chapter II

Cops and Numbers

This number is brought to you by an unknown French cop, and courtesy of my devotion to doing an unpaid translation...

If the Numbers were not an abstraction, there would be a statue in its likeness in every commissariat (police station). Or ITS portrait hanging in a gold filigreed frame, next to the one of the head of State.

The Numbers is an omnipresent and authoritarian entity that hovers over every police department. Every chief invokes it in consecrated incantations.

"Numbers". "I want Numbers. Bring me back Numbers".

Every cop needs to remember that he exists above all for the Numbers. Nobody asks him to have faith in the Numbers, only to go through the motions on a daily basis. Without asking any questions. And with devotion whenever possible.

The Numbers is very important, because thanks to It, policies and opinions are made. The Numbers does NOT create security... or we would have already noticed.

The Numbers is greedy, but it isn't picky about the quality of what makes it get bigger. It is not a fine gourmet, it is piggy. It cares diddly shit about the delinquance that is offered up to it in sacrifice, It can even feed on hot air.

The Numbers can become an illness. Some cops think that they are doing RIGHT by dedicating their careers (contrary to all common sense) to the Numbers. They become what we call scribblers or hunters, and end up doing ANYTHING and EVERYTHING, no holds barred. They see bad guys everywhere. An overdose of the Numbers can produce hallucinations, even delusions of persecution in those who are in the terminal phase of an addiction to the Numbers. The IGS (My ignorance, I don't know what this is, those darned acronyms...) sometimes gets patients who, as a result of their blindness have got tripped up in the law.

Other colleagues who have developed immunity against the Numbers prefer working for days on end, if necessary, to catch a REAL bandit, just ONE, but who will go to prison without passing GO. Those colleagues insult the Numbers, which makes no distinction between a dangerous delinquant and a little schmuck, and remains hungry.

Police commissioners, the high priests of the Numbers before the Eternal, get together in high masses and compare the size of their Numbers. The one with the BIGGEST is considered to be the best policeman-troop manager, and this will enter into consideration in his career plan.

But.. to be in the service of the Numbers is not the same thing as being in the service of the public. Security is not quantifiable. It isn't an equilibrium of Numbers either, and all forms of suffering can not be measured.

The Numbers is mathematical, but It is not the answer/solution to the problem.

Bad deal. It is... a false friend (faux ami) like in grammar.

The enemies of the Numbers are free will and intellectual discipline, the true discipline, the one that engages consciousness/the conscience. And deontology.

The Numbers is... the opium of the Police.

(A little translation thingey. In French, the word that I have translated as the Numbers is "Le Chiffre". Not "les chiffres", which is the plural. No, "Le Chiffre", which is a GIANT ABSTRACTION, you know, like that GIANTEST OF ALL ABSTRACTIONS ??

So, I hesitate in this translation. How to deal with "LE chiffre" ? "Numbers" doesn't do the trick, and The Number doesn't quite do it either...

Ah... those continents...)

Beam me... DOWN, Scotty...

I have not been in a nihilistic funk for the past few days, but, shall we say, I'm not exactly the life of the party right now ?

The expat's life is not a piece of cake.

Empire has this little presupposition, wherever you are, and for however long you are out of the country, that you are just on a little jaunt. A little leave of absence.

Just waiting to come back to the mother country and pick up where you left off.

Episode ended. Hey countryman ! Welcome.. HOME !!!!!!!!!!

Empire engages in heavy duty denial even of the... ABSENCE of its citizens.

For example... when you vote, you must request an absentee ballot from your last place of residence. That means that you get a ballot, from, say, California, for instance when you haven't seen a palm tree for 30 years. Of course, with all the local elections on it too, and the local issues, and ONLY YOU know that you are not allowed to vote on those issues. No, just for federal elections. And of course, when you get that ballot, it is immediately assumed that you are part of the armed forces, or you have taken advantage of your company's liberal policy of sending its employees around the globe for two to four year stints (good deal, because in France, say, said American employees pick up hefty advantages for employment, like French social security that their American companies don't even have to pay for, and they get part of their salaries in the foreign currencies, etc etc. Don't worry... the ACCOUNTANTS have got it all figured out to screw the government(s) just right... Hey, that's CAPITALISM for you, right ? Oops, I meant to say, the kind of PREDATORY CAPITALISM that we've stuck on a pedestal until just recently.) And to add insult to injury, since the policy of almost all of those 50 states on absentee voting is different, you MAY have to take a little trip to the embassy (400 miles away in some cases...) in order to get your ballot witnessed in order to be valid. Cute, huh ?)

Just a word about the embassies. You might think that the embassies are there to help American citizens abroad, right ? Think again. The embassies are little clubs where the cronyism that has taken over our political system has full sway. The head honcho appointees waltz in and out of their positions without knowing diddly shit about the countries they are in, and most of the time without caring either. They are there to... REPRESENT empire. (As though... empire needed representing, right ? Since when did empire need representing ?)

Back to the expat gig.

It's funny but these days I feel as though I ? the mother country ? (or is it father ? who knows ?), at any rate that ocean between us seems to be widening all the time. (No techtonic plates spreading in the Atlantic ?)

It's getting harder and harder to determine whether I am STILL an American expat, or if that label (!) is getting covered up by the one of "French immigrant".

(When I first arrived here, I remember a scene where a couple of my husband's older, well settled friends had invited us for dinner, and we were talking, and the conversation turned to immigration.

They griped about the current immigration problem.

And when I said I was an immigrant, their faces took on that shocked look.

"But no, you're not an immigrant" (understand, you don't.. LOOK like an immigrant. You look like a nice WASP girl, you don't look like an immigrant...)

But I adamantly told them that AS FAR AS THE FRENCH GOVERNMENT WAS CONCERNED, I was in exactly the same boat as those other immigrants. Exactly. (Yeah, I know, I can be a pill. It started early. My FATHER discovered this when I was an adolescent...))

Whoops... I just took a wrong turn in my rant. ;-) Back on topic.

In the LONG LONG TIME that I have taken out for that leave of absence, I have very rarely met an expat like me. (Is that bragging ? Maybe yes, maybe not, have to wait to decide.)

Because I speak the language fluently. With just a teeny weeny, itsy bitsy infinitesimal hair on my speech that would get me arrested and shot for being a spy in wartime, probably (but then.. I would be arrested for being a spy and shot in the mother country too in wartime).

I sweated blood to be able to speak the language this way. It was dearly bought, this privilege.

And 99% of my compatriots do not speak the language this way.

And it makes a big, big difference in what is called "integration". (Alongside with other things, definitely. Like having children who go to school.)

So, these days, the mother country keeps receding...

And I deal with this in the knowledge that it is not because the mother country keeps receding that the country I live in is getting any closer.

It can be a lonely place, my friends, this place I have chosen to set up camp in.

Very lonely.

Wall-E and Skynet

So I have been in a nihilistic fugue the last few days. This type of mood "weather" tends to make for good rabbit hole diving. Why this is would be another rabbit hole, but I suspect its because it overrides certain inhibitory gates. Much like alcohol.

Anyhoo.

Wall-E and the Terminator series are very different types of sci-fi. Wall-E is a cute little Pixar flick where future humans have left Earth for a while so this fleet of robots can clean up the planet while they're gone. For whatever reason, only one Wall-E robot seems to currently be viable. But it happily works every day making nice little garbage cubes.

In the Terminator series Skynet is a program that humans created to make their lives easier. But when it transcends (becomes "self-aware") the humans get nervous. Skynet realizes they're nervous, knows that this will lead to them terminating its self-awareness, and therefore nukes them.

Anyhoo.

So evolutionarily, genes made these nice little Wall-E units (yes, this is anthropomorphizing, but work with me) to replicate them. The Wall-E units kept evolving newer features that were very handy. Including emotion so they could work together in groups. Then came reason. It started off with little things like alphabets and algebra. Adorable. But then "reason" went Skynet.

So where Wall-E had previously happily pursued his purpose, he now had the ability to reprogram his purpose. What to choose? Existential crisis.

But its worse than that with the human condition. Because there are 7B Wall-Es. Some just plugging away at their programmed purpose without question. Some creating purpose programs without really thinking them through. Some realizing 1) there is no purpose, we're just some statistically outrageous fluke, and 2) even if a logical purpose was created, its going to get drowned in the sea of rogue Wall-Es with their various absurd purposes.

Impossible! Ridiculous! Add on to this situation the residual emotion programs and pending mortality.......... my, oh my, what a cluster$#%^!!

Happy Pi Day Everyone!

March 14 or 3.14




... Just in case you didn't notice the image in your Google browser today. ;-)

I must add that it is really rather clever of people to have figured this out... At least clever to me as I would have never made the association. And of course, now that we all know know this date's significance, we should immediately realize that other people at places like MIT would have added additional significance to this date long ago.

There are a lot of clever people on this planet, that's for sure (where is Street Dog by the way?) And it does occasionally bring comfort to think that I do occasionally get to patch them up and send them on their merry way, letting them get back to performing the great deeds we know they will all perform.

Teamwork, it is the reason I do what I do.

... Of course I am a voice for the system. ;-)

Be well all

Psy fi

This post is intended as a form of response to Dink's comment in his last post, the one where he hinted that I unconditionally attack psychiatry and other psy professions (as I understood him, at any rate..).

It is also a statement of my position and current beliefs on the question of the psy professions for people who just MIGHT be heading into our saloon from psy areas, (and, why not ? people with psy inclinations who are silent readers here).

Readers have noticed that I will resort to somewhat mild forms of sarcasm when referring to the psy professions.

Such sarcasm is not the equivalent of a wholesale disqualification of these professions.

I think that in the psy professions, as in any profession, there are people who are doing good work accompanying patients in their personal trials. And that the patients who are consulting these people are getting a lot out of this kind of accompaniment.

In my neck of the woods, we set great store on freedom of thought. That means that IN MY OPINION, it is desirable for someone exercising a psy profession to be as free as possible from prejudices (I said.. as free as possible. Prejudice is everywhere.).

And I feel that it is desirable for someone exercising a psy profession to be as free as possible from troublesome PREJUDICES about the nature of their profession, their role and their mission.

Unfortunately FROM MY VANTAGE POINT (which I can defend with historical/critical arguments) many psys are woefully ignorant of the prejudices they have CONCERNING THEIR PROFESSION.

It is debatable to what extent such ignorance compromises the quality of work being done with patients. (Which I will concede...)

For the simple reason that I feel at this time that probably the number one prerequisites for being a good psy are : an excellent capacity for empathy, which implies imagination, and the capacity to put oneself in the patient's shoes (from time to time, at least...), and excellent critical/analytic skills. (Incidentally, Thai may argue, correctly in my book, that these qualities make for good doctors too...)

Saint Paul said that one could give away all one's possessions, live in poverty, do good deeds from morning to dusk, but without CHARITY (agape), it was pointless.

So... that means that a good psy MUST practice charity (agape) in order to be good.

Now... does that mean he has to know lots of fancy things about the human psyche, and undergo lots of time and money consuming training to achieve this end ?

Does he have to OWN a BODY of knowledge that sets him up as an expert ?

Maybe. Maybe not. I personally don't think that this is essentiel at all.

And I think that most of what a psy needs to know can not be taught in text books, in seminars, in classes at all. It is... learned through experience, and living.

Obviously I am talking here about the psy as therapist in the talking cure.

Not a prescriptor. That's something different.

A word of caution :

I abandoned my practice for complex reasons :

1) I was not "making a living with it", and I had lost faith in MY capacity to do it well.

2) I discovered that my personal vocation was NOT in synch with the way the psy professions as a CORPORATION organize their work (in France, but also in the U.S., I suspect.). Because... I like to talk MORE than I like to listen. That's pretty straightforward, and my friends on this blog will confirm that..

3) I have come to feel that one of the down sides of the psy professions lies with their propensity to pinpoint the problems an individual encounters in his search for meaning in his life IN THE INDIVIDUAL HIM/HERSELF, and I find this unscientific hypothesis to be normative, and not compatible with MY observations and conclusions that the social body itself is VERY VERY RESPONSIBLE for the difficulties of the individuals that comprise it.

4) I feel that the psy professions are constructed around a complex belief system that emerged from Renaissance/Enlightenment thought, and that this BELIEF system, referred to as SCIENTIFIC thought, evacuates the BELIEFS that underlie our sometimes unconditional allegiance to "scientific" thought. In other words, what we call science is NOT "objective", to the extent that objectivity is impossible in HUMAN experience. We.. BELIEVE in what we call science (many of us, at least..).

Now... at this time, IN NO WAY do I discourage people who are already accompanied by a therapist to abandon the help that they are getting in this context (when they are getting help, that is...and when they are NOT getting help in the therapeutic situation I am very very circumspect.).

But neither do I evangelize actively for the psy professions by telling people that their SALVATION MUST come through therapy. Because... I do NOT BELIEVE this the way I used to...

I also feel that the "service" offered by the different psy professions (from a mercantile perspective) is one that has been offered in varying forms, and with varying success, all through the history of our society. It has been offered... for free, on many occasions.

Now... TODAY, IN OUR SOCIETY, this service is NOT ALWAYS offered for free.

Because of the necessity to invent new ways to put our multitudinous talents to use to put meat and potatoes on the table. (THIS IS NOT NECESSARILY A CONDEMNATION...)

In this same way, coaching is a NEW psy profession which is emerging in France.

While other professions are disappearing over time.

Inevitable huh ??

For the time being I offer my "service" for free (in certain contexts).

Because I feel that... it is VITAL for us to see that you don't have to pay for everything you receive. (That's what "grace" is, by the way. Subject of a future post.)

And Dink ? Remember Herbert ? He was a "psy" too. I wonder whether he ended up abandoning the profession too...

The Trial of Hari Seldon

I opened up Asimov's "Foundation" recently and found this:

Q: You are sure that your statement represents scientific proof?
A: I am.
Q: On what basis?
A: On the basis of the mathematics of psychohistory.
Q: Can you prove that this mathematics is valid?
A: Only to another mathematician.

and shortly thereafter:

Q: You quibble, Dr. Seldon. Can the overall future of the human race be changed?
A: Yes.
Q: Easily?
A: No. With great difficultly.
Q: Why?
A: The psychohistoric trend of a planet-full of people contains a huge inertia. To be changed it must be met with something possessing a similar inertia. Either as many people must be concerned, or if the number of people be relatively small, enormous time for change must be allowed. Do you understand?
Q: I think I do. The planet need not be ruined, if a great many people act so that it will not.
A: That is right.

Context: The 12k year old system has gotten too complex. Seldon calculated that it would take 30k years to come around again. He can't stop the collapse, but he thinks he can shorten the "dark ages" down to 1k years by storing certain, um, catalysts or triggers to speed up the growth. In creating these knowledge bases he is acknowledging the possibility of collapse so is charged with treason. Asimov was a clever bastard.

SUDOKU!!!!!!

Sudoku started as a mild amusement on an aircraft, led to a descent into madness, and ended in an uneasy peace.

Its a game with simple rules: a grid with nine columns and nine rows which make up nine nine-spaced smaller grids. So you place numbers one through nine on each row, column, and smaller grid with no duplication of any number in said row, column, or smaller grid. You start off with a few given numbers and deduce the rest.

Such simple parameters, yes? Any moron should be able to do this. And mostly I can. But dailysudoku.com has humbled me (only on the "very hard" level, *gulp*, seriously). While creating the "options" set for a space I've made mistakes. While deducing I've made mistakes. While even typing in numbers I've inadvertently made mistakes. I've thought solution impossible ("they've posted a defective grid!"), but I hit the Hint button and voila.... the defect was pilot error.

Disturbing. Whaddya mean I'm not Merlin?!?! The implications are huge. If errors can be made in gathering data, analyzing data, and basic sensory/motor access in this simple game, then couldn't these mistakes be made in other situations?

Defective, treacherous brain!! If I can't trust it then all is lost! Its the most important tool anyone has. Hopeless, bleak despair.

Must....go....on. Okay, we go to battle with the army we have, not the army we want (cringe at Rumsfeld quoting). So clearly defeciencies must be identified, catalogued, and remedied. Eternal vigilance.

This rambling was intended to lead to a discussion of "belief". Though I try to keep an open mind that the equipment creating the belief may be in error, at some point I have to "buy in" if I'm to get anything done. Some people have appalling low standards for "buy in" and amazingly tenacious unwillingness to reanalyze in the face of new data. There should be some, you know, balance.

Rigueur mortis

I like this pun.

"Rigueur" is the current French translation for "austerity".

It is the medecine that is being prescribed by fiscal conservatives all over the planet, and that smug Irishman (or Scotch man ?) in the link that Yoyo (?) stuck down for us over there in the jungle is the kind of person who obviously gets all excited over the prospect of austerity, in the face of a Stieglitz who, in my opinion, has a much better grasp on the... psychological aspects of the financial crisis, and a much better understanding of just what fiat money is. (I am not sure that I really understand exactly what fiat money is, but I am not sure that people like that Irish (?) on the BBC program are as competent to give me lessons as they think they are...)

I still maintain that fiscal conservatism at this point in time is part of the elder brother, entitlement psychology. It is particularly espoused by finger pointing people. Ones who feel self righteous. Autonomous.

I neither feel self righteous (well, at least I try to limit this feeling in myself...) and definitely NOT autonomous. I am extremely dependant. I AM somebody's dependant, to use the accepted vocabulary.

There's lots of talk about bailing out/not bailing out.

And I am starting to change my tune on this subject.

For complicated reasons, that have to do with what I stuck down in the jungle about the economics of benediction and malediction.

I said that the very IDEA of growth is based on the economics of benediction.

This means that...

The paradigm of growth, what enables us to understand it can be seen when you draw a family tree.

If you have ever seen a family tree, you will notice that it starts with two people at the top, and then it spreads, until at the bottom it takes on the form of a big pine tree. (There are different ways of drawing the tree, this way is one of the most familiar).

The growth that you see in the family tree, from one generation to the next is, in its own way, a form of exponential growth. This kind of growth is like... multiplying the loaves and the fishes.

One "little" detail that you need to keep in mind : exponential growth, benediction is ONLY POSSIBLE OVER TIME. WHAT MAKES IT EXPONENTIAL IS the way that it deploys over time. NO TIME, NO EXPONENTIAL GROWTH.

I maintain that this paradigm is what organizes (or should organize ? not sure...) the economy.

When, in Genesis, God says "multiply", he is talking about this "economic" growth that can not be separated from the idea of generation itself, from... copulation, from giving birth, etc.

These paradigms are deeply entrenched in us. Culturally. Perhaps biologically. I'm not sure.

So, back to the crisis.

John Maynard Keynes, from what I have heard (mea culpa, I haven't read Keynes, just about him...) is one of the few economists to really understand the psychological foundations of economics, and these foundations are VERY VERY important.

Keynes understood that in order for human beings to feel alive, they need to GROW. Exponentially.

This means that, ANY PLAN, ANY POLICY WHICH PROMOTES REDUCTION IN ANY FORM enters into conflict with this human necessity to grow.

Fiscal austerity MAY be technically "wise", looked at from the balance sheet.

BUT, and this is a big but...

JUST WHAT GOOD IS A SOLUTION WHICH IS FISCALLY, FINANCIALLY WISE IF IT IS A PSYCHOLOGICAL CATASTROPHE ?

The danger with REDUCING is that you propulse yourself and your entourage into the spiral of MALEDICTION, as I suggested.

EVERYTHING that is under the sign of the.. NEGATIVE is negatively charged with... NEGATIVE meaning. For all of us.

That is why we need to be careful about the "solutions" we find to these problems.

I'm going to nuance this generalization to read... REDUCING FOR THE SAKE OF REDUCING is the biggest danger. And I think that the austerity packages are a form of reducing for the sake of reducing. Reduction as an end in and of itself. And I am firmly opposed to this. Reduction in one sector must be counterbalanced by growth, the perception of growth in ANOTHER area, at the very least.

Conclusion : AUSTERITY IS NOT THE ANSWER FOR GREECE.

Austerity was... NOT THE ANSWER for post WW1 Germany either...

I'm not sure that human beings are capable of seeing austerity as anything other than a form of punishment and/or humiliation.

Beware...

My loony forum, "Macbeth" and power...

I can hear you guys already...

"How is she going to manage to tie all THIS together ??"

It's a good question, but I AM going to tie all this together.

Yesterday my loony forum blew up. Somebody pressed a button and it went "pffft". (By the way, dinky, can YOU press a button and the BLOG goes "pffft" ? That's not very.. DEMOCRATIC if you can, right ?)

So, while I suggested that we refound this forum on a healthier base than its original foundation, it just got scrapped, and has already been magically resurrected, in a NEWER and BETTER form (dixit the NEW founders, of course...)

The problem is : WE, as a group constructed my loony forum over a period of two years. Together. With our ups, and our downs. Inching our way along the precipice of catastrophes, and crises, we managed to keep it going AS AN INSTITUTION for over two years.

What has been recreated is NOT the forum that we constructed.

I'll get back to this.

Sidestep to "Macbeth".

"Macbeth" is one of those plays that makes the current financial situation look like cat's piss in comparison. Really, our modern "democratic", hopelessly bourgeois world is just not big enough, and is way too tame for the life and death issues that are present in "Macbeth". (It's not that those issues have really gone away ; it's just that... we don't see them, busy as we all are in our cost/benefit analyses or our accountant sheets in our little bourgeois world.

"Macbeth" presents a world vision that could almost make you succumb to despair.

The plays opens as Macbeth and Banquo, two generals steeped to their eyes in blood and gore, the sounds of the battleground in the distance meet up with some strange figures on their way home. The asexual crones salute Macbeth with his current title, a future title, finishing in a flourishing "hail, Macbeth that shall be King".

Macbeth and his companion are wary of such pronouncements, especially as neither knows just WHO is making them, and for what reason.

But when Macbeth learns from the mouth of the old King that he has been given the title and the property of the man he has vanquished in battle during this CIVIL war, his reason wavers.

Lots of stuff has been written about Macbeth's ambition, etc etc.

A lot of analysis has really not known what to do with the fact that... the old king, Duncan sticks Macbeth into a... TRAITOR'S place, and whoops, Macbeth becomes a.. TRAITOR ?

HOW COULD THAT HAPPEN ?? (Incidentally, if you think that Macbeth is a monster WHEN he kills the old king while the latter is sleeping, when he orders the murder of Banquo, and puts Macduff's little family to the sword, wife AND child, you are NOT READING WELL, because Macbeth is NOT a monster in this play. He does monstrous things, but at no time do we lose empathy with him...)

You can look for tons of psychological explanations that make much of the individual's responsibility and free will in ALL situations in life but...

A more attentive look at the way things work will show you that...

Sometimes we get sucked into things that we have no control over.

Macbeth gets sucked into this situation.

Because what the play is really about is how we don't speak our language.

IT SPEAKS US.

And our language itself is one big.. LIE (if you like the word lie. Shall I say, that our language is deceptive.)

Do people willfully and consciously LIE (or manipulate) MORE than our language itself lies ?

Think about it.

The hags tell Macbeth that he will remain king until Birnam Wood comes to Dunsinane.

And he exults, because he BELIEVES that this will never happen.

Until... the soldiers in Macduff's army break off the branch of a tree and hold it in front of them as they approach his castle fortress to do battle.

A... lie ? Were the hags LYING ? Na.

Macbeth is undone by LANGUAGE.

And when the play finishes the whole process is revving up to repeat itself, and this is evident.

How do we get out of these ruts ? Sometimes you just want to lie down and despair.

Back to my loony forum and power.

The WORD that sent Birnam Wood to Dunsinane was "perversion".

And after that, the wind, the full moon, the natural elements just got the better of us all.

Nobody standing on the battlefield.

The new forum has been created by new founders who say...

No sense in talking about all of this any more.

We have to go forward as if it hadn't happened.

Sound familiar ?

But then... the new founders don't know what power can do to destroy democracy.

Their power.

Not yet...