thelastpsychiatrist.com - A Surprising Number Of Teens Think They'll Die Young, Or Live Forever, Whichever Comes First. Adnotated.

An unsurprising number of adults don't care either way.

CHICAGO - A surprising number of teenagers -- nearly 15 percenti -- think they're going to die young, leading many to drug use, suicide attempts and other unsafe behavior, new research suggests.

The study, based on a survey of more than 20,000 kids, challenges conventional wisdom that says teens engage in risky behavior because they think they're invulnerable to harm. Instead, a sizable number of teens may take chances "because they feel hopeless and figure that not much is at stake,"ii said study author Dr. Iris Borowsky

15% is surprising -- because it's smaller than I would have guessed, no? How many teens did you know in high school who thought they'd die by 30 (their parents' age when they were 4...?) or 33 (Jesus?)?iii

The really surprising thing is the logic: how do they make the jump from thinking you'll die young, to using drugs?iv Is it only those 15% who use drugs? Do the majority of those 15% go on to use drugs? etc.

How many teens think they will live forever? Not like vampires, but how many can't imagine their lives three years into the future, let alone 30, and this finds expression in the sentence "I'm never going to make it to 35"? It would be equally (in)valid to conclude, "teens belief that they will live forever leads to risky behaviors."

II.

Borowsky said the magnitude of kids with a negative outlook was eye-opening. Adolescence is "a time of great opportunity and for such a large minority of youth to feel like they don't have a long life ahead of them was surprising," she said.

Yes, I'd expect someone of my generation to say something that obtuse.v

III.

Adolescence is supposed to be an identity Schrodinger's Cat: multiple simultaneous states which eventually collapse into only one. The goal of adulthood is to let go of the other possible existences and to make the best of the one. A successful adult is one who understands that it doesn't matter which life you ultimately pick, only that you live it well.vi The same potential for, say, happiness exists whether you are a construction worker, porn actor, or wealthy industrialist.vii

Meanwhile, it is in no way contradictory for a teen to think he'll die young AND live forever; or that he'll become a chef AND be an infantry colonel;viii that he'll raise his kids on a farm AND roam the earth celibate like Kung Fu.

But the idea that kids are having multiple potential lives, simultaneously, doesn't sit well with adults, especially when the adult is more concerned with how the kid impacts their life, not the other way around.

IV.

As an aside:

The study suggests a new way doctors could detect kids likely to engage in unsafe behavior and potentially help prevent it, said Dr. Jonathan Klein, a University of Rochester adolescent health expert who was not involved in the research.

Of course it does. Because in the new era of healthcare, there's no money in the treatment, only in the detection. Question: once detected, what do you propose we do about it? It's a deadly serious question, I want a serious answer. You can't give them Zoloft, they're not yet "sick." Will you put them into therapy against their will? Monitor them? Social services? Outsourcing the parent? It takes a village, etc?

You are witnessing the nationalization of parenting.ix

Question: why would a parent want their parenting outsourced? Oh, yeah.x

VII.

Does the study really show that kids who think they're going to die young engage in riskier behaviors? No. Not even close.

First, the trick of the study -- and it is most certainly a trick -- is to present the strongest data first, but report the weakest data in the press, and conflate the two.

Here's the strongest data in the study -- not found in the press story:

In adjusted models, illicit drug use, suicide attempt, fight-related injury, police arrest, unsafe sexual activity, and a diagnosis of HIV/AIDS predicted early death perception at time 2 (1 year), time 3 (7 years), or both (adjusted odds ratios: 1.26-5.12)... Adolescent involvement in risk behaviors predicted a belief in premature mortality 1 and 7 years later.

See it? I'd call this "Bait And Switch," but I already used that for another post title. Here, the data shows that kids that are already being risky will later on in life believe they are going to die young. But the press reports it the other way.

Look at the study more closely, or once anyway, and you'll observe that

1. although 15% of kids said they probably wouldn't make it to 35, only 3% actually voted as having "no chance" or "probably would be dead."

2. Six years later -- when they're no longer adolescents -- only 17% of the 15% still thought they'd be dead at 35.

3. There was no difference in actual death rates.

In other words, very few kids actually believed they'd be dead, most kids grow up eventually, and it doesn't matter what they think.xi

VIIb.

Hard data for early pessimism predicting individual risky behaviors:

I'll grant you that predicting a suicide attempt makes sense; and I'll grant you that the relationship to HIV seems strong with no clear explanation. But beyond that, there is very little you can predict from early pessimism; and certainly nothing that justifies the article quote at the top.

"Oh, the press misunderstood our study..." Sure they did.

The best way to create a public health problem you can bill for is to allow a journalist to report your findings.

VIII.

"But even if the reporting isn't accurate, surely the data themselves are valid? Numbers are numbers, right?"

They used to be.

Here's an example: in the study, they make a big deal about separating out the races of the kids, because of course different races can have different perceptions about their futures. Fine. Meanwhile -- think about this -- they question as "adolescents" all kids grades 7 to 11. Do you remember the gigantic difference between 8th grade and 10th grade, let alone 7 to 11? Well, they can't. To them, it's all just "adolescence."

One of you is right now thinking, "well, how could this study have been done better?" You're asking that because you've been brainwashed: there was no need to do this study at all. This is not a question that needed to be answered.xii What if 100% thought they'd die by 35? Or 0%? Do any of these results tell you anything? This is another one of the quadrillion self-referential, running-in-place studies that constitute academic research. They tell us nothing about the world around us, they are solely masturbation.

FYI, someone funded this study, and it wasn't Pharma.

IX.

But even masturbation can be beneficial if it is done with a pure and selfless heart. So let's be fair: does this study and story contribute to the understanding and betterment of adolescents?

Turns out the answer is mocking laughter followed by scorn. The researchers, and the press, have no actual interest in helping adolescents or even understanding them. Their interests lie first in themselves, and the kids only in how they impact that interest. For example, based on her comment, what Borowsky finds interesting about her study isn't the ability to predict future risky behaviors, but that kids don't share her optimism. "Wow, would you look at that!" If all adolescents were optimistic about their future, she'd have thought that was completely normal.xiii

Here's another example: the authors of the study cite references and make hypotheses about the causes or meaning of the kids' pessimism. This is strange, and by strange I mean it figures, because when they did this study they could simply have asked the kids themselves.xiv It, apparently, never occurred to any of them. That's precisely the point.

You might say, "well, maybe the study was such that they couldn't get kids' feedback..." Then why do this study at all? The core question everyone would want answered you don't even ask!

To trade a generalization for a generalization: they, The Dumbest Generation Of Narcissists In The History Of The World, does not care about their youth. They care about them as a body, as a construct, but not as individuals, not as people with their own lives, hopes, wants, etc. That's definitional narcissism, in case you thought you were on TMZ.com.xv

Oh, they care about them in societal or general terms. "What should we do about these kids today?" the way someone might ask about penguin overpopulation or the quality of bottled water. It's too much hard work to look at each individual kid, in the context of their own environment and their own livesxvi -- hard work previously undertaken by parents, but as I've said we're in a new era -- and then deciding if there's any pathology. It's much easier to use, as a shortcut, the extent to which a kid disrupts the life of the nearest adult.

Adults have virtually no interest in teens as human beings; they are voyeuristically consumed with knowing what they're up to, and love chatting about why they do things. To them, understanding is parenting. Let someone else do the actual work; they have a Time Magazine waiting.xvii

X.

One last example. Teens like movies, they identify with characters, for better or worse sometimes those characters are the blueprints for their current or future identity. In other words, the characters matter.xviii

When Time did a story on Borowsky's study, this is the moviexix they chose to depict this new generation of pessimistic nihilists:

If you want to show how completely oblivious you are to the perspective of today's teens, this is how you do it. Why not throw in Jethro Tull? They didn't even make an attempt at finding a current reference.

I'll say that last part again, because it's the key: they didn't even make an attempt, because it wasn't important to them or their readers.

———What the fuck pious fraudster does it take to call this shockingly low value "surprising" ? It ain't fucking surprising, it's what you get for having really, really boring turdkids. An expectation of dying young is a required developmental goal in teenagers, what the fuck retards have you been hatching over there ?! [↩]A view that also happens to be correct, let alone anthropologically sound. [↩]Right. [↩]You mean, like phenethylamine / piperidine ? Oh I dunno... [↩]That stupid cunt belongs nowhere outside a cage, seriously now. Time of opportunity indeed. [↩]This, incidentally, is nonsense. Of course it fucking matters ; the adult isn't one who "finds peace with how everything's the same" ; the adult is either the cuck, who finds peace with the fact that his existence is utterly inconsequential in se, or else the world eater, the Great Hero of legend.

Yes, it's true that historically the need for beasts of burden had already died off slightly before the need for proles also died off, and so for a brief flicker in time it almost looked like the common man has some sort of meaning, or importance. Nevertheless, feasting cada muerte de obispo doesn't mean life's a feast ; yes eclipses happen but the sky's not an endless eclipse, and so following. [↩]Absolutely out of the fucking question. No potential for happiness exists outside of liberal professions (something today's medicine isn't), and more generally universal (in the sense of, unspecialized) manhood.

Selfless dedication, such as is the lot of the prole whether he wants to or not does permit flawless contentment (the flawlessness a function of the selflessness), however this is exactly the opposite of what Ballas imagines happiness to be (as it happens, the selfless prole can't distinguish between contentment and happiness, but this obvious point is invisible to anal children). [↩]Contrary to what the adults ridiculously imagine, kids do not think they'll "become" an X ; kids who don't merely pay lip service to the adult weirdness but actually spend any mind time on this "becoming" nonsense are actually retarded (and usually female). [↩]No, actually, it's the "service economy" running its course. Everyone's gonna be rich by doing each others' laundry, it worked so well for the adults it's gotta be extended smore. [↩]The whole schmuckelodeon works on the firm basis of imaginary "adversarial proceedings" -- it's not whether Schmuckster McSchmuck is comfortable, it's whether "you could accuse him of not being comfortable" ; and whenever they start noticing the whole conventional approach to consensusing "realities" doesn't actually work they... up the ante on the associated "rules of accusation". Currently they've turned that knob all the way up to "can accuse each other of rape for no reason", just so the whole "reality is what's left once all the things you can accuse me of are removed" charade keeps on pumping their temple veins. I can't accuse Apple of being a scam (according to the rules of how such accusations may be brought), you see, and so therefore... if I accuse it of being a scam anyway I'm... I'm... I'm illegal! That's just not how delusions work! Do I even know how the delusion cycles work ?!

It's a sad universe built by twelve year olds to be inhabited by twelve year olds. Nobody could possibly see what they're up to, is the fifth grader logic, because "there is no proof". Any adult can see right through them, in enfilade and defilade just as well irrespective, but that's just because the adults are assholes, it has absolutely nothing to do with the intrinsic transparency of simple minds deploying purely conventional approaches. [↩]This being by far the most important conclusion of this, or any other study : it utterly does not matter what kids think. About anything. [↩]And yet he doesn't understand what managers are even for. [↩]Especially if that optimism was centered on how all-important shrivelled up old cunts are. Oh, wait... is there any other kind of optimism, anyway ?! [↩]The problem is, the kids have no fucking idea, there's no optionality to culture. Have you seen Lo sceicco bianco, by the way ? [↩]In truth, it's not outright inconceivable that this cohort of insufferable morons finally disposed of, the world may revert to being a less shitty place. Actually... Trilema is rather dedicated to that optimistic view, I suppose. [↩]He means, "as slavegirls, living in your house, eating your bread, trying their best to please you" etc. [↩]This paragraphis yet another one of those trademark Ballas gems of perfection. Go him!

As he aptly points further above, the teens don't factually exist, they're not people, they're these vague clouds of possibilities. The job of the adult is to provide the crystallization point around which all these floating potentials can organize into something specific, to force the realization of the adolescent into adulthood by capturing them into the history of their own existence. I guess this sounds difficult, but it's actually quite easy to do ; I guess it also sounds unpleasant, but honestly it's exactly like vaginal intromission, or murder -- it only bothers the very first time. [↩]I suspect this is "running on fumes" -- films sufficiently thoughout out as to permit this used to be made, but not really anymore. [↩]Apparently some 1988 thing with Winona Ryder that I've never seen, something with schoolgirls from Ohio. He has a solid point, doesn't he. [↩]

« The Misfits

thelastpsychiatrist.com - Atkins v. Virgina and the Execution of the Mentally Retarded. Adnotated. »

Category: Adnotations

Tuesday, 06 August, Year 11 d.Tr.

thelastpsychiatrist.com - A Study Finds Antidepressants Don't Work, And Suddenly It's October 25. Adnotated.

ABC News, and others, report that the NEJM study found that antidepressants "may be duds."

Climb on the bandwagon, my bolsheviks, no brakes, no driver, let us see where it takes us.

An article like this has consequences, widespread social consequences. They are massive, you just don't see it.

Let's say antidepressants really don't work, and this could/should have been known. Have the last 10 years of psychiatry been a lie?i It was all a shell game?ii If so, is anyone going to step up and apologize, take responsibility?iii "We were wrong, we've been pushing sham treatments -- sorry?" I don't want to hear, "we suspected this..." I want someone to stand up and announce, "you know, I've been prescribing these for years, and I now realize I was duped."

If it's true, then what were we doing to all those patients all those years?iv

These guys write this as if to say, "I told you so." It's all so clear to them. And to read the interviews, you'd think they were sipping on a Diet Coke -- poured into a glass, with a lime -- smugly announcing what they've known all along.v

These guys are hailed as some sort of heroes, exposing the lies of Big Pharma. But they aren't, they are the worst possible self-promoters; they should be ashamed, they should be ashamed to show their faces in public, let alone practice medicine. They are worse than hypocrites, they are unconscious hypocrites.

Before you email me saying, "what -- you didn't want this published? You want them to simply pretend everything is ok, that the data for the meds really isn't weak? That data isn't really being suppressed?" let me state my point as clearly as possible:

THE PROBLEM ISN'T THE STUDY WAS PUBLISHED, THE PROBLEM IS IT SHOULD HAVE BEEN PUBLISHED 10 YEARS AGO.

It's the exact same data they had 10 years ago, the exact same data. This isn't a discovery, this isn't Woodward and Bernstein, this is a bunch of academics who are no longer on Pharma payrolls who have now decided that they have nothing further to gain from pushing antidepressants.vi

Now they can pretend to be on the side of science. We reviewed the data, and found some of it was not published.

You knew that already. You were the ones who didn't publish it -- it's your journal. Turner worked for 3 years as an NIH reviewer. He just notices this now?

Is no one wondering how it is that this study comes out now, when all antidepressants but two are generic?vii

As suspicious of Pharma as everyone is, no one seems to see that they are no longer getting Pharma money, they are now getting government money -- NIH -- so they're going to push the government line. No one finds it at all suspicious that the two biggest NIH studies in the past two years both found the generic to be the best?viii

You think that in 2000 those studies would have been published? But now -- 2007, 2008, if they'd found Cymbalta to be the best on the NIH's dime, you think that they'd get re-funded? What's the difference? Same authors, same studies, same data. All that's changed is the climate.

People want a direct financial link to show bias, not realizing that bias is much more prevalent and more powerful elsewhere.

And oh boy, there is going to be hell to pay.

This study isn't just about antidepressants, it is a call to arms -- and I'm sure these guys had no idea they were playing with revolution -- it's the rally cry of the disenfranchised, the powerless, who will say, "look, see! Big Business! Everyone leeching off the poor public!" Do you think ABC News picks this story up because they care about antidepressants?

Again, I'm not saying hide the study -- but publishing this 10 years ago, with the same fanfare and media attention, would have prevented the coming storm, the storm caused by them -- and others -- and others -- the building anger and resentmentix -- not to mention maybe altered psychiatric practice in the first place. All of this could have been prevented. IT'S THE SAME DATA. But no one cared then. Times are different, I guess -- because the people are not.

Huckabee wins Iowa; recession looms under the direction of an insecure but resentful, spiteful, Fed Chairman -- even as oil goes to $100 and no one cares; China rises, Pakistan falls, and Russia is a viable solar energy plan away from collapsex; pointless obsession about NSA eavesdropping, while Google and others shuffle along archiving your DNA, voice, and existence, all for future governments to decide what to do with; a public anger and distrust of the "system" that rivals the 60s coupled with an apathy and narcissism that rivals, well, any time, ever.

We are doomed. Look on my works, ye mighty, and despair. Nothing besides remains.

The Cold War ending had the reverse effect of making socialism ok to consider.xi And socialism combined with public apathy and near total control over the existence of information is...

You want to salvage your kids' futures? Forget about bonds, forget about gold. Buy Google. You'll get your chance tomorrow, when we collapse.xii

———Absolutely. [↩]Yup.

It's hard to see from "inside", but yes, it's all been a lie. [↩]Nope. It's kink high, nobody there has any particular identity or notion of the self. They're just kids at play. [↩]You were servicing them. [↩]Like it or not -- this is exactly the situation ; just, not the situation of some dudes at ABC News. Of course not. The situation of some dudes you really don't like to think about. [↩]Awww. [↩]Well, no one is wondering because the morons don't know and the rest knows already. The "wondering" sliver is vanishingly tiny. [↩]And yet Ballas himself still imagines there's a division between socialist entities, there's a "government" and a "Pharma", arbitrarily. [↩]But paroxism is how the cuck-faggot works! [↩]It's funny how reliably & dedicatedly the walking dead keep underestimating Russia. Must be some kinda D-K manifestation. [↩]No, it made it ok to apply ; much like the "fall" of Nazi Germany made their take on propaganda and statal organization mandatory in both Moscow and Washington. [↩]Buy nothing. Slaughter the boys and teach the girls how to climb the pole without using their arms. It's what defeated populations are for. [↩]

« A nickel's worth of clues

The Misfits »

Category: Adnotations

Monday, 05 August, Year 11 d.Tr.

thelastpsychiatrist.com - A Solution To The Pharma Problem. Adnotated.

The problem so far is all arguments against Pharmai (prices too high; no interest in making meds people need; no interest in cures, only maintenance treatments, etc, etc) fail because they are ethical arguments.

The problem and solution require our reluctant acceptance that the problem is an economic one, and only economics will solve it.ii

Though I divide the solution into a "Doctor Side" and "Pharma Side," it is imperative that both solutions be executed simultaneously. Doing only one will absolutely fail.iii

Doctor side: Pharma does not make meds for patients, it makes them for doctors -- they represent the demand. Read that again, that's Axiom #1.iv

Doctors have no current incentive or pressure to consider the cost (effectiveness) of the meds.

But without the pressure, there is no incentive from Pharma to create products that are cost-worthy.v If doctors don't have to consider cost, then Pharma can effectively get doctors to add on, say Nexium. It works, so why not? If doctors must explicitly consider cost, then not only can't Pharma successfully market Nexium, it will not even bother to create it. Pharma will work on something that's really worth the money.

Consider also that unlike other consumer products, price has no relationship to relative value. Nexium and Lipitor are the same price, but (arguably) Lipitor is more important.vi

So doctors need to consider cost, which in turn will force Pharma to consider cost. So doctors -- not patients, President Bush -- must be given a healthcare budget, specifically a pharmacy budget. $20 per patient per day. Go.

That changes the market. If you do that, prices come down, especailly for "luxury goods" (e.g. Nexium.) And Pharma will create wonderful things (not that they haven't already.)vii

Pharma SideAxiom #1 is: Pharma makes meds for doctors, not patients.

Corollary: They don't need to make a drug that is useful, or is awesome; only a drug that doctors will prescribe. Sometimes the two are the same, but that isn't by design.

Pharma gets no points, no credit, for creating drugs that work, only drugs that sell. No one I know has hugged a Lilly repviii, thanking them for having a drug that works, even if imperfectly. Their only thanks is the money.

The single problem from the Pharma side is the blockbuster drug model.ix

The common criticism against the blockbuster model is that it entices other Pharma companies to invent "me too" drugs -- another SSRI, another statin, another Nexium.

But there is a much greater, critical, consequence of the blockbuster model: it makes doctors think that the mechanism of action of the blockbuster is the only, or most, important one -- it creates a paradigm that is hard to think outside of.x In other words, the blockbuster model confuses science. It may be that lowering cholesterol is itself a red herring, and that the actual benefit is something elsexi -- consider Vytorin lowered cholesterol more than simvastatin alone, yet was not better at preventing intima thickening. But because cholesterol drugs -- nay, HMG co-A reductase inhibitors specifically -- are the big drugs, that's all doctors think about.

From 1980-1998, SSRI were all psychiatrists thought about. So obsessed were they with SSRIs that they tried to explain nearly all psychic phenomena by serotonin. Depakote was such a blockbuster that people couldn't even comprehend a "mood stabilizer" that wasn't an antiepileptic.

You can't get a novel mechanism passed an NIH grant reviewer; Pharma isn't interested either. How is it that 6 atypical drugs all have prominent serotonergic activity, but no one investigated glutamate? You have a working paradigm, you have stuff that is well established, it's hard to abandon it and try something new. Not when you operate on the blockbuster model.xii

And meanwhile, Pharma loses out on new opportunities.xiii) Pharma may have already invented a novel mechanism drug that reduces heart attack risk -- but not only does it have to bring it to market, it has to retrain doctors that they trained to be statin obsessed -- that cholesterol, after all, isn't everything. Strattera and Cymbalta -- both invented at the same time as Prozac -- languished in Lilly's basement because the world (of doctors) was not ready to hear about drugs that weren't "selective" or serotonergic.xiv

But as long as doctors don't have to consider cost, blockbusters are the best way to make money. You want to make a drug that doctors will simply add on to everything -- and they will, if they're not paying.xv

The Incentive Model: Broadly, there are three categories of people working from different incentives.

For Pharma researchers, the incentive is to get FDA approval for an indication.

For reps, it is to get market share. Many reps compete against other reps in their own company. (e.g. if they come up with a great sales pitch, or have an awesome speaker, etc, they don't want to share them with other territories.)

For managers, it is indirectly market share, more directly certain rep based metrics (reps made growth targets, reps conducted the right number of programs, all expense reports were done on time, etc.)

For the company itself, the current incentive is to create what doctors will prescribe.

It's obvious that the incentives are different, and none are actually in alignment with the company's goal of increased revenue.

1. Bringing a drug to market should not be incentivized, even from the basic profit perspective. Just because it gets an indication, doesn't mean it will generate any money. But since researchers are incentivized precisely on that, you see a lot of obvious "me-too" drugs and indications. The fix here is to incentivize researchers based on the future success of the drug, not the indication. Coupled with a pharmacy budget for doctors, the incentive will be to invent a drug of value -- whether in a disease that has few treatments; or a significantly better/safer alternative. While more difficult, it will be more profitable to the researcher than another SSRI (which doctors won't want to spend their budget on.)xvi

2. Market share is also a bad metric, yet it's the one everyone uses. It does not matter at all that Seroquel has more market share than Zyprexa because they may not be used for the same things. It's not Coke vs. Pepsi. As an example, for Lilly, Zyprexa competes against Geodon, but not against Depakote -- because it doesn't share the same FDA indication -- even though in the treatment of bipolar, Depakote is a much bigger competitor than any antipsychotic. If Zyprexa wins all of Geodon's market share, it gains very little in real dollars. But convert all the Depakote to Zyprexa, and Lilly wins.

3. Managers. I am not really sure if there is any value to managers.xvii I am not being glib or insulting, and I'm open to information. But my read is that Pharma could easily cut the number of managers in half, reducing expenses but also freeing reps to focus on selling. Or, it could use a mentor model where good or senior reps are paid extra to mentor newer reps.xviii

4. Next, you have to incentivize Pharma to make valuable drugs; at least don't de-incentivize. There is a gigantic likelihood that any really useful drug will be commandeered by the NEJM's Marcia Angell and her band of merry socialists. Why would any company want to spend any money on a cure for HIV, when there is a real chance it will be stolen by the UN even before it gets approved? And we're supposed to accept that, because society "needs" it.xix "Sanction of the victim" is what Ayn Rand called it (and I'm confident I just lost readers by invoking her name. Bite me.) So instead, you know what Glaxo's next big drug is? Treximet: Imitrex + naprosyn. Commandeer that, Dr. Angell.

The Research Model: The current model is completely broken. Allowing "thought leaders" to peer review grant proposals is as good an idea as allowing senior Senators to choose your next President.xx Letting Pharma do it is like letting Coca-Cola decide your breakfast cereal.

I recognize that it can't be fixed all at once, so I propose an incremental solution.

Pharma puts money into a pot to fund independent research, no strings attached.xxi

They can still fund their own stuff, of course, but we need a pool of non-taxpayer capital that private research can use. I recognize this is an expense for Pharma -- but not huge, NIMH budget is $1.5B -- but it earns considerable respect, and will likely lead to new ideas and directions -- and someone at Pharma will ultimately benefit.xxii

The problem is who will manage this pot: putting it in the hands of "thought leaders" and academics is stupefyingly obviously a bad idea. You may as well let the Politburo decide. (Yeah, I said it.) Want to know what that would look like? The NIH.xxiii

The solution is a "Digg" style voting of research projects.xxiv Any doctor -- not just psychiatrist, because you need people with different mindsets to make good evaluations -- can vote up or down a research idea/protocol.xxv If you want to get fancy, they can also vote up the amount the study gets (as opposed to simply approving an amount.) It's possible that allowing other scientists to also vote could be of benefit, but there are some problems with it that I haven't worked out.xxvi

Again, Pharma and the NIH can continue the same biased, barely readable quasi-research they have always done, this is just another funding source.xxvii

———

"I think you're gonna find, when all this shit is over, I think you're gonna find yourself one smiling motherfucker. The thing is, Butch, right now you got ability. But painful as it may be, ability don't last. And your days are just about over. Now that's a hard motherfuckin' fact of life, but that's a fact of life your ass is gonna have to get realistic about. See, this business is filled to the brim with unrealistic motherfuckers. Motherfuckers who thought their ass would age like wine. If you mean it turns to vinegar, it does. If you mean it gets better with age, it don't. Besides, Butch, how many fights do you think you got in you anyhow? Two? Boxers don't have an Old Timers Place. You came close but you never made it. And if you were gonna make it, you would have made it before now." (holds out the envelope of cash to Butch, but just out of his reach) "You're mine, dig?"

"It certainly appears so." (takes the envelope)

"Night of the fight, you might feel a slight sting. That's pride fuckin' with you. Fuck pride! Pride only hurts, it never helps. You fight through that shit. 'Cause a year from now, when you kicking it in the Caribbean, you gonna say to yourself, Marcellus Wallace was right."

"I got no problem with that, Mr. Wallace."

"In the 5th, your ass goes down." (Butch nods silently) "Say it."

"In the 5th, my ass goes down."

Hey, remember back when the UStards still had the spunk to complain about the broken shards of their leftover scraps and shreds of industry scattered meaninglessly about ? Back when they'd protest perceived dysfunction rather than be overjoyously happy there's anything there at all, Argentina-like ? Well... those days are gone. Gone like the smoke, gone like that song, gone to be replaced with "nowadays".

And that nowadays... o boy howdy, lemme tell ya. Nowadays, the same sad, broken, dysfunctional "Pharma" is proudly denoted as "Industria Americana", with no further epithets, to signal the disinclination to discussion. They sit around, watching each other with panic in their eye, a dozen grown adults on a "farm" (so says the shingle). They're gathered about a single, solitary, poxy hen. They watch it shed feather after feather, they watch each other watching for an egg that ain't ever gonna come, not no more, and as they're watching they dare not bring up "pustule" while the days go by and by. [↩]This is what dead cultures say. It is literally homomorphic to "we are dead", when ethical arguments no longer prevail the elvis has left the building. It isn't a correct statement of fact, as it implicitly pretends itself to be. It isn't even incorrect. It's just a rattle, descriptive but contentless. It just happens to be called The Death Rattle, that's all. [↩]"In the first phase, only trucks will change to driving on the left side..." [↩]And the SOPS is not made for businessmen, it's made for lawyers. They "represent"... see the system yet ? [↩]But it is also impossible to create the pressure in economic terms, because incomes are not comparable. Consider the "brilliant DA" in Fracture. He boasts a "97% conviction rate". Do you know how he got it ? Let's see how he got it.

Have a seat.

Thank you.

William "no middle initial" Beachum. Wow, a 97% conviction rate. That's impressive.

Thank you, sir.

Course, you traded all your losing cases to other DDAs.

Well, uh... I took on two or three cases for every one I gave away. They just couldn't handle their caseloads... and I don't like to lose.

You won't always win working at Wooton Sims.

Ahem. Working at Wooton Sims sort of is winning. Isn't it?

Well, you'll need a middle initial.

Sir?

Well, those guys all play squash and have middle names.

Ahh. Huh.

They go in for their mother's maiden name a lot.

Well, my mother doesn't have a maiden name.

I think you belong here, William.

Well, with all due respect, sir... I just didn't work this hard to stay where I belong.

Yeah, well...I didn't think so. Well, you have your litigation experience... your chops... and your, uh, juicy private sector job. Pretty soon you'll be courtside at Laker games. Anything else the City of Los Angeles can

do for ya?

No, sir. I think that'll be all.

Yeah.

The incomes aren't comparable, see. Something comes in, a district attorney's office, or a doctor's office, or any other bureaucrat's. You know them, they're the scar tissue that forms once ethical arguments no longer prevail ; you gotta talk simple economics with them, generally about how you'll have their head. Something comes in, and now it's a "case". In a "file". An item, see, an entry in a ledger, part and parcel of the great socialist delusion, that "everything is the same thing".

I say delusion, but they need it. It's unavoidable. They can't just give it up, it is fundamental to socialism because it is where the metaphisical problem with their system leaks if constrained under a particular rule set. This is the thing with essences, see ? They can never be pushed out of the world. And this is the thing with rulesets, see ? They can never be complete. It thus unyieldingly follows that any attempt to constrain reality by ruleset will produce some warts, like trying to squeeze a balloon in your hands, or stepping on the garden hose in cartoons. In the particular case of Roosevelt-socialism, the fundamental problem reforms as this particular delusion. It's inoperable.

Those "cases" in those "files", those items, ledger entries that are nominally, by necessary representational fiat, "the same thing", are just as necessarily factually different. This contrast, incidentally, creates the premier tension of "modern society" (by which term we denote the last surviving socialism, for very good reasons). The smarter agents in the bureaucracy will trade themselves into supremacy ; the rest will grumble passively.

So if, indeed, there were incentive for doctors to consider either the cost or the efficiency of medicine, that incentive would not result into what Ballas' inept societal model promises him ; they will result in some doctors, the better ones trading out leukemia to trade in apendicitis, and yes, they'd heal three apendectomies for every leukemia they trade out, and yes the grumbling Calibans will have "not been able to handle their caseload", being as they are the system-designated rug under which to hide the necessary dysfunction of an unfixably dysfunctional system. Would that be better medicine, where good doctors only treat things I can treat myself, and as soon as you get something actually dangerous you're up shit creek with Patel for a paddle ? (And fucking spare me the vomit about how "Indians can in principle make just as good doctors as anyone." In principle you can make just as good a slut as my sluts -- but do you ?!)

PS. Don't you find it remarkable how much more than him I have to say on the actually interesting topics ?

PPS. Did you get the "Spielen wir Liebe" reference implicit in that article title ? Oh, "which one", is it. Right. [↩]Actually, Lipitor is more damaging. [↩]This is possibly his lowest point. [↩]But if the reps are... sorta-hot, why not ? What sort of company does this man keep ? [↩]This isn't the problem "from the Pharma side". This is a fundamental, and unavoidable, problem of socialism : it can't finance itself. It has to draw the metaphysics into the monetary base somehow (no matter how!), because a confusion of causes with purposes results in the direct and strict impossibility of balancing the books. [↩]For "doctors", which is to say, for pointedly non-thinkers. Who cares about them ? Oh, I guess people who want a dental bridge built as fits in their mouth, rather than as the doctor felt it should go ? I guess we're fucked, then. [↩]What does the author want to believe ?

That there is a benefit, yes ? Review note i, I guess. [↩]It's unclear whether he's saying it's not hard to abandon paradigm and try something new when on the blackluster model, or something else. In any case, from my own experience (in a different field), the Hollywood model is relatively (when compared to the other approaches) rather promotive of alternative pathways. Certainly more likely to find something new than the faith-driven Afro-Indian imbecility, or the uppity-old-cunt-driven "farmer/artisan" system. In a word, I suspect he's dissing cars for being sluggish on the strength of his ignorance of wagon trains and lack of experience walking. [↩]Not like they're going anywhere -- the steam engine the Greeks had but wouldn't apply waited patiently (eighteen centuries!!!) for the English to apply instead. This is a misrepresentation transparently constructed so as to protect Ballas' psyche from the actual opportunities that come with actual expiration windows ; it's a good thing "pharma loses out on new opportunities" because this way Ballas doesn't have to think about losing out by not having showed us his tits in time. (Yes, that was ongoing just about the time he phf'd. [↩]Maybe the solution is simply to do away with the USG.FDA arm of nonsense, and simply let anyone prescribe anything ? No ?

Why not. [↩]Which provides one a fine heuristic in dealing with USG.bureaucrat "doctors", to go with the one we already have for dealing with USG.bureaucrat "lawyers" and the other one, for dealing with USG.bureaucrat "scientists" : never take any SWAG-drugs. If "everyone" is taking Lipitor, you don't take it, because "everyone" is just another name for organised and militant retards. It's a heuristic, which means it won't work perfectly -- but it's a good heuristic, which means it's guaranteed to statistically work better than the alternative. [↩]The result will be that... no, seriously, guess. What will be the result ?

"Researchers" still have to meet fixed periodic expenses, in the shape of rents, meals, weekly cocksuckers etcetera. They could of course self-insure, bridging the gap between certain present expense and uncertain future revenue out of their own, fat pockets. This will not happen, because, simply put, there's not enough slack in Inca lands to afford this kind of largesse, and should these "researchers" somehow have the fat pockets... why... they'd be dekulakized. Their owner, who isn't me and doesn't care, also has better uses and more pressing needs for that money.

So no, they won't self-insure. They'll buy insurance, which means, quite specifically, they'll hire someone to pay them fixed amounts each day in exchange for whatever future upside. In other words... exactly what's happening now ; because what's happening now isn't happening because no special cuntlet of Ballas' caliber yet crawled out of cunt, to tell us all how his 5yo inventions would go. Because this is how it works, if you make a "rule" to stop them from being stupid, they create an indirection layer to get around the rule (while explaining why the rule should be repealed in the first place).

That's the mechanism of rules, their lifecycle, you understand this, don't you ? Just as soon as the last horse fled the coop, "rules" are "created" to "cement public trust". To assure Joe Q Nobody that "no such thing could ever happen again". The rulepile is at this juncture entirely pointless, much like a reinforced door to an empty coop, and therefore everyone agrees it is both sound and needed.

Then, as the various pressures mount (in direct relation to the rule's efficacity), more and more "dissenting" voices are heard, explaining how the rule is "outdated", as if that means anything, and that "we only need doors for empty coops! what point does a door to a full coop serve besides keeping things from going in", thus therefore the rules being "anti-business" and so following. Because paralogism is the true and universal substance of human "thought", and the simple observation that "the more ants you shove into a matchbox, the less likely for another ant to go in through a crack, and the more likely for an ant to go out of a crack, should you open it a crack" is entirely foreign to everyone. Somehow, magically, it's how "the wisdom of crowds" goes.

So then the door's loosened, and the horses run off again, and there you have it, paroxistic behaviour as a fundamental human mode of existence. I expect you're plenty familiar with it, being exactly the way you've been training your asshole to give you up when we meet : right after you've fucked yourself in the ass, you come up with promises about how you won't do it again, and make up rules to ensure you won't, and so following. And they "work", too, in the limited sense that for as long as you're not fucking yourself in the ass, you're not fucking yourself in the ass ; but then... as the time comes for you to take it up there again... you do, don't you. When the time for it comes you do it again, and then make up some rules again, which are your companions for the downtime. You just don't remember them when it's time to take it up the ass again, that's all. Right ? When the time for them to be applied comes, the "rules" are just so much wet paper. At all other times they're cock-solid, though, of course, of course. Just not when they're about to be useful -- then, they're just in the way.

This is how "society" works because it's how you work. And this is also why it's not society, and you aren't anybody. [↩]Then again we knew all along he has no clue about how anything works. [↩]Or it could fire all psychiatrists, and just let the rep managers stamp the "prescriptions". After all, when hiring astrologers, hire the cheapest. [↩]Well, the niggers involved certainly do need it. [↩]Yet judging by all the butthurt over Trump getting in, it'd seem that's precisely what the aspies wanted in the first place. They're certainly letting Apple pick their breakfast cereal, at that. [↩]Keks.

Why is this always the go-to of the aspie, "large pot of money, and it's all for me, free of anything" ? [↩]I propose instead that everyone on Ballas' block puts up their daughters naked into a truck. It's not a big deal, their lives suck anyway ; it'll earn considerable respect and ultimately someone on Ballas' block will benefit.

The only difference between his insanity and my insanity is that mine's actually happening, as in, right now. His never will. [↩]Except everyone in socialism is "academics" aka the Gosplan. This is like proposing to pay the brothel janitor instead of the madam, "because it's more moral that way". What the cuck ?! [↩]O yeah, totally. Idea of the year, this.

By the way, whatever happened to digg ? Remember that thing, back in the day it was just as much a pretender to "this is everything" as retarddit was earlier this decade. What happened ? Did it buy Russia ? Or did it buy the barn, the same old barn all these glories've been buying like cockwork ? [↩]And they will, because... what ? Someone might be wrong on the internet ? [↩]Such as what, Perelman voting you all down to 0 ? For perfectly good reasons ? [↩]Just another imaginary "funding source". Homeboy's ready with a gameplan.

Then again... maybe medicine could just win the lottery ? [↩]

« thelastpsychiatrist.com - Are You Mom Enough? The Question Is For What. Adnotated.

thelastpsychiatrist.com - As The Population Ages, Will Suicides Increase? Adnotated. »

Category: Adnotations

Sunday, 04 August, Year 11 d.Tr.

thelastpsychiatrist.com - A Quick Word on Porn's Effect On Your Penis. Adnotated.

A reader commented that I was minimizing porn's negative effect on women, that ubiquitous internet porn has damaged womens' psyches irreparably. That it makes women have to conform to some impossible standard.

Nay.

Porn is not the problem. I'm not saying it's a tremendous boon to society, but you can't blame porn for failing relationships, the pressure on women to attain impossible standards of appearance and performance; and male disinterest in normali sexual relationships.

Certainly porn puts pressure on womenii, but the effect is not directly from porn, or even from men. Here's an example that the reader offered: porn forces the women to shave. Not exactly -- they want to shave. Why they want to is a cultural discussion, but it isn't because men are explicitly commanding them to do so.iii

Certainly, porn has affected men. Ok, women want to shave; why do men suddenly want to, also?iv And, I'd expect that a frequent porn user (whatever that exactly is) might have some difficulty with arousal in normal (or repeat) circumstances.

But there's a greater problem that can't be blamed on porn. Every comic since Marx (Groucho, not the other nut) has joked about how men want sex and women don't. But in the past three or four years, I've heard comics make the opposite jokes: women want it, men could just as easily pass it up. Men are disinterested in sex with their established partners. As comic Mark Maron put it, "[I prefer masturbation because sex] takes up too much energy and it involves other people." Men always are ready for new women, but what happens to sex with your partner over time? Sure, ordinarily it may decline a little, but this is different: this is male disinterest, "lack of energy," lack of motivation to keep a connection with one's partner alive. The penis may still go up -- but everything else is gone.v

Let's face it, porn may make women feel inadequate, but how the hell adequate can a woman feel if her boyfriend/husband would rather watch TV than have sex? "But I'm tired." How tired could you possibly be?vi

So there are two parts to the problem. The easy, and smaller, part is media/porn objectification of women, and its effects on women and men. But the second, more crucial part is male "impotence" (metaphorical) and apathy. Let me be clear about this: porn might magnify this effect; but it doesn't cause it.

I know no girl in the world is going to believe this, but it's true: if you ask the average guy over 30 if they'd rather be with a girl they have been with many times before or masturbate, they'll pick masturbate. You know why? Because their soul bailed out when they were 15 -- because they are narcissists.vii What in life is worth aspiring to? You don't feel a part of anything bigger, everything seems distant, unreal. Everyone is waiting for something to happen, for their life to "start" -- they're 40 and they're still waiting. (As Mike Birbiglia joked, "I'm not going to get married until I'm absolutely certain nothing else good can happen in my life.") Concepts like loyalty don't even get a token nod, because today they seem outright preposterous.viii

And men have a distorted view of what it means to be loved. They want to be loved not for who they are, but who they think they are. "I'm an actor." "I'm a major force in WoW." "I'm a fiscal conservative but a social liberal." What he wants is his girlfriend to say, "I love him because he is such an intellectual, he knows so much about politics."ix What he doesn't want is her to say, "I love him because he's good to me."x

"Sure it'd be better to be with a girl, but when are you actually ever with a girl? They don't want you, they want what you represent -- a good job, security, to be taken care of, a big penis." It doesn't occur to them that the woman who doesn't want these things in her man might be the one to avoid?xi

I suspect -- I haven't been able to do the survey -- that even sex is a form of masturbation for these guys.xii That they see you, but they don't see you. The arm, the breast, the hip, all these become fetishized and transport him to another world.

Our birth rate is 2.1; France 1.7; Spain 1.3; Russia 1.3. In two generations, there will be 1/2 as many Spaniards, excluding immigration. We can't even get it up long enough to procreate.xiii That's not porn's fault. It doesn't help, sure, having the internet's tubes tied isn't going to fix that problem. Men are becoming less interested in establishing meaningful relationships with other people as an ultimate goal than in inventing identities for themselves.xiv

———When it comes to sexual relationships, normal is what males are interested in. So Shut The Fuck Up, "robust" uglies fatlogic team. Nobody asked you anything ; get that ass on the elliptical and then when you're done two hours later go make somebody else a sandwich. [↩]It's not "porn". It's the sexual revolution, id est the early phase of the destruction of the femstate at the hands of the republic. And it's not anti-"women" ; it's anti old, stupid, fat, coy/ugly -- all the supernumerary spurious scumbags which aren't women.

Get lost, yo. Get lost, because nobody wants you, nobody likes you, and unless you get that ass into gear and start delivering nobody's gonna be tolerating you in the basement, let alone fucking feeding you anymore. [↩]The women want to shave, specifically because it distinguishes them from the scum ; the scum wants to whine about how it distinguishes women from them. [↩]Because most men aren't. [↩]Yes, the substance of the femstate is gone -- both at this level and at the other level. No more "jobs" and no more "workers" => no more "society" ; no more "monogamous" "partnerships" => no more "family". Altogether no more of any of the crap. Deal with it, and fuck you.

PS. This was deliberate, it didn't "just happen", it isn't a case for the "who could've predicted" wankmill. The -- permanent and irretrievable -- fucking of the femstate was just as deliberate in general as in all particulars. No more, get the fuck off the planet. [↩]Motherfucker, her adequacy is something she works for. Not "works for a little". Works for until she fucking falls over, every single fucking day, no exceptions. Her adequacy is not something she's inherited from Mother Mula -- it is something she purchases with blood, sweat and tears, every single fucking breath she takes. Now git. [↩]No. It's because they suspect, on the basis of experience, that the girl they've been with before will try to get away with doing less instead of putting work into it. [↩]What possible loyalty can be expected from a declared, deliberate and self-entitled dependopotamus, to the degree that she's not merely intending to try and get away with less work on the next date rather than the obvious requirement of doing even more, but actually pretends not to even be aware of the whole thing, as a superlative form of whining loudly as to how she shouldn't have to do what she exists for ?!

O wait, wait. Were you pantsuiting loyalty into its exact opposite, were you contemplating the situation where someone just feeds and strokes the horror... for no reason, aka because "loyalty" ? That's not what loyalty is, nor what it's for. Fuck you, and get the fuck off this planet. Now. [↩]She could maybe try starting by saying "He is my God ; I know no other nor do I need another." How about that ? [↩]He who does, gets himself a dog. [↩]Dude, stfu, seriously now. Nobody cares, nobody wants to hear it. Shake the ass or get off the pig. [↩]Amusingly, this is the second time I hear this theory today. Isn't it slightly concerning when TLP starts echoing some obscure cheesedick from fucking Romania ?

Why does he do this, would you say ? What are they trying to will into being true ?

And what chances have they got ? [↩]It doesn't pay nearly enough to be bothered to procreate. Fucking's entirely unrelated (though the same obscure cheesedick from above similarily conflates the two, and for similar reasons). [↩]No, actually, men are withdrawing from the femstate. There's exactly 0 interest in paying "taxes", there's exactly 0 interest in following "the laws", there's exactly 0 interest in validating the self-delusions of the ridiculous narrative womanhood as imagined by niggers, there's in general 0 faith in and 0 credit extened to Mother Inca, and so following.

Now drop fucking dead. [↩]

« thelastpsychiatrist.com - A Quick Word On Google. Adnotated.

How to restructure the categories of articles on MP-WP »

Category: Adnotations

Wednesday, 24 July, Year 11 d.Tr.

thelastpsychiatrist.com - A Quick Word On Google. Adnotated.

Dropping over 150 points in a few days is worth a comment.i

However, it is a high priced momentum stock, and as such is the first to elicit the "no way am I the last one holding this" feeling. You sell it, and suddenly [you're] $600 "richer."

I'm not a technician, but unfortunately everyone else on the planet it: when you see falls like that, you have to ask where does it stop? And the 200 dma is a good guess. So if you selling yesterday was illogical: 570 is a floor, because everyone believes it to be.

So I wait, earnings next week.

A word on the Fed: there is a not implausible case to be made that he is not reacting to the markets, as some say, or even "behind the curve" but is specifically targeting traders out of resentment. Example: the cut came Monday morning -- after options expiration, when all the money had already been lost. You say: well, that was a reaction to Europe; but he did the same exact thing in August, waiting until precisely after expiration to announce a discount rate cut. And the overall odd way of parcingii out information -- it appears designed for maximal pain. Just a thought.iii

Anyway, Google is still on track, soon to be the global supplier of personal information to totalitarian regimes everywhere.iv

(long GOOG, MO; short the Fed, humanity, truth, the Red Pill)

———There have been a number of successive layers of "actual market being replaced by USG fantasy" to date, this 2008 sell-off being one among the many. [↩]Parcelling ? [↩]Everything always appears specifically designed for max pain, because max pain is a trading necessity. To the four year old everything similarily appears specifically designed for falling down -- we just call it gravity. [↩]Alphabet is actually fucked, but paper markets don't track reality. [↩]

« thelastpsychiatrist.com - A Primer on Pedophilia. Adnotated.

thelastpsychiatrist.com - A Quick Word on Porn's Effect On Your Penis. Adnotated. »

Category: Adnotations

Wednesday, 24 July, Year 11 d.Tr.

thelastpsychiatrist.com - A Primer on Pedophilia. Adnotated.

This is the most important part: most pedophiles aren't sexually attracted to kids.

Like most other terms used in psychiatry and politics, the meaning appears to be self-evident, but it's actually wrong. Other examples include "insane," "antisocial" (it means criminal), and "inflammable." ("Inflammable means flammable? What a country!"i)

Pedophile had originally been divided into two groups, fixated and regressed. Interestingly, even these terms don't mean what they look like they mean. They don't describe what kind of kid the pedophile likes; they describe why he is a pedophile.

Fixated pedophiles are fixed in a certain developmental stage, and are exclusively attracted to kids.

Regressed pedophiles, using the original definition, prefer adults but, if stressed, will regress to an earlier developmental stage; this regression leads them to prefer children. The regressed pedophile likes kids because he himself has "become" a kid (more technically: he regresses to a pregenital sexuality, which finds its satisfaction in oral (e.g. masturbation, fetishism) or analii impulses (e.g. sadomasochism) and its naturaliii compatriot, the child.)

The terms homosexual and heterosexual apply to the primary object choice, not necessarily the sex of the victim (e.g. "heterosexual molester of boys.") Fixated pedophiles tend to be (i.e. think of themselves as) homosexual, and regressed (think of themselves as) heterosexualiv.

But the easiest way, and most forensically useful way, is to simply describe pedophiles according to their sexual object preference: Fixated pedophiles are true pedophiles, they are only sexually aroused by kids.v Opportunistic (regressed) pedophiles would rather have a hot 25 year old, but will take the best offer. Regressed pedophiles don't think they are pedophiles.vi

Remember, whether they are homosexual or not isn't the differentiating factor (e.g. male homosexual regressed pedophiles prefer adult men but would settle for a kid. Heterosexual fixated pedophiles prefer kids.)

An example of the fantasy life of each is illustrative: the fixated pedophile might be married, but will take a feature of the adult and "see" it as child like.vii Maybe the slope of the calf, the hair style, etc. Fetishism is also important, and there is a clear (to the pedophile, not to anyone else) direct link to children (a type of cloth or pattern; sounds such as bells, crowds; language or words, etc.)viii

The regressed, or opportunistic, pedophile does the opposite: "I know she's only 13, but have you seen her ass?!"ix

So now you can see why all of our attempts at catching pedophiles before they offend are doomed to absolute failure: they're everywhere.x I know no one will admit this, but remember how hot you thought Britney Spears was in the original video "Hit Me Baby One More Time?" Guess what. You're a pedophile.xi You say, "but I'd never act on it." Well, you say a lot of things.xii

But that's the crux, of course: desire and action are very different things, and, arguably are controlled by entirely different parts of the brain, or personality factors, or superego departments.xiii Not a day goes by I don't want to plasma gun 50 people I meet. But, so far body count = 0. This is why we can only be judged on our behaviorsxiv, not our thoughts (though a person must judge himself on his thoughts.)xv

You don't know what a person is capable of until they are presented with the temptation, so I'm saying we shouldn't tempt them.xvi The problem with opportunistic pedophilia is that it is opportunistic, not pedophilia. The goal isn't the child; it's ejaculation. And you simply don't know where a person's "line in the sand" for ejaculation is. At what point do they say, "this is probably not right?"xvii Not: "this is wrong," that's usually easy to describe. Probably wrong. 16? 14 if they're famous? 12 if you're in Thailand?xviii

The guy on the IM or chat who gets a 14 year old girl to meet him at the pier -- he's a "regressed pedophile." He would have liked her to have been a 25 year old NFL cheerleader; but, let's face it, a 25 year old NFL cheerleader would sooner swallow her own eye than hook up with this freak, and he knows it. So he bypasses her ("they're all sluts") and cons a 14 year old. It's no surprise that 75% of heterosexual pedophiles described their offenses as "compensation."xix

Fixated pedophiles are sometimes described as "child centered." In fact, they see themselves as the peers of the child, and prefer to interact with the child on its levelxx (while regressed pedophiles try to elevate the interaction with the kid to adult level.)xxi They're not in it "for the sex" but for the emotional connection.xxii For the regressed, the sex is the whole point. And here's your forensic problem: a regressed pedophile kidnaps a kid to have sex with. Once done, well, anything can happen. If the kid "liked it," (maybe defined as "didn't put up too much of a fight"xxiii) there's a good chance they'll meet again. But if the kid didn't like it... A fixated pedophile kidnaps a kid to -- live with. That fantasy rarely gets realized (kid likely doesn't want to move in) and violence can therefore occur.xxiv But appreciate the difference: for a regressed pedophile, the violence is part of the offense. For the fixated, violence is secondary or utilitarian.xxv

I can already hear the screaming objections.xxvi Look, I'm not trying to defend anyone, I'm trying to explain the offenses, the thinking. In simple terms, your child is a billion times more at risk from "pedophilia" with an adult they know (30%xxvii of victims have known their attacker for a full year prior to the offense), who is already married with kids of his own that he has not molestedxxviii, then they are from the registered pedophile who lives in your city who was hoarding child porn in his mom's basement. I know it sounds cooler and more self-righteous to rail against the pedophile than to worry about your (weak-minded) social contacts, because you think you know them, and especially since they outnumber you. By a lot.

You say, "but certainly not everyone is a pedophile, there must be something specifically different about them?" Or, if you work for the Supreme Court: "there must be some mental abnormality which is properly the domain of medicine?"

No. Not in a way that's useful.xxix For example, a very recent MRI study of fixated pedophiles vs. controls found pedophiles had decreases in grey matter (smaller brains)xxx, especially in certain brain regions (orbitofrontal, ventral striatum, limbic regions), and generally decreased intelligence. But before you see this as proof that pedophilia finds its origins in brain biology, the physical brain changes didn't predict anything you might expect (number of offenses, psychopathy, etc) -- but it did predict obsessiveness. In other words, this study found biological evidence of OCD spectrum pathologyxxxi, but not of pedophilia, per se. No, pedophilia isn't a disease with distinct physical pathology, and no, it isn't properly the domain of psychiatry.

I may write a "profile" of the pedophilic sex offender, and another post reviewing the developmental and biological studies so far. Or, I may just go have a drink (or 4.)xxxii

———English doesn't use either in- or im- as privative. Yes, i- is privative as such, so you can creatively compose irregular from regular ; but it does not promise anything, seeing how "gnorant" is not a word.

Meanwhile in- and im- are actually still somewhat live rudiments of Latin construction, which is why to inflame a passion is "to make it take on the nature of flames" and to impound a car is to "take it to the pound", both roughly following ye olde Latin adverbial principle. Nevertheless, there's no "agine" even if there's [im]balming (though usually spelled with leading e, from a different layer of attempted systematization of the language), there's no "itation" even though [im]partial, and impact and impair (yes, I'm aware these don't trivially "sound" like they work, but what can I do, etymology's a bitch, and lived way longer than you have), and then no "munize" though [im]pending and [im]planting, and [im]printing and [im]peril and [im]pressing and [im]port and [im]prove and [im]pulse and [im]posture so following. Or if you prefer the in- side, [in]augural though no "eptness", [in]festing (from German) and [in]ebriate though no "dexing" and [in]ductor, [in]fatuate etcetera. Yes, it's true that on an even later attempt at systematizing the language in- privative was introduced, shown in eg indelible or incurious or ineffable or incurable -- but this is mostly Johnny-come-lately poofery rather than some sort of usable rule. [↩]Note the implied hierarchy : oral is better (as in, more "satisfying") than anal. This "natural" situation is a correlate of the actual developmental evolution in humans, where the oral stage coming after the anal stage -- the implicit, subconscious logic being that regression being bad (in that it goes against the flow), the less you regress, the better. [↩]Yes, but natural why ? [↩]Note, again, the naturally implied hierarchy between heterosexuality and homosexuality : heterosexuality > homosexuality. [↩]Technically, this would be a fetish, as stated.

The correct definition would read "The sexuality of fixated (true) pedophiles is so utterly dysfunctional and fundamentally broken that the presence of an adult human strictly precludes its expression ; only in the company of children can their inner contortion take an ever-so-evanescently shape in this world."

The age of the child-support then convincingly meshes into the theory -- as children develop, they eventually express preclusors of core elements of the pedophile's impossible mental world ; the nature of pedophilia as parasitic is neatly, fundamentally and convincingly exposed (sounds a lot like biomolecular chemistry, doesn't it -- once child grows enough to express any of the pedolithic enzymes, it's buh-bye to pedointerest) ; and the difference from mere fetishism is made evident, in that fetishism is a learned perisexual behaviour, where this is original organic dysfunction.

On the basis of the foregoing, pedophilia in its true form is then necessarily a kind of schizophrenia. It even expresses in the right age range! [↩]Nor are they, as a factual matter, because sociocultural norms are no part of any serious discussion of psychiatry. [↩]This is batshit insane, for its suggestion that somehow suburbia's full of dudes in polo shirts playing golf on Wednesday, going to the office 9-5, and looking at Mrs-Robinson-from-two-houses-down's calves during the Sunday cul-de-sac BBQ "as if it were a child" thus therefore "pedophiles".

Yes, pedophiles may be married, strictly speaking ; but no, your chances of mistaking one for "a regular person" are about the same as mistaking a psychopath, which is to say nil, or, if you prefer, entirely depend on just how fucking wilfully blind and outright imbecilically imperceptive you find yourself. I suppose if you systematically stick to the Seinfeld lifeguide, and absolutely never saying anything to anyone "so as not to possibly offend them" you could miss a pedophile. Then again, you could probably miss an elephant in a tutu, you're no part of this discussion. [↩]Which directly paints fetishism as a confounding factor -- in fetishism, the fetishist's fetish is obvious to everyone else but not necessarily (nor usually) to the fetishist himself.

This is also why all the "fetish lists" on retarded alt-sexuality wannabe websites "the user" is supposed to self-report are such fucking hysterical exercises in nonsense. If it were a matter of genuine fetishes (as opposed to a typically UStarded wigger-like appropriation phenomenon, "we have no culture so we'll pretend we're black this summer") they'd have to be sourced from the group, somehow, not self-reported. [↩]And there is entirely nothing medically wrong with this. [↩]No. They're imagined.

And since we're on it : the same criminal conspiracy's "attempts to catch spree killers before they spree" are doomed to the exact same absolute failure : until they fix the actual problem -- specifically, that naggy old women aren't routinely convicted to the pillory on the simple say-so of respectable, powerful, rich men -- they will have to deal with its consequences. [↩]Nonsense. Also, better example : What gets me hot. What, everyone was pedophiles back then, too ? Aww. [↩]No, actually, you say : shut the fuck up before you have to spend the night in the supermarket parking lot. [↩]Or not at all.

How the fuck is this latest xtian bullshit supposed to work, you have two brains, and then they... what, they vote ? Forget about it, sheer maleficent nonsense. There's absolutely no difference between desire and action ; and attempts to introduce this difference result in typically UStardian impotence. [↩]Yes, and you suck. [↩]This is altogether dubious ; it is perhaps the case that strictly speaking it could be done, by an extremely competent practitioner -- nevertheless, a large reason why you fail in practice is that you keep trying at this, ineptly. [↩]What the fuck nonsense is that! [↩]As a general question -- never. The world either delivers or burns, that's what life even is in the first place. [↩]To the specific point... Honestly, anything under 20 or so is extremely unlikely to work out, I have extremely complicated requirements. [↩]I can see it -- except for the "pedophile" part. [↩]With little exceptions here and there, though. It's not clean child emulation (and if it were / when it is it probably goes by unnoticed for lack of harm), it's a peculiar alien-child decoction. [↩]Which happens to be exactly how children learn ever anything, in the first place. [↩]Speak the words : ephebophiles are loser males, whereas actual pedophiles are exactly female. Right ?

It's true, isn't it, the female mind run amuck, wanting to interact with the kid on its own terms and for the emotional connection, we finally have a passible cybernetic theory of actual pedophilia : much like males have nipples on their absent tits even if having no tits they haven't any use for the nipples, just so it's entirely possible males have mother brain mechanisms in their own brain -- it was cheaper to leave in place than to vpatch away, from the natural muntzing perspective, so there they stay. Male nipples never become a big deal, and similarily motherly brain chunks in male heads -- but if they ever do, if they cancerously manage to involve or subvert the rest of the mind... well ? [↩]Or maybe defined as, genuinely liked it. [↩]Nah, violence occurs directly and strictly because broken "legal" environment. Take the illustrative case of Gacy : dude wanted boys to suck his cock ; once the old woman chorus put him in jail for it, he simply proceeded to kill all the boys that sucked his cock, something he hadn't done previously.

Carefull with that "law", Eugene -- the only thing you'll lop off with it is your own foot. [↩]I confess I do not see this difference. [↩]While I doubt he could hear any of the actual objections, nevertheless, please, don't be shy : there's a whole comments box below, and it's all for you! [↩]This number is immensely skewed by the confounding factor of there being two main types of scenarios in which little boys get the wee wee chopped off / shoved in their butt / other unwelcome such. The vast majority of kiddy surprise buttseksers know the kid, it is part of their extended family ; a tiny minority of kiddy surprise buttseksers go on sprees, taking up youths from the bus terminal. These contribute a lot more to the victim count, in disproportion to their personal rarity. [↩]And now we finally fall on the third group of "pedophiles", neither "true" nor "false" but familial. The grandfather who rubs the crotch of three generations of little girls, every night, for thirty+ years, is an entirely different pathology -- a point greatly illustrated by how little the changing of the guard of little girls bothers him. It barely registers! This is very much not how pedophilia works, and he very much isn't in it for any kind of emotional connection -- but he also isn't a loser male, nor into it for the sexual gratification at all. So what then ?

Who knows... complex considerations of family and filiation, probably, an entirely different part of the brain broken but still churning, I have no idea. I've never actually seen one of these, I have seen sufficient reports, three or more hands away, to be reasonably persuaded they do in fact exist (a stance muchly bolstered by the fact that the theoretical infrastructure I employ readily permits their existence, I confess), but... [↩]Rather : yes, but not in any way that's useful. [↩]Still with this ? What is it, the 1860s again ? Fucking spare me. [↩]I can readily see how limber thought process is a major bar to any kind of sexualization of children, either in representation or in practice -- specifically because children are so fucking similar. So yes, it's very very likely that anyone whose interactions with children would piss you off is also someone whose fixed thought process would piss you off. Not much of anything, but it's what it is. [↩]There's no good way to put this into the putative interview format, sadly -- but if he ever does return, I imagine a discussion of pedophilia is de rigueur. [↩]

« I own erotica like Zeus owns Olympus

thelastpsychiatrist.com - A Quick Word On Google. Adnotated. »

Category: Adnotations

Wednesday, 24 July, Year 11 d.Tr.

thelastpsychiatrist.com - A not very happy observation about +/- being a woman. Adnotated.

one of us has a question

I'm writing a long post about psychiatry (I write several posts at once, and finish them randomly.) As with many other posts, I often email academics, journalists or other primary sources to ask them a question.

Sometimes I ask because I don't know, but often it's a "stupid" question to test someone's bias/perspective/actual knowledge.

As a recent example: I asked two different academics (paraphrased) "how does seroquel work as an antidepressant? Is it the NET, and how much binding is there?"

Key point here: these are "famous" or busy or important individuals, used to getting a lot of emails; and my questions are very basic, very easy to answer, and an ordinary person should have been able to look up the answer themselves.

I construct the email to appear as if I am a college-aged person.

My observation having done this several dozen times:

If I use a (fake) male email address, e.g. "petermiller@" no one ever responds.

If I use a (fake) female email address, e.g. "melissamiller@" I get answers almost every single time.

I'll add that the majority of the people I email are male; the few women I've emailed haven't been any different. I've confirmed this by waiting a long time (month) and re-emailing a different (but still simple) version as a woman.

The conclusion I went to first was that there is some unconscious sexual element; not that the academics thought they were going to seduce me, of course, but that they derived some greater pleasure in answering the women than the men.i

But perhaps there's a different explanation: there may be an assumption that if a guy asks such a basic/stupid question, then he's an idiot and not worth bothering with; but if a girl asks it, well, a college girl isn't held to the same standard/ expected to know as much.ii

I'd be interested in knowing other people's reactions and experiences with similar scenarios. I'm quite willing to accept alternative explanations.

———Or rather, that nobody needs boys for anything -- which is part and parcel of why most of the anythings worth the mention end up being male. [↩]Doh. [↩]

« thelastpsychiatrist.com - Another School Shooting -- Sort Of? Adnotated.

thelastpsychiatrist.com - Antispychotics and Lawyers. Adnotated. »

Category: Adnotations

Tuesday, 23 July, Year 11 d.Tr.

thelastpsychiatrist.com - A Little Bird Told Me. Adnotated.

1. McCain may drop out of the race -- running mate Romney to continue?i

2. Oil prices were pushed higher (Iran/Israel tensions, etc) by a concerted government effort to generate oil revenues for Iraq, promote greater stability so as to allow partial withdrawal of troops before election; and a subsequent reduction of oil prices to erase them as a campaign issue. Both Iran and Israel were in on the plan.ii

Tin foil hat stuff, but thought I'd put it out there.iii

———Keks. [↩]Rotfkeks. [↩]Yeah, sure. Stick to daytrading from the den. [↩]

« thelastpsychiatrist.com - A Generational Pathology: Narcissism Is Not Grandiosity. Adnotated.

thelastpsychiatrist.com - All Girls School Or Coed? Which Is Better? Adnotated. »

Category: Adnotations

Sunday, 21 July, Year 11 d.Tr.

thelastpsychiatrist.com - A Final Thought On Cho's Mental Illness. Adnotated.

A thoughtful reader concerned about backlash against the mentally ill asked me to write a piece basically saying that not all mentally ill people were homicidal maniacs.

It's a fair request, but in this case it's counterproductive. Here's what I mean: you want to say that "not all mentally ill people are violent". You want counterexamples to Cho's example. But that's a defensive posture, unnecessary because... Cho wasn't mentally ill. He was a sad, bad man who killed people because his life wasn't validated.i There was no psychosis, there was no cognitive impairment, there was no psychiatric impairment in insight [or]ii in judgment. There was a lack of sex, but that's not yet in the DSM.iii

Not to reduce his life down to a soundbite, but he was a guy who thought he deserved better by virtue of his intelligence and suffering; found himself in a sea of mediocrity but couldn't understand why he couldn't therefore excel; and, worst of all, found that all the things he thought he deserved eluded him -- especially hot chicks, who not only dismissed him and found him creepy, but, worse, chose to be with the very men he thought were obviously inferior to him. It's Columbine all over again. It's almost even the same day.

Forget the Prozac, forget the involuntary commitment (where he was found by the court to be "a danger to himself and others" -- that's standard boilerplate, it is clinically meaningless). Those are red herrings. You may as well blame wearing black t-shirts. He's not mentally ill; he's an adolescent.

The difference, the single difference, between us and him is that when we were sulking in high school, we listened to Pink Floyd or U2. He watched Oldboy.iv We had a battered copy of a Playboy down at the creek under a rock, that was so creased we had to infer the boobs. He had the internet. Maybe we bought a pocket knife, or -- wow -- a butterfly knife. He bought two Glocks.

In other words, the difference is this: he decided to shoot 30 people, and you didn't.v That's it. I know it's not a satisfying answer, I know we want explanations, but there aren't any.vi Forget genes, forget DSM. He chose to do something badvii, he knew it was bad, but he did it anyway.

Don't worry about the mentally ill. Worry about the nut politicians and media outlets who will look to the easy and convenient excuse of mental illness, rather than have to do the hard work of figuring out why our society is melting.viii

———What exactly is so sad/bad about that ?

Killing people is what you're supposed to do when your life's not being validated. That's actually the fucking point of life in the first place. What did you think it was ?

No I'm not fucking kidding, what the fuck is this! If I'm not happy with how things are going, I'm taking heads. Always have, always will. What the fuck! [↩]I'm not going to add a note each time I put in a conjunction he forgot. If you see the brackets, you know what it is. [↩]There was also some interaction with the runaway dumb cunt coven at Virgina tech, inept nobodies with pompous names like "Yolande Cornelia "Nikki" Giovanni Jr." or the everlulzy "Professor of Africana Studies" Lucinda Roy, of "Narrative Arcs in Hindsight". You ever saw that sadness ? No ? Here :

You've been fed, once again, into the circular saw of the moon by another's turbulence. But the principal cause for concern is Jarrell's "90 North," where pain doesn't amount to wisdom, only to pain -- a cold blue apex where meaninglessness abuts suffering -- a refutation of the classic tales that led you to the top of the hill then back down again denoument-ally, the way a parent puts a child to bed. In the story-shadow the arc becomes a scythe raking across your 1st-person point of view the way a Glock -- that furious cousin of parallax -- raped the point of view you'd held for years. (The setting moves from Jarrell's climactic cold to William Duffy's farm in Pine Island, Minnesota where James the Right rocks hammocks. I have not wasted my life, you insist, pinning wax butterflies to Jim's suicidal sky.) The older you get the more you believe in relationships -- the one between the writer and the thoughts of other writers, for example, or the one between the maternal and the future -- a rare constant that reproduces constancy. Though sad men may seduce, the need to reply is also fundamental. The arc isn't a covenant with others, it's a covenant with the self in its universal disguise. We're all gods of the inter-dependent clause. Maybe the secret is simple: the moment must function both as climax and as point of view. After so much loss, you still want to believe the Small-Life we weave can dance a cosmos.

Isn't that vomit just tops ? And yes, I had to take out her microshit glyphs, of course, of course. And yes, she pretends to be black, of course, of course. And so on.

If you're looking for "who's responsible" in any sort of actionable, political sense, look no further. The promotion of idle stupid cunts comes at this great societal cost. Eat it if you wish, but don't fucking complain about it while eating it, then. You got your stupid cows preening about, if it's what you wanted then why aren't you happy ? [↩]That thing's fucking terrible, I have nfi what QT was quaffing. [↩]Because you suck.

The difference, the only difference, is that you're by and large not worth the bullet while he was exuberant enough he didn't care of that cost differential. [↩]Yes there fucking are. You suck. [↩]Shooting random drones on a US "collegiate" campus is about as "bad" as raising animals for meat. Going to college in the first place is actually slightly worse. [↩]Because. You...

Ah what's the use. [↩]

« thelastpsychiatrist.com - Advertising's Collateral Damage. Adnotated.

thelastpsychiatrist.com - After You Shoot Three Women, Who Should You Call? Adnotated. »

Category: Adnotations

Saturday, 20 July, Year 11 d.Tr.

thelastpsychiatrist.com - A Diagnosis Of Schizophrenia. Adnotated.

should be accurate to 10 dolichoi

When I read psychiatric articles, I wonder if the authors think that because the stars in the sky are small, a microscope would be the best tool.i

Nassir Ghaemi and Frederick Goodwin make the case that diagnostic divisions (between bipolar, schizoaffective, and schizophrenia, in this case) are still very important.

They write,

[The] overly broad use of the term schizoaffective was illustrated in a patient referred to one of usii as schizoaffective. However, his manic and depressive episodes, both of which included periods of florid psychosis, responded prophylactically to a combination of lithium and valproate... When the lithium dose fell below 75 mg/day, psychotic symptoms recurred; when lithium was reestablished at only 75 mg, the psychotic symptoms disappeared. Clearly, this patient is not schizoaffective but rather has severe psychotic symptoms integral to bipolar illness.

Slow down.

II.

A 22 year old Omani male with no prior psych history, but with a family history of psychosis, presents with change in personality. He says that he hears "spirits" that tell him other peopleiii because they have done bad things. He says his food has been poisoned by spirits. His father has been possessed by the devil. He is not interested in doing anything, and does not want to do anything but sit in his room.

However,

within traditional Omani society, abrupt personality changes or altered states of consciousness are commonly attributed to spirit possession. The belief in possession is embedded in social- cultural teaching, in which invisible spirits are deemed to inhabit the earth and influence humans by appearing in the form of an anthropomorphic being.

Father confirms this is part of their belief system.

He is given Lamictal 100/d and Risperdal 2/d, and is cured.

III.

If you're confident he doesn't have a demon, applaud yourself for your advanced scientific insights.

One of the main tenets of a biologically based system of psychiatry is that an Omani man with schizophrenia may have different cultural manifestations of the disease, but it's schizophrenia nonetheless. This looks like schizophrenia, not bipolar disorder. The Lamictal was probably useless.

However, the neurologists found that even though he had no seizure activity on EEG, on SPECT scan he had low perfusion in the left temporal lobe while psychotic, and an improvement in perfusion when he recovered.

From a biomedical perspective, the condition of the current patient would suggest symptoms of chronic schizophrenia, a diagnosis that is supported by a family history of psychosis. In the parlance of modern psychiatry, the patient met criteria for schizophrenia and responded to risperidone, a known treatment for psychosis. [However] the possibility remains that lamotrigine may have ameliorated the patient's psychotic symptoms by controlling 'non-convulsive seizures'.

If you think he was merely misdiagnosed, you have missed the point. There is nothing short of a SPECT scan that would have made this diagnosis. Prior to these tests, he had schizophrenia -- not appeared, but had it -- formally, according to phenomenology, course of symptoms, family history, and degree of impairment.

No amount of evidenced based medicine will protect you from this. A thorough SCID, family history, and full panel of labs would diagnose him with schizophrenia. Under that diagnosis -- which he reliably has (several people using the same diagnostic techniques diagnose him the same) there would be no "evidence" for the use of Lamictal.

Worse, under Ghaemi's plan, improvement on Lamictal would be suggestive of bipolar disorder. Which he didn't have at all, i.e. not based on either biology or phenomenology.

III.

An example. You don't need to know anything about the internal anatomy or biochemistry of a rhinoceros to know one when he gouges you in the face. Purely on phenomenology alone, you get it right 100% of the time. This is important: 100% of the time. It could be bigger, smaller, whiter, blacker -- none of this will confuse you. Ever. In the same way, there's no theoretical reason we would need to know the biology of schizophrenia to diagnose it accurately.

However, the simple reason we get the rhino right is because we've all seen a picture of a real rhino. No one tries to identify a rhino based on compiling a list of shared characteristics of rhino-ness. We do it with a split second comparison to an already agreed upon sign.

i don't like it when people try to impose labels on me

Even the word "rhinoceros" is a sign. You don't phonics out the letters "r-h-i-n-o-c-e-r-o-s" in order to know what it says. The word is actually an image.

Schizophrenia isn't like that at all. There's no "ideal" schizophrenic to match it to. Even when you think you're sure, it could turn out to be... non-convulsive seizures. Or bipolar. Importantly, this isn't a case of "schizophrenia is wrong; he actually has non-convulsive seizures." By the most rigid definitions, he has both disorders, in the same way a kid with pesticide toxicity also has ADHD. Which, of course, is nonsense.

So how would you know? You wouldn't, so what Ghaemi proposes is to take medication response as informative. That's even less reliable.

If a depressed guy responded to Seroquel in 1999, did he thus have bipolar? The answer is thus yes, but of course not.

IV.

You think you can explain why bipolar disorder isn't schizophrenia?

To show how hard this really is, try it with animals: explain why a unicorn is not a rhinoceros.iv

Your immediate reflex will be to call up some other agreed upon sign, and compare it to that: "A unicorn is like a horse..."v

Ok, horse -- but is it a type of horse? Is it more of a horse than a rhino?vi If it is -- if unicornness is closer to horseness than rhinoness, then why did Marco Polo think a rhino was a unicorn but the horse he rode on wasn't?vii

What's a triceratops, then?viii

These difficulties exist with animals that everyone knows on sight.ix Now, imagine trying to identify an animal without some common ideal type, just based on the reaction of the animal to something.

V.

We do that already, and we do it badly. If I tell you "scaly cold blooded quadruped climbing a tree" you'll at best say, "umm, it's a lizard." But if I tell you that the animal in question changes colors -- boom, "it's a chameleon!"x

And now you are able to make numerous predictions about it, without ever seeing it: (e.g. changes color for camouflagexi.)

But it could be a gecko, right? So at what level of taxonomy did you make the error?

Kingdom: Animal

Phylum: Chordata (vertebrate)

Class: Reptilia

Order: Squamata (lizards, snakes, worm-lizards; not crocodiles (crocodilia) or turtles (testudines)

Family: ?

Forget species, forget genus. You're stumped at the family level. That's how wrong you are. Gekkonidae vs. Chamaeleonidae. In order to do better than this, without resorting to an ideal image of the animal, you need not just more information, but exponentially more information.

That's reflected in their common names: "gecko" and "chameleon" are derivations of the family name. This is for animals which exist, that everyone "knows when you see it."

Psychiatric diagnoses suffer from the same exponential information function. When you call someone a schizophrenic, all you're sure about is that he's either a snake or some kind of lizard, but not a crocodile.xii

don't lump me in with these freaks

VI.

It seems like lunacy for someone to criticize evidence collection as a basis for an empirical science, but here we go.xiii

If you gave Aristotle ten thousand unplugged computers of different makes and models, no matter how systematically he analyzed them he'd not only be wrong, he'd be misleadingly wrong. He would find that they were related by shape -- rectangles/squares; by color -- black, white, or tan. Size/weight; material.

Aristotle was smart, but there is nothing he could ever learn about computers from his investigations. His science is all wrong for what he was doing. But Aristotle would think he knew a terrible amount about computers from his studies. In fact, he'd probably be considered an expert. "To fix this computer, we need to make it more rectangular. Get chopping, malaka."xiv

That's where we are now. But modern science is so "advanced," surely it can come closer to the truth? No. But surely the amount of data we have on psychiatric diseases must amount to something? No.xv

The last time they did this kind of taxonomy, they built a brontosaurus and told us it was real.

And they, at least, had real bones to work with.

VII.

I understand the temptation to refine a paradigm that's worked ok so far.

And I understand that there's a feeling that we're on the right track. "No matter what you say, I know a schizophrenic when I see one."

I know you doxvi, that's not my argument. My argument is that what you think you know is lessening your knowledge, not increasing it. When you say he has schizophrenia, you may know what you mean by that, but I don't know if it isn't a seizure.

You have it backwards. You think saying "schizophrenia" is some kind of detection, a whittling down of possibilities, informative. Similarly: "I've screened him for ADHD, I think he has it." But those diagnoses don't exclude any other possibilities at all. Do they mean he doesn't have a seizure, depression, pesticide poisoning? Your ghost term doesn't exclude any real things.xvii

You think you're telling me "he has a cluster of symptoms and behaviors that generally resemble X." But every time we make a diagnosis, the world pauses: oh, so that's what's wrong with him.

How long would the Omani man have had "treatment resistant schizophrenia" without an uncalled for Lamictal prescription or a waste of money SPECT scan? Forever. "We just need to improve our diagnostic skills, tests." You're not listening: the diagnosis of schizophrenia was the specific reason he wasn't given a SPECT scan.

"We need to improve the accuracy of the diagnosis." No. The diagnosis isn't going to get more precise the more we know; the diagnosis is going to disappear, replaced by thirty other more specific diagnoses.

Sure, in the meantime I'm happy to go with "schizophrenia" and chuck dopamine blockers at everyone, because that's the best we can do today. But why the pretense that we need to refine the diagnosis, or the whole DSM, when we don't have the tools to do it? Shifting around consonants and vowels, substituting one fairy tale for another doesn't make it more accurate. Schizophrenia vs. bipolar isn't a distinction, it's a distraction. "I don't think he has a demon, I think he has too much black bile." Then it's settled. Send the priest home and bring out the leeches.

———I'm sure alf will be happy to hear the microscopy market's ever expanding. [↩]Fucking bullshit vague nonsense, these muppets couldn't possibly be scientists. And this in a piece complaining of vagueness! [↩]Is a "to kill" missing in there perhaps ? [↩]The only approach to this is to start from categorical difference and work backwards. So : a unicorn is a mythological creature, whereas a rhinoceros is a natural creature. Therefore one exists in one sense, and the other exists in another, narrower sense : you can fantasize about sex with either unicorns or rhinos, but you can only be stomped to death by rhinos. [↩]"Reflex" is what we call the unexamined tendencies of the illiterate or what exactly ? No, it's not my "immediate reflex". A unicorn is like a horse in the sense your imaginary girlfriend is like a girlfriend. The whole fucking point is that she isn't like a girlfriend. [↩]As a factual matter, the unicorn is closer to being the number nine than to being a rhino, and no, neither unicorns nor numbers are any kind of horse. Nobody goes to college anymore, okay, but not even to Lyceum ?! [↩]For the obvious reason : people prefer concepts to objects when they're trying to model phenomena unfamiliar (and for very good reason, too : concepts are sparser). [↩]A triceratops is a real animal, that exists no more, but used to exist. This is a kind of real ; not a kind of ideal -- things that never existed, and maybe will. The airplane, for instance, is both an ex-ideal and a current real. At some point it was a current ideal and a future real, except nobody ever knows the future. [↩]Except for the part where unicorns aren't animals, and so for that reason nobody knows them on sight. [↩]Actually, iguanas also change colors. Hence the point here : yes, a conceptual constructive test will verify the adherence of the respondent to the conceptual tree the construction was based upon, which may (or may not) translate the respondent's adherence to reality, the conceptual tree's adherence to reality, the respondent's adherence to the inquirer, or some mix thereof. [↩]A better example would be, "round pupils", because guess what ? Goats also climb trees, and also change colors -- hey, that's what he said, yes, "changes colors" -- but they have... square pupils. And they're warm blooded. So therefore... cold blood causes round pupils ? [↩]Actually, all you're sure about is that they have too small round pupils ; which might be either a case of human taking heroin or the case of a goat with a congenital defect or that of a chameleon which we call gecko because it's an iguana standing in too much light. THAT is what you're sure about, when you call someone schizophrenic. And you're also sure that if you give them any of a set of three dozen or so poisons, their pupils will become sufficiently larger if not necessarily round anymore, and their tail may not always fall off for this reason, or at all, if they had one in the first place which you're not too sure about to begin with. Can schizophrenics ever produce anything worthwhile intellectually or is the fact of schizophrenia incompatible with absolute achievement in art or science by its very nature ? Hm ? [↩]Deny is one thing ; criticize is another thing -- the one thing that doesn't sound like lunacy. [↩]This is just about right, yes! [↩]Absolutely not, for very good reasons. [↩]I don't, and I'm way the fuck better at it than whatever turdhead he might ever be talking to in the zone. I don't because I'm serious about my own thoughts, and don't simply use "criticize" for "deny" or "dump core" for "I wanna sound cool". [↩]This is an exceedingly effectual avenue of attack towards rendering the idiocy : "your diagnosis doesn't exclude things". [↩]

« Proper html linking : the crisis, the solution, the resolution & conclusion

thelastpsychiatrist.com - Advancing Paternal Age And Bipolar Disorder. Adnotated. »

Category: Adnotations

Saturday, 20 July, Year 11 d.Tr.

thelastpsychiatrist.com - A Case Study On Why Policy Changes Fail: Pharma Paying Docs. Adnotated.

The authors report no conflicts of interest

Two reporters' investigations into docs who speak for Pharma have found:

Fewer than half are formal educators affiliated with academic medical centers or prominent leaders in their medical societies. The rest are a mix of physicians with limited credentials or about whom little could be gleaned.

Five of the top 43 are from Tennessee

Eleven of the 43 have board certification in the small field of endocrinology... Eight physicians, the next-largest subgroup, hold no advanced certification, despite speaking on specialized diseases and treatments.

Only three of the top earners are women--all endocrinologists

More than half worked for two or three companies. One Tennessee diabetes physician worked for five. Seven earned money solely from Glaxo.

A different article goes into more detail:

And in Georgia, a state appeals court in 2004 upheld a hospital's decision to kick Dr. Donald Ray Taylor off its staff. The anesthesiologist had admitted giving young female patients rectal and vaginal exams without documenting why.i He'd also been accused of exposing women's breasts during medical procedures. When confronted by a hospital official, Taylor said, "Maybe I am a pervert, I honestly don't know," according to the appellate court ruling.

Last year, Taylor was Cephalon's third-highest-paid speaker out of more than 900. He received $142,050 in 2009 and another $52,400 through June.

The underlying principle is, "Docs should not accept money from Pharma." If this is indeed what you believe, then you should look upon these reports and articles with dismay: they're helping Pharma.

II.

I have to wonder if as they uncovered all this stuff, there wasn't a sense of glee, rubbing the hands together like Perez Hilton does when he discovers Lindsay Lohan's gmail password. (It's "velveteengirl"ii)

But that's all besides the point. While this information is interesting and salacious, it is masturbation: purposeless and for yourself only. From a (Machiavellian) policy perspective, the thing to do would be to bury this info about bad doctors, not publicize it.

Approaching this from the "bad/crazy/uncredentialed docs speak for Pharma" angle changes the focus from the noun (docs) to the adjective (bad/crazy).

This happens all the time in political debates, which is why nothing gets done.

Because the outcome you've guaranteed is that Pharma tightens their speaker's bureaus -- and only uses top tier academics. So if you are worried your doc might give you Depakote because he gets paid by Abbott, imagine what will happen when your doc is told to use Depakote by the academics who write the journals and the reviews, who are paid by Abbott. You don't have to imagine it, you just have to remember it, 1999-2006. Were you on Depakote? Yes. Did your doc speak for Abbott? No. Enjoy your liberal democracy.

"Well, it shames the docs so they don't accept the money!" Why would it shame them? In fact, it gives them a defense. "Since I'm not bad or crazy, since I do good clinical work, since I am not doing vaginal examsiii, therefore I can take Pharma money."

You can extend this to any social or political question. There's an internal sense of "rightness" or "wrongness" to some issue, but lacking the information, logic, or simply the skills to defend the position, people resort to a core dump.iv They hope that either something will stick or the volume of criticism will speak for itself.

But it doesn't, it allows the other side to counter with logical, precise, and legitimate fixes to your myriad of complaints -- all while keeping the main premise intact. "Ok, we shouldn't pay docs to speak, we'll only pay them to write."v

If you think using oil is bad for the environment, don't say that it also leaves us beholden to terrorist nations. I know you think that helps your case, but it doesn't, it gives the other side a straw man to ignite.

Argue from principle.

Arguments with your spouse go bad for the same reason. Her chronic lateness is the problem, but you bring up her past infidelity, cooking skills, bitch friends, etc. Result: you've just given her three new options for a counterattack. If she can effectively defend any one of them, you lose the entire argument.vi "My husband is an ass." She's kind of right.

III.

The problem is that the principle is often a cover for more base instincts. Put down your Diet Coke for one second and really consider what I am about to tell you.

While considerable investigative journalism went into finding out how much money speakers earned, their backgrounds, disciplinary actions, CVs, etc, not one single reporter has actually listened to one of their presentations. Think about this. Not one reporter thought it important enough to investigate what they said.vii

No one's even interviewed an attendee. "Hey, what goes on in there?"

That should be your signal that they don't care what was said, what matters is the money.viii Which makes this much less about Pharma influence on medicine, and much more about class warfare: why should they get to have so much money?ix

While I completely understand the sentiments, this approach, let alone this sentiment, won't make patients feel better or healthcare run better. (Which is why the solution I offered -- simply making it illegal to accept any kind of Pharma money, at all -- is the most honest way of approaching it. But, as I pointed out, it will have some consequences society may not be ready to accept.)

If it's class warfare you're going for, be honest about it. Just say you don't like docs getting paid so much, period, or you don't like taxes so high, or so low, end of story. You hate welfare handouts. You hate how investment income is taxed at half the rate of earned income, it seems unfair to you. At least these are arguments that everyone can participate in because they're honest, they are your true sentiments undisguised by intellectualization. If you're ashamed to say these things, however, then perhaps you need to ponder why you believe them.

If you pretend -- even to yourself -- that it's really about Pharma causing doctors to do something they wouldn't/shouldn't do, then you have to explain how this happens. I'm not saying this is a hard thing to do, either, but it must be done, it's not enough just to say it.x

But, and this is the point, if you have not really be[en] honest about your principle, once you explain your reasons the other side will quickly dispatch a series of remedies which legitimately address each of your complaints, all while leaving the underlying principle untouched. And yes, now I'm talking about today's elections.

———Training for a job with the TSA, maybe ? [↩]I wonder if this is a reference to the rabbit, or to tubgirl. [↩]I can't decipher this guy's stance anymore (or, for that matter, his culture's). So, on one hand, "we all know what cheerleader means" would require "young women getting a few more rectal exams is all the better for everyone, loosen them up a little". He even says this explicitly in a different context (spoiler : it's psychiatry) : "whatever-- sure, those people could use a psychiatrist" ; "did many have a legitimate disorder? sure. whatever." For that matter, the whole thing about "national security" seems to gravitate around the para-religious belief that giving some random people a free rectal now and again will impress the Ether gods, and thereby preserve us all for another day. Heck, even roadside anal-ization by the police is popular over there, as a factual matter ; and [what passes for] education's been on a multi-decade kick of publicizing among [relatively young] teenagers the glories of stuffing various objects up their respective holes.

Why is he then turning around and (seemingly, maybe I misread) implying that free, clean and secure anal/vaginal insertion's a bad thing now, and undesired / undesirable ? What the hell sense does this make ? Is he / are all of them so very deeply conflicted about all of this, no possibility of making up their mind's available ?

The young women in question'd have been way the fuck worse off getting free fries instead of free probings, also as a factual matter. Or is this also in question ? [↩]Check him out, he knows what core dumping is ?! Just... how ?

I suppose this'd be the first question I'd wanna ask a resurrected Ballas, "say, where'd you hear about core dumps ?" [↩]This is actually a most astute description of the historical problem of the provincial colonies : they "fixed the problems of Europe", but "as they understood them". Which... [↩]If the relationship with the spouse is "argument"-governed, meaning if there isn't a clear font of authority the other submits to, the relationship's already lost anyway ; both are "an ass", in the sense of, two subbies arguing with each other to see who has to dom for the evening. Discussing "correct argument techniques" with a view to domestic arrangements is a lot like discussing correct yoga postures with a view to being drawn and quartered. [↩]For that matter, I'm still curious whether Dr. Donald Ray Taylor's free medical procedures were officially a bad thing or what.

You know that as part of boobjobs they offer a histopathology exam, by the way ? It makes sense, since you've opened the thing up anyway might as well send some tissue off to the lab. You have to pay for it, and it's generally pointless, as in, serves no legitimate medical purpose. It's not an exam, in the usual sense, it's not ordered by a clinician for some kind of reason ; it's a matter of availability, "rather than throw out 100% of the material we might as well throw out merely 99.95% and laboratorize the rest, do you feel like paying for it ?" They even tell you, "it's very likely a waste of time and money". But be that as it may, some people pay, some people don't -- I imagine most do, seeing how if you can afford thousands to bolt on tits for purely aesthetic reasons you probably can also afford fiddy bux to discover early an extremely improbable case of cancer. Is this also a bad thing ? Should they be ashamed of themselves ? I mean, it's tits, right ? Shame ?

Supposedly there's nothing wrong with the doctor seeing you naked, feeling up your tits, sticking two fingers up your cunt, etcetera. Some dude you barely just met five minutes ago, but it's also not sexual, it's "medical", and anyway you can't formalize yourself over such a thing, the social narrative goes. It'd be barbaric. Right ? We're civilised people over here, unlike Arabic lands or whatever, we have no problem being doctored upon by the doctor, it's the doctor after all. So then ? Does something magically change if... if what exactly ? Inadvertence ? Negligence ? Humanity ? That's what it is, isn't it : if the doctor ceases being a robot the shame philter magicaly loses its magic power, and suddenly it's not okay to be having a perfect stranger's fingers right up your slutty daughter's snatch. You realise every other boy in school already scratched her / deposited random if microscopic collections of scum and assorted fungi down there ?! The doctor's at least working with a god damned glove.

Suppose he found something. What then ? My best guess would be, that should the doctor feeling exploratorily around the teenager's vagina out of sheer curiosity discover malignancy, the victim/patient would apply to the court : for the adventurously curious doctor to be disdoctored, and for the malignancy to be thrown out of court, as fruit of a poisonous tree. It was after all discovered without a warrant, so it shouldn't cunt. Doesn't that sound just about right to you ?

You're fucking insane, all of you, you know that ?

PS. To make your eyes really pop out of your head : you realise those girls could very well have refused the procedure, do you ? The accusation specifically isn't that good ol' Dr. Taylor gave anyone procedures they had refused, it's merely that he failed to explain to whatever standard why he, in his professionally deranged medical opinion, deemed them worth his time. Medicine has a lengthy tradition of trying to get people to undergo procedures they don't need, from the tonsilectomy craze to a whole regiment of dentists that've for twenty years been trying to convince me to operate my jaw to extract my copasetically benign wisdom teeth. I just refuse, and that's that.

Those girls could have said no. If they cared one way or the other, they could just have said no. Do you realise that ? Since they didn't... they enjoyed themselves, yes ? He's covered, or at least, just as covered as you are, come Sunday noon. [↩]To me, it seems rather that they do not believe themselves equal to the task of judging what was said. They perceive this approach to be "more objective", which is why they stick to it.

And yes, they do pretend that "objective" matters and that this is more "objective" than that for ulterior reasons, but I also do not believe those ulterior reasons amount to any sort of projection of power. They don't think these sorts of things because they're conspiring to take over the world, they think these sorts of things because they have a lot of trouble mentally resolving the unresolvable chasm between how much they're repeatedly told they're worth and how little they ever manage to produce. It's this esteem-power dichotomy that drives them to seek "more objective" aka "nobody can accuse me" venues towards what they perceive to be their goals. [↩]I do not buy the "class warfare" line for half a second.

The problem with the money is this : since we're so overvalued and so ineffectual, it is extremely dangerous to us for value to be squandered. If these other guys get X but produce Y that means great Inca's perhaps leaking turkey dollars and we'll all starve.

That's the concern there, entirely outside of any possible class consideration, as the drones involved already live in a wholly imaginary, completely realised socialism, which therefore has absolutely no classes nor any possiblity of such a wonder. Their concern with the money wastage here is of the exact kind as their concern with how much styrofoam garbage their office lunches produce, it's purely an ecological concern. [↩]Well, reading between the lines, the proposed argument would be that a) Pharma selects for the type of "curious" doctor who'll look up a girl's twat whether she needs it or not -- because he needs it, or whatever ; then b) that like people work with like people, and therefore this sort of rep will in turn increase the density of similarily minded doctors and simultaneously decrease the density of all other types of doctors ; which c) eventually will result in an environment more attuned to the needs of Pharma and less attuned to the expectations of people who are simultaneously ashamed and not ashamed of their cunt and simultaneously can and can not reason about the topic at hand.

It's a decent theory, as such ; but as the plain statement thereof also makes directly obvious, it can only be the theory of someone firmly committed to the dualist insanity. Everyone else will just resolve that part, and get a free solution to the "problem" as a package deal. [↩]

« thelastpsychiatrist.com - Acadia Gives Up On ADP-104 -- Maybe It Shouldn't Have. Adnotated.

Odd Comments and Strange Doings in Unix »

Category: Adnotations

Friday, 19 July, Year 11 d.Tr.

thelastpsychiatrist.com - 7 Things To Expect In Our Brave New World. Adnotated.

Financial turmoil directed by CNBC; a U.S. Presidential election so important that they are running a guy no one really ever wanted vs. a guy no one's ever heard of in an election subtitled "More of The Same vs. Less Of Everything." May you live in interesting times.

Here are five other things you don't want that are coming:

1. The return of pubic hair and mustaches.

The good times go with no hair; the bad times go with more hair.i I don't like it any more than you do, but we're about to be bombarded with Starsky and Hutch look-a-likes and the totally earnest use of the phrase "luxurious bush."ii I'm going to go throw up now.

2. Fashion trends:

2a. Dressing like elves.

As in the Hobbit, not Keebler. Brown boots, green leggings and oversized shirts/sweaters doubling as skirts.iii

2b. Hose.

Just as society finally recovered from the 50 year self-mutilation called pantyhose -- even the WSJ debated whether it was still required for the office -- it will soon be making a comeback. If anyone in the fashion industry is reading this, stop killing your children. No one should be wearing pantyhose unless they're about to rob a bank. Please, I beg you all, stop this.iv

3. Another terrorist attack: February 2009.

Maybe I'm cynical, but has anyone noticed recessions are ended by wars? And that the S&P 500 closed yesterday, October 7, 2008, at the same point it did ten years ago, October 7, 1998? Which was also the historical low of the LTCM disaster?v

Most recently 1989 S&L bailout lead to Gulf War I; and the scary similarity between the S&P500 pre 9/11 and now:

which was cured by Gulf War 2 in 2003... Do we get another attack to bring us down, then a war at S&P 800?vi Early, to test a new President's resolve? Stay tuned. I hope President Obama is ready.vii

Of course, it could be domestic terrorism/riots/Presidential assassination attempt, which unfortunately seems likely as well.

4. Conspiracy Theories:

Like the above! Many of you will not be old enough to remember how the Nasca Lines, Lost Civilizations, Cryptobiology, JFK and Egyptology are connected, but they most assuredly are, as Mr. Spock explained to us, in 168 episodes of shroomy genius. And Erich von Daniken wrote 20+ books while the economy was crippled with stagflation.viii

5. Wrestling.

Pick any show that's been running from 1995 to now. So many of them have seen ratings trend lower, except the WWE (formerly WWF before the panda patrol got testy.)ix

There was a surge when The Rockx and Stone Cold were on, but ignoring that period ratings have been stable for over a decade. And that doesn't account for growth in Europe.

As people lose their jobs and look for a choreographed release of their frustrations and prejudices, one might be tempted to smellxi what you know who is cooking. And the stock, also stable between 13-19 (now 15) now pays a 9.7% dividend. Take that Bank of America!

When your kid endows body parts with political significance and then tombstones his brother, you'll know I was right.xii

6. Mercantilism. Enough said.xiii

7. Secular humanism. In case your last experience with it was high school, let me point out that this is a bad thing, not a good thing. Yes, it's wonderful to have an ethical system free of religious foundationxiv and therefore premised in reason, or something, but what happens when the humanist's "reason" is in sharp contrast to the "reason" of the humanist with the tanks?xv

It also overlooks the historically indisputable point that human(ist)s like killing each other and themselves, and will do so with little provocation. Indeed, many actively seek out reasons to open fire. "We are no better than they are" (and why isn't that ever, "they are no better than we are?") is a popular refrain among those who haven't been on the wrong end of the not any worse they, but it makes choosing sides a lot more difficult when, well, you have to choose sides. And if the S&P500 chart is any indication, we're going to be needing to choose some sides pretty soon.xvi

Did you know Julian Huxley, eugenecist and brother of the author Aldous, was once an American Humanist Association's "Humanist of The Year?" So were Kurt Vonnegut, Margaret Atwood, Benjamin Spock, Isaac Asimov, Betty Friedan and John Kenneth Galbraith. Do you see the connection? They're all science fiction writers.

———Off to a slow start, public pubic mounds still looking prepubescent in 2019 ; and likely forever.

I don't expect pubic hair on females is ever coming back, short of Apocalypse on such a scale as to also take out hot water as a going concern. Like it or not, the 12 year old look of the adult female is here to stay, like male pattern baldness and high heels. Corsets, nipple piercings and bellybutton ornaments may come and go on a cycle, but as it turns out shaved snatches, high heels and pony tails are perennial, gotta get used to it. [↩]A very slight male-beard revival did occur, but as a completely marginal hipsterism. [↩]Not really. There's some "sweatpants are ok on subway because I've seen some yoga instagrams/youtubes", there's also some "this tshirt is also my skirt" seen mostly at raves and other such late teenage sluterias, but otherwise nope, the "catniss bow fashion" caught on about as much as seinfeld's puffy shirt. Turns out nobody wants to be an elf pirate. [↩]Wtf is his problem ? I mean, I get it, the snatch should be always accessible, sure, thus stockings and garters rather than the cheap I-lose-at-life pantyhose thing. But bare legs belong on young teenagers : after they've started bleeding but before being discovered for usage (and, I suppose, on adult women too -- occasionally, for a romp or a caper).

PS. If you're going to put panties on (occasionally, for a romp, or a caper) please remember they go on AFTER the stockings, never before. [↩]This is broadly correct, however the war that'll end this perma-recession will consist of the re-colonization of the Americas (with the respective beheading of the hags & males and chain-slavery of all the cunt still young enough to retrain naturally and well). You know, like they did it in "Yugoslavia".

So far, seems nobody can be found that could be arsed to expend the GJoules in work a few hundred million beheadings require. Maybe in another decade. [↩]I kinda find his "stock market" posturing endearing, in a "look at the puppy, it opens doors!" kinda way. I am starting to suspect the whole "feel like a trader" thing was actually autobiographical. [↩]As a factual matter Bahamas was quite ready, eager, and willing : he swallowed it all, to the very pubic hair, and then blew bubbles from the nostrils. Then it went up his poopy hole, and then back up his craw again, and he blew slightly browner bubbles (is that racis to say, wanna-be black president blew brown nosebubbles?) and then again, this time slightly redder, and so on and back and forth. "America" shed more colonial empire to become a mere "the US" than the British empire shed to become "united" ; and faster, too!

Make Britannia Great Again! [↩]Nobody fucking read them. [↩]This turns out to have been a miserable prediction. Wrestling didn't come back in any sense ; it only survives ever so slightly in that some ex-carsalesman somewhere came up with the idea of hiring ex-strippers and doing a "female" version, which of course works out to being entirely indistinguishable from any other daytime TV drama / reality TV / etcetera -- it's still mostly dumb whores with nice racks "arguing" with each other -- but occasionally it comes out cheaper to produce, and so occasionally it's competitive. You can watch along in "sports" bars on the ground floors of the better brothels outside the zone and wherever else someone tunes on Fox Sports 3 or whatever it is (ie, nowhere else). You're not missing much, honestly.

Remarkable how tough the predictions racket is, huh! [↩]You know, we were in the subway today and I saw a particularly lulzy ad.

"Who the fuck is that ?", I ask.

"That's the Rock."

"Who ?"

"Dwayne the Rock Johnson. And John Stratham."

"Holy shit it is. That poor fuck, Stratham. So Madge's boi (or was he QT's boi ?) made... well, he made a joke. And we laughed, and one of the props in it... well, it kinda caught on a life of its own. I mean, sure, people liked Turkish as a character, the British humour was toned down enough as to be socially acceptable... it was a thing. Poor schmuck's been doing that same one thing ever since then, he must've done twenty, fifty movies, who the fuck even knows. Poor him."

That's the situation : a movie set prop went zombie. Like, one of the buttplugs or double dongs or whatever left in the bowl labeled "used" started crawling around the room. First it's all "omfg, animated silicon!!!" but then... well... it doesn't really do anything, you realise ? Just sorta slithers arouind, back and forth, maybe it rolls over but then... back to the slither.

Within half hour at the most it's "Booo-ooring" and well... you know ?

What the fuck, who gives a shit about rocks now. [↩]Question : what does the author wish to make true ?

Pro tip : that "people" matter. Because that way, he could "win" by merely being part of the team. He's a people too, ain't he ? [↩]Except why would I play genital lottery ? What, I can't just take the cunts I want, when I want some ?

I can ; and I do ; and I make them into anything I fucking feel like, too. [↩]This is too complicated to get into ; suffice it to say that "we" is exclusive -- it's like saying "we are all poor now". Yes, you who are, are -- as you very well fucking should be. You choose to be poor, even though you pretend to not have chosen. We the rich are still rich, and no we don't have your problems, but then again we also give 0 shits, so yeah, down at the bottom "we" are all whatever the fuck. [↩]There was no religious foundation to anything man-made (by which we mean, European, white -- the various orcs & coloreds aren't in any sense people for the purpose of this conversation) at any point in history. Not ever.

The "religious" claptrap is how morons, coloreds, orcs and assorted marginals stuck in the colonies, margins, provinces and assorted shitholes cope with Man. The claptrap it may be perceived as subjectively important by them, much like junk is perceived as important by the junkie ; nevertheless it has no merit and absolutely no involvement in either the unfolding or the history of the unfolding of any kind of phenomena. [↩]He eats it. What did you think was gonna happen ? [↩]Aaactually... that window kinda closed. You already chose, pretty much. Best of luck and all that. [↩]

« thelastpsychiatrist.com - 5 Things You Need To Understand About Wikileaks Before You Celebrate. Adnotated.

thelastpsychiatrist.com - 8 Characteristics of Family Annihilators. Adnotated. »

Category: Adnotations

Wednesday, 17 July, Year 11 d.Tr.

thelastpsychiatrist.com - $51M Vioxx Verdict Overturned. Adnotated.

Judge Fallon decides that the jury's $50M award is a bit much for a heart attack in which the guy is still alive and well. He leaves in place the $1M punitive damage award. (The $50M was compensatory damage.)

I also refer you to the PointofLaw blog, in which is observed the inconsistency of the jury's verdict: no, they aren't strictly liable for failing to warn about and causing the MI; and yes, they were negligent in failing to warn and causing the MI. How can you be negligent if you weren't liable?i

Liable=responsibleii

negligent= "careless in not fulfilling responsibility" (from law.com)iii. There was a duty toward the person AND you didn't do what a reasonable person would have done AND what you did actually caused the damageiv

———This'd be the fundamental problem with laymen trying their hand at professional fields : they don't understand the meanings of terms. Apparently there can quite be such a thing as "negligence without fault". What now ? [↩]Strict liability is not liability in general. One not being strictly liable does not automatically mean one isn't liable in the general, and it implies relatively little about negligence -- in point of fact the concepts overlap poorly. Let's look at it in some detail.

Suppose the law says that

"[to protect the blabla] and with a view to the welfare of 15 yo girls, anyone found in a room with a 15yo girl wearing any kind of clothing will be fined $100"

This law as stated contemplates strict liability : meet the conditions, suffer the penalty.

Leaving aside how intolerably insane such constructions are, it still stands that any person found as described will be fined -- such as the sleeping family some dressed 15yo cat burglar home-invaded ; such as the restrained Abu Ghraib victim of the USG criminal gang across the room from a dressed 15yo Lynndie England ; etcetera. A whole lot more will be indicted -- such as the responsible fellow who is whipping a restrained but otherwise nude 15yo (in the opinion of the arresting officer, ankle leather straps constitute "any kind of clothing"), such as the indolent fellow who, too lazy to interact with the naked 15yo seated at the kitchen table, is unfurling a length of tin foil to safely fridge a plate of pasta with white sauce in such a way as to obstruct the seated girl's tit from the view of a law enforcement drone passing by the window ; and so following.

If there's a rule proposing that one's not to obstruct the view of law enforcement drones, the fellow with his plate of pasta may well be negligent ; but the jury must (not may, must) still find him not strictly liable for the $100 fine, because the legal conditions were not met. The jury must (not may, must) also find the sleeping couple liable, even though they may well find them not negligent! And so, on and on in this vein, isn't "common law" a wunderbar pile of useless nonsense! [↩]That's an utterly shitty with twinges of horrifyingly bad definition.

Negligence as the legal concept is the deed or omission which a) goes contrary to the views of a "responsible"-yet-"average" person in the locale, and which b) conceivably results, while the alternative conceivably would not have resulted c) in an actionable harm.

Those are the three elements of negligence : first, "something bad" must-possibly-happen "because" that could-have-not-happened-otherwise ; then that something bad must happen in such a way as the courts are inclined to remedy (a spy leaving the toilet seat up in an enemy base is still not negligent -- because the enemy cunt sitting down on the bare bowl is still an enemy, and thus can't plea for redress through the court) ; and then finally an alternative course must've been available.

Then from there, together with "did anything bad actually happen" and "did the negligent party actually have a duty towards the sufferer of whatever ill effect" liability is constructed, but only after, of course, the whole matter's been strained through the degree-of-magnitude cheaper filter of strict liability, because that's why that insanity exists in the first place : the tort view of the world that common law tradition ended up forcing upon the world is simply untenable. "Strict liability" is a hack atop a dysfunctional tower of chairs, a long-overgrown attempt to plug the wrong end of a funnel resulting in geometric increase of complexity on the backend as a result of linear increase in complexity on the business end. [↩]The original actually ends like this, midsentence and without even a punctuation mark. What can I do ? [↩]

« thelastpsychiatrist.com - 50% of American Kids Receive Food Stamps. Adnotated.

thelastpsychiatrist.com - 5 Signs Your Child Is a Psychopath, According To The NYT. Adnotated. »

Category: Adnotations

Monday, 15 July, Year 11 d.Tr.

thelastpsychiatrist.com - 50% of American Kids Receive Food Stamps. Adnotated.

Marx was right. America is finished.

I saw the news article late last night, then read the study in the Archives of Pediatric and Adolescent Medicine, and was blown away. The data were solid: simple enough, just ask people if they'd ever been on food stamps, and count them.

30 years of household interviews, 1968-1997.

By age 20, 50% of all kids will have used food stamps at one time.

For black kids, the figure is 90%.

40% of kids in married households will have touched food stamps; it's 91% of kids in unmarried households.

The good news is that only 19% will use them for more than 3 consecutive years, which, of course, is also the bad news.

I was all set to be terrified about America's future, until I read the accompanying editorial, which reminded me of something someone said:

The bottom line is that the current recession is likely to generate for children in the United States the greatest level of material deprivation that we will see in our professional lifetimes.i The recession is harming children by both reducing the earning power of their parents and the capacity of the safety net to respond. However, it is also essential to recognize that children have been made extremely vulnerable to this recession by a decades-long deterioration in their social positionii.

That something was: what does the author want to be true?

II.

In this case, while the results are technically accurate, they don't mean what it looks like they mean, i.e. that we should dust off Oliver Twist for a glimpse into our future.iii

Although the Food Stamp Program described in the paper is separate from the Women-Infant-Children (WIC) programiv, it appears that the study conflates the two. It's not relevant to the outcome of the study, so I'll simply focus on the WIC to show you why the headline is alarmist and misleading.

First, in determining household income, only the legal family is counted. The income of unmarried couples, grandparents, etc is not counted. This is true, e.g., even if the boyfriend is the biological father and he lives there or gives money.v

Second, even though cutoffs for income are written as annual figures (e.g. $22,050 for a family of 4 or "185% of federal income guidelines"), they don't look at the past year's income, they look at how much the household is making right now, and then extrapolated.

Don't be fooled by "rate" of income. If you just lost your job, your rate is zero; you are eligible. And the next "mandatory" review is every 6 months. See you then.

Third: No proof? No problem.

Fourth: and more relevant to food stamps, a person can receive income from exempted sources (there are many);

Fifth: unlike unemployment, in which you have to "show" you are looking for work, food stamps aren't tied to need, only to nominal income. If you choose not to work (or choose to do volunteer work) and thus have no income, you're eligible. I'm not accusing people of abusing the system, but it is evident that some people would make adjustments in their behavior if food stamps didn't exist, rather than be committed to growth retardation and scurvy.

III.

There's also a bit of crazy, crazy math in play.

Nevertheless, only approximately 60% of those who are eligible for the program actually participate in and receive food stamp benefits. Consequently, it could be argued that the number of food stamp recipients represents an undercount of the total number of households in need of food assistance.

So... 90% of America is in need of food stamps?vi

IV.

You will notice that I haven't used this study to make any judgment on whether food stamps is a "good" or "bad" program, not because I don't have a... nuanced... opinion, but because the study can't be used that way. However, it will be/is used precisely in that way.

It's troubling that, as scientists, it never occurs to the authors to objectively speculate why these figures might be erroneously high; in fact, they assume that they are too small.

Studies like this one are op-eds with numbers. They promote the particular bias of the doctors (read: social policy analysts) writing it. If 50% of kids get food stamps, then food stamps are necessary, end of story -- that's the point of the study. No politician in his right mind would dare question the implementation of such a program, let alone the need. In other words, it's not the the actual data that compels social policy, but rather the ability to say, "doctors have determined that..."

The press report interviews the author, the author of the editorial, and James Weill, "president of Food Research and Action Center, a Washington-based advocacy group." Gee, I wonder what they're all going to say.

I've many times remarked that doctors spin data to subtly impart their particular bias. Sometimes, however, they just yell it at you. Here is the first sentence of each paragraph of the editorial:

Clinicians always inherit the results of bad social policy.

Children are poor because their parents are poor, a fact that ties the well-being of children to the employment status of young adults.

Children are particularly vulnerable to the current recession owing to the longer-term crisis in the American family's ability to provide for its children.

In meeting the basic needs of children, the only real alternative to the family is the state, an alternative that is increasingly incapable of meeting the growing need.

And goes on like this, until the last paragraph:

Children depend upon political proxies to advance their societal claims.vii

Note that he sets up the government not outside a family helping it, but inside the family, as a proxy parent, able to pick up the slack. Since the government has money, it looks like this works, and it seems crazy to say you want them out ("are you saying you want the government to stop handing out food stamps?")

But the populace is being trained to see themselves not as solely responsible for their children, but as part of a larger network of interested parties. That may sound comforting, but it radically alters behavior. It reinforces your connection to the state, as opposed to fostering your independence from it; and you become willing/obligated to sacrifice more and more in defense of the bureaucracy.viii

———Top keks. "That we will see... until next five year plan rolls around", of course. [↩]You gotta sell something. [↩]What does the author want to be true ? [↩]Think about such a program even existing in the first place!

Where's the Men-Beer-Vidya program ? Why aren't your dumb bitches naked outdoors, pounding mud and running inside a large hamsterwheel to generate electricity to run your game console ?

Social justice, amirite.

PS. Do you suppose that's why all the Latina and generally orc chickies want nothing better and dream of nothing more than going to Miami ? Hm ? [↩]Something that totally fucking happens irl, too. [↩]Maybe back in 2014. By now... [↩]Gee, just like before ? What, then, has changed ? [↩]Just in time, too -- that bureaucracy's just about to need a helluva lot of defending. [↩]

« Bitcoin Recapitulation

thelastpsychiatrist.com - $51M Vioxx Verdict Overturned. Adnotated. »

Category: Adnotations

Monday, 15 July, Year 11 d.Tr.

thelastpsychiatrist.com - 4 Unintended Consequences of Seroquel's Adjunct to Antidepressants Indication. Adnotated.

cutting edge research on this drug should be coming any day now

In 1998, I discover something is red. "It's red." Sweet.

In 2010, I discover that same thing is also hard. "It's hard." Nice.

The question is: what is its primary attribute? Is it a Red thing that's hard, or a Hard thing that's red?

II.

Imagine you did it the other way around: in 1998 you discover it is hard, then in 2010 it's found to be red. Does that change things? Is the primary attributei based on history, or something else? "I guess it all depends on what you use it for." You guess?

III.

Seroquel is that thing, discovered first to be efficaciousii in schizophrenia (translation: "antipsychotic") and now found to be efficacious in depressioniii ("antidepressant").

So is it an antipsychotic that treats depressioniv, or an antidepressant that treats psychosis?v

"I guess it all depends--" Shut it. Scientists are talking.vi

IV.

You might think it doesn't much matter what you call it but rather how you use it, but it matters. If you call it an antidepressant, regardless of mechanism of action, price, or data it gets slapped with a suicide warning. If you call it an antipsychotic you forever battle a diabetes warning regardless of the truth of it (see Geodon, Latuda.) And call it the wrong thing, or the right thing at the wrong time, and your company gets to pay $1B to the government.vii

V.

Seroquel is a special case study in the semiotics of psychiatryviii, because much of the naming was intentional.

1. Excessively high dosing.

One can't fault the FDA for striking a balance between safety and efficacy. They voted nearly unanimously "Yes" on its monotherapy efficacy in GAD and MDD-- they agreed it worked; but they didn't want it being used as commonly as Prozac, so voted unanimouslyix "No" on safety. So no monotherapy approval.

Recall that one of the monotherapy trials of Seroquel showed efficacy at 50mg. However, because the FDA chose to go with the adjunct indication for safety reasons, it can only approve the doses used in those adjunct trials: 150mg. Three times higher than the "minimally" efficacious dose in a monotherapy trial.

So in choosing an indication out of safety concerns, it tripled the doses used.

The reps are not allowed to suggest you use 50mg, or tell you that those studies exist; indeed, they aren't told about those studies themselves.x

2. Reinforcement of an erroneous mechanism of action.

The FDA wants to "protect the public". They know docs will generalize the indication of one drug to others in the class. Hence, the FDA's and AZxi's interests run in parallel: not all antipsychotics are antidepressants.

So AZ avoids all talk about mechanisms of action which are shared by all atypicals (dopamine or serotonin antagonism) and settles on a mechanism which is specific to Seroquel-- the NET inhibition.

However, as I hope is clear, from part 3, the NET probably has nothing to do with it.

3. Reinforcement of the cult of polypharmacy.

It worked fine as monotherapy; but it's indicated as an add on to drugs (SSRIs/SNRIs) that failed for over 100 days at high doses.

If the combination works, what then? Was it the Seroquel alone that did it? Was it the SSRI just taking longer to kick in? Or some kind of synergy? The FDA answer is that since you don't know, you use both.xii

But you do know: Seroquel worked as monotherapy in at least two FDA trialsxiii. Given this, it would be most logical to taper off the SSRI after a while, because you don't know two drugs are better than one drug, but I can promise they are twice as toxicxiv and twice as expensive. But you won't find that recommendation in the PI or any academic journal. The FDA is causing psychiatry to move backwards: more polypharmacy; less safety; greater costs.

4. Pharma/academic focus on "bipolar depression."

Seroquel isn't indicated as monotherapy for MDD, but it is indicated as monotherapy for bipolar depression. Fortunately, 1) bipolar depression looks exactly like major depression during the episodexv; 2) it's indicated at 300mg, so you can be guaranteed to get heavier.

From the company perspective, the obvious marketing strategy is to push for "awareness and detection of bipolar depression" (read: "recurrent major depression is probably bipolar disorder"), and "incentivize" the reps to have their scripts skew towards 300mg. Farewell, depression, again.

For example, if Seroquel is truly an "antidepressant" then the competition would be Prozac. But it isn't; it's Geodon. Reps aren't measured against SSRIs, only against atypicals, which, in theory, they're not really competing against.

VI. Should we worry about any of this?

Nope. Once Seroquel goes generic, the impact of all of this nonsense will be minimal. Then no one will care how you use it, at what dose; whether you use it monotherapy or in combination with nine other drugs none of which anyone cares about either. Do a Pubmed search on Zyprexa research in the last year. Anything?

Granted, there's probably patients who do care. But.xvi

———There's no such thing as a "primary attribute". Attributive primacy is not a matter of ontology. [↩]Seroquel is not efficacious in schizophrenia ; at least, not anymore than "fuel economy magnets" are efficacious : in winter, when a colder engine makes the heat->energy conversion slightly more efficient, it's not entirely inconceivable one might "show" them to be "efficacious". [↩]There is no such thing as the medical condition of "depression" ; at least not anymore than the medical condition of "not buying enough winning scratch lottery tickets", or "always getting a flat at an inconvenient moment in time". [↩]For the same money he could have said the moon is a celestial essence that treats the medical condition of "female hysteria" ; historically they have. Or I guess une crise de foie, or any other item off the lengthy list of historical "diseases" constructed in the same manner by the same kinds of people.

Come to think of it, you could attempt to treat love sickness. It absolutely must be a legitimate sickness, it even has "sickness" right in the name! Who can argue with that ? [↩]Is the result of dividing four by zero greater or smaller than the result of adding two and the square root of minus one ?

That's exactly the mental process involved : the result of dividing by zero might look, superficially, to the naive observer, like a real. It isn't! And the thing you feed a schizophrenic may look, superficially, like medicine. But... it isn't! You may appear to be acting exactly like someone giving sulpha to a girl with UTI -- yet you aren't doing anything even remotely similar.

From the other side : comparing complex numbers to reals may look, superficially, like you're engaging in a comparison. You aren't. "Treating" depression may look, superficially, like any other treatment. It isn't. [↩]Oh, right, the scientists making the science "America runs on". With scientists like these it's inconceivable anyone'd need priests for anything. [↩]The problem with this view is that "the corporation" and "the government" are in no sense distinct ; not only is the supposed "payment" so much thin air, but more importantly the only reason Inca under his aspect of "the company" even has "a billion" to pay Inca under his aspect as "the government" is because "the government" gave it to "the company" in the first place.

The whole exercise in wordage reduces to something quite like "getting a flat tire at an inconvenient moment results in your left coat pocket sending a piece of scribbled paper to your right pants pocket". O noes, I guess ? [↩]Rather, the psychiatry of pseudoscience, but whatevers. [↩]A point sufficiently well established by now : "consensus" votes aren't. [↩]Right, right, because this is science we're talking about here, a methodical approach, proceeding rationally from empirical observation on the basis of a few self-evident truths, or however that went.

Nuts. [↩]Astra Zeneca, the "company". Private company, might I underscore, it's owned by "pension funds" which consist of the money "the government" gave to "the people" so as to... spend it... wisely... on owning "the company". Why do you not see the rationality immanent in the scientific system "America runs on" ? Hm ? [↩]The answer is, you're not a doctor, you're a bureaucrat. [↩]Everything worked to the same standard of working-ness, including the Ptolemaic planetary model. [↩]It is improbable two drugs given together are merely twice as toxic as the average toxicity of each of them in isolation. [↩]And exactly like "female hysteria" at all other times. Go ahead, write the differential diagnostic manual for "depression" and "female hysteria", it'll be fun to watch ; and no, you don't get to walk out of it with weakass "do we still have to do this". Of fucking course you still have to do it, that's what the fuck science even is. I never heard of a mathematician unable to cross the Pons Asinorum waving his hands and "do I still have to do this"-ing himself all over the landscape.

Science, rite ? [↩]Fifty or so years of this, that's exactly how the whole thing ended itself. [↩]

« thelastpsychiatrist.com - 4 Easy Steps Towards Weight Loss That Aren't Drugs, Diets, Or Excersise. Adnotated.

Bitcoin Recapitulation »

Category: Adnotations

Sunday, 14 July, Year 11 d.Tr.

thelastpsychiatrist.com - 4 Easy Steps Towards Weight Loss That Aren't Drugs, Diets, Or Excersise. Adnotated.

I can't tell you not to eat it, but I can tell you how

I.

Type II diabetics -- and everyone else -- have two problems with their diets. First, eating too many calories causes weight gain. Second, food (like carbs) that causes excessive or prolonged insulin secretion, while helpful in the immediate (it clears the sugar so you aren't hyperglycemic) over time leads to insulin tolerance and resistance.

Hence, low carb diets are favored for both weight loss and for keeping insulin levels low(er).

However, while carbs are potent stimulators of insulin, protein and fat contribute as well. For example, consider two meals each of 2000kJ and 40g of carbohydrate:

Meal 1: steak and potatoes

Meal 2: bread, peanut butter, and milk

Not only is the insulin secretion not the same, it isn't even close: Meal 1 induces only half the insulin response of meal 2.

An old study measured the insulin response to some foods, relative to white bread (=100.) It also measured glycemic score, (e.g. per 1000kJ of it, not per 100g of it.)

You can see that the insulin response is not always related to the glycemic score. For example, brown rice is "as bad" as white bread (same glycemic score), yet causes considerably less insulin secretion. If you're diabetic, you'd want to eat brown rice instead of white bread. Etc.

In a more recent study, the weighted average of the insulin scores in a mixed meal was the best predictor of actual insulin levels -- carbohydrate amounts and glycemic index were not. (Fat, however, was a predictor.)

Summary: same calories, same amount of carbohydrate can result in different insulin responses.

II. How much insulin do you really need?

If I give you 100g of oral glucose vs. 100g IV glucose, will the insulin response be the same? No -- the oral glucose causes 3 times more insulin to be secreted. Think about this.

The reason is that hormones GLP-1 and GIP are secreted by the intestine within 15 minutes of eating -- specifically, after the absorption of fat and glucose there -- and are responsible for (among other things) 50%-70% of the insulin response.

The amount of insulin secreted is determined not just by the glycemic load, but the rate at which it reaches the intestine, because that's where GLP-1 and GIP will be released -- the main drivers of insulin response.

Notice that when the rate of infusion is doubled (from 2 to 4kcal/min), the insulin must explode upwards to result in the same level of blood glucose. You don't want that: chronic high insulin leads to insulin tolerance and resistance.

But now imagine taking a fixed amount of glucose, and either:

closed symbols: big dump (3kcal/min for 15 min) followed by trickle (0.71kcal/min next 2 hours)

open symbols: constant rate (of 1kcal/min x 2 hours)

All that's different is how you "eat" the glucose. Look at the graph. Circles are diabetics, squares are normals:

Observe that the blood sugar is higher if you ate the sugar faster. For that meal, you were exposed to higher blood sugar. And insulin, more pronounced in the normals. For about 30 minutes, the people with the quick appetite experienced almost twice the insulin.

So slowing the rate at which glucose/food gets to the intestine would result in lower insulin levels and lower blood glucose, without necessarily changing the calories. If that sounds weird to you, learn it in the reverse: speeding up the glucose to the intestine will increase the GIP and GLP-1 and insulin response.

Eating smaller meals and less sugar clearly will help. But I think you see where I'm going:

III. Small Changes That May Help More Than A Little

Obviously, changing what you eat and how much you eat is very important. But these suggestions are not about altering the content of your chosen meal.

They're going to seem obvious now, but you should do them anyway.

1. Eating the same amount of food but much more slowly.

Any association you make to the European meal is your own business. The science says cramming the food down your throat while driving to the prison camp is a very bad idea.

2. Same amount of food, but change the order of the food you are eating.

Eating the fat and protein portion of your meal before the carbohydrate will slow gastric emptying. (It may also make you feel full and you eat less.) Don't eat extra fat and protein -- just move the protein portion to the front.

What you should not do is crack open a soda or iced tea or juice before you eat. If you must drink soda, which you mustn't, do it at the end.

If you are including a salad in your meal, definitely eat that first. (Soup would be an even better idea.i)

3. Get more sleep.

Growth hormone is released during slow wave sleep, especially around 4-5am. Cortisol is inhibited. Sleep deprivation reverses this.

Even if total sleep time is the same, suppressing SWS reduces glucose tolerance. So: no sleeping pills, and get the sleep apnea handled.

Prolonged partial sleep deprivation increases ghrelin (appetite stimulating) and decreased leptin (appetite suppressing.)

4. Put cinnamon on your meal.

A bit of a cheat, but...

3g of cinnamon added to rice pudding reduced insulin levels with no effect on blood glucose. How can the body get away with using less insulin to deal with the sugar? Apparently because a) it increased GIP (see above); b) it stimulated the insulin receptor, resulting in increased glucose uptake. It should be logical, therefore, that cinnamon could exert its effect even if given separately from the meal: a small study found that 5g of cinnamon even 12h before the meal helped reduce glucose responses.

———The only comment I have about this article is to point out that it's a 1k word declaration that the way I eat is the right way to eat. Which... yeah ok. I'm shocked! [↩]

« thelastpsychiatrist.com - 3 Media Narratives About The Middle East You Should Defend Against. Adnotated.

thelastpsychiatrist.com - 4 Unintended Consequences of Seroquel's Adjunct to Antidepressants Indication. Adnotated. »

Category: Adnotations

Sunday, 14 July, Year 11 d.Tr.

thelastpsychiatrist.com - 3 Media Narratives About The Middle East You Should Defend Against. Adnotated.

if you're watching it, it's for you (that's why the signs are in English)

1. Youth In Revolt

Ha! That's hilarious. Wait -- you're serious? You know Jay-Z is 40, right?

According to Time, these are the guys who toppled Mubarak. That one guy in the back punched him and the girl poked him in the eyes. The guy in the back right ate the body.

The New Revolutionaries: a liberal, pro-democracy group of consumeristsi concerned equally with global warming and expressing themselves, discreetly lip-synching the words to Lose Yourself as they march on Freedom Square.

You'll have to excuse my cynicism: I've seen this exact same movie a lot of times, admittedly to a CCR soundtrack.

Of course the young(er) are looking for social changes and a better life.ii And I don't doubt that they at least believe themselves to be earnest. But the media narrative that it is they who are the force behind the acute changes is both wrong and manipulative.iii

It's manipulative because it is easy. We can understand that kids might not like the world as it is, and the youth certainly appear to have enough energy drink to march for a week straight or yell anti-Bush obscenitiesiv, so it is logical that they're the ones to focus on. It gets Time, et al, out of the hard work of trying to figure out why the revolution happened, happened now, and if it's a good thing or a bad thing. Even Obama's not sure how this plays out, so the more we hear about youthful idealism on the march, the less we have to worry that Israel doesn't first strike Iran, just in case.

Also, it's self-aggrandizing. This is the folks at Time saying, "hey, man, we get this hip generation."v It makes them think they're young and in touch, ("they even figured out how to use the internet for something other than porn!") and I'd bet 10 piastres every guy working at Time thinks the girl in the bottom right would find them interesting.vi

The narrative is wrong, or at least woefully inadequate, because -- in the simplest terms possible -- the guys in the picture aren't the ones changing the world. I'm sure they'd have thought voting for Obama was going to bring change, too, but they'd have been way wrong about that as well.

Here are some sobering statistics for the Time readers. There are 80M people in Egypt, 10% unemployment and 40% in poverty, as defined as less than $2/dayvii. About a third don't know how to read.viii None of those people are in the picture. None of those people want the same things as those in the picture. None of them will ever listen to those in the picture.ix

There may have been 100k students in that Square, but if their 50 year olds are anything like our 50 year olds, then their 50 year olds might actually find those students infuriatingly arrogant regardless of what side they're on.

The sad truth is revolutions start with the disenfranchised, get attributed to the idealism of "students" and "the youth," and are ultimately resolved by thugs or corporations. Sideways Glasses Guy is in for a jarring quarter-life lesson in economic history, and I'm guessing he's not going to pass.

1b. The Young Are Mad As Hell, And They're Not Going To Take It Anymore. Sorta.

In the next issue of Time after that one, I found this picture of the Wisconsin union protests (click to enlarge):

Some observations:

1. Look at the crowd in the background. They're all older people. But Time has put the young ones front and center.

2. They do not appear to be members of the teacher's union. Or particularly fond of teachers.

3. They are smiling.

They're not angry, they're not outraged, they're... socially conscious? I'd bet a lot of money those kids aren't there to support the unions, that's not exactly their fight, but that fight happens to have a common enemy (feel free to speculate who that common enemy might be.) This explains precisely what is wrong with so many fights and positions and ideals: they are not for something, but against something else.

"What's wrong with coming out in support?" Well, go ahead and ask Time: "what's wrong with putting them front and center?" Because if I was agnostic about unions, and interested in really deciding who I supported in this fight, one look at that picture guarantees I side with whoever they're yelling at. If you want to know exactly what is wrong with the "political discourse in America today," it's that we are trained to pick a side against something we hate.x

So choose your "face of the revolution" carefully because if it's an emotional response you are trying to evoke, there may be some unintended consequences. That's what happened in the 60s, too -- Woodstock the revolution and you landslide in Richard Nixon with a victory margin 3 times higher than Obama'sxi. Guess music can't change the world after all.

2. The Mad Dictator That Has To Go

Oh, he may be a nutjob, but once he's out -- what, exactly? He's not a lone nutjob. There was an entire government in place there and while they don't all have voluptuous nurses you can be damn sure they want voluptuous nurses, and if they can't get that they'll settle for all your money and your obedience.

It's a narrative that existed long before the nights of Saddam, get rid of the dictator and things will get better. Sometimes it works, sometimes it doesn't, and if your country has oil in it it usually doesn't.xii

Imagine you replaced George Bush with Obama, but kept Cheney and Rumsfeld, Wolfowitz, Pearle, Rice... Imagine you get rid of all the Congressmen, but kept all the lobbyists, all the civil service employees, intelligence services, all the guys previously on the take -- and the media infrastructure. "The media supports the people!" Oh, yes, that has long been my experience with media.

It's so easy to get distracted by the Evil Despot that we aren't horrified that Egypt's chaperons of future democracy are the military. Really? "They didn't turn on their own people!" Wow, that's your metric? Do you think they're just going to step aside when the kids show up to sell off the tanks to pay for education?

I am certainly in no position to decide whether you Paul Bremerxiii everybody in a uniform or keep specific people on the payroll, but I can at least tell you this "new" government isn't going to have any room for the likes of Sideways Glasses Guy.

The best thing that can happen to him, is a long, boring, bureaucratic shuffle towards elections, because if you do them in anything less than a year the old entrenched powers will win. Or the Muslim Brotherhood, who are going to win anyway (my prediction.)xiv

If the kid in Time wants to participate in government, he needs at least a year to get his act togetherxv, not to mention money from the U.S. (You didn't think we were going to stay out of it, did you?)xvi

The media likes the Mad Despot narrative because, again, it's easy, but, again, it's wrong and manipulative. And it backfiresxvii. When George Bush pulled the Mad Despot card, the media reacted against it -- but that was itself a manipulation, because they wanted the Mad Despot to be Bush himself.xviii Offered no other choices than "one of these guys is utterly, completely, evil," America was forced to choose who they thought was actually the Mad Despot; and -- tip for the media -- most Americans will think it's the foreign guy.

3. The Power Of Social Media

The intended subtext of this myth isn't that facebook and twitter aided people in their revolution; but that those were somehow the cause of the revolution. That the technologies themselvesxix "need" freedom, they force freedom, they cause freedom, by their very existence.

This is a letter to Time:

Re: Why It's Different This Time" What we have on our hands today is not only a revolution in Egypt but also the beginning of an era when a new medium finally proves to the world its equal and comparable importance to that of the printing press. Social media are no longer just how we stalk ex-girlfriends or update the world about where we bought coffee. It fuels revolutions...

In my short time on earth, I've lived through: papyrus, morse code, radio, yelling, mobile phones, and I have only just recovered from TV. All of these "disruptive technologies" share two commonalities. First, they empowered the people to communicate, congregate, and share ideas. Second, and more importantly, all of them were eventually co-opted by the government and business to manipulate those people, who didn't mind one bit as long as the ads were under 30 seconds.

It's fairly obvious why media companies would push the idea that the media itself is responsible for puppies and Reese's Pieces cookies, but when the medium becomes the message, there's no message.

II. So What Are The Lessons Of History?

From The Economist:

In Tunisia Zine el-Abidine Ben Ali met peaceful crowds with concessions. In Egypt Hosni Mubarak tried to ride out the protests by mixing concessions with force. In Bahrainxx King Hamad bin Isa al-Khalifa resorted to violence, but did not have the stomach for the fight. In Libya Mr Qaddafi seems to crave blood. Screaming ghastly defiance in an hour-long tirade on February 22nd, he vowed to "cleanse Libya house by house". If he prevails, dictators the world over will know which course to follow.

Or: every time history repeats itself, the price goes up.xxi

———This being the important part. The whole progressive, liberal, democratic, whatever song and dance is merely a distraction from the fundamental point : the consumerists wanna keep consumering.

Kill them. [↩]Where "better life" stands for "doing less, at all costs though preferably at the lowest cost possible". [↩]Not exactly manipulative. Rather, masturbatory. [↩]Hahahaha what! [↩]That's not why it's self-aggrandizing. The problem's not of Time, Inc. some tiny-ass groupuscle of neutered dweebs pretending like somehow, beyond all reason, they've some kind of relevancy to the world.

The problem's rather of UStardia whole, of that collection of powerless, inconsequential fuckwits spread all over the Northern half of a continent better people already started reclaiming. That is the self-aggrandizing part, the bunch of dorks on their hands and knees, swallowing whatever the Chinese ships bring in all thankfully, turning around and pretending to themselves like they have something to do with the events in the world.

Forget about it, the last time something meaningful or important happened in simple English the year was leading 1's. [↩]For which reason he sure as fuck wouldn't be saying anything to her, ever. [↩]I thought it was $1/day. How things have changed... [↩]Or use a map -- which observation directly leads us to the substantial difference between yours truly, shaper of worlds, and the Time demo of inconsequential fuckwits : unlike the idle morons talking importantly and "apparently knowledgeably" (hey, "nobody could accuse them" of talking out of ass, right ?) about any random topic each week, I've actually been in Egypt. Been.

This isn't some coincidental, domain-specific knowledge, uh-oh he happens to be Egyptian. I'm not fucking Egyptian, I'm dominant. I have been everywhere ; I have done everything. Unlike the aspirational class, the people who actually make the calls... well... they actually make the calls, what! [↩]I listen, by the half hour, subject to some qualifying criteria. [↩]This is a ludicrous notion borne out of very firm investment in the theory of self-importance. In actual reality, what is wrong with discourse in the US is simply the fundamental failure of all discourse among the inconsequential. They can't possibly say anything worth saying because they can't do anything worth doing. [↩]Funny how nobody seems to remember this. [↩]Talking about how patently shitty the bleater network is these days : that particular picture of Mubarak is gone ; I don't mean "it doesn't come up on a superficial search", I mean getty is fucked. [↩]Remarkable Bush look-alike, managed to lose one billion USD in bills somewhere in the sands of Iraq. Literally, though not personally. [↩]D'oh. [↩]From personal experience, kids do not get their act together. [↩]You didn't think you were going to matter, did you ? [↩]Oh, how it backfires... [↩]This is exactly what happened, by the way, the "masters of the narrative" got owned by a supposedly illiterate moron so, so hard... [↩]Get over yourselves : twitter isn't "a technology". [↩]Here's a spot not mentioned anymore, much like the very victoriously taken Mosul. Heard anything of Mosul lately ? Was it "freed" yet ? [↩]It's not inflation, though, it's 401k.

/sarcasm [↩]

« thelastpsychiatrist.com - 3 Important Things About The New Wikileaks Controversy. Adnotated.

thelastpsychiatrist.com - 4 Easy Steps Towards Weight Loss That Aren't Drugs, Diets, Or Excersise. Adnotated. »

Category: Adnotations

Sunday, 14 July, Year 11 d.Tr.

thelastpsychiatrist.com - 3 Important Things About The New Wikileaks Controversy. Adnotated.

um, yeah, this is the best picture from 2007 we could find for today's Guardian

Last week, Frontline did a documentary on Wikileaks which blew my mind. In it I learned Bradley Manning is gay. And short. And nothing else. No wait, about ten minutes in I learned I hate Frontline.

enemies of the state

I didn't think anything could make me an Assange supporteri, but it turns out that the enemy of my enemy is my friend. That's right, I'm Alone.

I.

Assange wanted to leak to the NYT, Der Spiegel, and the Guardian. However, he wanted the NYTto publish first to avoid the U.S. charge that he was leaking info to foreigners, i.e. take advantage of the 1st Amendment. But the NYT wanted Wikileaks to publish first, so then it could simply report on what was leaked, rather than be a leak.

These are probably legitimate concerns except for the fact that Wikileaks and the NYT are having this discussion explicitly. I'm not a lawyer but isn't that racketeering? It is like a bunch of mob guys discussing who should be the one to do the hit based on their parole status. Assange:

There was collaboration from beginning to end in terms of timetabling, researching stories, talking about how to understand data, etc., etc., embargo dates, the works. [NYT editor] Keller has tried to say we were just the source; they were a passive recipient... in order to protect themselves from the Espionage Act they needed to be completely passive, or be presented as completely passive.

One man's collaboration is another man's conspiracy. So any collaboration between a journalist and a source, between one media organization and another media organization, can be viewed, the Attorney General Justice [sic] [Eric] Holder says, as a conspiracy that flows through.

Assange is diabolically clever, I wouldn't expect anything less from the self-aggrandizing Cobra Commander. He's made this "collaboration" the point. Since they collaborated, the NYT can't pretend they were passive recipients, so they must therefore defend the legitimacy of such collaborations in general.

He's holding the press to task: your job is to keep the government accountable.

But they're terrible at it, as evidenced by the fact that while they were "collaborating," while they had all this juicy info sitting in front of them, the story the Times chose to run was one about... Bradley Manning.

The New York Times must stand up, and it must hold the line of the traditional form of journalism, because if it is not protected, it will be the end of holding the national security sector to account!!!

II.

Remember Climategate? Sarah Palin had a public orgasm and 4092 commenters blew up like Scanners. Climategate was the set of leaked emails that appeared to show climate scientists hiding data against global warming to suppress the critics; a global warming conspiracy.

"Climategate is an interesting case [says the Frontline interviewer]. What's the intent that you had when you leaked the Climategate e-mails?"

The truth needs no policy position, so there does not need to be an intent. We have a framework, and the framework has an intent.

This is exchange is so powerful it takes days to understand it.

First, Assange didn't leak the Climategate emails, which makes one of these two people a fibber and the other a fool. Assange did, later, host the data after the initial leak; and since it doesn't affect the next point, let's just move on.

III.

"Climategate is an interesting case [says the interviewer]. What's the intent that you had when you leaked the Climategate e-mails?"

The truth needs no policy position, so there does not need to be an intent. We have a framework, and the framework has an intent.

Assange believes that truth needs no intent, which is obviously false. Without a context, the truth can mislead. Excluding the context on purpose, when you know that it will be misunderstood, is often as good as lying. This has always been my/everyone's concern about Wikileaks.

But note the interviewer's question: "what's the intent you had?" That sentence is everything that's wrong with the press. Here are the assumptions the interviewer has made:

He assumes Assange believes in "global warming." Why would he assume this? Because Assange is anti-U.S. government. So to the reporter, anti- U.S. government and belief in global warming go together.

If Assange believes in global warming, the interviewer assumes Assange wouldn't want to release those documents because it would hurt the cause. Even though Assange has repeatedly said how he wants "everything" public, the reporter assumes that Assange would only want to release things which complement his own personal biases. In other words, he assumes Assange is going to be like him.

Which is why his incredulous follow-up question is

But if you believed that we had a climate problem, that man was contributing to rising greenhouse gases -- I don't know, do you believe that's a reality?

He's stumped, exasperated. Why would you hurt your own case? I mean.. you don't doubt global warming, do you??????

That's the difference between Wikileaks and the regular press. For the reporter, climate change is not a scientific question, or else it wouldn't matter what cables get released. It's a political one, in which competing narratives are bolstered by circumstantial evidence and appeals to authority and control of the debate.

Assange picks up on this and replies:

I do not think anyone working outside of climate science understands whether that is true or not, because people simply do not understand all the complexities. Rather, instead we look to see who is the most critical voice. What are the motivations behind those people?

Assange just dropped a truth bomb about science, evolution, psychiatry, energy policy, economics, etc: since most people have, at best, a college level understanding of the science but not nearly enough to appraise it themselves, the debate about science is really a political debate -- no, a religious debate -- adorned with the trappings of "measurements" and "data."

I would have preferred we try to "elevate the debate" and talk about primary sources; but he seems to think that won't work on the public.ii So Assange will use intent as a proxy for truth, the closest approximation in the absence of really understanding what's going on.

The reporter thinks that intent is the only thing that matters.

So you publish the truth regardless of what effect it's going to have on the debate? Fair?

Read that quote again. And again. And again. This man represents the Fourth Estate that decides what truth you're allowed to read.

IV.

How can an organization go about doing things it shouldn't do, but wants to?

...we got hold of Guantanamo Bay's main manuals, we discovered that there were sections outlining how to keep information from the Red Cross and how to falsify records in relation to Red Cross visits to detainees. And this really surprised me... who would be foolish enough to put in a military manual that that sort of deliberate fabrication...?

But I came to understand why: that if you have a center that is devising policy, the center of a military [or a] commercial organization, and it wants to have that policy widely implemented, including by grunts, then it needs to go down in writing, because otherwise you just have Chinese whispers occurring, and the grunts can't work out what it is precisely that they are meant to be implementing.

Instead, [the grunts will] conduct behavior that is purely in their own interests, and the central policy gets distorted.

That's what the Cobra Commander thought, too, which is why he structured it like a traditional military operation. Regardless of whether your orders are good or bad, the only way to have them reliably executed is to make them official.

So that's a rather interesting understanding of how organizations really only have two choices to deal with transparency. The first choice is they can simply stop doing things that embarrass the public, so instead of committing an unjust act, commit a just act.

Passiii. What else you got?

The other choice is that they can spend more on their security... they can take things off-record, speak orally and continue with this course of unjust action. But if they do that, they will become inefficient compared to other organizations, and they will shrink in their power and scale. And that's also great because unjust organizations are in economic and political equilibrium and competition with just organizations.iv

It is very easy, very easy, to decide whether what Wikileaks is doing is right or wrong. I don't mean you'll decide correctly, I just mean it only takes you a second to decide. Just like it took you with WMD and climate change.

The hard question to answer is what happens now that Wikileaks is a reality. The wholesale release of secret documents is now part of our cultural foundation, like porn, coffee, cohabitation, English, pants, driving, football. These things will be with us for generations. Assange thinks that this reality itself -- not the documents themselves, but the ability to access secrets, reduces the size and power of governments. Is he right?v

If online porn can be seen as the wholesale leaking of sexual secrets, then its effect on traditional sexuality -- good and badvi -- may serve as an analogy worth pondering.

———One has to wonder : why not ? [↩]Which has always been my own wonderment on the topic : a man who clearly betrays a firm conviction that the public's not worth the price of a decent burial with every move nevertheless pins his longer term survival on some kind of mystical power of the public ? How is the same public incapable to form a meaningful notion of anything important in the general case going to form a meaningful notion of Assange, Assange's personal history, or Assange's life work sufficient to ensure his continued existence ? Is this a superheroes problem or something ? [↩]A stupid place to pass. [↩]This is so fucking stupid, only a postdoc drone could possibly have fucking come up with it. [↩]He is absolutely right -- it reduces the power and size of empires. The republic's doing fine with a very public log, the battlefield of the future reduces in power and size the shitballs of the past, not the dominant agents of the future. How could the very instrument of their dominance do anything else ?! [↩]Quite. [↩]

« thelastpsychiatrist.com - 1 In 5 Cars Has A Personality Disorder. Adnotated.

thelastpsychiatrist.com - 3 Media Narratives About The Middle East You Should Defend Against. Adnotated. »

Category: Adnotations

Sunday, 14 July, Year 11 d.Tr.

thelastpsychiatrist.com - 1 In 5 Cars Has A Personality Disorder. Adnotated.

Almost one in five young American adults has a personality disorder that interferes with everyday life, and even more abuse alcohol or drugs, researchers reported Monday in the most extensive study of its kind.

And the article then becomes a list of every cliche and conflation possible.i Though the article is about personality disorders, they then lament how common "mental problems" in college are, and the need for further treatment. One psychiatrist found the "widespread lack of treatment worrisome... it should alert not only ''students and parents, but also deans and people who run college mental health services about the need to extend access to treatment.''

Here is awesomeness:

Dr. Sharon Hirsch, a University of Chicago psychiatrist not involved in the study, praised it for raising awareness about the problem and the high numbers of affected people who don't get help. Imagine if more than 75 percent of diabetic college students didn't get treatment, Hirsch said. ''Just think about what would be happening on our college campuses.''

Are we still talking about personality disorders?

It has the obligatory references to the Virginia Tech and other shootings. I seem to remember everyone's insistence that those were not due to personality disorders?

Well, I can see that the current crop of adults, age 35-60, I so admire for leading our country into moral, economic, and intellectual greatness, have accurately identified one of the most pressing problems today. Nothing worse than an alcohol abusing, personality disordered college kid. Exactly what Allan Bloom would have thought, or, more accurately, exactly what they think Allan Bloom would have thought, as they can't be bothered to find out.

II.

The NYT is a blog pretending to be a newspaper. It's for adults, or people who want to pretend they're adultsii, who remember as kids that reading the Times meant something that they'd now like to apply to themselves. Now it's Bandwagon of the Month reporting: anyone see any global warming articles recently? Bush is suppressing them, I guess.iii

So the problems it describes must always be of the form: "the other guys who are not you are bad." That's widely perceived as liberal bias, though that's not accurate. It's "not you" bias. The online readership is 37 years old, print 42-- this is the demographic that says, 'College kids are weak and pampered, if I could only go back to college and do it all over again..." [Do] What? Get a physics degree, or date sorority girls? Or both?iv

III.

The article's conflation of "personality disorders" with every other kind of mental illness is a hint that an agenda is lurking. That a popular press article would even bring them up-- previously, everything was bipolar or schizophrenia and not personality disorders (think Virginia Tech)-- means that an agenda is lurking.

That the actual Archives of General Psychiatry study, from which this "1 in 5 Young Adults Has A Personlaity Disorder" news article is based, the one--

Results Almost half of college-aged individuals had a psychiatric disorder in the past year. The overall rate of psychiatric disorders was not different between college-attending individuals and their non-college-attending peers. The unadjusted risk of alcohol use disorders was significantly greater for college students than for their non-college-attending peers (odds ratio=1.25) although not after adjusting for background sociodemographic characteristics. College students were significantly less likely (unadjusted and adjusted) to have a diagnosis of drug use disorder or nicotine dependence... than their non-college-attending peers. Bipolar disorder was less common in individuals attending college. College students were significantly less likely to receive past-year treatment for alcohol or drug use disorders than their non-college-attending peers.

--in which the finding of personality disorder does not even merit a mention in the abstract, so insignificant was that finding to the study itself--

all that means an agenda lurking. You're not being given information, you're being given a worldview. Eat it.

IV.

But let's take it at face value-- 1 in 5 kids 18-21 have a personality disorder.

What's surprising about that is how low it is, considering that many of these "disorders" are normal developmental stages. When your 17 year old stays out past midnight, doesn't call, and then has the nerve to get mad at you for being mad at him -- that may be a discipline problem, but it's not a personality disorder. I get that you're angry, I'm with you, but the solution isn't a psychiatrist. The solution is not to consider that the problem is pathological, but that it is the default behavior that you must help them change.v

Given the move towards infantilizing kids, that personality "disorders" would linger a little past adolescence -- into the sheltered Quad of Prolonged Adolescence U -- is not surprising. What matters is not the availability of treatment, but whether these "disorders" can be expected to resolve themselves naturally as they age, find relationships, jobs, a stable identity.vi Of course they can. Or, more to the point: the bias should be that things are normal, not pathological.

V.

But let's take a philosophical approach. What does having a personality disorder even mean? Can an inanimate object have a personality? Apparently, yes.

In Human Nature: 40 people looked at pictures of cars and had to rate them against 19 traits (gender, maturity, submissiveness, etc.) The subjects consistently identified the same traits among the cars.

"The study confirmed with some rigor what many people have already felt -- that cars seem to have consistent personality traits associated with them"

Obviously, cars don't have personalities, they are inanimate. We attribute personalities to them. No one would dispute this. You might say the cars are designed to elicit certain feelings towards them -- fine -- but the cars themselves do not possess character attributes, they only possess appearances.

Yet in the study, the different subjects -- these are not all genetic clones, they've had different lives and experiences -- still rated the cars as having the same attributes. What does it mean, really mean, when everyone thinks a car is aggressive, or submissive, when it isn't? Think about that, long and hard.

We have internal personality constructs which are completely invalid. That they are hard wired into us, that so many other things are hard wiredvii into us, doesn't make them less invalid. An optical illusion is still an illusion. These are cars. Metal.viii Your mind is tricking you, on purpose. What you saw was wrong.

When you look into the abyss, the abyss looks also into you.

VI.

Surely I'm not saying personality disorders don't exist? Or that people don't have personalities? If you were the Last Man On Earth, you'd still have a personality, right?

Even when you're alone, there's still "another person" present -- that internal dialogue you have with yourself, as another person. You're never truly alone, even if sometimes you don't like the company. And I haven't even brought up one's interaction with God, as epistemiologically unfashionable as that is to talk about nowadays.

All that aside, personality is the interplay between your physical/biological/innate/whatever traits and your life as you experience it (books and movies count); the interaction between you and Others. As such, it can be drastically altered, both by you and by other people, by time and environment, on purpose and not on purpose.

VII.

The consistency in the ratings of personality was, the researchers found, related to the appearance of the car; how far apart the eye/headlights were, etc. In other words, the cars were judged by how they look. "What's inside" the car, how it behaved, wasn't even relevant.

If this is true, how hard will it be for a person to overcome the prejudice based on appearance? How much will they have to overcompensate to make up for it? How strongly will you believe the person is a smart/mature/aggressive/etc, no matter what he actually does? Keep in mind these subjects know what a car is, they know that the appearance of a car does not reflect how it performsix, they know cars don't have personalities, and still they give it certain attributes. How different will that be in people?

How easy will it be to resist simply conforming to the way you are viewed? How hard will it be for one person to say NO to the world, and self-identify? To resist the negative and the positive perceptions of others, in favor of who he decides he wants to be?

Pretty darn near impossible, I should think.x

VIII.

Back to the NYT. I'm sure I'll be disputed, but hear me out: we're entering the age of Keynesian Psychiatry, and the NYT can't contain its ejaculate.

It's an era where "free will" and the normal checks and balances of society and superego are considered ineffective.xi No one can be expected to resist the idxii, and we need our parents to help keep us in control, or bail us out, send us money, when we need it.xiii

We have massive bailouts, where the solution to 30 years of prior deficit spending is -- sit down-- more deficit spending; when the solution to overconsumption and undersaving is -- even more consumption and less saving. Similarly, 30 years of maladaptive behaviors will be treated with -- different maladaptive behaviors.

It's not profits and growth, it's "fiscal stimulus" and "infrastructure development" -- in psychiatry this means less focus on treatment, less focus on "remission," and increased spending on detection, prevention, education -- you're already sick, you just don't know it. This dovetails nicely with the (temporary) death of Big Pharma, who won't be generating any new treatments any time soon. And if it's not obvious why early detection and education is bad: you don't get to decide what kind of detection or what kind of education. Psychiatry does.xiv

So too will there be increased "services" for the "mentally ill"-- redefined as anyone at all who wants the benefitsxv -- even if these services weaken society in the long run. Both are Ponzi schemes built to fix prior, failing Ponzi schemes. They'll fail, just in time for our kids to get drafted.

Just as you see a move towards more government regulation and control, so will you see psychiatry mirror this. Laws will be written and revised, focusing less on punishment while simultaneously emphasizing surveillance. For example: "taking cocaine is a disease, it shouldn't be punished, it should be treated. So let's have mandatory drug testing for everyone 14 and older, you know, for early intervention."

Psychiatry as an arm of social policy means we have accepted society's new mantra: please save me from myself.xvi

———For instance, I'm willing to bet "abuses alcohol" means something asymptotically close to "uses alcohol".

My idea of withering irony is to observe that the current implementation of the old woman lobby, pointlessly if spuriously pretending to "Academia", is strictly retracing the exact same intellectual horizons of the previous edition of the old woman lobby, back then pointlessly if spuriously pretending to "Church"! They're gonna put an end to that devil drink, dontcha know! A one woman mission for the personal salvation of every guy with something better to do than give a shit about stupid old cunts!

Incidentally : are you aware just how much of the pantsuit verbiage, narrative and mythology surrounding "the plight of the Negro" before Obama gave them 40 acres and a mule is simply copied off old Marxist texts penned originally in German and Russian principally between 1910s to 1930, and discussing originally... the plight of the African Negro, at the hands of the Imperial powers (mostly, the weird Belgian personal domain over Congo thing) ? "Translated", incomprehendingly, from Russian, and translated, geographically, into their rural sphere of interest. Sound familiar ?

The last time old women in pantsuits contributed something to the history of ideas the year was counted in triple digits! Fucking remember that. [↩]Which is very much not the same thing at all... [↩]Speaking of which, the lulz unyieldingly continue : Finnish And Japanese Researchers Find Incredible Lack Of Evidence For "Man Made Climate Change" [↩]Except the NY Times "readership" (which is to say, people who pretend to be reading the New York Times, as nobody actually reads the sad thing) never fucked sorority girls, a point made all the more self-evident by the intrinsic contradiction in his formulation : "date" sorority girls ? When the fuck did this happen, mixer ~= orgy and in any case nobody sexually active dated in fucking college, back when sororities and dating were things, which is to say cca 1980. [↩]But isn't that what the psychiatrist does ? [↩]How is one of these marginal kids going to "find jobs" ? There are no more jobs. All that's left are activities, which very much aren't the same thing as jobs : the cage for him and the bed for her.

So no, none of these "disorders" are going to resolve ; pl0x #nowhine [↩]"Hard wired" my foot. Just because the vast majority of English speakers alive today imagine anyone asked the woman anything doesn't mean asking women is "hard wired" ; particularly large conventions, fashions and mores do not become anything more by their expansion just like particularly large organisms do not become immortal through size. [↩]Metal my foot. [↩]I am not so sure these "knowns" are in fact known. These same people could not explain how a refrigerator works, I find it altogether dubious they have a technological, rather than magical, take on vehicular ontology.

Seems rather the case that the same mental processes that gave Diana chastity and Venus sluttery may well give a Toyota bravery, in the same way for the same reasons. "It's there", right ? [↩]I perceive no difficulty ; nor do I recall a time when I did perceive this supposed difficulty.

Psychopathy, rite ? [↩]It's not that they're "considered" ineffective. They are, factually, necessarily and quite readily provably ineffectual. [↩]This is not the matter. [Almost] nobody can be expected to make sense of their surroundings and general context in anything like an actionable timeframe anymore. Complexity explosion driven by cognitive developments coupled with utility dilution (through machine-driven efficiency increases) has resulted in a 90%+ supernumerary species -- there's literally no reason for most people to even be here. [↩]Rather, "we" in the sense of not-me need "your parents" (though the "girlfriend" readily qualifies) to underwrite the very expensive attempt of pretending to keep up with me.

In subsidiary : yes, the female tendency towards magic thinking is very much not driven by the female's own laziness/stupidity/anything else ; but entirely driven by the batshit insane burdens her owner is putting on her -- through the unlikely avenue of not loading her properly. [↩]And by Psychiatry he means "psychiatry". [↩]No, actually, the "benefits" won't last. Already the "benefit" of being part of the great Inca's empire are chiefly poor-er nutrition than the world average. While the victims may defend their victimization furiously, nevertheless nobody actually benefits from participating in any USG-run scheme today, nor has for many, many years. [↩]Rather, it means society's accepted the new reality : there's literally nothing to do with, for, or about the vast majority of extant walkers. As bullets cost turkey dollars, while words can still be had for paper dollars, well... [↩]

« Christos Ballas ("TLP", thelastpsychiatrist.com) archive

thelastpsychiatrist.com - 3 Important Things About The New Wikileaks Controversy. Adnotated. »

Category: Adnotations

Sunday, 14 July, Year 11 d.Tr.

The working philosopher and the what-if philosopher

The working philosopher is a man, in the classical understanding of the term, who manages, day by day and year by year, the two universes dependent upon him and borne of his presence : the harem, and the workshop. The private, and the public, aspects of man's life on this here earth. The first's fulla sluts, the second's fulla grunts -- what precisely "full" means and just how slutty or tame the sluts are, just how capable or useless the grunts are we'll leave to the side. What matters is that the man provides meaning for both these groups ; not merely in the shape of the substance in "Our Lord, our daily bread", but essentially in form.i

What he does is something all-important : in the daily flow of problems, he recognizes the issues encountered for what they truly are, and perpetually makes sure the solutions deployed are derived from the global maximum, and not some local maximumii. He spots the measles and doesn't call them merely "some pox", he spots the chancres and doesn't call them "warts", and this not on the body of his women but on the whole, complexiii and extensive corpus of reality!

Obviously this process will leave him in posession of some notation, scribbles indistinct and incomprehensible, that nevertheless permit him to answer unexpected questions of unbounded domain in a timely manner. This is the philosophy of the working philosopher, a tree that reaches all the way to the core of all things but which nevertheless is kept pruned by mighty strong winds and pressures. The ticking clock, which forces the scribbles into their peculiar shape, the demands of workshop and harem (and therefore, the limits they impose) magically permit reliable structure and also comprehensibility -- because these problems are universal then therefore the working philosopher can spark the gap of being, and understand others -- not merely other men, but also other men's grunts and sluts, rendered to him comprehensible by their fundamental commitments.

The "mandate of heaven", so to speak, is this peculiar relationship with meaning, where one can make the sovereign promise : that whatever any other comes up with, it'll have been included already.

The what-if philosopher is an idle fellow, rather in the vein of the "idea man" ironized in Bitcoin for years (not that it started there), fretting importantly about "what if the pie in the sky had hostile intentions". Whether he's a shy (and fundamentally boring) child, born of the femstate and surviving off its many teats as a friar 2.0iv, or whether he's a deranged (and fundamentally sad) adolescent, "seeking" in poverty and howling confusion as a mendicant monk 2.0v... I suppose the only proper way to describe him would be "a grunt, working in someone's workshop", which readily brings the problem into view : there can not be such a thing as "a grunt's philosophy".

Yes, a man could perhaps pick up what the grunts grunted out, and from those disparate and by themselves deeply useless and entirely meaningless parts fashion himself a philosophy. But only a man could! "A man, Jerry! People with jobs! And secretaries!"

So no, there's entirely no reason to fret about things like say the French "public intellectual", the Derridas and Baudrillards of this world. There's no such thing, and pretense to the contrary howsoever buttressed doesn't resolve the problem. We were discussing "cool" in the harem the other day, and they pressed me to come up with someone I think was cool. I had never considered the matter, or in any case not in a while long enough to have meanwhile forgotten what results if any the consideration might've produced, but as I was dithering through the ample space trying to organize myself I idly mentioned -- to their shock -- that it couldn't be a musician.

It can't be one, rockstars aren't cool enough to be cool. You see ? "Fans" isn't on the "sluts", "grunts" list, and the fundamental problem with Cocksucker Blues as with the other, many, countless attempts at faking being me without actually being me is always the exact same : they didn't own those whores, did they ?

Howsoever reproduced, as an "elected representative" or "public intellectual" or whatever else -- the rockstar fundamentally isn't cool enough. He's not important anyway, what's important is philosophy : the problems rockstars encounter in their quest to meaning, doomed to failure from the onset as it is, are indicative of a problem with the rockstars in question! Their model's broken, they're defective series products. If some dork keeps trying to skate and keeps falling on his dumb head, or consistently breaks one of his four noodly appendages, the conclusion isn't, nor ever could possibly be, that "there's something wrong with skating". Skating's fine, it enacts a partition in the world : between they who can, and they who can not.

A stone stands, context irrespective -- whether you think "it stands in the forest" or "it stands in the parking lot behind Olive Garden" is entirely irrelevant. Some touch it and it hums, some touch it and nothing happens. Just because every time a schmuck in "office appropriate attire" touches it nothing happens doesn't say something about the stone!

———Now tell me which of these two's the ousia.

No, but seriously, consider : the substance's subordinate. The form's dominant, and more important. A crust of bread will be found for all whores as for all knaves. That much's a given, and therefore unimportant. What matters is the how, specifically how was the crust found, and what that finding means, and what that finding stands for. The forms of the finding stand above the substance of the finding, because the substance's given implicitly -- what lives will have sustenance, and daily, and of its exact kind -- whereas the form's left libre to signify.

Thus what's essential is the form, not the substance. Now tell me how you translate ousia. [↩]It's not really this simple -- if it were, everyone'd be doing it. In a quest for expressive precision, doomed to failure from the onset as we find ourselves, we could nevertheless attempt "maintains the communication with the global maximum open", as a second approximation.

You know, like if you were playing Bridge, the card game. Gotta keep communication and control, right ? [↩]Understand : no one's safeguard from the whore's conundrum ; nor I. The day he said that and I failed to say my piece in response is the day I fail ; and contrary to what "everyone" thinks, everyone's life is composed entirely (and to the shining exclusion of all else) out of exactly such failure. The objection to one, pick one, any one -- RMS, say, or the golden bolix boys or whatever you might pick -- is precisely that they failed this one, first, foremost and only job, duty and constitutive substance of the existence of man on Earth. [↩]These prefer being called "academics", notwithstanding that is the one thing they are not. [↩]These prefer being called many things I've not the patience to delineate. [↩]

« Well, since I started, might as well...

Platoon »

Category: Cocietate si Sultura

Wednesday, 27 February, Year 11 d.Tr.