thelastpsychiatrist.com - "Because I Said So". Adnotated.

I have written endlessly about how language controls psychiatric thought, and that it will be impossible for psychiatry to progress while semiotics trumps science. Here is a recent example:

In the Oct 2006 JCP, there is an article about the efficacy of Depakote ER for acute mania.

As I read the introduction to this useless paper, I get kicked in the throat by this:

"Currently approved treatments of the acute manic phase of bipolar disorder can be categorized primarily as mood stabilizers (e.g. divalproex sodium, lithium, and carbamazepine) or as atypical antipsychotics (i.e. aripiprazole, olanzapine, quetiapine, risperidone, and ziprasidone. (5)"

Note carefully that the authors have taken a set of medications and artificially divided them into "mood stabilizers" OR "antipsychotics." Ok, well, wouldn't it be great if reference 5 actually justified this? Using data or logic? Well, it doesn't.

But the damage has been done. Unless you have a computer with FIOS and three monitors and are reading every reference, a quick skim registers that there is a reference, which you assume has been checked, and move on. In fact, the authors here don't even feel that a reference is necessary -- everyone knows what a mood stabilizer is. It's too basic to even reference.

So, is there any reason that seizure drugs are "mood stabilizers" (read: prophylactic) while antipsychotics are not? For antipsychotics, is there anything about their pharmacology, half-life, color, or pill size that a priori exclude them from the "mood stabilizer" category while including the seizure meds?

The artificiality of the terminology is confirmed when you actually look at the data: the only drugs listed here which actually are "mood stabilizers" are lithium, olanzapine and aripirazole (over 6 months).

A study may eventually show Depakote is a mood stabilizer after all, but that's not my point. My issue is that in the absence of data or logical necessity, how can we take an arbitrary set of names and make unjustified deductions?

This is the semiotic trap of psychiatry. It doesn't actually matter what the data says (e.g. Depakote is not a mood stabilizer, Zypexa is), what matters is the language, the categories. This isn't science. Just because there are graphs and chi-squareds, doesn't make it science. There's no science here at all. At best it is linguisitics. At worst, propaganda.i

I'm not saying they are lying. It's worse than that. It's the structure of psychiatry. It's a subtle manipulation of reality to make people believe what you "already know" to be true. They are trying to convey a perspective, not report a finding. For example, later on the authors try to make the point that higher levels correlate with efficacy, but go too high and you get toxicity:

One analysis noted that serum valproate concentrations between 45-125 ug/ml were associated with efficacy, while serum valproate concentrations > 125 ug/ml were associated with an increased frequency of adverse effects. 19

This isn't what reference 19 says, exactly. What it says is that 45 is a pivot point; below it is not as good as above it. But it doesn't say that higher and higher levels give you better and better efficacy. What makes the omission of this rather important clarification all the more perplexing is that reference 19 was written by the same authors as this article.

But the damage has been done, again. Now you think you have read a statement in support of what you already assumed to be true. So you push the level.

You may argue that I am misinterpreting the author's words, that he never implied that efficacy had a linear relationship with level. Ok: prior to reading this blog, did you think that there was? Where did you learn that? Did you pull it out of the ether? No -- you skimmed articles like these that left you with half-truths, and never questioned it because everyone knows this already.

Let me show you what I mean. Here's the relationship of the Depakote level to maintenance treatment:

Higher serum levels were modestly but significantly correlated with less effective control of manic symptoms in a maintenance study. The study therefore supports a somewhat lower serum level range for maintenance treatment than for treatment of mania.

Did you know that? That the efficacy decreases as the level increases? I'm not asking if you believe it, I'm asking if you had ever heard it. Because if the answer is no, then there is something very, very wrong with the way we convey our knowledge. *

-------------------

*Contrary to the opinions of former girlfriends, I am not an idiot. I can plausibly explain this odd finding: the most manic patients got higher and higher doses, so the least responsive ended up getting the highest doses and levels. So it looks like higher levels were associated with decreased efficacy, when really the highest doses went to the sickest people. Ok, good explanation. But this supports my earlier point: you can't take something which requires a post hoc justification and use it to make a leap in logic to conclude something else.

———Rather, it's all astrology. How do you divide some arbitrary signs into "water" and "fire" ? "By observation", right ?

Classical astrology had way the fuck better studies (not to mention immensely more the fuck studies) behind it than USGistani "psychiatry" ever will. Think about it -- the zoromagi had ten centuries + to "make observations", which they did. There was no TV then, and not much else to do with one's time. [↩]

« thelastpsychiatrist.com - Bait And Switch: Surveillance Movie Review. Adnotated.

Etude en foodes »

Category: Adnotations

Friday, 09 August, Year 11 d.Tr.

thelastpsychiatrist.com - Bait And Switch: Surveillance Movie Review. Adnotated.

I saw the movie Surveillance.

As bad as it was, the movie wasn't the problem. The problem was the trick they used to get me to see it.

I spoil nothing in telling you that if you can't guess the entire plot in the first nine seconds of the movie then this review won't help you because you probably have had a stroke.

It is about two masked serial killers, the kind whose main ability is to remain totally calm the way no one ever is even when asleepi, while their victims cry, stumble, make astounding errors in judgment and never, ever fight back.

Two FBI agents travel out to interview (the only three) surviving witnesses of a 6 person gore fest mediated by stupidity. The agents place the three stereotypes -- a cop, a junkie, and a little girl, what else -- in separate rooms, and set up cameras to monitor all three simultaneous interviews. The idea is that witnesses are unreliable, or, as the director put it in an interview -- and you're going to want to sit down for this -- versions of the truth change when you are being watched.

I know, I know.

So why tell this story? Why should the audience want to see it? The director explains:

I haven't seen a serial killer film the way I want to see a serial killer film and I want to confuse people about what good and bad look like. I want to break that 'book by its cover' mode and play with that."

Because no one ever suspects "the guy you least suspect."

II.

The problem is we aren't watching it because we think the director made a new kind of serial killer movie. We aren't even watching it because we like serial killer movies. We are watching it because the director is David Lynch's daughter, and David Lynch himself is the executive producer.

We're hoping this is going to be like Twin Peaks II.

"But the funny thing isii, he had nothing at all to do with it," Jennifer Lynch says.

It's your movie, I get it. I know it's hard to come out from a famous parent's shadow and find your own voice, and I'm sure she doesn't want people assuming this is a David Lynch movie, but can you blame us? It's not like anyone makes any attempts at hiding David Lynch's involvement. In fact, they take extra special care to bludgeon you in the face with it.iii

Here's how a woman who wants to be her own kind of director with her own creative vision distances herself from her father: first, she would change her and David's name to pseudonyms or hide them altogether and make the movie posters as different as possible:iv

She would cast people who are as un-David Lynch as possible, who invoke in your imagination completely different kinds of movies. Actors who have never even seen a David Lynch movie, let alone been in one. As an example, she would be very careful to not cast Bill Pullman and Julia Ormond because, well, you know.

shh... I'm Bruce Willis... and there's a plot twist coming

She would be careful not to shoot scenes or images that call to mind any of her father's work :

or choosev to feature objects that have symbolic importance to her father:

And putting a haunting image of a disfigured/masked face coming out of the darkness; ethereal sounds, inaudible whispers -- all those are completely out of the question

Whose movie did she think we were going to see? I'm not saying that Jennifer Lynch has to make movies like David Lynch; nor am I saying I expect her movies to be like David Lynch's, except in the single circumstance that she goes out of her way to tell me it is a David Lynch movie, and make it look like a David Lynch movie.

Which, again, is fine -- but then actually make a David Lynch movie. No. Instead, she doubles back and makes the most obvious, conventional movie possible given the budget. This movie is more linear and predictable than The Honeymooners.

Again:

"But the funny thing is, he had nothing at all to do with it," Jennifer Lynch says

I can see that. That's the problem.vi

In fact, the key stylistic difference between the two Lynches is that Jennifer shoots careful, focused scenes that are incomprehensibly irrelevant to the story.

At first I thought such shots were simply mistakes? but then I read her description of the two killers:

How did you want to see a serial killer film in ways we hadn't seen a serial killer film before?

JENNIFER LYNCH: I hadn't really seen one that had what I considered to be a real examination of how messed up violence and sex and stuff get because the people who hurt have been hurt themselves.vii Although I don't pinpoint those moments for our characters, I felt like I got an opportunity in the end to examine just how awful and confused that moment became for both of them and that these two killers were never thought of, in my opinion, as anything other than wounds or failures or victims or criminals until they saw each other and then they met each other and decided this was how they were going to live their lives until they couldn't anymore and what a nightmarish thing that is and yet how in love they are and just that dark mess.

I don't know what movie she is talking about, maybe Natural Born Killers or Finding Nemo, but it certainly wasn't Surveillance. Is it possible the actors and camera guys were working off a different script?

What kind of back story did you envision for these characters? How long do you think they've been at it? How do you think they met?

JENNIFER LYNCH: I think they've been at it for about 8 months in my head. They've been in love for a while but it's a new love. I wanted each of them to write a love note to each other in case something went terribly wrong. If not literally keep it in their back pockets, then imagine that note in their back pockets.viii

I'd like to see that movie if she ever decides to make it, it sounds awesome.ix Meanwhile, what? The Transformers? If this is really about understanding the characters, getting into their heads and asking questions they might ask, then explain why it is that a 8 year old girl who watches her family get butchered and then figures out the killers are the FBI agents shows no emotion whatsoever? She's not sad, she's not terrified. She actually says this: "I can go to the bathroom by myself-- I'm almost 9!" Maybe she's in shock? Maybe she's retarded? We'll never know.x

At one point-- right after she asks to go to the bathroom, amazingly-- she has the FBI agent/killer bend down so she can whisper, "I know who you are" in his ear. She does not bite it off and run.

When she escapes, she does not use the police radio or the phone or a hand grenade. She does, however, teleport herself out of the police station and into a field far away, taking only a white bag that I must assume contains oranges. Why oranges? Exactly.

III.

I know playing "here's what would have made the movie a thousand times better" is a fool's game, but if you're making a movie called Surveillance, it should occur to the characters, not to mention the director, to make some use of the actual surveillance cameras which are mounted in the police cars.

You might say, "well, maybe she didn't know cop cars had cameras in them." This isn't a comic book where the author has to imagine what might be in a police car, in the same way he has to imagine what a woman looks like in spandex.xi Unlike said comic book guy, the director and the actors have physical possession of a cop car.

"I hope the camera doesn't capture me missing an unarmed guy five times and then getting hit in the head from behind by the other guy who snuck up on me in this wide open field on a clear day with no noise"

The problem with Surveillance isn't that it is a bad moviexii-- the story will be formulaic and predictable for anyone over 16, but the directing is solid-- but that it, she, is suffering from an identity crisis. Who does she want to be? Carry on her father's work, or go a different way? How does she want other people to think of her? This movie was less a character exploration of two killers than a "trying on of identities" for the director.

Many of David Lynch's movies can be thought of, and interpreted as, dreams. The events, people, and objects are symbols for other things. The movie/dreams don't tell a story, they convey emotion, resistances, information about the dreamer.

Maybe this is a David Lynch movie after all.xiii

———People who don't give a shit are ; sleep don't enter into it. What... does... the author... want to be true ?

Caring is failing.

Caring is failing. It is. Now, who's claiming the opposite, and why would they ? Hm ? [↩]Not merely not at all funny ; but using "funny" as code for an "accept this nonsense as true" imperative within the structure of typically pantsuit power-of-suspension-of-disbelief attempted handshakes marks her as the worst kind of fucktard just like "Sir, I will need you to..." marks out the lowly USGistani bureaucrat.

Peggy made David a retard. [↩]Yes, but "that was someone else". See, pantsuitist factitious alt-realities work divisibly : if there are any bad results they charge that a few persons, working against them, ruined their plans; but if there is a good result, they take the credit for themselves. The marketeer advertising Jen's father worked without Jen's permission in the context of it not being Jen's film, and with Jen's permission in the context of the film being sold. That Jen can separate these two is the foremost promise of pantsuitism. [↩]Actually, no. In the insane logic of pantsuitism, taking a measure against something validates the existence of that something, therefore "proving" culpability on the part of the agent. The only acceptable "action" in pantsuitism is non-agency, therefore she has to completely ignore the glaringly obvious facts of the matter. This then comes with the side benefit that nobody could accuse her of being daddy's glorified beautician. [↩]Motherfucker went to all the trouble to copy/paste images in fucking ms-paint, yet he still made them 35 x 16 pixesl. God damn it... [↩]In other lulz, he actualy has a

<img src="file:///C:/DOCUME%7E1/C/LOCALS%7E1/Temp/moz-screenshot-8.jpg" alt="" />

included at this point, if you can believe this. I'll spare you the rest of his terribly executed illustration ideas in this article. [↩]Can you believe how fucking stupid she is ? I don't mean, smart, but dumb. I mean outright fucking stupid, no light flickering behind the eyes at all, just a barely functioning meat-powered shannonizer. [↩]Or maybe they could secretly mail it to postsecret, right ? That's just about the timeperiod, and moreover, it's precisely the etsy retard cultural sphere. It's truly a wonder class isn't "a subtext of the show", but maybe in time. [↩]No it very well fucking doesn't. [↩]Maybe she's Jenny Sue, an imaginary little girl of no real consequence who spends a lot of time "thinking" herself important. Like so :

I sit and dream for hours about me as a fairy godmother or me as a star or me as Sinatra's wife.

I'll spare you the shots of an ugly fat frog in the buff. [↩]Zzzzing. [↩]Are you fucking kidding me ?! [↩]Or maybe Ballas would benefit immensely from reading some film reviews written by people who actually know how to write film reviews. [↩]

« thelastpsychiatrist.com - Bad At Math. Adnotated.

thelastpsychiatrist.com - "Because I Said So". Adnotated. »

Category: Adnotations

Thursday, 08 August, Year 11 d.Tr.

thelastpsychiatrist.com - Bad At Math. Adnotated.

i

how much is this worth

The doctor was at work doing the usual, which means patients, and a 20 year old hispanic man bursts through the door and right away the doctor knew he was in big, big trouble.ii

The man wore sunglasses, the kind of one solid plastic band around the eyes that you don't wear unless you're insane.iii He locks the door behind him and shouts, "if you give me any shit, I'm going to fucking kill you."iv That was his opening line, the next few lines were derivatives of the same.

He was yelling in English, but at about three threats in he says, "I want a translator--" so he opens the door and the secretary (hispanic) that had come to the door to see what the yelling was about steps in, no, he pulls her in, locks the door again, and goes back to yelling. "You're fucking dead, do you hear me? Fucking dead!"

One other thing: he has a gun.

Putting it together later, yes, there will be a later, the doctor had seen that man, Juan, once before. He had demanded Xanax max dose three times a day, and in the subsequent negotiations it was agreed that as long as the guy could provide clean urines he could get one Xanax half dose a day, along with the other medications. Deal? Deal. So he got a script for 14 days, "come back then and we'll see how things are."

Somehow Juan had taken the 14 tablets as a personal insult, he expected 90, even though it was clear that it was only for two weeks, and however he figured it in his brain the doctor was screwing him. So he came back -- three months later -- looking to show the doctor he messed with the wrong guy. "You think you're going to play me?"

The room they were in was the size of a large closet, about 8x8 square.v The door opened inwards, then there's a desk, and then the doctor -- so the desk is in between the doctor and the door. The waiting room is full and it's right outside that door, so everyone can hear the yelling, but no one can see the gun. Not yet, anyway.

The problem, logistically, was that even if the doctor wanted to jump him, he couldn't -- Juan is blocking the door, and the desk is between them.vi If he comes over to hit him, then they're closevii, but with that desk in between, the doctor was completely at his mercy.

The other problem, the GIGANTIC problem, is now there's a woman in there with them, and she can't get out because she would have to open the door into herself (she'd end up behind the open door) and then move towards him to get out.

Patients yelling at the doctor to give them Xanax is nothing new -- they threaten, they yell, they posture, and it's all part of the game. The doctor had always played the game respectfully, cool, calm, no anger, and he let them, nonverbally, understand that he respected the power that they had -- if they wanted to, they could kill him -- but that the job is the job, nothing personal, you're not getting Xanax not because I hate you but simply because I don't think it's right. And he let them know that he'd do whatever else he could for them. Sure some people left angry, but they left.viii

And when they yelled he let them, let them go on for so that they felt like they had delivered their message, and eventually cut them off; ultimately they just need to feel that they chose to let him go, not that they were turned away or rejected but that it was their choice to move on, and when they left that would be the end. It happened about once a week to him and all the other doctors, it's just the nature of the businessix and there's no billing code for "pissed off xanax seeking guy."

But this guy was different, this guy wasn't looking to get something. This guy came with the specific intention of killing him, he wasn't looking for more xanax or anything else.x

And he wasn't psychotic, he was logical, specific -- just very threatening. "You think I'm playing?" "I'm going to tell you what's what." "You think you know me?" Every gangbanger movie cliche, as if he was reading from a scriptxi, but if that guy stayed true to his character then this was going to end very badly.

So Juan locks them all in, and she's scared, and the doctor is scared. Because now, with her there, he was completely sure he meant to kill them.xii Before she came in, it was between him and Juan only, and he might be able to talk him down, but when Juan brought her in it was clear he wasn't worried about being caught or identified or collateral damage, he just wanted to kill.xiii

So he yells for about 30 seconds (it felt like an hour) and then the doctor tells him that perhaps he can get him some Klonopin, which is a lot like Xanax. The Klonopin was incidental to the argument, but he figured that if he could get this maniac to focus on something concrete, turn it into a treatment or at the very least a transaction, in which he could be "given" something, the guy might back down just enough to not kill everyone.

But the problem was the woman. She was scared but also... irrational. Would she try and run? Would she try something stupid?xiv Was he going to kill her, too? He had to get her out.

So the doctor turns to Juan and says, "but I need your insurance card to make sure I can give you Klonopin." That was a lie, but it was a distraction, turn the focus to something else.xv Juan gets his wallet out muttering, "he wants my card now, my card, this fucking (something) wants my card." And he gives it to the doctor, and the doctor hands it right to the woman and says, "I need a copy of this immediately. Immediately." She hesitates, she's unsure, she moves towards the door slowly but Juan lets her pass. Thank God, he thinks. It's going to be okay.

Wrong. As soon as Juan closes the door behind him, he goes ballistic. It was like he remembered what he was there for. "You fucking [this], I'm going to fucking [that]!" and etc. Whereas before he was waving the gun aroundxvi, now he kept his arm locked, gun pointing towards the floor. He's still yelling, cursing, threatening. The gun is there and it's pointing down and it's simply waiting for him to decide to raise it.

Again, even if the doctor could disarm him, he can't because of the desk. He can't throw anything, there's nothing else on the desk. He can't run. If he stands up, he'll get shot in the chest. If he ducks down, it forces Juan to lean over the desk, which means he'll get shot in the back of the head or the spine.xvii

This was the plan: turn to the side and let him shoot him in the shoulder or arm.xviii

What did he think about? He thought about his kids, how sad they'd be that their father was dead.xix They would cry.xx He thought about how this nut would eventually get caught and the kids would have to face the man who did it and listen to his words and the words of everyone else. The kids would have to look around at an insane world that tried to explain everything with lies. And then they'd have to go home and grow up. "That's life," someone would tell them, because it's true and that helps.xxi

He also thought about how stupid this guy was, how terrible he was at valuing things, he had decided that his life was worth throwing away over... what?xxii He wasn't stealing his car, there wasn't anything of value at stake. Xanax? He could have gotten it anywhere else, easily, anytime. Revenge? It wasn't like the doctor had raped his sister, he had just not given him something. But somehow in his calculus this grudge was worth carrying for three months, worth killing someone over, worth 25 years in jail. This wasn't psychosis, this was a man who was bad at math.xxiii

The plan is to give him the shoulder, take it in the shoulder, and not turn, not go down.

Then the woman comes BACK. What caused this woman to come back is unknowablexxiv, but she opens the door and it bumps him because he's in front of it. So he turns around to see who's coming in and he grabs the paper out of her hand and he sort of flings it at the doctor.

But everything is different now, because the door is wide open, and everyone in the waiting room can see them.

So the doctor, as calmly and with as much authority as he can muster, looks at the paper and says "ok, I can give you 30 tablets of Klonopin with this." He tried to make it sound like that was what they had been talking about the whole time, a treatment, a transaction. It wasn't about the doctor, it was about the pills.

Juan reflexively says, "no, Xanax," and the doctor responds, "no, all I can give you without a urine (drug test) is Klonopin,"xxv and Jaun says, "I want 90 of them." And the doctor says, "only after the urine."

Whatever calm exterior he displayed was not mirrored on the inside, and while he was trying to show steady penmanship he made a mistake- and he wrote Xanax instead of Klonopin. It just came out. So now Juan sees the doctor writing that, and the doctor has to decide if he was going to give it to him that way or not. But if the reason he was still alive was that he had turned it from something personal into a treatment, then handing him the Xanax was an admission that it was, after all, not a treatment but a stick up. And maybe that would remind Juan that the doctor had screwed him the first time. So the doctor says, out loud, "dammit," tears up the script and rewrites it. Doing the job correctly.xxvi

Juan took it, made a few more threats, and left. 20 minutes after that the police finally came, and while they were there he called the clinic and said he was coming back to kill the doctor because he only got 30 tablets. A man who is terrible at math.

When the doctor went back to see the patients who stuck around, all of them, men and women, told him the same thing: "Yo, man, I had your back, if anything happened, I was going to bust in here." Of course they would have.xxvii

What's unsettling, however, is that Juan had been in the waiting room for an hour before the doctor even got there, muttering to other people that he was going to "fuck him up." But no one said anything.

There's not much more to the story, except that the doctor went home, felt a little shaken, had a drink or three, debriefedxxviii with some people and not with others, and eventually 3am came and he went to bed. And when he woke up it was gone, merely a memory, it all felt like it happened a decade ago. That's life.

———Holy shit, we made it to the Bs! 68 done, 630 to go, 10% here I come!

(We're actually slightly over the 10% mark by bytecount, which I suppose shows the great power of statistics : notwithstanding that his articles are all over the place, lengthwise, all that's really needed is a few dozen sample out of a few grosse total to obtain very close fit between article count and character count.) [↩]Hispanic, amirite.

No kidding, for some reason big town practicing psychiatrists are at risk from deranged Latino dudes like big town convenience store clerks are at risk from unintelligent black dudes. Coincidences everywhere. [↩]How's that for a dead fucking culture -- they don't even have a word to denote that thing. They use it, they make it, they just don't know what it's called. Suppose you go into a shop and wish to communicate the item to the clerk, what word do you use ? There's words for soup and stu, to distinguish soup and stu ; there's words for car and truck, to distinguish cars and trucks. You don't walk on a lot and start gesturing, "I need vehicle, like this but big and with dump trunk", do you ?

Well ? [↩]Pro tip : "I'm going to fucking kill you" almost never means he'll kill you. [↩]And here I thought they made bank in USGistani bureaucratic services! [↩]Herpitty derp, Ballas was about to kung-fu the puerto rican, if only his feet weren't glued to the floor by those darn kids such that he just couldn't sidle discreetly that way while talking to the horse. [↩]Or rather : if he asks the time and you punch him, someone could accuse you, but if you wait for him to punch first then nobody could accuse you, this "could accuse" nonsense being the only actually important part in dreamer ideology.

PS. Look at that, first logs.nosuchlabs linkage! Mazel Tov! [↩]This is so fucking naive, I don't even see it's worth approaching. As the expression goes, the fish may throw up no matter how many meters of line, but never the hook. [↩]The "business", rather. It's the nature of being female and trying to build socialism.

What, psychiatry can't exist practiced by men, that's the fantasy here ? Gimme a break, back then it actually somewhat worked. [↩]Sounds rather like dominance than any specific intention to murder him (which is definitionally a sex crime). The guy came in with a vague, non-verbalized intention to dent the femstate, but lacking for better strategy or any leadership he just ended up ineffectually hassling some lowly USGistani bureaucrat instead. [↩]Part and parcel of the socialist script is to misrepresent anything not in their script as... a script. It well fucking isn't. [↩]This is such fucking nonsense... Seriously, what forensic psychologist looks at this description and draws the same conclusions, I wish to fucking see this wonder. How do they reason ?

Leaving aside how the dude's sliding all over the place -- first Juan wanted to kill him, now he wants to kill them, which is exactly not how the fuck any of this works... There's precisely zero percent chance dominance crimes end up with a compliant female dead just as there's precisely zero percent chance sexual crimes end up with a compliant male dead.

As a matter of fact, amply documented without counterexample in the lengthy history of breaking the law, if the response of the female shop clerk being held up (ie, dominance crime) is overtly sexual ("Oh maaan... you're so fucking cool... I think I'm in love. May I suck you off ?") the would-be perp will likely be too confused to carry on his original intention in the first place ; but the woman is certainly not getting hurt. (And spare me the "these don't exist" moronisms. Of course they do ; more so than you exist, in any case.)

Contrarywise, if the male half of a couple being home invaded (sex crime kind of home invasion) eggs on the attackers, providing assistance and helpful hints, they'll likely not stop, but they'll also likely take him along next time they go for a spot of fun. He's sure as fuck not getting hurt, not even a little.

The dominance and sexual pathways for paroxistic behaviour are very well separate in normal humans. It's true that abnormal humans also exist, and that in some vanishingly rare cases might confuse the two (this is so unlikely in reality, especially if you're talking functional as opposed to catatonic abnormal humans, that you're stuck taking for a mental model the shy homosexual in Dog Day Afternoon) -- but these almost never act alone, they're always someone's sidekick. Not to say "almost never" means "never" -- Tarantino's villain (Gandolfini) in True Romance is so fucking scary specifically and precisely because he does confuse the two, and he is functional, and he does act alone. Have you noticed we're stuck with discussing constructed, synthetic beings ? You're not going to meet one of these. Not in this life. [↩]No, actually, he just wanted to express his dominance over the field. They don't train psychologists these days, I take it ?

Someone who just wants to kill takes two SMGs into subway during rush hour, goes into a middle car sorta midway, opens fire between stations taking care to mow down everyone in his car, drops the guns and runs off through the door yelling and screaming bloody murder. Good fucking luck even distinguishing the one excited maniac from the rest of them coming through the tunnel, let alone ever pinning it on him. Oh, wait... actually... the sheeple've been trained to stay in the car should this occur, yes ? Guess why.

Juan just wants nobody to give him any shit, what's so hard to grok about this ? Or rather -- why does the author want to pretend something this simple is nevertheless overwhelming his powers of comprehension ? New slavegirls try this "not understanding" tack too, you know ? Before sufficient beatings inform their basal ganglia of the unwiseness of this course of pretense, that is. [↩]The irony of socialism is that while it is modeled after the worst qualities of women, it's always modeled by men. Women don't like it, don't feel well in it, want no part of it. Consequently the sort of men that tend towards socialism also tend to distrust them

Thursday, 08 August, Year 11 d.Tr.

thelastpsychiatrist.com - Autism and The MMR Vaccine. Adnotated.

Just as I was writing about the consequences of ideological bias in autism research...

Mea culpa, I will admit that I never read the primary sources either. If I had, this blog would not exist, I would have quit psychiatry in 1998 and opened a bar called Cougars and made a fortune.i

In case you do not have kids or ears, there's a controversy about whether the combination measles-mumps-rubella vaccine causes autism. The controversy arose from the observation that previously normal kids began to regress soon after receiving the vaccine.

If you had only a rudimentary understanding of the facts (e.g. most doctors, including me) and were trying to create an explanation, you would have intuited that it is either the virus in the vaccine, or perhaps you would have recalled the word "thimerosal," a mercury containing preservative in vaccines, which has also been linked to autism.

And you would have left it at that; on the one hand is the association, on the other hand is "the published literature" (or what you heard is the published literature) saying there is "no evidence of a causal link." (Well of course, they have to say that.)

And then approaches the peon with the autistic child, who, recognizing the limitations on medical science doesn't expect you to have a solution, but is hoping at least for a legitimate explanation. Your reply to this peon, who dares to ask a Medical Professional (expecting an insider's view of the data and an educated opinion, and not expecting you to simply make stuff up based on what you heard on CNN) is: "there've been some reports, but we simply don't know enough to blame the vaccine outright."

At this point, three things should have happened:

1. You should have wondered if "there've" is really a word, or if you just made it up. Maybe you just threw two words together that sounded like they fit? That's a metaphor for everything else you said.

2. You should have realized that you don't actually know if it is the MMR vaccine, or vaccines in general, that are the alleged cause of autism; and that you aren't even sure if there was/is any thimerosal in the MMR vaccine to begin with.ii

3. Your ignorance of contractions and medical information did not prevent you from spewing vague crap to your wide-eyed inquisitor; nor did it prevent them from believing you.

II.

It won't be giving anything away to tell you that the evidence for the link is absolutely laughable. But take a step back and look at the controversy itself. "Is it vaccines?" ---No, it isn't. ---Yes it is. ---No it isn't. The controversy is so powerful not because it's about vaccines, but because engaging in the controversy serves a more important function: the reinforcement of an ideological bias: "we don't have definitive evidence that the culprit is the MMR vaccine -- it looks like it is, but it may be something else. But definitely it is something that happens after birth."iii

III.

The controversy exploded with the publication of a single paper, Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. The title is not one that would be expected to herald a 10 year ideological war, but there you go.

First: the title of the paper that launched a million other papersiv, you'll observe, does not contain the following words: vaccine, thimerosal, MMR, combination. We'll get back to this.

The actual evidence is this case series of 12 kids who developed autistic features shortly after receiving the MMR vaccine. The entire basis for the link is this single sentence:

In eight children, the onset of behavioural problems had been linked, either by the parents or by the child's physician, with measles, mumps, and rubella vaccination.

That's it. If you're looking for something more solid than "parents or the child's physician" linking the two together, you're going to be disappointed.v

You'd think that wouldn't be enough to merit a publication in Lancet, let alone a controversy. Let alone a substantial decrease in vaccination rates.

However, the focus on this extra, tertiary observation masked the real point of the paper, which was observing a relationship between -- read the title -- bowel inflammation and autism.

Get it?

No? Then it worked. You're not supposed to focus on it -- it's supposed to become unconscious.

Still confused?

Bowel inflammation is not natural; in other words,

Both the presence of intestinal inflammation and absence of detectable neurological abnormality in our children are consistent with an exogenous influence upon cerebral function.

That something could be anything, and the bowel involvement suggests maybe it's something you eat -- indeed, the authors suggest the possibility that it is certain foods (grains), casein from dairy, B12 deficiency.

They also list the other exogenous possibilities, including viruses. And then there's the vaccine.

But what's important here is the understanding that the inflammation means it's exogenous. What's important is that the belief that it is exogenous become axiomatic.

III.

"But wait, couldn't bowel inflammation simply be another sign of autism, not the cause? Couldn't the, say, genetic cause of autism also cause coincident bowel inflammation?"

Of course, but as long as the controversy is about the vaccine as cause, then it isn't about bowel inflammation as cause; and as long as we are not arguing about whether the bowel infammation is the cause, then we are certainly not arguing about whether something exogenous is the cause. We are quite likely to simply internalize the something-exogenous-as-cause link.

"You're kidding, right? You think people are that stupid to fall for that?"

IV.

So what do we do? Well, it was one popular recommendation that if the vaccines must be given, they be given separately, not as the combined MMR. This recommendation came right from the lead author, Dr. Wakefield, in a press conference after the study's publication.

It's sleight of hand; blink you missed it. He took it up a step; the controversy has now become whether the combined vaccine is the cause, not whether a vaccine is the cause -- despite none of this appearing anywehere in the study. Wakefield made this the controversy, out of thin air. And everyone fell for it.

"What do you mean? Not everyone believed it." That's not the point, right? The point is to make the MMR the focus, allowing an exogenous case to become our default understanding.vi

It is so infective, this bias, this groupthink, that the highlighted CDC recommendations about the vaccine which are supposed to allay fears reads:

The MMR vaccine protects against dangerous, even deadly, diseases.

The most common adverse events following the MMR vaccine are pain where the vaccine is given, fever, a mild rash, and swollen glands in the cheeks or neck.

No published scientific evidence shows any benefit in separating the combination MMR vaccine into three individual shots.

V.

"Surely the Lancet tried to do something about this?"

Ha! Don't be ridiculous. They were far too busy studying social justice and peer reviewing "America 2004: voting for a decent global society." I'll spare you the read: vote Kerry.

Ok, that's not entirely fair on my part. In fact, the Lancet and other medical groups/journals/individuals were highly critical of the paper. Not critical of the results, but rather of the fact that Wakefield didn't disclose he had been previously retained as an expert in a lawsuit against the MMR manufacturer.

Before you jump onto that wagon, ask yourself: is that the single piece of missing information that would have revealed this study to be silly? Knowing that would have made them reject the paper? Is not knowing he was connected to lawyers the reason the entire planet missed the lack of connection between his verbal statement "separate the three vaccines" and his own study to which he was referring?

Is money the only red flag for these idiots?

VI.

If I had to come up with a punch line for all this, I couldn't do better than this:

According to the February 8, 2009 edition of a newspaper that is not written by or for doctors, Wakefield made up his findings.

However, our investigation, confirmed by evidence presented to the General Medical Council (GMC), reveals that: In most of the 12 cases, the children's ailments as described in The Lancet were different from their hospital and GP records. Although the research paper claimed that problems came on within days of the jab, in only one case did medical records suggest this was true, and in many of the cases medical concerns had been raised before the children were vaccinated. Hospital pathologists, looking for inflammatory bowel disease, reported in the majority of cases that the gut was normal. This was then reviewed and the Lancet paper showed them as abnormal.

This would be a good place to ask the basic questions, such as

why the Lancet and all journals peer-review manuscripts, but never ask to see the original data itself;vii

why they allow the public to assume that the journal does scrutinize the original data;

why original data is not public information anyway;

why three idiots and an editor were not able to predict how a study would be used, and ask for the appropriate modifications;

why the presence of "financial conflict of interest" is the only critical test of bias, such that its mere absence earns it the imprimatur of truth. This does not apply to NIH money, of course, which is is free of moral influence: Nihil obstat.

———Yeah, right. [↩]And therefore, should have simply said, "I don't know it isn't the vaccine, therefore throw it out ; and likewise everything else your kid's taking. Right ?

Because if you don't know something's good, the stance is to not feed it to kids and find out. Right ? [↩]That's not the fucking issue at all. The issue is rather ownership of young bodies, and who exactly gets to stick things in there -- more properly speaking, who gets to decide for the young bodies when and what things get to go in. It's very cleanly and purely sexual, which is why it's publicly interesting at all. [↩]He's clever like that, he's heard of the face that launched a thousand ships and other introductory notions from an old haberdasher's set of cliffnotes on greekology. [↩]What'd be more solid ? The autistic kid himself penning a diary, perhaps ? [↩]Considering autism is entirely a post-modern disease, exogenic causation needs very little argument in support ; the contrary view indeed needs plenty. [↩]Some people working in a hospital finding the gut of some kids on govt insurance normal is about as much proof of normalcy as pedophiles finding preteen vaginas "normal".

As a factual matter, if one were to take one hundred, or ten million, cases in which parents and hospital pediatricians disagreed, with the parents claiming something's wrong and the pediatricians claiming everything's normal, at least 60% if not outright 80% would be adjudicated on the side of parents by an actual professional, the sort who keeps a private practice and makes house visits in affluent neighbourhoods.

So no, this "disproof" don't disprove all that much. [↩]

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Thursday, 08 August, Year 11 d.Tr.

thelastpsychiatrist.com - Atypicals for Maintenance Bipolar. Adnotated.

In my post on the NEJM article about antidepressants in bipolar depression, some people couldn't see how I made the leap to a political movement away from SSRIs and seizure drugs, and towards atypicals.

First, I'm not against atypicals. I have long advocated for fluctuating doses of antipsychotic instead of Depakote.i I do think they can treat depressive states. I don't disagree with the study or the data.

What I find perplexing is the timing. I was trying to show how academic psychiatry has now decided to move towards atypicals. Why now?

Here's an example. Eduard Vieta just released his hit single, Current Approaches to the Treatment of Bipolar Disorder With Atypical Antipsychotics, in Primary Psychiatry. In it, there is only one short paragraph on Depakote, describing its one maintenance study, in which (it states correctly) Depakote didn't beat placebo. That's it. 81 words.

Find me one other article written before 2007 that is so curt and dismissive of Depakote.

It goes on to explore the data on atypicals -- and there's quite a bit. It rightfully concludes, "atypical antipsychotics have shown promising results in bipolar disorder maintenance therapy."

But here's the point: with two exceptions, all studies on atypicals referenced here came from 2004 and earlier. The two exceptions were from 2005.

So it's not new data, it's old data. Did they suddenly read the back issues?ii Holy crap, atypicals might work? That's why that NEJM piece is so important. It marks the point where academia has decided to embrace atypicals and move away from Depakote. If this move was really data driven, they would have done it in 2004. Hell, they would have done it in 2001 when the Depakote maintenance study didn't beat placebo.

There's no conspiracy here, there's no exploitation of the weak for personal profit. I'm not saying these are bad people, not at all. They are not conscious of it. That's what makes this politics, not science.

You have an academic career, you want to do clinical research, who's going to pay? NIH money is hard to get.

So you turn to Pharma. You "get" to do a clinical trial of Depakote for the treatment of bipolar. When you're done, maybe they hire you to do another one.

You, personally, don't even get the money -- the department does, and they use it to pay your already set salary. But you get a career, an identity. But you start to believe the prejudices of your chosen stomping grounds, and ignore the shortcomings. You become a nationalist.iii You start to believe that Depakote is first line, despite data; or that all seizure drugs will work; or that this thing you called bipolar is actually what you're treating. That there are actually two poles.

Then the money dries up. But Abilify says, could you do a clinical trial of Abilify for bipolar? And you say, sure, why not? maybe Abilify could be an add-on? And then it's monotherapyiv. And then Seroquel funds a study.

The last part is when you don't simply move on from Depakote -- you distance yourself from it. "You know, its data was never that great, it was really just an antimanic, and anyway, it had horrible side effects." It's the next step of political hypocrisy: I was never really a citizen of that nation, I have really always been a citizen of the world.v

———Valproate is quite possibly the driver behind the "autism epidemic", so by all means, anything but Depakote's a good idea. [↩]This is not even improbable. Have you read all of Trilema ?

And understood what it says ?

Three-four years, which is the time window contemplated here, is certainly not so long an interval as to put much bite behind his diss. Indeed they very well might've just now read the back issues. [↩]This is how paradigms work in science in the first place ; and there's excellent reason for their existence, too (in a few words : that they permit a complex issue to be narrowed enough so some actually productive work may be done, instead of spending whole life paralytically gazing at the starry sky). Someone might benefit from reading a little theory of knowledge / history of science I'd say. [↩]What he means is, "and then Abilify becomes the only drug to use". [↩]This is how females throughout history survived long enough for there to even be a species in the first place, you know ?

Do you know ? Model, for curiosity's sake, what happens if every time tribe A defeats tribe B, the female portion of tribe B goes down with the ship. Ready ?

So there's 100 tribes, and they are normally distributed between 100 and 10`000 members. Every generation each female has four boys and five girls, and there's a major war, pitting 1/3 of the tribes against each other, in random pairings. Every time a tribe reaches 10`000 females it splits into two tribes, one carrying 2/3 of the males and 1/3 of the females and the other carrying the rest ; every time a tribe reaches 0 females it disappears.

Do you see how if the result of conflict is "all the males are killed", the population stays on a slow but stable growth pattern exactly matching historical record whereas if "all members are killed" the population dwindles to nothing within a dozen generations, or do you have to actually run the numbers ?

Loyalty in the sense here contemplated was mostly bred out of females before writing was a thing. The pressure's there, and in evolutionary terms the prize for dying early is... not being represented downstream. The deep reason for "not asking the woman anything" as the central pillar of human sexual activity has nothing to do with contempt, and everything to do with historical reality : what the fuck was she going to say anyway ? [↩]

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Thursday, 08 August, Year 11 d.Tr.

thelastpsychiatrist.com - Atypicals and Diabetes: Glucose Transport. Adnotated.

Glucose is absorbed through the small intestine into the blood.

All glucose is taken into cells via hexose transporters: this is facilitated diffusion (no ATP). Facilitated diffusion is passive diffusion through a channel made by a transmembrane protein; the proteins are able to open and close this channel. There are many ways channels can be opened/closed: ligand gated (i.e. neurotransmitter receptors), voltage gated (neurons), or, in the case of hydrophilic molecules such as glucose, mechanically gated: the channel is shaped like a closed "V". Glucose goes to the bottom of the V, causes a conformational change and the "V" opens, but closes at the top (makes an upside down "V".) Glucose can pass, and the V recloses. All diffusion is down a concentration gradient.

The hexose transporters are called, randomly, "Glucose transporters 1-5" (GLUT1-5).

GLUT4 is the main transporter in muscle, fat, and the heart. GLUT4 is insulin-sensitive (though it can also be activated by muscle contraction -- go figure.) In the absence of insulin, GLUT4s are stored in cytomplasmic vesicles floating around in the cytosol. If insulin binds to the insulin receptor (an ATP dependent tyrosine kinase receptor -- NOT the GLUT4), a signal cascade is activated that causes the cytpolasmic vesicle to go to and bind to the plasma membrane and lodge the GLUT4 there. The GLUT4 then allows glucose to diffuse through. When insulin disappears, the insulin receptor reconforms, the signal cascade stops, and the GLUT4 pinches off (by clathrin and other contracting proteins in the cell membrane) into a vesicle again (pinocytosis).

Thus, if there is no insulin: even if there is much glucose, there is no signal for the vesicle to go to the plasma membrane and lodge the GLUT4, so there will be no transport of glucose into the cell; so glucose stays high in the blood. Thus we have Type 1 diabetes.

Insulin also stimulates the creation of glycogen in the liver and muscle. [Insulin activates hexokinase (1st enzyme in glycolysis) as well as phosphofructokinase and glycogen synthase) and inhibits glucose-6-phosphatase ( (opposite direction of hexokinase, same reaction) gluconeogenesis).]

Insulin promotes fatty acid synthesis. Once glycogen synthesis has maxed out (i.e. about 30g, about 20% of the carbohydrate part of a studied meal, max in 4-6hrs,) then fatty acid synthesis IN THE LIVER takes over. Glucose is converted to free fatty acids (FFAs) and dumped back into the blood as lipoproteins -- which are then broken up into FFAs.

FFAs go into the adipose cells of the body. Glucose also goes into adipose cells -- via GLUT -- and are converted into glycerols. Glycerol + FFAs= triglycerides.

Thus, insulin's role is to store fat and/or oxidize glucose. Too little insulin will also trigger protein catabolism.

GLUT1 and GLUT3 account for 95% of the glucose transport to the brain. GLUT1 is for the blood brain barrier (the tight junctions of the BBB are what require these channels), and GLUT3 is in the neurons. GLUT1 is also found in muscle.

These are not insulin dependent (like GLUT4 is) so the brain can continue to get its energy. Not only does the distribution of GLUT 1 and 3 mirror capillary density and areas of relative glucose utilization, the GLUT1/3 densities can change depending on chronically increased (or decreased) need for glucose. Interestingly, nicotine, which increases brain glucose utilization, increases GLUT1/3 but not capillary density.

GLUT2 and 7 are in the liver. GLUT2 can also carry D-fructose.

GLUT5 is in the intestine, and some glial cells of the brain.

Type II diabetes is insulin resistance, not lack of insulin. There is not, at least initially, a problem with the pancreas's secretion of insulin in response to high glucose. The problem is at the level of the insulin receptor and/or GLUT, which become insensitive to the effects of insulin -- because there has been so much of it for so long. (For more info, see: News Physiol Sci. 2001 Apr;16:71-6.)

Next up: how do antipsychotics affect glucose/insulin/transporters?

(For a review: What We Know About Facilitative Glucose Transporters )i

———Cool, I guess. Textbook stuff, but what can it hurt. [↩]

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

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Wednesday, 07 August, Year 11 d.Tr.

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

Once again, I appear to be all alone.

...Because of their disabilities in areas of reasoning, judgmenti, and control of their impulses, however, [the mentally retarded] do not act with the level of moral culpability that characterizes the most serious adult criminal conduct... [over the past 13 years the] American public, legislators, scholars, and judges have deliberated over the question whether the death penalty should ever be imposed on a mentally retarded criminal. The consensus reflected in those deliberations informs our answer...ii

So opens Atkins v. Virginia, as opined by Justice Stevensiii.

It seems unassailable that the mentally retarded should not be executed. Justice Stevens spoke of a consensus; the APA's amicus brief to the Court stated:

(1) there is a clear and unmistakable national consensus against the imposition of the death penalty on persons with mental retardation, and (2) the American people oppose the execution of individuals with mental retardation because the practice offends our shared moral values. (emphasis mine.)

So once again I am the sole hold out to national consensus.iv Okay. If I am to grant that such a national consensus does exist -- which it most obviously does not -- it is not in small measure due to misunderstanding what mental retardation isv: it isn't Down's syndrome. It isn't a guest spot on the Howard Stern Show, it isn't finger paints and a baseball cap at age 30 moaning, "I wanna eat tato chips!"

If it was this, I'd agree a consensus might even be close to unanimous. Ironically, such a consensus would be irrelevant as such individuals don't commit capital offenses.vi

But this is not what mentally retarded is. Atkins, the above defendant, was determined by the defense expert to be MR because of an IQ of 59. With this IQ, he was able to get drunk and smoke pot (which, FYI, does not diminish responsibility,) drive a car (which he was licensed to do), kidnap and drag his victim to an ATM to force him to withdraw $200, then drive him to an isolated spot and shoot him 8 times -- not to mention be competent to stand trial, cooperate in court and with his attorney, etc. He was also able to pull [off] 16 other felonies in his life. An IQ of 59 allows reading at a 6th grade level -- comic books are 4th grade and Time Magazine is 9th grade.vii

But that was Atkins. A diagnosis of MR is an IQ less than 70. Can someone with an IQ of 70 appreciate that shooting your kidnapping/robbery victim in the chest 8 times and dumping him in an isolated location is really, really, wrong? From 1976-2002, 44 people with "mental retardation" have been executed; all but 2 had IQs at least 58.

So a categorical exemption for the mentally retarded might be sensible if someone could tell me exactly what mentally retarded means. Because the psychiatric definition quite obviously covers individuals well within competency standards. And that's the point.

Here's an example: if the exemption was for "Down's Syndrome" then this would be plausible, because a) we can reasonably agree how Down's impacts the defendant; b) we can identify it. But "retardation" means -- what? Mentally ill, as an exemption, is worse -- does depression count? Only psychosis? Does the presence of only a hallucination count, or do you have to have a thought disorder? "Schizophrenia?" What's that? The John Nash type, or the homeless crackhead type? How about borderline? Narcissism? If you can't be sure of what constitutes "mentally ill", how can you make a blanket exemption for it?viii

We can take this debate up a level, and observe that with every other psychiatric disorder that impacts on legal matters, the question for psychiatrists is simply, "what's his disorder?" or "how does the disorder impact this case?" -- we have an advisory capacity, leaving the ultimate decision of culpability up to the courts. In this way, we put some distance from the outcome. That's what expert testimony is all about. Fair enough. But now, with MR, the diagnosis automatically gets you out of execution. As long as the IQ test comes back 59, the sentence changes. Mental retardation is binary, apparently, and if you are fortunate enough to have it, you live -- regardless of how well you understood the wrongness of your actions, or how egregious were the crimes.

Which is ridiculous. There are practically no valid measures for any psychiatric illnesses -- everything is up for debate and interpretation. MR especially is a continuum disorder. Factors as trivial as which IQ test is used, or when it is taken, can affect the diagnosis. One study finds a 6 point increase using older tests vs. the newer version of the same test.ix

"Our findings imply that some borderline death row inmates or capital murder defendants who were not classified as mentally retarded in childhood because they took an older version of an IQ test might have qualified as retarded if they had taken a more recent test," Ceci says. "That's the difference between being sentenced to life imprisonment versus lethal injection."

But now the law has set an arbitrary and empty, binary cut off for execution. Psychiatrists now actually choose the sentence. Not inform the sentence -- choose it.

I'm fairly certain the APAx didn't think about this when it filed its amicus brief. They never think these things through, because they believe they are an instrument of social change.xi But, like forced medication to render competent to be executed, psychiatrists have now boxed themselves into a corner. It is now solely up to them -- and their "tests" -- to decide who gets executed.

Consider the ethical dilemma for a forensic psychiatrist asked to evaluate for MR: given that the defendant can fake MRxii; and given that finding the defendant does not "have" MR -- or suspecting that he is faking MR -- is exactly equivalent to sentencing him to death, can there be any other medically ethical outcome than finding they are MR? Think well. In other words, an answer is forced, an answer is created, simply by asking the question. The situation here is identical to the judge leaning over and asking, "Do me a favor and decide for me. Should I hang him or put him in prison?" Um, well, gee, it's up to me? um, since you asked...

I know, doctors are going to inwardly smile, pat themselves on the back for their cleverness; after all, the goal is to abolish the death penalty for everyone, one group at a time. And I am sure there are organizations who will actively, openly, exploit this loophole.xiii

Notwithstanding the laudability of this goal, this isn't about the death penalty, it's about who decides the death penalty.

Just remember, when society allows psychiatrists to decide who lives or dies, then psychiatrists will also decide who dies or lives. I want everyone on the planet to take a very deep breath, and think about this.xiv

———Leaving aside the obnoxiousness of random words being applied to random concepts -- how the fuck is anything abstract an area ? Here's a simple heuristic : if you can't answer as to acreage in the next pass, do not call something an area in the present pass. Simple as pie area!

But leaving that aside, what the fuck is supposed to be the difference between "reasoning" and "judgement" that this moron was contemplating in his >2 hectare moronarea of a "brief" that's anything but ? What is he, a woman preparing her wedding dress, "add a little more blue" ? Is the only reason he didn't say "reasoning, judgement, acumen, inference, interpretation, thinking, hasuayeil, barneyeil, verday, heill, alzeyeill, szeyeill, bacapel, zelfayeill, morayeill, borayeill, alpheyeill, arobilin etc" instead is that he didn't have wifi (and never heard of LJH anyway, so wifi wouldn't have helped even if he had it) ? Or what, should "thinking" not be there because it's too... ordinary ? And this dumb cunt writing longs and calling them briefs dun wanna be appear ordinary (precisely because that's exactly what she is) ?

I really don't like people who use language in the manner of monkeys using man-made tools. It's one thing when they're truckers or whatever, but by the time the pretense is that they're thus earning a living for themselves... [↩]Holy shit, consensus of "the American public" ? Drop dead. [↩]Can you believe this shit ?! John Paul Stevens would have readily flunked my Introduction to Philosophy class, but he nevertheless was good enough to opine off the supreme court bench for thirty-odd years. I guess they do what they can with whatever crawls out of whatever barn animals they've got ; it sucks being a rural province, but what can you do. [↩]Fancy that wonder, APA can invent reality, and just as long as some braying mule somewhere doesn't readily perceive the falsification, all's coming up roses. Well, stable-side roses, you know, like cow patties are patties so these are roses. [↩]Actually, it's in no small measure due to a concertina of niggers, arms stuffed into ears up to elbow, yelling "nyah nyah nyah consensus". Who the fuck asked a glorified secretary at the APA anything, and why the fuck did they ?!

More importantly : why does the rural province in question glorify secretaries ? I run into these morons all the time, the "good girls" who "aren't sluts", ready to tell me "what the rules are" and whatever assorted nonsense they came up with "so as to..." bla bla bla. I loudly, and regularly, and publicly shame them for their developmental failure. Why don't the North American plebs ? [↩]As these nigger-engineered "consensuses" ever work -- take broad agreement on an irrelevant edge case, shave off the edge and call it "consensus". [↩]To further complicate matters : whathever lofty nonsense Stevens is paying lip service to here, the actual dispositive fact of the matter is that the death penalty is way the fuck better for the perpetrator, and way the fuck more expensive to the system. That's what they're actually doing : not giving some offensive asshole the benefit of the thing they call worse but is actually better, under the pretext of humanism-driven consensus etcetera. This is yet another case of socialism stealing the having stolen : Atkins is not merely given the worst punishment available, but is given the worst punishment available while they claim to be doing exactly the opposite. [↩]So as to leave wiggle room, the only thing keeping this tall tower of piled-up of nonsense-chairs tottering on the brink of obvious, but so far barely averted, failure. They'll know it when they see it, which begs the question : if your supposedly rational system is ultimately made up of a whole lot of "knowingwhenyouseeit", why even bother with the pretense in the first place ? What, hanging sherrifs can't know it when they see it ?

They'd be a whole of a lot cheaper, you realise this ? And women would be a whole lot more pleasant for the grinding down, too! God knows they benefit from it a whole lot more than horses do. [↩]Think about that for a moment -- are the UStardian goatfuckers getting dumber every year, or do their pretenses to "their fair share" of intelligence simply increase in step with food and fuel costs (not part of inflation numbers, mind you) ? [↩]By which he means, the one glorified secretary working in a building under three letters that have as much to do with practicing psychiatry as they have to do with computer science. All one soap! [↩]No, they never think these things through because lots and lots and lots of mommy-hos nobody's ever said no to, that's why. It fucks with their heads. [↩]Think about it -- if intelligence didn't offer the option of being as dumb as you wish up to a certain ceiling, what the fuck good would it be ? Who would possibly want intelligence as a floor ? [↩]Cuz that's precisely how everything's gotta work, over there in common "law" goatfuckistani lands, a huge pile-up of scammers scamming scammers scamming scammers. And they're so clever with it, too! It's an achievement by consensus! [↩]Yet precisely nothing has changed : A lunatic with a bloodied axe could be ringing at your door! This is how socialism goes, one bureaucrat or other is going to kill some people. Do you really give a shit if his name is specifically Adolf, or Djugashvilli, or whether the lettering on his desk is QFT or BWU or anything else ? Socialism is socialism is socialism, you already bought all the downstream the day you bought any of it, that's how dealing with the devil goes.

The spittoon, it's always in one strand. [↩]

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Tuesday, 06 August, Year 11 d.Tr.

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

Don't bet your life on it.

An editorial in AJP opens,

In most countries of the world, older adults kill themselves at higher rates than any other age group. Given that the leading edge of the large post-World War II "baby boom" cohort will reach the age of 65 in 2011, demographers predict a rapid rise in the number of seniors taking their own lives in subsequent decades. The need for effective approaches to late-life suicide prevention is pressing.

No.

First, I'd like to debunk the prevailing belief that almost all suicides are due to a psychiatric illness, a belief he supports using an article he himself wrote that references studies that don't actually show this.

Construction Of Pathology.

Simply assuming anyone who commits suicide is therefore "somehow not normal"; or "only someone mentally ill would kill himself" is wrong.i

If a serial killer says, "kill yourself or I kill your kids" and you kill yourself, are you mentally ill? Was Ajax mentally ill? Consequently, the fact that you committed suicide is not proof of illness, in the exact same way that death cannot be proof of pancreatic cancer.

Attributing causality to a complex behavior is masturbation with words.ii How is killing yourself from MDD different than killing yourself because of terminal pancreatic cancer?iii Note that the syntactic construction forces me to say "from MDD" but "because of pancreatic cancer." But is that a real, existent distinction?

Is it the same biological mechanism? Different? Note: "He was depressed, he killed himself, for no reason, his life was great." The presence of pathology is assumed because of the absence of causes; psychiatry abhors a vacuum.

While it is clear that suicide is a risk in depression, the issue here is whether one can assume depression if they committed suicide?iv

Three Problems Of "Psychological Autopsy"

Hearsay:

The evidentiary support for the presence of mental illness in those who commits suicide is mostly determined not by a past history of diagnosed psychopathology, but by a post-mortem psychological evaluation ("tell me what he was like?") in which the deceased has drastically biased everyone around him by killing himself.v A psychological evaluation is basically interviewing "informants" (e.g. family), over three hours, asking psychiatric screening questions to determine diagnoses. Think about this, seriously think about this. The guy is dead, and you're asking the family if this guy ever exhibited signs of mental illness.

The closest analogy is doing a post-mortem of a marriage by only asking the ex-wife. "The evidence strongly suggests 75% of divorced men are manipulative jerks." Oh.

Validity of Symptoms Descriptions:

Example, from one of the sources of the above article:

Where subjects suffered both physical illness and depressive symptoms before death it was often difficult to judge whether a depressive episode was present. To ensure a consistent approach to diagnosis, we took possible depressive symptoms at face value; thus, if a subject was reported to suffer tiredness, this was included as a depressive symptom regardless as to whether it may have been due to physical illness.

Go figure: 77% of these people "had" a psychiatric diagnosis.vi

Generalizability:

So it's legitimate to ask, what percent of suicides have ever been diagnosed before they died? What percent have been to a psychiatrist or primary care doc for psychopathology? The answer varies from 30-60%, which is another way of saying 40-70% have never been. A full 75% had never attempted suicide in their lives -- this was their first and last attempt. It's important to keep this in mind because the point of the editorial is to offer the elderly "access through a care manager to algorithm-driven treatment" -- yes, that's what he wrote -- then you're going to help a maximum of 45% (the so far best response rate in psychiatry) of the 50% you actually ever meet.vii

———But it is wrong in a very specific way. There's wrongs delicious to socialism, wrongs that old women find tasty ; and then there's wrongs bitter to socialism, wrongs that old women find insufferable. Saying "only someone mentally ill would kill" is not merely wrong -- it is ideologically evil. [↩]Really ? Are rape, or for that matter... banking, any less complex than suicide ? [↩]Because "MDD" is not a real disease ?

I know you don't want to admit this, like you magically can't remember what chromosomes are when "discussing" "transsexualism" ; nevertheless : pancreatic cancer will kill the patient whether he's asleep or not, in a coma or not. MDD will not. [↩]The only real issue is the obnoxious tendency of the living to try and impose their meaningless psychogenic noise on the dead. This doesn't stop or start with suicide, take for instance all the infuriating nonsense about "battle with terminal disease", as fucking if that's what goes on...

The common man is fucking insufferable ; and he's insufferable when trying to come up with something to say to pick up a slavegirl waiting in a queue, when trying to speak at his best friend's wedding, when trying to give testimony, or standing above a grave, or going into unknown territory, or at all other times. That's the long and the short of it. [↩]Think about it -- you know for a fact he's not about to come back and demand satisfaction out of you, yes ? [↩]Inflationism is a consistent behaviour of socialism. There's a very important reason "tiredness" has to be on the list of depression symptoms, notwithstanding it experimentally has very little to do with depression and semiologically is of extremely little value in discerning anything from anything else : if it's not there, then so many cases of suicide no longer get the third "symptom" that's "required" to classify them as "depression", thus either the "requirement" will have to be dropped to just two "symptoms", or else the world narrative old women favour will suffer some humiliation. This last else only provided for theoretical completeness, in practice it ain't gonna start happening until you start caging old women. [↩]Rather : he'll get to spend more imaginary "money" from the USG pile of scrip while delivering exactly nothing and, importantly, avoiding any responsibility for any of the foregoing. Which is the only point of the entire exercise. [↩]

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Category: Adnotations

Sunday, 04 August, Year 11 d.Tr.

thelastpsychiatrist.com - Aren't Two Antipsychotics Better Than One? The Most Important Article on Psychiatry, Part 3. Adnotated.

MY PSYCHIATRIST WANTS TO GIVE ME TWO ANTIPSYCHOTICS AT THE SAME TIME. WHAT SHOULD I DO?

Undoubtedly, your first impulse will be to punch him in the testicles, but as you know, the Kellogg-Briand pact (1928) expressly forbids thisi. However, it is notably silent on the issue of voodoo / shark attacks, which can be used with discretion.

Go back and read Parts 1 and 2. I'll wait.

Antipsychotics exhibit their antipsychotic effect through D2 blockade. There may come a day where a drug is invented that works through some other mechanism, maybe glutamate, but as of right now, all the available antipsychotics work through D2 blockade. Everything else is irrelevant. Now, these other receptors might be relevant for other effects (reducing anxiety, antidepression, etc) but let's try to focus on the specific problem and not get all Andrew Weil here.

Got it?

Take a look at the following figure again, showing % blockade of receptors (serotonin or dopamine) as a function of dose.

So you'll observe a few things.

First, these antipsychotics will have equivalences in dosage. If you use 10mg Zyprexa as a baseline, how much dopamine does it block? 70%. How much Risperdal does it take to block the same amount? 3mg. Therefore, 10mg Zyprexa = 3mg Risperdal. If you look at the graphs for the other antipsychotics (not shown -- sheer laziness), you get the following conversion for antipsychotic effects:

10mg Zyprexa = 3mg Risperdal = 500mg Seroquel = 120mg Geodon

Interestingly, most comparator trials done -- which look at symptom responses -- show these same equivalences. For example, ZEUS Geodon vs. Zyprexa trial: 126mg Geodon = 11mg Zyprexa. This shouldn't be surprising since THAT'S HOW THE DRUGS ARE WORKING.

Second, no drug company can claim their drug has superior efficacy, because, again, they're all working through the same mechanism. Certainly, people tolerate each drug differently, but that's not efficacy, is it? Certainly an individual might respond to one better, but you have no way of predicting that. You simply cannot tell, by looking at someone, which drug will work and which won't. I'll show you: which drug will work best for this guy?

It's a trick question: the correct answer is penicillin.ii

The only way a drug company or study could claim to find superiority is if they don't use comparable dosages. "We found that Risperdal 6mg was significantly more effective than 100mg of Seroquel." Really? Bite me.

Third, and this is really a math question: Since there are a finite number of D2 receptors in your skull, if you are on 6mg or Risperdal -- which blocks 90% of them, and the doctor decides to augment with some Zyprexa, where's the Zyprexa going to go? Answer: your thighs.iii

Tom recognized her instantly despite the red anonymity bar

It's not going to D2 receptors, because they're all already blocked with Risperdal. So it's just going to go around to other receptors -- H1, a1, M1, etc -- all of which have nothing to do with bipolar or psychosis.iv Issues of tolerability aside, mixing two antipychotics is no different than giving more of just one antipsychotic.

"Abiliquel" -- taking Abilify and adding Seroquel -- is sheer idiocy of such magnitude that even Eli Roth is repulsed. The first time someone told me what Abiliquel was, the room became filled with the sounds of six guys screaming in horrific pain, and that was because I was punching them in the testicles.v Why not just give him Motrin + Advil? Oh: "But I use it cleverly: I give 15mg of Abilify and 25mg of Seroquel. See?" I see. I see that you're bleeding from the testicles. Guess why.

You give 15mg Abilify -- that's acting as a D2 blocker. 25mg Seroquel isn't even a D2 blocker, it's an H1 blockervi, you're paying for an antipsychotic and getting Benadryl. You say, "well, I know," (liar), "but I'm using the Abilify as an antipsychotic and Seroquel as a sedative." But, Gwynethvii, you could have gotten the exact same effect by giving Abilify and Benadryl+trazodone -- which would be cheaper, and safer; or giving simply 500mg Seroquel alone, which would have gotten you both antipsychotic effect and sedative effect, thus reducing the cost by half, etc, etc. Remember that scene in the movie Hostelviii where Matthew McConaughey gets bitten by a radioactive lab rat and transforms into an immortal superhero?

Matthew McConaughey (Owen Wilson) proves there can be only one.

No? Do you know why? Because you knew better than to see that celluloid atrocity. How come you didn't know better than to prescribe two antipsychotics at once? You don't mix Zoloft and Paxil together, do you? Haldol and Prolixin? Seriously, do you just make crap up as you go along, or do you have pharmacological non-[sequiturs] prepared in your Moleskine?

The same, by the way, goes for all you nutboxes who work in hospitals. If you have a patient on, say, 10,000mg of Seroquel, and he goes into an ER and gets indignant and flips a table over, and you inject him with 5mg of Haldol (90% blockade), you think that 10,000mg of Seroquel is doing him any good as an antipsychotic? I gots news for youse all: every time you prn (emergency dose)ix someone with Haldol, their brain is only on Haldol. Any other antipsychotic you give them that day is strictly a monetary gift to Big Pharma; you may as well PayPal them $180 and spare the patient the exposure.

On second thought, you may as well PayPal me.

———Part of the complex web of cunt-sponsored nonsense that ushered in the Great Patriotic War. In practical terms it's how you said "pantsuit" last century. [↩]The implication being his disease is gonorrhea. [↩]The implication being that you're going to get fat (in a certain sort of way, ie like the uglier black women -- which is why the illustration has to be white trash). [↩]As a factual matter, this isn't specifically known ; not that I'm proposing the opposite is true or anything. [↩]Somebody's been reading Maddox, or something. [↩]Ie, antihistamine. [↩]Nfi why he's singling out the inventor of goop for her supposed ditziness. O, wait. [↩]I suppose this is where the obscure jew reference ties in, though I confess disinterest. [↩]prn actually stands for "pro re nata", literally "as things are born" but with the intension of "as the situation demands". [↩]

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Category: Adnotations

Monday, 29 July, Year 11 d.Tr.

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

at what age does it become incest?

i

I'll leave the discussion of the merits of attachment parenting to people who actually have parents and attachments, but it's kind of a moot point, I've seen more Taliban snipers than I've seen boob sucking kindergarteners.ii

So forget what Time is showing you, ask instead: what does the magazine want to be true?

Postulate: Time doesn't like breast feeding. If you disagree at least grant me that no one at Time thinks four years of it is admirable. Right? So you are supposed to hate her. Ok, how?

"Umm, 'how?' Well... there's a kid sucking on a boob..." Come on, man, that's weird but it's not hatable, hating her doesn't somehow reinforce who you are -- unless you're a woman who didn't breast feed.iii What if you're a guy? "Well, she's hot..." Right. The secret fear of marriage is that the kid wins the Oedipal drama.iv

At some point someone needs to notice that the intensity of the emotions about this issue are way out of proportion to the... prevalence of the issue. I'm pretty confident breast feeding on the way home from Webelos is a terrible ideav but is it worse on your kid than getting divorced? Or staying together, depending? Extra year of boob or lifetime without a father. Hmm. Is this open book?

Other than the volume of your voice, do you have any reason to be sure of what you think?

So since Time has created a controversy out of thin air, we should consider that the controversy is a proxy for something else.

She's a billionvi, so either Time was writing a story on Attachment Parenting and found the hottest subject they could find to make it be ok, or they chose the hottest subject they could find to make it NOT be okay. So hot= shallow egomaniac using her boobs and then her kid to get noticed.vii

That's what Time wants you to think, anyway. But there are things you don't see that I can't unsee, which is why I've been at the bottle stashed behind the big rock at the creek's bend since I was a pre-teen. She's 26 and the kid is 3, subtraction= 23, so you have a super hot well manicured blonde having kids way the hell too early for a super hot well manicured blonde....................viii and there are only two reasons why such a person would be pictured in American media: she's from Utahix or Jesus is her co-pilot. Amen. The fastest way to get Time's Hatable Person Of The Week cover is to a) work for Goldman Sachs or b) praise the Lord. I guess it's possible she works on a trading desk but my money says this is a story about why religious people are insane.x

So while the rest of you bah bah black sheep are led to complain that she's hatable because she breast feeds, when the Time comes -- and praise be to Jesus, it is coming -- for you to learn she's nipples deep in the Lord Is My Shepherd maybe you'll then remember which candidate you're supposed to hate.xi

There's hate in them there pictures, the worst kind of hate, the kind that makes you hate without knowing why, without knowing that you hate. The kind of hate that ends up defining you as a person in opposition to something else. And then you disappear.

Once you've made this prediction everything else is downhill. She'll homeschool the kid, which is hatable. She'll be wealthy for no identifiable reason: hatable. She'll be carrying around that kid 24/7 with no nanny yet still weirdly find time for mani/pedis and barre class. So hatable. And co-sleeping doesn't mess up her sex life or her sex interest because her husband plows her on the deck, in the car, in the pool, in elevators. Sigh hatable. You can't make a right on red but this woman is forcing the world to accommodate her, bend to her way, her life, and she appears to be succeeding and happy. Bitch.

Look at the comments as people struggle to explain why breast feeding a 3 year old is bad: they sense it's bad, but can't come up with a concrete reason to explain it. Well, Time is the magazine for you. They offer you a blonde cypher trusting that you'll solve it: she co-sleeps because she's a religious nut. Phew.

"When you think of breast-feeding, you think of mothers holding their children, which was impossible with some of these older kids," Schoeller says. "I liked the idea of having the kids standing up to underline the point that this was an uncommon situation."xii

That's Time's photographer explaining that simply having her breast feed wasn't good enough to make his point, he needed to stage the scene to "underline the point." This is why the sentence before that one is this:

Using religious images of the Madonna and Child as reference, Schoeller captured each mother breast-feeding her child or children.

If you have the urge to email me complaining that I'm defending religion or attachment parenting, please don't, your brain is broken. The point is to show you how the media e.g. Time manipulates you to hate some things by linking them to other things: it polarizes you, which means it makes you irrelevant. E.g. when an election "is determined by" one particular group of "swing" voters -- whom you deride for being too stupid to have made up their minds yet -- it doesn't mean your vote has been factored in but that you are so predictable that you don't count. Power never thinks of you as an individual. Power never thinks of you at all.

Maybe attachment parenting is good? Bad? Time doesn't care to find out. It could easily have PubMeded the story and found a hundred scientific articles to discuss. Nope. It needed space to tell me that Dr. Bill Sears was a Catholic, converted to evangelicalism, and back to Catholicism, and his wife goes to Mass every day. Oh, I get it, they're crazy people. This is a typical media trick, rather than exploring an issue it explores a person, describes him, his background and his faults, this is the kind of person who believes this, this complicated issue that is too difficult to understand on its merits. You're free to choose.

Do you think Time cares about breast feeding? Do you think Time cares about you? Time hates you. It hates everyone, especially its readers, it thinks of them as credit card numbers, as registered voters, as organ donors. It wants what it wants and if we have to throw a kid under a boob, so be it. Like Marshall McLuhan once yelled, there's a war going on out there, and it isn't between liberals and conservatives or atheists and believers or attachment parents and detachment parents, it's between us and them, where them is defined as everyone who is not us and us is defined as me. You lose.xiii

———He can't be fucking serious ?! Incest requires vaginal copulation. Anything up to and including sodomizing your close relatives ain't incest, per the fucking definition of terms -- sodomy may be sodomy, but it ain't fucking incest, nor is breast fondling or anything else. You may call it incestuous, if you must, but it's quite exactly like calling a solution "aqueous" : water it is not.

Aww, what's the matter, you thought you could make sodomy okay and then simply escape the consequences ? Now why did you think that ?!

PS. It's also not incest if you use condoms. Or if mom/daughter's on the pill. It's very fucking simple, really -- no pregnancy risk, no incest. Because that's what incest fucking is ; and it doesn't care whit one about what you'd need it to be so that your society doesn't implode when you cut down some other spokes holding it together from over there. Figure your shit out some other way. [↩]Late weaning is not actually that uncommon ; certainly it is more common than people who need psychiatry. [↩]Who is everyone "working" the whole "media" angle ; but if that were true the woman depicted would have tits like my slaves, not like the lesser half of a $100 two-fer. [↩]What do you mean "fear" ? It's how traditional marriage is supposed to play out, the dude's name is not Laius, is it ? This "fear" is like the fear that an US team will win the "World Series". Who else was gonna win it ?! [↩]Why, specifically ? I don't dispute the negative, yes, it's not a good idea ; but why exactly terrible ? Specifically -- better, or worse than biting nails ? Ok, why ? [↩]No, seriously, she's the lesser half of a benjie's worth. Get out more. [↩]This dude got some serious issues. [↩]Seriously ?! Because the kid looks more like he's five to six, and she looks more like 32 than 23, nor can I see the supposed manicure in the better resolution illustration I replaced his original stamp with. But leaving all that aside... when my mom had me, as [upper class] women had kids back then, which is to say right after college, ie about 22, the doctor pointed out to her everyone in there also having babies was a teen and chided her for making his work harder than it needed to be, "this isn't how this is supposed to work". As far as I know, for the largest part of modern history the largest chunk of literate females to have babies at all had them aged 20-24. What the hell is this man talking about ?! [↩]They're going to depict "manicured hot blondes" from Utah ?! [↩]Actually, strong family correlates with both strong religious sentiment and late weaning, so this isn't such a bad bet -- nothing is more annoying to the Inca state and therefore discussed in worse terms on Inca's mouthpieces than star pattern resistant social groups. Strong family bonds are probably the most-perceived Inca threat since at least the 1818s, ie when Italian nutcases first started writing Inca fanfic. [↩]The slighty toasty one ? [↩]Since when is the visual inhabituation of idiots who have literally never beheld female breast relevant to discussion of its function ?! [↩]Why so angry, anyway ? [↩]

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Category: Adnotations

Saturday, 03 August, Year 11 d.Tr.

thelastpsychiatrist.com - Are You Good At Reading Faces? Adnotated.

Can you correctly identify emotions if they only briefly flicker across the face? How good do you think you are?

Try the test.i

Was a certain emotion harder or easier for you? Did it seem like some of the faces flickered faster than others? It may not have anything to do with the emotion. It might be the test.ii

Did you notice how some emotions flicker across the screen faster than others? (They don't, really.) This might lead you to conclude that you are not as good at perceiving certain emotions. But that might not be the case.

The problem with the test is that certain expressions in this test lateralize to one side of the face -- the expression is mostly visible on one side. (See contempt 4 and 8.) Depending on which emotion is displayed, and which side of the brain is dominant in you, reading one side of the face may be easier or harder for you.

For example, contempt goes to the boy's (4) left face, but girl's (8) right. It might have been easier (or harder) for you to perceive if it went to a given side.

To show this, get a mirror, place it perpendicularly on the screen on the z-axis (out), facing the side of the expression. Then, look into the mirror (not the screen) and see if the expression is easier or harder. If it is, the problem for you is lateralization, not expression reading.

As a rule of thumb, anger and contempt are naturally (i.e spontaneously) expressed on the left face of right handed people.

As an aside, I wonder if people who are "face blind" (can't read faces) aren't a) majority left handed; b) have the most difficulty reading right handed people's expressions, especially anger. Can they tell when a dog is happy or sad? (Considerably more symmetric in facial expression, don't ask me why.)iii

As an interesting experiment, photograph yourself making the various emotions.iv Then, video yourself (and I don't know how you'd do this) spontaneously making the expressions, for real (have a friend bring you a naked chick, a bag of maggots, your rival, Sandra Oh, etc) and compare. How does your fake differ from your natural? Look carefully. What part of your face did you "forget" to fake?

Liars are easy to spot, because they are faking their expressions. Pathological liars, however, are much more difficult, because they aren't really faking.v

———The clickbait he links includes no test of any kind, not even the utterly useless sort usually found on webpages. Instead it's a pile of idiotic nonsense of sheer pantsuit orientation that I've remorselessly ablated.

PS. The only way to get good at reading emotions, irrespectively how briefly they flicker across the face, and even with no flicker at all, is to fuck a lot of women. I don't mean fucking just a few ; I mean a lot of them.

PPS. Men don't have emotions. [↩]In other news, dogs also not remarkably good at recognizing bones in website displays. Meanwhile no website any good at finding any actual bones -- certainly not as good as any 20-lb, 20 dollar basset hound. [↩]How about fridges ? Can they tell happy fridges from sad fridges ? Fucking insanity... [↩]Why, because everyone's an accomplished actress now ?! [↩]Men are particularly easy to fake, because look here :

[↩]

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Category: Adnotations

Saturday, 03 August, Year 11 d.Tr.

thelastpsychiatrist.com - Are Schools Breeding Narcissism? Adnotated.

Comedian Todd Barry :

The guitarist for Third Eye Blind was on MTV Cribs, showing off his house. He picks up a guitar and says, "this is my favorite guitar. With this guitar, the songs just write themselves." Yeah, sure. Blame the guitar.

Warning over narcissistic pupils:

The growing expectation placed on schools and parents to boost pupils' self-esteem is breeding a generation of narcissists, an expert has warned.

Dr Carol Craig said children were being over-praised and were developing an "all about me" mentality.

Dr Craig is chief executive of the "centre for confidence and well-being" in Scotland. What? What are you looking at?

She told head teachers the self-esteem agenda, imported from the United States, was a "a big fashionable idea" that had gone too far.

She said an obsession with boosting children's self-esteem was encouraging a narcissistic generation who focused on themselves and felt "entitled".

I wanted to investigate this further, so I went down to the local elementary school, I grabbed one of the Zach Effron looking bastards by the neck, and I shook him like a dog, I said, "listen you North Face wearing organ donor, why is self-esteem so important to you? Why do you have to feel good about yourself all the time? Huh? Huh?"

Well, Zach ran off, bawling, and then I realized: he's not the one who cares about self-esteem.

Right? The kids didn't sign up for the self-esteem classes because it was pass/fail and fit in 3rd period. Adults made a collective decision that this was going to be the core educational philosophy from which everything else would be derived. So? What did adults think was wrong with the way they were raised that they thought self-esteem was so important to teach their kids?

I agree with: schools shouldn't be in the psychology business; emphasis on "feelings" paradoxically (read: not paradoxically) increases the likelihood of depression and anxiety; the more schools dealt with emotional well-being, the less parents would take responsibility, etc.

But she misses the cause. She sees the teaching of self-esteem itself to be the source of the problem; but the real problem is the cultural mindset that thought up self-esteem trainingi -- and a million other things. Even if we stopped promoting self-esteem in schools, the kids are still going to have to watch TV created by these same adults; learn about other cultures from them; learn how to manage money from them; learn that the worth of the individual from them; learn whether killing is right or wrong, and whenii, from them. Not directly from them, of course, which would actually be a dialogue worth trying out; but by osmosis, from living in the world that adults have created for themselves, that kids have no choice but to live in.

In short, they're still going to have to go home to their parents.

Here's an example. I'm down at the playground stalking pedophiles, and I observe that all of the kids are there with a parent, and most of them are with both of their parents. The parents are actively playing, too, they're not just sitting on the benches socializing.

Wow, I think, there are actually more parents than kids on this playground. My parents would never have played with me/us like that. If they actually came (they never would have) they would have sat on the benches. Socializing.

And then I observe that there are 15 or so adults, all crowded around on this playground; however, none of the parents are talking to each other, they are talking only to their kids.

But they are so physically close to each other that it is visibly weird that they are not talking to each other; they must each have made a conscious decision not to interact. And then, it hits me: the reason these parents are playing with their kids and not on the benches is in order not to interact with the other parents. They're using their kids as human shields. They don't know how to have a personal but not intimate interaction with another adult, they can't figure the boundaries. All they know is stranger, friend and sex. All they know are roles.iii

Self-esteem training is besides the point: how are kids going to not become narcissists when their parents train them on purpose to avoid meaningful interactions with strangers?

It boggles the mind how adults complain about how "kids today" are soft, or narcissistic, or impolite. What, is that due to sunspots? An oncogene? "Kids today" aren't any wussier than their parents are making them.

"Kids today are soft, when we were kids we didn't wear bike helmets..." But the kid isn't asking to wear the helmet, you're putting it on their head.iv

She said an obsession with boosting children's self-esteem was encouraging a narcissistic generation who focused on themselves and felt "entitled".

She means the kids; yet the focus on children's self-esteem is the mechanism by which the parents protect themselves.v If my kid is happy, then I have a happy kid; I don't have to do anything. It's the parents who feel entitled -- to having a happy kid.

"Narcissists make terrible relationship partners, parents and employees. It's not a positive characteristic..." she said.

Nice call. A generation too late, but nice call.

———Ah, sweet cute echoes of an earlier time, back before MP-style wholesale ablation was the default, and menalone idly contemplated fixes, cures, salves, poultices... [↩]This is important. [↩]Well, these parents' parents would have looked at how the other parents are dressed, for instance, and sorted each other into a hierarchy thereby, and behaved adquately to that, which is what permitted them to functionally interact and "socialize". Once you've decided blacks can be people too, and "can't judge books by the cover" and actually "don't judge, at all"... [↩]Technically, it's his mules that are putting it on his head. [↩]This'd be one of those gems I was saying he's fabled for, and that I deem to justify the whole adnotation effort. Yes, very much so : the children's self esteem is the mechanism by which the parents protect their own ego. Armed with this basic observation, there's no USGistani family you can't destructure. Eat them. [↩]

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thelastpsychiatrist.com - Who Are Academics Writing For? (For Whom Are Academics Writing?) Adnotated. »

Category: Adnotations

Tuesday, 30 July, Year 11 d.Tr.

thelastpsychiatrist.com - Are People Attracted To Good Dancers? Adnotated.

i

Chris Rock: a father's only responsibility is to keep his daughter off the pole

"Study: Flamboyant male dancingii attracts women best"

LONDONiii - John Travolta was onto something. Women are most attracted to male dancers who have big, flamboyant moves similar to the actor's trademark style, British scientists say in a new study.

Awesome, another "front page" science article that misses the point.

The researchers filmed some men dancing, and then CGI'd them into silhouette avatars which they forced sober women to watch.

"There are lots of cues females use when choosing a mateiv, like a peacock puffing out its tail," [some evolutionary behaviorist guy] said. "Dancing for humans could signal whether a male is fit because it requires the expenditure of a lot of energy."v

It could also signal you have to pee. On the one hand, the study itself gets it wrong; and on the other hand, the reporting gets it even more wrong. Two wrongs make a post.

II.

The actual study found that:

According to the women, the best dancers were those who had a wide range of dance moves and focused on the head, neck and torso [and not arm and leg movements]

Somehow this got translated to "women are attracted to good dancers" but it only says they liked that kind of dancing, it did not say the women thought those men were more attractive, especially since they weren't men but CGI humanicons with no visible external genitalia such as tattoos or Nautica T-shirts. Extending "I like his dancing" to "he's hot" is the sexual equivalent of extending "he has good penmanship" to "he writes like Balzac. I'm so looking him up on Facebook."

And you can't bring up examples like the professionals at Dancing With The Stars because they possess what's called a "confounding variable," namely that they are all extremely attractive CGI humanicons with prominently displayed external genitalia that I have never DVR-paused to get a good look at, even as I have never fast-forwarded through their ridiculous interpretations of the cha-cha to get to Brooke Burke.vi

Of course women will like good dancing more than bad dancing, but I am not sure that women are attracted to better dancersvii -- which is the only reason evolutionary psychologists would be interested in the question. If it doesn't lead to penetration, they don't want to hear about it. But here, "more attractive as a mate" does not logically follow from "better dancer." A Craig Ferguson joke: "A new study reports that women are attracted to better dancers. The ironic thing is that they're all gay."

III.

But the more serious problem with the study this:

He and his colleagues thinkviii dance is an honest signal to women of the man's strength and health, just as it is in crabs and hummingbirds... It makes sense that women would care about men's ability to dance, says Helen Fisher, a biological anthropologist at Rutgers University in New Brunswick, New Jersey. "For millions of years, a man with well-coordinated movements of the head, neck, and trunk [which he used when throwing weapons] probably signaled his ability to provide"

This is completely crazy.ix She could have used that same explanation if flailing arm movements were what was more attractive, she just has to replace "head neck and trunk" with any body part that was preferred and she can win tenure. I also don't know if she's aware that the words "man" and "millions" and "throwing weapons" and "well-coordinated" have no business being in the same sentence, unless that sentence is the one I just wrote.

Consider also that this is dancing today, in western Earth. If this is supposed to be a generalizable observation about intraspecies attractiveness, how would we rate the hotness of the dances people did in the middle ages, the ones with the ribbons attached to poles? Wasn't Maypole dancing itself derived from a pagan fertility dance whose purpose was to get you knocked up?x

If this study is valid at all, then it is only valid for modern, culturally created attractiveness. It is identical to saying "women prefer men with body hair because it signals virility." When was this? The only people who find 1970s pornstars attractive are 1960s pornstars, and communists, which are the same thing.

Maybe somebody can explain to me how evolutionary psychology can make predictions on a non-evolutionary time scale without resorting to genes, which it can't do anyway because it doesn't know of any.

Besides: natural selection stopped being applicable to human beings the moment we allowed other people to tell us what is attractive to us.xi

———Duh. Of fucking course they are. [↩]Holy shit, what ?!

Go home, faggots. Women aren't "people", certainly not in this context, and what the fuck "attract women" idiocy is this! [↩]Holy shit, LONDON, really ? [↩]Prediction : the sort of dingleberry who imagines women "choose a mate" by watching bois dance ends up a "scientist" in LONDON.

Pro tip : women "choose" their mates like dingleberries "choose" their careers, or LONDON. There was a lot of choice involved, yes, all these various other "options" and shit. [↩]Holy shit great guys, back the fuck off. Dancing in females signals fitness for usage, what the fuck is with all this gayola & faggotry! [↩]LONDON scientists cry themselves to sleep every night. [↩]Women are absolutely not attracted to any kind of dancers. [Some] girls are attracted by the bois working their ass off, strictly as a curiosity thing. Women are attached to the chill guy on the sofa owning all the things. I hope you can spot the difference. [↩]What to these dweebs want to be true ? [↩]No shit. LONDON. [↩]Either that, or to get it to rain, or to get the young hussies used to the idea the phallus is the center of the world, or whatever. [↩]This is quite so ; and it starts earlier : since man has been living in artificial environments since forever (as the definition of "man" specifically revolves around the creation and usage of tools, which are definitionally the little portals through which the artificial seeps into nature) it therefore follows natural selection never controlled to man's evolution. Chew on that for a while. [↩]

« thelastpsychiatrist.com - Aren't Two Antipsychotics Better Than One? The Most Important Article on Psychiatry, Part 3. Adnotated.

Fracture »

Category: Adnotations

Monday, 29 July, Year 11 d.Tr.

thelastpsychiatrist.com - Are Law Schools Lying To Their Applicants? Adnotated.

Fordham's post-graduate employment data

Almost at the same time no one was asking why the WSJ was publishing excerpts from Amy Chua's, How To Make A College Student, no one was also asking why the NYT was interested in whether law schools weren't a scami. I respect that this is an unwieldy first sentence, but it's late and I'm drunk.ii That's how I start my essays.

I.

The New York Times asks, Is Law School A Losing Game?

The piece has two main points. The second one is that students incur a huge amount of debt with little ability to pay it back, and, if the law jobs don't materialize, won't ever pay it back. This second point is presented first, indeed, in the first sentence:

If there is ever a class in how to remain calm while trapped beneath $250,000 in loans, Michael Wallerstein ought to teach it....iii

Mr. Wallerstein, who can't affordiv to pay down interest and thus watches the outstanding loan balance grow, is in roughly the same financial hell as people who bought more home than they could afford during the real estate boom. But creditors can't foreclose on him because he didn't spend the money on a house.

He spent it on a law degree. And from every angle, this now looks like a catastrophic investment.

Which brings us to the first point, the main point: law schools are lying. Despite the fact that "JDs face the grimmest job market in decades" the schools are somehow reporting to prosepctive applicants that, e.g., "93% of grads are working" and "the median starting salary of graduates in the private sector is $160,000."v

How do they do this? "Enron-type accounting standards...", says a law professor. "Every time I look at this data, I feel dirty."

A law grad, for instance, counts as "employed after nine months" even if he or she has a job that doesn't require a law degree. Waiting tables at Applebee's? You're employed.

The schools do this because the schools are extremely profitable businesses: high cost, low margin.

"If you're a law school and you add 25 kids to your class, that's a million dollars, and you don't even have to hire another teacher," [said an ABA commissioner.]

II.

Why do law schools bother to fake this data? If it was "80% employed" vs. "90% employed," who would notice?

They fake it because that pointless data gets handed over to the illusionists at US News along with other pointless data (expenditure per student, library facilities, max bench press) to generate a single overall ranking, which is just the kind of simplistic, pseudoscience objectivity that students, parents, and schools demand.vi

A quick word on the US News rankings. 25% of the ranking comes froma "peer quality assessment" in which schools rate each other. So, say you are Clemson Law School. What should you do? "Rate all other programs below average." And, of course, do what University of Wisconsin did: give the highest score only to itself and one other school that you're not really competing against.vii You can also bring up that "alumni donations" factor by calling alumni and asking them to donate $5, and whoever doesn't donate label as deceased.viii

A ranking, like the "percent employed", is an example of information bias. You think you know something, but you don't. If Fordham is #21, is that different than saying it is #29? Or saying it is in the second decile? It's a deliberately obfuscated precision that you can't act on. That level of "certainty" does not inform your decisions.

By the way, the ranking doesn't have to be inaccurate for it to be information bias. A ranking can be deadly accurate and still be ridiculous. Back in college and yesterday, me and my boys used to rate women to the tenth decimal place, "yo, yo, yo, check this out, I just got maced by this 8.9!"ix and while our scale had confirmed 100% inter-rater reliability, what were we going to do with this information? Was our audition going to be any different with a 8.4 vs. a 9.7? "Hi, I'm here for the part of sketchy boyfriend, here's my headshot, references... Light my head on fire? No problem."x

See? Grade inflation. We already know about the problem of grade inflation in colleges; the LSAT was supposed to help offset this by offering a standardization. Now the ABA wants to do away with the LSAT requirement. Fine. But the result of all this is you can't really be sure how you compare to other applicants, so instead you demand objectivity in the schools' rankings as a proxy to guess where you might belong. "I think I belong in a top tier school..." How do you know? The analogy is you have no idea what kind of a man you are and thus what kind of a woman would be right for youxi, so you just harass the girls that other people think are the best. Then if you don't get her you're angry at the girl ("these bitches just want jocks and legacy applicants"); and if you get her you're surprised to find that three years with her has left you unfulfilled.xii

And once they're in law school, there is more grade inflationxiii and even retroactive adding of .333 to everybody's GPA. And now law school graduates are surprised to find they're unemployed. Law students had no real measure of their status as an applicant; no reliable descriptor of what kind of a school they went to (short of branding); and no reliable measure of their performance there. "What do you mean I can't get hired?" They think to themselves, "aren't I bright? Hard working? Fluent in legal theory?" And the employers respond, "how the hell would we know that?"xiv

III.

That's Mr. Wallersteinxv, I assume clutching a yellow legal pad.

The structure of the NYT article is to offer a profile of an unemployed graduate and use it to explore the law school system. In the vein of its analysis of the unemployed college grad, it exposes him as intelligent but entitled douchebag.

Here's an example. Though his massive debt is in the first sentence, it isn't until page 4 that you learn why he's in debt:

WHEN Mr. Wallerstein started at Thomas Jefferson, he was in no mood for austerity. He borrowed so much that before the start of his first semester he nearly put a down payment on a $350,000 two-bedroom, two-bath condo, figuring that the investment would earn a profit by the time he graduated. ...Mr. Wallerstein rented a spacious apartment. He also spent a month studying in the South of France and a month in Praguexvi -- all on borrowed money. There were cost-of-living loans, and tuition of about $33,000 a year. Later came a $15,000 loan to cover months of studying for the bar.

He lives with his fiancee who is "unperturbed by his dizzying collection of i.o.u.'s." She doesn't want him to get a corporate law job because (take a sip first): "we like hanging out together." Carly, another unemployed law graduate explains, "I guess I kind of assumed that someone would hook me up with something." I'm sure she felt she deserved it.

Do you hate law grads yet?xvii Hold on, here's how the article ends:

MR. WALLERSTEIN, for his part, is not complaining. Once you throw in the intangibles of having a J.D., he says, he is one of law schools' satisfied customers.

"It's a prestige thing," he says. "I'm an attorney. All of my friends see me as a person they look up to. They understand I'm in a lot of debt, but I've done something they feel they could never do and the respect and admiration is important."xviii [my edit: he isn't actually practicing law.] ...And he's a quarter-million dollars in the hole.

Unless, somehow, the debt just goes away. Another of Mr. Wallerstein's techniques for remaining cool in a serious financial pickle: believe that the pickle might somehow disappear.

Bank bailouts, company bailouts -- I don't know, we're the generation of bailouts," he says in a hallway during a break from his Peak Discovery job. "And like, this debt of mine is just sort of, it's a little illusory. I feel like at some point, I'll negotiate it away, or they won't collect it."

He gives a slight shrug and a smile as he heads back to work. "It could be worse," he says. "It's not like they can put me jail."

Haters: this guy is asking for it.

IV.

Let's take all this at face value. Is he entitled? Delusional?xix

I don't doubt for a moment he sincerely believes he is a lawyer, because lawyer for him isn't a profession or even a job, it's a label, a code word for a kind of intellectualism he wants for himself. As long as "all of my friends see me as..." it was well worth the cost. He didn't study to become an attorney, he bought a back-up identity.

It's worth asking why Wallerstein chose a JD as a back-up identity, and not an MD or a PhD. Can we agree it was easier?xx Why not an MBA? Because an MBA is for something else; a law degree is a brand in itself. You can get an MBA and still be nothing unless you find a job. Get a law degree, you're always a lawyer.

It's probably the same reason he didn't try some other hail mary like, say, borrow $200k and just open up a coffeeshop or become a daytrader. You could fail at those. Graduate from law school -- and everybody does -- and you can't possibly fail. (Surprise.)

I go through this to show you that law school, while it attracts people wanting to practice law, also attracts college kids who are brightxxi but emotionally adrift. They don't know what they want -- besides a mental image of a lifestyle -- and they don't know who they are -- besides a mental image of an identity. A three year law program is a great way to postpone reality and still have something to show for yourself.

This is as good a place as any to point out that a huge portion of this failure to mature is the fault of the undergraduate college that gave him up for adoption. If four years of mandatory intellectual exploration not to mention electives in acid and penetration can't guide you to self-awareness then you probably paid too much for the experience. Smart students will always tell you that most of what they learned in college they learned on their own, which is true but opposite to the purpose of college. Demand a refund.

Law schools are [a] magnet for those kinds of people, because to people not in law school it sounds like it's three years of elevated debate, philosophy, history, thought, with a feudal ka-ching at the end for joining the club; in other words, it sounds like what college should have been.xxii

In actuality, law school is utterly useless. The only thing that was useful was the writing class, which basically taught you how to argue thoroughly but efficiently on paper. Law school is also the first place that many people are confronted with someone who tells them their conclusions are stupid, so I suppose there's benefit in that.

IV.xxiii

Please remember that as I quote the Times' description of Mr. Wallerstein, I have no idea if it's true, I only know that the NYT wants me to believe it's true, which makes me more suspicious than 6 clear vesicles on bothxxiv labia. The one thing I know for sure is that the New York Times -- throw in The New Yorker and The Atlantic, too -- hates its readers. It wants them, of course, but see them only as organ donors. The Times is accused of being a leftist/socialist paper, but that's not true, their collectivist perspective comes from assuming all of you people are free range cattle.xxv It thus feels it has an ethical obligation to construct stories that will get you to believe their message, even if the facts of those stories have nothing to do with the message they're interested in. If you follow this, you then discover that Mr Wallerstein is an unemployed law grad -- let alone an entitled douchebag -- but a straw man.

While it looks like this is a story about law schools, it is in fact a story about debt -- and who's to blame. By debt I'm talking American style debt, the kind that Greece and Iceland scooped up like a Komatsu front loader only to discover they couldn't print money like we can.

So now we have a rewrite: You're promised the American dream. You borrowed against that dream, but now the dream is gone and the debt remains. Someone's to blame. That's the story of housing in Florida.

Put that way, of course it's the law schools'/mortgage brokers' fault. How could a kid -- or a hispanic -- be smart enough to ever consider that they were too much in debt when the people in charge were saying it was okay to leverage because it would all work out? Predatory lending.xxvi

Now, no one would dare propose taking that money away -- we want everyone in big homes -- but something has to be done, right? What would be an effective solution to the high cost of law school?

Steven Greenberger of DePaul recommends a mandatory warning -- a bit like the labels on cigarette packs -- that every student taking the LSAT, the prelaw standardized test, must read. "Something like 'Law school tuition is expensive and here is what the actual cost will be, the job market is uncertain and you should carefully consider whether you want to pursue this degree,' " he says. "And it should be made absolutely clear to students, that if they sign up for X amount of debt, their monthly nut will be X in three years."

That is exactly the kind of solution I'd expect from a lawyer: completely ineffectual and CYA.

Solving the J.D. overabundance problem, according to Professor Henderson, will have to involve one very drastic measure: a bunch of lower-tier law schools will need to close.xxvii But nobody inside of the legal establishment, he predicts, has the stomach for that. "Ultimately," he says, "some public authority will have to step in because law schools and lawyers are incapable of policing themselves."

And again, the lawyer answer: we need more regulation.

If you want one single sentence that summarizes precisely what is wrong with the interpretation of what is wrong with law schools, it's this one:

Today, American law schools are like factories that no force has the power to slow down -- not even the timeless dictates of supply and demand.

If something is immune to the laws of supply and demand, it's usually because someone deliberately set it up to circumvent those rules.xxviii

Supply and demand should have caused these lower tier schools to lower their costs to entice students away from the better but more expensive schools. But they don't need to, because all law schools are free. Read it again. All law schools are free.xxix

Not after you graduate, of course, but right now. Law schools can charge anything they want because everyone has enough money to pay for it -- today. As long as there are guaranteed government loans available for this, there is no economic incentive to lower the costs. And as long as the price is zero, demand will always be infinity.

If it was true supply and demand, #1 ranked Harvard and #100 ranked Hofstra wouldn't have the same tuition. But they do, the same as stupid Washington University, which is so stupid it's in Missouri. "It's underrated." Bite me. Are we saying that Hofstra's worth the same money as Harvard? That people would pay anything to go to Hofstra? No, they don't have to pay anything to go to Hofstra. That's the point.

You cannot, on the one hand, say you want to lower the number of students while on the other hand incentivizing them to go. But you're not incentivizing the students, are you? It's a wealth transfer to universities. That's why you want to directly limit the number of schools while keeping the payments to the rest of them intact. More for you. And if you have to throw Mr. Wallerstein under the bus to hide this truth, well, sacrifices have to be made.xxx

———No, actually, the USG.Pravda (aka "New York Times" in-universe) is pushing the line whereby USG.Gosplan (aka "Harvard" etc in-universe) are all 100% certified luft, pure&unadulteratred hot air, but that's okay. [↩]Meanwhile his ever so clever and professional "trick" of peppering question marks in the titles is starting to get on my nerves. What the fuck is this leftover 1950s Mickey Mouse shit anyway. [↩]Not really. The textbook is actually here. [↩]Technically, it's "Mr. Wallerstein, who can't be coerced to pay", not "Mr. Wallerstein, who can't afford to pay."

The fact of the matter is, a little bratty boiwhore formely known as Wallerstein would afford to pay quite readily, once the vans labeled Lagerbordell showed up ; venturing a guess his hebe ass would probably earn a decent penny bacha bazi-ing Pakistan. Right ? Lotta oil money ready to change hands in exchange for sticking it in the jew juuust where it hurts. [↩]Fucking ridiculous nonsense. The "private sector" denotes about 1% or so of all college grads employed in the field, which was less than half of the output even back in 1996, when Fracture was supposed to be occuring and the senior DA is complaining that he's been working there for five years and he can't even get an interview with this "private sector".

Most kids with a JD in the general "become" nothing, they stay the same barristas / fluffers they were to begin with. Most kids with a JD from a "good" school, eg Duke, become Tucker Max, which is pretty much the same thing. A very tiny fraction of kids with a JD become... "magistrates" : public defenders, DDas, "magistrate" judges aka glorifed clerks, etcetera. It is a sort of schoolteacher, for bois. They make slightly more than what the food stamps would provide anyway. There are maybe five kids in a generation making that 200k a year, but once you spread the respective million over the hundred thousand hungry mouths you realise going into debt to buy scratch tickets is just as good. [↩]Because they're educated folk, because they were educated, because... [↩]Understand -- this isn't something the schools did wrong. This is something they did right, as per the logic of the system ; this is what america is, and always was ; the america of "I know obscenity when I see it", the america of "prevailing community standards", the america as it stands and always stood, entirely unrelated to the VHS America perhaps floating about in your thick shelled orc head. [↩]Amusingly, he's giving away "trade secrets" that constitute the entire profession of college administrator (fingerbanging skills were never required, teenage sluts come either practically on their own or else not at all). [↩]That'd be the first decimal place ; the tenth looks like 0.1234567891. [↩]Must've sucked to have been this dude (and "his boys") back in college. When I was nominally in college the 9.5s and above made a coupla hundred bucks per six hour session (also including the benefit of getting to spend those six hours in a local dacha as opposed to the parental hruscheba). And they fucking loved it, and were absolutely grateful for the opportunity to make us five figures in profits. The vast majority of the 9.5s and over, we're not talking stragglers here, we're talking the fucking bulk of broadhood. [↩]"Kind of woman" ? "Right for you" ? What does this tard want to be true -- besides, of course, not getting laid in college. [↩]Stupid fucking bullshit... "three years pushing the car suck, and three years pulling the car also suck". What the fuck, who pulls/pushes cars about ?! Get inside, turn the key, step on the pedals, move the donut, holy shit. She's there so you teach her how to serve, not so you expect her to "fulfill" you, what the fuck nonsense is this, if a woman can fulfill you you're about five years old. [↩]aka how the Disaster of Commons sunk the Western World. [↩]No, actually, the "employers" respond nothing because socialist government long subsumed all of them, and socialism is necessarily quiet. [↩]Whoa, check the ugly fuck out! He looks exactly like some pre-diabethic schmuck I wouldn't hire to dishwash the used buttplugs / mop the jizzmats. [↩]I can guarantee you what he was trying to study there were cheap Eastern European sluts ; in the same certificate I can also guarantee you he managed to actually study exactly none. [↩]Not really. [↩]This is fucking hysterical, an ambulance chaser thinking he's respected by someone, somewhere. It's almost as if the US is trying to rebuild Argentina (which it exactly is). [↩]Actually, he just thinks himself female, and good enough at it to interest me. Which he isn't, of course, but he's neither "entitled" nor "delusional", he's just aspiring, like all confused young cunts aspire : to fulfilling greatness. [↩]Yes, actually, it was easier -- but that's not why he chose it. He chose it for the same reason through the same process the talking cunts on TV "news" lulz choose their glued-on skirts. They're not easier, they're just what "they all agreed". If tomorrow Kink High settles on astrophysics... why, "astrophysics" will suddenly... get easiest. [↩]The notion that this ugly jewtard is "bright" is exactly like the notion that Tyra Banks is a coprophiliac because she's somewhat toasty-looking. Mulatto girls don't get their color from ingesting feces, and jews aren't racially smart, not at all. Quite on the contrary, actually : they're racially dumb as fucking rocks, are we on the same page here yet ?! [↩]And was, back before blacks could vote. [↩]This article gets two fours, apparently. [↩]I suppose he means "each labia", though considering what we've seen to date it's a wonder he didn't say "both vagina" or something equally retarded. [↩]This is remarkably perceptive ; no socialism yet ate its own dogfood. [↩]Rather, the necessary end result of "all lives are sacred", "human rights" bullshit -- everyone becomes incapable of valuing anything, all prices become zero and all demands infinity. Dead market. [↩]Actually, it'd be infinitely better to close a bunch of supposed "top" tier schools, starting with Harvard. It's not like they produce better lawyers, in any case. They also don't really employ better teachers. When hiring astrologers... [↩]Nope. Nobody has such power, whether through deliberation or any other means. If something appears immune to the laws of supply and demand, it's always and necessarily because that something doesn't exist. No exceptions possible. [↩]Consider what "free" means : all schools equally put no demands on the students. Not merely financial -- intellectual, either.

All law schools are free because no such thing as a law school exists. Makes perfect sense now, doesn't it. [↩]Except Wallerstein's so fucking stupid, he actually likes going under the bus.

It's genetic though : his father, Wallerstein Sr, was dumber than wet rope, while his mother was a stupid whore. [↩]

« thelastpsychiatrist.com - Are Drug Companies Hiding Negative Studies? Adnotated.

Deluge in Kiev, and other excess stories. »

Category: Adnotations

Monday, 29 July, Year 11 d.Tr.

thelastpsychiatrist.com - Are Drug Companies Hiding Negative Studies? Adnotated.

Let's skip right to the punching.

I. The Not-Punching Part

A study in the Wednesday edition of the Journal of the American Socialist Party reports that 31% of antidepressant trials were not published, and almost all of the unpublished basically showed negative results.

This is bad, obviously, which is why we need a website for all raw data.i But let's be clear: this was a review of studies found in the FDA registry. The FDA had this data, and used it to evaluate the meds. No one hid the data -- they gave the data to the FDA, all of it. What didn't happen was publication.

So the real question is why didn't they get published.

Certainly, Pharma doesn't want negative studies published. But these are Phase 2 and 3 clincial trials. They're not done down at Lilly HQ -- these are done at universities. Pharma didn't block their publication -- they were blocked by the academics who did them, and the journals themselves.

Hi. Is this thing on?ii

You say: why would the academics themselves, committed as they are to science, block publication? Because they'll lose their jobs, that's why. Academics need grant money, and negative studies don't get grant money. Not from Pharma, not from NIH, not from anywhere.iii "Hi. Nothing we've done is better than placebo. Can I have tenure now?"

But more importantly, they don't publish the studies because they're not in the CIA. When a study comes out negative, the academics don't break out the special redacting marker, they don't say, "better bury this." They say, "Mama Mia! It didn't work!" and start over. Their bias is that the study should be positive; so if it comes out negative, the unconscious assumption is that something was wrong with the study.iv

You go up to a girl in a bar, with your new playa skillz, and she maces you in the face. You don't assume you're a tool, you assume she's gay. Oh, and you don't change your skillz.v

Next are peer reviewers, who are unanimously dismissive of any study that doesn't separate from placebo. They don't think its worthy of publication unless it showed a positive result: "this study does not meaningfully add to the existing literature..."

Keep in mind these studies were done > 5 years ago, back when the culture wasn't "everything has equivalent efficacy." Nowadays, that's the hot topic -- studies showing Pharma sucks, or branded meds are no better than generics. Back "then" journals were all about finding the next big thing, the assumption of progress, etc. There's no room in journals for the null hypothesis.vi

Lead researcher and psychiatrist Erick Turner points out to The Wall Street Journal that doctors unaware of the unpublished studies can make inappropriate prescribing decisions for their patients.

My retina just detached. Seriously? That's the problem?vii

II. The Punching Part

Says the study:

There can be many reasons why the results of a study are not published, and we do not know the reasons for nonpublication. Thus, we cannot determine whether the bias observed resulted from a failure to submit manuscripts on the part of authors and sponsors, decisions by journal editors and reviewers not to publish submitted manuscripts, or both.

That's it. Two sentences. Ok, let's grant them the asylum of ignorance. Explain, then how those two sentences can be interpreted:

But Dr. Jeffrey M. Brazen, editor in chief of the New England Journal, explains to the New York Times why the study is so alarming for doctors and patients. "When you prescribe drugs, you want to make sure you're working with best data possible..." he says. Moreover, patients who agree to be guinea pigs "take some risk to be in the trial, "and then the drug company hides the data?" he asks. "That kind of thing gets us pretty passionate about this issue."

You have to have the deluded bravado of a DJ Khaled video to say the drug company is hiding data when, in fact, you are the one who is responsible.viii

The authors are themselves peer reviewers. Did they ever review a negative article that they recommended publication?

Lead author Erick Turner has "30 publications in peer reviewed journals." How many of those publications had negative results? One: B12 was not effective for seasonal affective disorder. So did he submit negative studies and they were rejected, or did he simply discard them? Turner was also a reviewer for the FDA -- why not simply release all that data? Open acccess? Don't give me this crap about clinicaltrials.gov. Don't ask Pharma to put their data there. You already have the data -- just release it. To his credit, he has already made this exact recommendation. In 2004. Making this article superfluous...ix

Dr. Drazen, above quoted editor-in-chief of the JASP, has to be insane.x HE'S THE ONE MOST RESPONSIBLE FOR THE REJECTIONS OF THE NEGATIVE STUDIES. His predecessor was Marcia Angell -- arguably the single worst thing that happened to medicine, everxi. Together they form an impenetrable wall of meaningless social policy articles that no simple negative study could ever penetrate. They reject articles showing Prozac is better than Zoloft; what chance does a Prozac=Zoloft article have?

But the cake goes to anchor author Dr. Rosenthal. You know what his area of research is? "Self-fulfilling prophecies" i.e. "the effects of experimenters' expectations on the results of their research." This guy should know better -- I'm sure he knows better -- than to publish a study like this and not comment on the responsibility -- ok, the effect -- of the academics themselves.

But that would be asking the dog to bite the jaw that it was eating with, which is both impossible and painful.

———Which was paid for yet still never happened. [↩]He's implying something in the vein of being in front of a microphone. [↩]Not anymore ; steady stream of pantsuit-mocking negative studies is a certain way to Republican tenure. [↩]No, their unconscious assumption isn't that "something was wrong with the study".

Their unconscious assumption is the cunt mind : they want to be part of something, and they assume (quite falsely) that the only thing there is to be part of is the mass of retards. Consequently, they censor themselves like highschool junior cuntlets, who will happily and in all seriousness report their "straightedge"-aligned dreams, fantasies and assorted psychogenic noise while their "boyfriend" and his male group are "straightedge" -- only to seamlessly switch to (ever so different! believe!) "gothic" dreams, fantasies and psychogenic noise the same day the vagaries of male prepubescent sexual choice push her into the arms of some equally dorky teen from the ever-so-distinct "gothic" group.

"We were always at war with Eastasia" is such a recognizable macula of the socialist state because, like all utopias, the socialist state translates into the public sphere the private mechanics of the fundamentally female brain function. Like all brain function the female brain also organizes phenomena into ideal structures according to an ideological structure ; it just happens that the prime imperative evolution has selected for the female is the salvation of as many children as possible, and therefore stability ("truth", in male terminology) has to take on a secondary role.

They're just saying what they figure authority wants to hear so they don't get killed, what's so hard about this concept ? There's no further content in there besides this projection of will, which is why their silencing is preferable. [↩]This is exactly the wrong example ; but then again the author wants some things to be true, and looking at how divorce incidence is a linear approximation of exactly how much it pays the female to get one wouldn't bring much support. [↩]And how did it become the hot topic ? For that matter, how did the Republic become the dominant force in Anglo culture ? Don't tell me "there was some demand, which was filled", I was there when the demand was Dirlewanger'd out of "society" / "mainstream" / "media" / etcetera assholes, on iron hooks. I forged many of the very fucking hooks employed! [↩]Prescribing decisions, keks. [↩]Here's a fun fact : did you notice I altered the schmuck's name, from the original Drazen to the much more context-adequate Brazen ? No ?

Awww. So you're saying he's practically anonymous, at least in the sense that no responsibility can meaningfully attach to him personally, irrespective of what he says ? How can this possibly be bravado, then ? Braves risk death, this guy's just safely working the numbers. What else would you have him say ? (Spoiler : he'll say it). [↩]This entire pile of safe players, "making recommendations" for others to act upon, just as long as those others can be found to eat all the downside and deliver all the upside... they're all fucking superfluous, altogether. [↩]He's not insane, he's just ESLtarded. [↩]And coincidentally a woman, I'm sure ; and just as coincidentally Harvard, of course.

She was the first female ever permitted to edit the NEJM.

Remember Hussein Bahamas ? The first nigger presenting black permitted to "president of the united states" ? [↩]

« thelastpsychiatrist.com - Are Certain Behaviors -- And Jobs -- More Masculine? And Out Of Our Control? Adnotated.

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Sunday, 28 July, Year 11 d.Tr.

thelastpsychiatrist.com - Are Certain Behaviors -- And Jobs -- More Masculine? And Out Of Our Control? Adnotated.

wouldn't you know it, all the best derivatives traders are lesbians

There are many reasons to think testosterone affects behavioral outcomes. Just on semantics, high testosterone would be expected to correlate to virility, aggression, and leads in action movies.i

But what is the effect of brief, intra-uterine testosterone?ii Do people who were exposed to higher testosterone in the womb become/behave different/ly?iii

An example: fraternal twins. Does the girl's stewing in the boy's testosteroneiv make her a better athlete, President or serial killer?

In an attempt to answer that, there's been considerable research on the effects of intrauterine testosterone on later life outcomes.v

I. (This is how you construct a lie: don't answer the question that was asked, answer the question you want to answer.)vi

III.

An example, a somewhat famous study. Researchers examined a group of financial traders:

(Introduction) We therefore formulated the hypothesis that higher prenatal testosterone exposure would improve a trader's performance.

(Discussion) The finding that a marker of prenatal testosterone levels predicts a trader's long-term profitability...

The success and longevity of traders exposed to high levels of prenatal androgens further suggests that financial markets may select for biological traits rather than rational expectations.vii

And from Time:

Earlier studies indicated that prenatal exposure to testosterone... increases a person's sensitivity to the effects of the hormone much later in life.viii The greater the exposure as a fetus, in other words, the higher the levels of confidence, vigilance or risk appetite triggered by testosterone in an adult.

It's not hard to see why financial traders exposed to testosterone might be better at trading.ix And now you have to think about society: maybe there are real sex differences in performance in the workplace. It's perfectly ok to select a lingerie model on the basis of femininity. Is it -- should it -- [be] okay to pick options traders the other way? And how can we level the playing field for those with a slight biological disadvantage?x

A.

First Principles: what do the authors want to be true?

None of the studies linking biology to behavior are about either the biology or the behavior, they are only about the link.

The question that they are answering isn't "does environment matter more than genetics?" It's a more subtle, sneaky, social-policy question: "since we now know that genetics isn't as deterministic as we hoped, is there something else that we can focus on which is equally out of our control? What about the goings-on in utero? So that the environment factors matter only at that time, not later? Then we can safely say that behavior is "innate" and out of our control, while still leaving us the door to intervene in people's lives for their benefit."

No one in the behavioral sciences discovers something, and then constructs policy recommendations. "We learned that people are like this, so..."

It's the other way around. The policies come first; the money is spent on the research that supports them.

In questions about evolutionary psychology and behavior, the question they want to answer is always of the form, "how is it not the individual's fault, but we can meddle anyway?"xi

IV.

Back to testosterone. In order to tell if trading is related to that brief in utero burst of testosterone, we need a proxy: the ratio of the index finger to the ring finger. Bigger ring finger (and smaller 2D:4D ratio) = more testosterone in utero.xii

There are many such studies, of very different behaviors: aggression, lesbianism, athleticism, success, risk appetite -- and they are all surprisingly robust, there really does appear to be some kind of link.xiii And it helps that the behaviors all have an intuitive connection to "masculinization" -- (which was the whole point of the testosterone.)

And the associations are just as revealing when they're absent. A recent study found no association to ADHD: "These findings challenge the hypothesis that fetal testosterone exposure plays a prominent role in the aetiology of ADHD." So it must be something else...

B.

The problem isn't the data, but the words.

None -- read it again, none -- of the studies found any link between the behavior and fetal testosterone. All of them found the link between the behavior and finger lengths, which are proxies for fetal testosterone.

But what if finger ratios aren't actually proxies for testosterone?

"Then those studies are crap. Another example of science overreaching. All that research money wasted."

Oh, no, Murdock, it's much worse than that. The studies are valid, the data are solid -- finger ratios do indeed correlate well to these behaviors -- but all of the inferences you've invented about them are wrong.

A recent article discovered that in birds, the correlation was between digit length and estrogen receptors. If that turned out to be true for humans, what are you going to do with all the stories about "masculine" traits? You can't simply say, "oh, it doesn't have to do with testosterone after all." You must now explain why it does have to do with estrogen. Are these feminine behaviors? What?

There are other studies which similarly find the testosterone/finger story to be suspect or even backwards.

So the data aren't wrong -- they're right; they're just about something else. The social implications of the studies-- the very point of doing the studies -- are wrong. You can't dismiss the studies because they're still true -- you have to go back and explain how you got it backwards.xiv

Anyone who had taken a moment to look at the whole hypothesis -- masculine--> testosterone--> finger lengths--> behaviors would have said, "there are way too many loose connections to take this seriously." But no one would have taken you seriously.xv "Science" is three dimensional: "look at the stack of studies that find a relationship between testosterone and behaviors!" No one questions the intervening proxy (digit span) because to do so is perceived to be unrigorous. When you say, "I don't believe this testosterone link" they politely say, "look at the stack!" but if you say you don't buy the digit length, they roll their eyes: another amateur who doesn't understand how science is done.xvi They do this because there's no other argument to make.xvii "This is how we've been doing it for decades, and it's a quite satisfactory method." Yeah. That's what they said about missionary, too.xviii

Because there are so many researchers, and so many in the public willing to run with it, and so much time in between, there's no one to point to as responsible.xix You can't blame Cambridge University for the obviously preposterous notion that masculine traits make for better traders any more than you can blame the head of BP for the oil spill. Both situations are your fault. You wanted what they were offering, even though it was bad for you.

Either we're going to kill Iraqis, or we're going to kill ducks. It's the world's one and only truth, the law of equivalent exchange. For every barrel of oil, you need to replace it with a barrel of blood.

C.

But they are to blame, because when they presented you with their products, they knew exactly what you were going to do with them.xx

V.

I'm telling you this not because I care about finger lengths, but because you are being corrupted.

The article doesn't even have to spell it out for you: they just have to write "there's a relationship to testosterone " and we'll make the cultural/social value judgments ourselves. But they leave nothing to chance; thus Time Magazine.

That's not an unfortunate, unexpected by product of science -- it is the very point of it. In order for you to obtain this knowledge, you have to lose some other knowledge of equivalent value.

Once it's happened, once you've allowed this into your brain, there is no escape, ever, any more than there is an escape from oil.xxi No matter what else they discover, you will always have the suspicion that trading -- and lesbianism and risk taking and hand eye coordination -- are masculine traits.

Until, of course, new guys come in with a new story to tell. "Thanks Dr. Kohut, we'll take it from here."

VI.

The science error of our generation is this: If A is strongly associated with B, and B is strongly associated with C, then A is strongly associated to C.

That's not just wrong, it is extremely wrong.xxii If that seems counterintuitive to you, then you are the problem. Not in the way Robespierre was the problem, but in the way the French were the problem. "Sounds about right to me. And there's a guillotining at 6:94!"

It's not your fault, you weren't trained to understand this, indeed, you were trained specifically not to understand this.xxiii "Let's look closely at the statistics" (not the words.)

Science in the service of social policy is all about giving you everything you need to lie to yourself.

D.

I repeat: I have enough rum to get through what's left of my life, but the rest of you should heed my warning: if you do not rein in your social scientists, your civilization is doomed.xxiv

———In other words, stupidity.

Why exactly this expectation, outside of Anglo rehashes of Soviet era stereotypes on the Belgian Congo ?

It is prime bunk, for the record. There is no significantly higher testosterone expression, concentration, total production or metabolization in the tall, clunky, Caliban-like stereotypical sub-Saharan male, either as a naturally occuring population or visually selected to satisfy the stereotype. Meanwhile in actual microbiology, testosterone is a growth regulation hormone, expressed in both genders, working differently in each gender according to complex and on the whole poorly understood mechanisms, and in either case carrying a significant portion of the burden in neurological development (though not necessarily in the same way).

The whole "semantics" argument is a lot like taking "vit-amines" in the original sense, as dreamily contemplated back when the concept was introduced. God knows the testes-sterone stands with reality in about the same relationship as the vital amines of yore (actually, it was conceptually born in the same pre-systematic period of artesanal biochemistry cvasi-research). What would you say, are amines more feminine than sterones ? Is polystyrene inherently male and should little girls go around in aniline-stained clothing ? Should you offer tris at a bris ?

What the fuck nonsense is this! [↩]The effect of brief peri-penile lipstick is that I'll explain the aniline section of the joke. It's a pigment alright, but it smells like rotting fish, see ? You'll figure out the rest, I'm sure. [↩]Differently from what!

The fundamental fucking problem with tit floor washers masquerading as "thinkers" engaged in "intellectual inquiry" is that they're titfloorwashers! They set out to "measure" putative distances between impossible ends, such as in this case, where the damned thing necessarily can't possibly exist, as only one end can, as per the fucking definition, be present at any given time.

There can be such a thing as "the distance between Moscow and Paris", because, and only because both Paris and Moscow are definite things that exist at the same fucking time! There can't be such a thing as the distance between Paris and Pompeii, because Pompeii no longer fucking existed by the time they invented Paris into the world ; there can of course be measured the palliative "distance between Paris as it stands and the place where Pompeii formerly stood", of course, but this isn't the same fucking thing! At all! And the reciprocal, distance between Pompeii and the place where Paris will in the future stand, was never measured!

But be all that as it may : there can not possibly be any discussion of "the difference between people this way and people that way", strictly because if people are this way, then they're not that way, and therefore there can be no difference! This is what difference is, 8 - 5, not 7 - ? nor ? - 3, and especially not A - !A. This latter bit's just as good as division by zero, anything you come up with on its poisonous basis is sheer rot, to be discarded out of hand before it discards your brain out of your head for you.

Though I suspect we might be too late. What's the difference between nonense and the sense one'd have written had one had the brain they miss ? [↩]This is fucking insane, the mother's own production overwhelms the little boy's by a degree of magnitude. [↩]Rather, in an attempt to produce spurious justification for "research grants" ; much like a privately-held dependopotamus might carefully circle, underline and generally mark each edition of the TV Guide, in an activity very superficially reminiscent of "study", the publicly-held dependopotami copy/paste nonsense into "research papers". You can probably stack the years' worth of TV Guides on a shelf somewhere just as well, for all the good it'll do anyone. [↩]No, this is how you end up confined to a small room in the darkness, in between beatings. Ask anyone. [↩]Except for the part where "biological traits" in the sense of being male are actually the very rational expectations in question, seeing how males are actually better than females at the edges of human activity and experience. All this "morons unhappened some portions of reality and are now wanking impotently & waxing poetically around the ruptured margins where '''some portions of reality appear to have once stood''' but, supposedly, '''can't be seen any longer''', hear us roar" psychotic behaviour is fucking unseemly.

For the exact same money all those involved could individually buy a shotgun, load it with buckshot, check into a motel, shoot a hole in the vinyl siding passing for a wall, decide the hole never happened and then "examine things carefully", with the predictable results that "there appears to be some buckshot damage around the edges of where a portion of the wall still stands untouched by anything like a shotgun blast, tee hee". What in the actual fuck. [↩]Ye olde "global warming" magic trick, where supposed data of dubious origin and ever more doubtful quality is put through some kind of massive amplifying process -- because there's simply no other way to match the inflationary substance of the pantsuit world into "results".

You understand this, do you ? These are some a) believers in a Monochurch whose doctrine is that "all things are the same one thing" whose b) life continuation depends on a very specific dream process, whereby ever larger portions of imaginary future revenues accrue to them on the basis of unavoidable foregoing of consumption today (unavoidable by necessity, imaginary wealth can not be consumed). That this runaway process is unavoidable for very good reasons makes it "invisible", and then because of a) they're c) stuck "discovering" the same pattern everywhere.

Global temperatures have to be in a runaway pattern when regarded by pantsuit eyes, because the supposed "economy" of the pantsuit empire is in a runaway pattern and the pantsuit has to believe this is natural, and therefore all other natural phenomena will have to, for his own peace of mind, get retconned into displaying the same exact behaviour, as if an unseen FED was orchestrating each and every thing that happens.

A world composed of runaway processes, notwithstanding how simply and directly impossible it is, and how utterly contrary to any sort of systematic observation -- think about it, if life on Earth consisted of positive, rather than negative feedback loops, how would it even be possible at all in the first place, for more than a few minutes at the time ?! -- is then the necessary pantsuit perception of its environment, made necessary not by anything in the environment, but by the shit they rubbed in their own eyes. [↩]Especially if you're one of those morons that keep seeing things. Pro tip : what you're "seeing" here is the same thing you're "seeing" when you explain away why you can't walk up to a girl and say "Hi!" ; it has absolutely nothing to do with anyone or anything besides yourself -- to be specific, with your own attempts at not noticing the holes you buckshot out of your own head. [↩]Bwahahah, who said the disadvantage is slight ? And, for that matter, who said anything about "levelling the field", holy shit pantsuit monomania, not everything must end up the same one shithole!

It's a wonder all these schmucks don't move into Alabama, Indiana et all, it should be flat enough for their needs. What the fuck are they doing in California, Oregon, Washnigton etc, all the mountain states ? [↩]This'd be the core of the psychological process involved, yes, splitting and disavowal. [↩]Obviously, the indirection layer, the militant idiot's best friend. [↩]Almost looks like there's a hole right through the wall there!!! [↩]No, it's explained. What you have to do is go back and cage a bunch of old women. [↩]This is no spurious comment ; during the heyday of Maddof, most serious players on Wall Street at least suspected (to the standard of, being privately persuaded on strength of heuristic, and thereby for lack of incentive not bothering to formally establish the matter) the guy's running a Ponzi ; but "nobody" took them seriously, in the sense of, the chumps didn't. Similarily throughout, the chumps are the chumps specifically for this reason. [↩]Well, "science", at any rate. [↩]No, they do this because they like to eat, and being fucking stupid lack any other preoccupation. [↩]And other things. [↩]Cage. Old. Women. [↩]This is exactly what blame is not. Always, in all contexts and under all circumstances the "victim" is to blame. [↩]If this were in fact true, no such thing as a scholar were possible. But it's not true, just more of the same pantsuitist theoretical amplification at work. [↩]Or rather, not-even-wrong. [↩]This reads exactly like fault to me. [↩]This was never a civilisation ; as Frenchman living in London put it last night, "the shittiest Italian village is still better than whatever the Brits managed to do with all their profits from supposedly running the world for a while". [↩]

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Sunday, 28 July, Year 11 d.Tr.

thelastpsychiatrist.com - Are Antipsychotics Overprescribed To Kids? Adnotated.

does this make me look like I'm keeping an eye on waste?

10 year studyi of inpatient kids: 44% got antipsychotics. Is that a lot? Yes. It's a lot. And most of the time, not even for psychosis. 44% of the PTSD and ADHD kids got antipsychotics.

You can wrack your brain trying to figure this out or blame the usual suspects, but the answer is right there in the article:

Variables associated with antipsychotic use [included] male genderii, age 12 years and under, being nonwhite, and a length of stay 13 days or longer.

You'll observe that none of those words is "diagnosis" or "severity."

The cause of these high levels of medications is so simple you'll recoil from the truth of it, but pour yourself a drink and take it like a man: the kids showed up. That's it. The kid is in front of you and you have to do something, now, that results in an acute change. Not better grades 4 years out, or less sadness over the teen years; change the sleep tonight, make the kid less hyper now, and when it "stops working" you can up the dose or change the med.iii

It doesn't matter what the diagnosis is or what the symptoms are, really, whether he ate his dog or got a C on a test he's going to be getting somethingiv at qd and hsv because that's what you get when you put psychiatry as the cornerstone of a Multidisciplinary Treatment Team.

When a kid is presented to a psychiatrist, the psychiatrist is pressured, obligated, to do something pharmacological. If a psychiatrist looked a single parent a joint away from a nap right in the eye and said, "nope, he's acting out because of X, Y, Z, and medications aren't going to fix this" that doctor will get his head handed to him by parent or by lawyer. Justice will be done, you negligent elitist.vi

And the simple reason why the kids showed up is that the parents and the schools and the cops and the courts were told that's where you go when a kid punches another kid or becomes hispanic. That's why outside the oakwood offices of the private docs the shingle says "Practice of Psychiatry" in Palatino Linotype, but get within fifty blocks of a black kid and the whole thing is labeled "Behavioral Health" in what I think is Erasermate.

This is why reducing antipsychotic prescription is a Chuck Grassleyvii political diversion, if the kids don't get antipsychotics they won't get nothing.viii The problem is the overprescription of prescriptions.

I get that when a 15 year old starts up with cocaine it is a bad thing. But is it automatically true he has ADHD or BPD and needs medications? Check the map:

There's a very large system in place for not doing what's best for people, it is expedient and simple and the law but nevertheless ineffective and counterproductive in the long run. The trouble is, this system screws it up for people who actually need it. Just because a 10 minute med check is perfect for the vast majority of patients who don't have any psychiatric illness, doesn't mean it'll work on the kid with prodromalix schizophrenia and the crying parents who look at you like, wtf? Are you kidding me with this?

———The illustration incidentally brings a point in focus : Back in 2009, when Robert Mueller was the director of FBI, the USG spent millions each year to send government workers to Harvard for a month. The practice came to light when Grassley (depicted) asked Harvard about its Senior Executive Fellows program and to explain why it costs so much.

Do you remember what they called this back in the other soviet ? Do you remember why exactly it was absolutely necessary ? Well then! You're in a position to ask much better questions than Grassley, in the limited sense that you really don't need to ask any questions at all.

It's self-fucking-obvious why they have to attempt and conventionally sync their wooden tongue, what. [↩]And this isn't misandry, yes ? The boys just happen to be "genuinely sick", right ?

Fuck. You. [↩]This all sounds pretty amped up... [↩]Hey, this sounds almost exactly like the "criminal justice" system. [↩]qd is "quaque die", Latin for "once each day" (confusingly, qid is "quarter in die", ie, four per day ; while qs is "quantum satis/sufficit", ie "as much as sates/suffices") ; hs is "hora somni", Latin for "bedtime". None of these are all that usable, nor really used anymore because of the ample opportunity for confusion and the drastic reduction in cost-of-writing since the 1700s. Their only utility remains showing off, and it's likely to increase as they slip away from public mind. [↩]Proving in yet another form and venue the one universal truth of mankind -- that you can't have working systems without elitism. [↩]He's still there, by the way, currently president pro tempore of the whole senate. Yeah, you got his scheming number right from the first pic. Ninety years old, half of which "serving" his country as a senator. [↩]He means, "it won't be the case they get nothing at all ; they'll still get something". I think. [↩]This inane bullshit... calling it "prodromal" just because ~nobody knows what qs is and it sounds medical doesn't do jack for the argument. I wish to see this kid with schizophrenia sometime, if anyone ever manages to locate one. [↩]

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Friday, 26 July, Year 11 d.Tr.

thelastpsychiatrist.com - Are Antipsychotics Overprescribed In Kids? Adnotated.

According to USA Today, 2.5 million antipsychotic prescriptions a year are written for kids under 18. The rate for privately insured kids is 6.5 in 1000 -- it has to be easily ten times that for Medicaid kids.

The FDA database has 45 deaths; 6 from diabetes, the rest from CV disease, liver failure, suicide, etc. There were 41 pediatric NMS cases.

According to the article, 13% of antipsychotic prescriptions are for bipolar disorder.

So are antipsychotics being overprescribed?i The answer is yes, but not for the reasons cited in the article.

The article, indeed, all articles about pediatric psychiatry, make a special point about how these medicines are not FDA approved for kids. This is absolutely meaningless. FDA approval requires two double blind, placebo controlled studies. These studies are universally taken on by the drug companies. No drug company would ever assume the massive risk of such a study -- let a lone two -- in kids. How do you recruit the study subjects? What parent is going to allow it? Rich parents? No chance. So it will have to be Medicaid parents -- and thus will come the Tuskegee-like charges, dripping with the obvious social and racial implications of pharma testing on poor minorities. Pharma is already loathed; they're not going to take any risks for the sake of a medal from the FDA. So there will not be any new pediatric indications for psych meds. Not in this climate. Think this hurts Pharma? It's your kids that suffer.ii

But don't be confused by crypto-socialist hysterics who say that Pharma will do anything for a profit, including peddle drugs to kids. Drug companies do not market these antipsychotics for kids. They are paranoid to a fault about doing this; they know everyone is scrutinizing them, especially lawyers. If you are a child psychiatrist who sees no adults, reps cannot even call on you. And if they call on you for other things, they cannot mention the use in kids. In the past five years, it has never -- never -- happened that a rep detailed me about their use in kids.

The only two reasons these drugs are used in kids is because psychiatrists give them, and parents demand them.

First, the parents. They don't come looking for antipsychotics, specifically. But my experience is that they are unrealistic about what is going on with their kids; in near denial about the family dynamics impacting on the kid's behavior; and virtually devoid of insight into relatively obvious, though procedurally difficult, maneuvers that could improve the situation.iii If your kid doesn't sleep enough, and consistently -- if your five year old doesn't nap -- you cannot tell me your kid has ADHD. Period. Parents demand a diagnosis of bipolar disorder for their kids because it means the divorce had nothing to do with it.iv They demand another medication when the first one fails to get the kid to do math homework instead of playing Xbox all day. And their kids' marijuana and alcohol abuse can't possibly have anything to do with their own marijuana and alcohol abuse. Parents: don't flame me. Your situation is different, I know. I know.v

Second, psychiatrists prescribe them because of the pressure to do something, in the face of consistent failure.vi They don't start with antispychotics -- they end up with them. They prescribe them out of desperation. This is why, in every story about a child getting sick from one of these medicines, they are, in fact, on several medicines. First they start with Ritalin. If Ritalin doesn't help, or there is a side effect, or they can't sleep -- then a second drug is added. Maybe this helps, but after a while something else happens -- and another drug is added to this. That's why psychiatry's current obssession with the detection of underdiagnosed "bipolar disorder" is so important. This diagnosis justifies, and encourages, polypharmacy.

It is psychiatry's ridiculously dangerous, and ultimately doomed, paradigm: if you are not doing well on a medication, you must be so sick that you require two medications. It seems to have occurred to no one in psychiatry that failure on a medication could mean that it was the wrong medication.vii

The reason this polypharmacy madness is even possible is psychiatry's obsession with diagnosis, labels -- with semiotics.viii

What makes a drug an antipsychotic? Well, it treats psychosis. Fine -- but does that exclude its efficacy for something else? If it is later found to be efficacious in, say, depression, then what do you call it? Is the drug an antipsychotic that's also good for depression, or an antidepressant that's also good for psychosis?

There's no value in the label "antipsychotic" or "antidepressant" except what we give it. It's a drug that treats psychosis and depression, not an antipsychotic that treats depression (or the other way around). If you can't see the difference, stop reading now and go back to watching American Idol.

For example, why are antipsychotics viewed as "off label" for kids? The word "antipsychotic" is meaningless. Antipsychotics are tested against a scale, like the Brief Psychatric Rating Scale. But these scales measure a lot of things, like depression, and not just psychosis.

And at what point did we start making a distinction between psychosis and "dementia related psychosis?" Or bipolar depression and regular depression? Why do we need separate FDA approvals? Does someone know something about the physiology of these disorders that I don't? Do we need to start approvals for "diabetes related depression?"

Saying an antipsychotic is worse than an antidepressant for depression is a valueless statement, especially in the absence of data on this question. You are actually better off asking, "which is better for depression, blocking the serotonin transporter or blocking 5HT2a receptors?" See? Put this way the distinction seems less obvious. And even that question is valueless, as there is nothing (that we know of at this time) that allows us to say what effect either pharmacologic maneuver actually has. 5HT2A blockade does what again? Really? Do you have any evidence for that at all? And no more post hoc ergo propter hoc nonsense. David Hume laughs at you.

A Simpson's reference is helpful here:

Homer: Not a bear in sight. The Bear Patrol must be working like a charm.

Lisa: That's spaciousix reasoning, Dad.

Homer: Thank you, dear.

Lisa: By your logic I could claim that this rock keeps tigers away.

Homer: Oh, how does it work?

Lisa: It doesn't work.

Homer: Uh-huh.

Lisa: It's just a stupid rock.

Homer: Uh-huh.

Lisa: But I don't see any tigers around, do you?

[Homer thinks of this, then pulls out some money]

Homer: Lisa, I want to buy your rock.

I know. The FDA, the Scientologists, socialists, the parents at the end of their ropesx -- the easy thing to do is blame Pharma. I'm in the strange position of having to be a Pharma apologist, to be the only doctor willing to defend Pharma. There are plenty things I don't like about the way Pharma conducts business, but I can't voice these complaints because I have to use the time countering these inane attacks. I know what will happen if the Pharma critics get their way.

You think Pharma should have no sales contact with physicians? Fine. Now deal with the consequences.

———Yes. As long as any "antipshychotics" at all are prescribed to kids, then yes, antipsychotics are overprescribed in kids. Leaving aside how there is no such thing as an "antipsychotic", there absolutely is no such thing as psychosis in children ; and I find it particularly galling that the sort of insane fucks who will gleefully pretend there's no sexuality in children against all possible evidence will suddenly turn around and pretend there's such a thing as childhood psychosis, also against all possible evidence. Absolutely fucking nuts. [↩]Don't be fucking ridiculous! The less shamanic practices children are involved with, the better for them.

And yes, this includes your fucking "Santa" bullshit, along with pretty much everything else you came up with. [↩]Such as shut the fuck up and start making everyone sandwiches. No, nobody cares what you thought you "were" back in your 20s, after binge-watching "Days of our lives". Those weren't the days and they especially weren't of your fucking life. You eminently aren't that, not now. [↩]It has everything to do with it, and it is entirely your fault. [↩]No it fucking well isn't. [↩]This is one of those idiotic transactional psychopathy games where the only winning move is not to play. [↩]Wrong for being medication in the first place. This is the core here, the blind spot : medicine can't fail for being medicine exactly like a black dude can't fail for being black, or a woman can't fail for being female.

Oh what, what ? Touch a nerve, did I ? Had I said "a white dude can't fail for being white" it'd have been so much better, notwithstanding it's exactly equivalent (or at least so you claim to believe) ? Hurr, here's two ideas for you : calling collegiate periods semesters is patriarchy through and through, no wonder your daugthers fail so systematically at getting "a" job. Maybe it should be... an ovester ?

Did you want the other one, too ? Alright, here goes : why are all the pills white ? And if all the pills were black, would "medicine" as practiced in the US have quite such a problem with polypharmacy ? Hm ? [↩]No dude, it's because the pills are white. [↩]This should be specious, but I dunno if it's intentional transcription of the original material or what. This is after all the S-M-R-T show. [↩]How about you beat those children, instead of poisoning them. Nope, "child abuse", you say ? Why, because the welts are visible and the liver failure is hidden under the skin ? The welts are also gone by the weekend! [↩]

« thelastpsychiatrist.com - Are All Drug Reps Hot? Adnotated.

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Thursday, 25 July, Year 11 d.Tr.

thelastpsychiatrist.com - Are All Drug Reps Hot? Adnotated.

brought to you by Reaganomics

(This is only peripherally about drug reps.)

Someone was arguing with me about why all drug reps are hot. I told him they weren't, and I would know. I've seen a lot of reps, I even used to train them, fly out to their HQs and give them a two hour lecture on the pharmacology of their and the other drugs.

"Then why does everyone say they are?" He told me that a friend of his in the medical field also noticed they were all hot. And didn't CNN or some blog say they hire college cheerleaders and sorority girls?

Of course, he isn't asking me because he wants a date. The point he is making, the point everyone always makes when they bring this up, is that this is a strategic plan of Big Pharma's: hiring eye candy to influence prescribing.

How would that work, exactly? Pfizer tells HR to screen applicants by cup size? You know HR is run by women, right?

I shouldn't have to explain that a company can't have an employment strategy that discriminates against a protected class. Saying that your hiring practices are a necessary part of a marketing strategy does not get you out of this.i

There are some jobs where appearance is a bona fide occupational qualification (BFOQ -- see, there's even an acronym for it) and if you have to ask if your job is one of those, it isn't. Elite Modeling can hire based on looks, but Abercrombie & Fitch can't. I leaave you to tease out the details.

Surprisingly, ugly people are not a protected class, and phew. But while Pfizer can hire attractive women, it cannot be a hiring strategy. Could a manager choose the prettiest out of all the candidates and get away with it? Sure. But he couldn't hold out for only attractive ones. So if they did want their salesforce to be all attractive females, it would have to be, in effect, a conspiracy: everyone knowing the deal, and everyone playing along. Do you know how hard it is to get a conspiracy going in this country? It's impossible.

But most people have never met a drug rep. And people who have seen one in a doctor's office are sure they're hot -- "I saw her!" But the assumption is wrong, and your eyes are lying to you. You are all making the same mistake.

II.

When you hear that all drug reps are hot, you can be confident that the person speaking is a middle aged man and/or someone with... limited sexual power. These people are prone to two errors. A psychological one: fetishization; and a biological one: mistaking for beauty what is merely youth.

This is supported by the reverse complaint among young male residents, young male reps, and guys who've been around the block: where are all the hot reps? This company blows.

These women aren't hot, they are polished, hair and nails, new shoes, clothes, time at the gym and plenty of sleep. (Sigh, that was me -- never.) What would you expect of a single woman with a lot of disposable income magnified 10x by credit? If you saw them in a bar you might not even notice them, but in a doctor's office their appearance is jarring, out of place, no one else has such attention to their appearance. No one else is as young. No one else walks with such confidence.ii

III.

I'm not saying reps aren't trying to influence doctors; I am only saying that the looks aren't part of corporate strategy, and [it's] asinine to the point of insanity to believe that the 25 year old female rep put on an Ann Taylor suit and Nine West pumps to look good for you, so you'll prescribe Zyprexa.

If you found an actual hot rep, and asked her if she thought she looked hot in that suit, she would say, "oh God, in work clothes?"

But it's those clothes, that job, that make her sexy. Take a 25 year old and put her in a bar, she's a girl. Put her in the clothes and she's a woman -- so for a 40 year old, there's much less guilt about seeing her as a sex object, because she isn't a sex object, she's a professional.iii

"Sex for scripts" is not a derivative of prostitution. It is sexy because it is not prostitution. If it were strictly transactional, it would lose its sex appeal -- no one fantasizes about having sex with prostitutes, they have fantasies of paying for sex, and the fantasy isn't that she does it even though she doesn't want toiv, the fantasy is that she wants it so much she'll do it for so little.v What makes it sexy is the fantasy that the woman doesn't mind it at all; for her, sex is easy, comfortable, immediate. She'll have sex with a man simply out of curiosity: "I just wanted to see if he was any good."vi

They don't have to have sex with you, of course, but their threshold for doing it is much lower. The image of a woman offering her sexuality to obtain a non-sexual reward -- in this case scripts, but it's no different from the idea of the woman who blows the bouncer to get into a clubvii, or sleeps with the band's frontman even though she thinks he's kind of weird looking, just for the storyviii-- is comforting. It offers an explanation for why her sex seems so easy with other men and so out of reach for you: she's doing it for some reason that is not sex. So you make it porn -- she has the ability to enjoy sex even with people she doesn't actually likeix -- and now you ladies know why your boyfriend doesn't care a lick about the three years you spent with your ex, but goes all quiet when you bring up a drunken one night stand. Say this: "he was cute, I guess, but I don't actually remember his name," and strap in for the best sex he can deliver (or a beating.)

If I say "drug rep," you think she's hot. If I say, "she blew the bouncer to get into the club," again, you think hot. If I say she's a "nurse" then she's hot. But if I say she's a surgical nurse, or a nurse practitioner, then she's not hot. The more specific you get, the older you imagine her to be, and the specifics crowd out the fantasy.x

That makes being a drug rep a fetish, in which the jobxi -- not the woman -- is attributed with sexual power that it does not have, but we all act as if it does. That same girl in a supermarket might be ordinary; but call her a drug rep and give her the uniform, and it's boner time. That uniform is just as important as her actual appearance. Uniforms de-humanize (that's the point of them.) The uniform tells you to think of this person not as an individual but as whatever that uniform represents. But if that uniform represents sex (as do nursing uniforms, etc) then the woman can't help but being thought of as sex. So you have to abandon the uniform.

IV.

Instead of wondering why Pfizer hires only young women to be reps, you should ask why young people are lured into Pharma.xii

And why not? Money is great out of college; it's a purely white collar job, not much experience is necessary. While it's not a physically taxing job, who else wants to enter a career where they have to work three nights a week until 10p? I know it's at a restaurant, but these young women you expect to be hot have enough money to go on their ownxiii, with people they like, not a 50 something "I was an obstetrician in my country" or a table of know-nothing residents who all think they're going to Vasco da Gama the buried data of the presentation.xiv

But the hidden danger is that for most of these reps, there is no future in Pharma.xv Pharma cut more jobs than any other private sector industry, about 100k since 2009.

Whatever else you might think about reps, they represent the goal of the nation: young, motivated, college educated workers who want to 401k their future, have families, watch the Super Bowls and not get involved with nonsense.xvi The problem with the nation is that it didn't have any jobs to offer them except Pharma (and similar) jobsxvii. Those jobs don't exist now, and there aren't any other jobs for them.xviii It's one thing to say the poor/uneducated can't find work, it's another thing to say the explicitly desired outcome of this country's social and educational system can't find work.xix The supply is there; but there's no demand. And there's no demand because there's not enough people who create stuff creating stuff which would justify the other jobs.xx

When this occurs, a country has two options. It can support those young people through social services, healthcare, housing and food subsidies, etc -- with steady GDP growth of about 5%; or it can create jobs. The first one is called Egypt.xxi

Let's stick with the Pharma example, though it applies everywhere. If Pharma was creating new drugs, it could justify all these jobs. Now they aren't, so jobs are cut. Create new drugs and everyone's back in business. Ok -- but wrong.

They never were creating new drugsxxii, they were only creating new markets. I realize Zoloft and Lexapro are nominally different drugs, but they are really the same drug, packaged differently: markets were created to sustain both Lexapro and Zoloft; not one market with two products, but a doubling of the market. In a perfect world, Lexapro wouldn't have been invented, they would have worked on something else. But since they knew they could create a market for "another Zoloft," they took the easy route. And they hired a salesforce, accordingly.

While that was good for Lexapro, it's terrible for the country. Temporarily -- and ten years is temporary -- hiring all these people to essentially duplicate efforts cannibalizes resources from other industries.xxiii All of those reps might have done something else, back when they were young enough to do something else. You might say it's not for me to judge whether being a rep is more valuable to society than being, say, an engineer. I agree, that is not my place to judge, the market can do that; but it is the responsibility of the nation's administrators to decide what they want for their 18 year investment. And if they want more engineers, entrepreneurs, creators, they have to incentivize thatxxiv, and de-incentivize other choices. And if Pharma is offering $60k + benefits, the country's got to come up with something better.

Here's an example: Pharma offers 401k with matching benefits. The government, if it wants to use stimulus money the right way, could offer college grads who go into jobs the country wants (e.g. engineering) a matching pension.xxv In 2009, $50B worth of school loans were in defaultxxvi). If you spent only $10B a year on grants to pay for e.g., engineering, you could get 200k engineers through college. Etc.xxvii And many people who are already employed would love a way to fund side projectsxxviii, in essence doubling the output of a single person.

The chief predictor (actually, the only predictor) of suicide is hopelessness. A person can withstand all manner of attacks and traumas, but if you take away hope all bets are off. When the hopelessness becomes endemic, it looks like this:

———Holy shit-fuck this idiocy. Ugly women are a protected class ? Burn it all down. [↩]Must suck to be a doctor in the zone by now. [↩]Definitionally, a 40yo who experiences "guilt" over seeing a female as a sex object is going to have very little "sexual power". [↩]No, actually, that's the fantasy throughout the world. Not the practice, no, but the fantasy. [↩]No dude, the fantasy is that she's mom, except the aliens came and laid eggs in her nape and now she's a) much less threatening and b) ready to please. [↩]People who are interested in this fuck pornstars, which work exactly as described. [↩]That's not a woman, that's a girl, and the seductive part is that in spite of being a girl, she's figured things out. Nothing restores one's faith in humanity quite like a young woman that's nevertheless not entirely fucking stupid ; and nobody has so much room for some restoration of said faith as people with some experience of the world. [↩]No, not for "the story". It's the story of something, and that something is her duty. She sleeps with the dude for her womanly duty, and the story of her having done it. [↩]This is total fucking bullshit. Women like people on the basis of enjoying sex with them. This isn't saying that their enjoyment of the sex "itself" is the driver of the wider behaviour, but that the root node is the same for both and sex is closer to it.

And before you start with "no, they like their children" -- every mother in the history of the species has had sex with each of her children at least once, as per the definition of the fucking terms. See ? Nice and stretchy, too! Also exactly what I said above, "women like people on the basis of enjoying sex with them". Now, what is it that you do you not want to see, and why don't you wish to see it ? [↩]"Nurse practitioner" sounds like a cop-out, "not-really-nurse", "technically-nurse", like a nurse GED. This is never hot because if she were hot, nobody'd add the qualification, it'd be implied. "Surgical nurse" sounds merely kinky, the latex gloves and surgical steel tooling crowd out the bee-bop imagery. [↩]"Drug rep" is not a job, it's a femoccupation, like "student" or "tavern wench". By very fucking definition femoccupations are fetishizing (not fetishized, fetishizing. [↩]Young women (that aren't completely braindead) are always to be found in the same one position : in the way [of young men of means]. [↩]Not anymore ; those days are long gone, and were gone a decade ago also. [↩]Doctorhood sure went downhill, huh. [↩]Wtf "future". These girls are receptionists, give or take. The plan is to dress from Zara until marriage, that's the only future. [↩]What does the author... [↩]A "service economy" is the theory we'll claw our way to prosperity by doing each other's laundry.

Worked so perfectly well for Argentina, to... [↩]That's okay, girls that "hot" are also magically rich enough to afford going to restaurants with people they like, so they'll probably pull the country right back out of the hole.

Oh, wait... [↩]The 20-something chicks that could speak French in communist Romania were lookin for the exact sort of "work" : outfangwif for some dominant male somewhere. This is work, yes, but eminently not in the sense contemplated here, it's republican work, not imperial "work". [↩]No, actually, there's no demand because for each 1%-er spot opened in the hierarchy ten thousand 10%-er spots were destroyed, and the dumb cunts are vehehehery slow to catch on and adapt their strategies to the new realities.

Not that slow, though -- by now most girls coming of age now are rather into poly/BDSM/sanity than "marriage". It does leave a whole cohort now nearing 40 out in the cold, but you know what ? Tough titty, and fuck them. [↩]No. Nothing in the US can be called anything in the old world, for very good reasons. [↩]How the fuck are you even going to "create" new drugs, it's like pretending to create "new" music. What the fuck is that, new music ? Zee Germans already did it all. [↩]What fucking "industries" ? There's no industry left, and that aside, the only remaining activity is wank. [↩]Get off it, there's no incentivizing science. [↩]Why, so all the parasites could write "engineer" on their door, in the same crayon they use now ? [↩]By now, it's all of them, while everyone gleefully pretends not to notice. (Not even kidding -- last time it was even reported it was >1 trillion, covering ~10 million cases, back in 2014. For comparison, the total amount of school debt is about 2 trillion, aka 8% of USG GDP. [↩]What does the author... ahahahahahhaha [↩]Top keks. Ballas can be such a fucking lulzcow. [↩]

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Thursday, 25 July, Year 11 d.Tr.

thelastpsychiatrist.com - Ara Abrahamian Wins Award For Medal Toss, Saved By Passport. Adnotated.

Between 1am and 9am, a previous 2 paragraph version of this post managed to offend Swedes, Armenians, wrestlers, the Olympics, bronze medals and mats.

In the interest of completeness, I will this time include the French.

Background: Ara Abrahamian, Swedish wrestler, wins the bronze/loses the gold. At the podium, he steps down, tosses the medal on the mat, and says, "this medal means nothing to me. I wanted gold."

That's Roget's antonym for sportsmanship. Because competitions are so clear--winner/loser -- you're supposed to reserve your emotions. I'm not saying you have to be the Charioteer of Delphi if you win, but tossing your medal on the mat when you lose is a definite no.

I am told that he was robbed, that the judges didn't make just a bad call, but purposely made a bad call. I believe you. You don't need to convince me that Olympic judges border on corrupt, are susceptible to bribes or even petty personality/nationality controversies.

But that fact makes his behavior worse, not understandable. That's the point of sportsmanship. We know you were robbed, tossing the medal doesn't support your case; Better if he quietly taken the bronze, noble in the eyes of the world.i

Because if we didn't think you were robbed, we'd just think you were a jerk.ii

To illustrate this, imagine if this guy was American. The world would completely lose their marbles. "Did you see that fucking American!" would be all anyone would say about Beijing 2008 -- and that would just be coming from the Americans!

The Swedish wrestler had to be restrained by team-mates earlier as a row erupted with judges over the decision...

Can you imagine what would have happened if an American wrestler went at the judges?

Which brings me to the French. Michael Phelps decided "eat, sleep, swim" would be his tagline, and without reading too much into it, maybe it signifies an individual devotion to self-improvement in the service of himself/team/country. But when the French choose, "we will bury the Americans" -- is that a bit broad? Even "we will bury Michael Phelps" makes more sense, since he actually is their enemy, but "the Americans" actually aren't.

Flip it: imagine Phelps had said, "I will bury the French." If he actually wins, people will just dismiss him as an arrogant American who should have drowned. And if he loses, how did saying that help him? It makes him look, well, French. And that's all anyone would talk about, those arrogant Americans.

You will observe that no one, anywhere, is writing that the French team were a bunch of arrogant losers who got, as they say, pwned. That's a double standard, yo.

So Abrahamian was saved by a Swedish passport. Because he's Swedish, he doesn't carry any other baggage -- his tantrum only reflects on him and the judges. An American wrestler who tosses a medal would be General Assembly level outrage.iii

Especially if the American wrestler was robbed. Somehow, people would see it as a sort of justice, yeah, he was robbed but see how he's acting? He doesn't deserve to win anyway, he doesn't represent the spirit of the games, those Americans think they can do and have whatever they want.

"It's all politics," said Swedish coach Leo Myllari.

You said it, brother. People working out their grievances in ways and in forums that have nothing to do with either the way or the forum, and so creating new grievances. The judges, I'm sure, thought they were righting some social/personal/political wrong through the medium of point deductions; the French were voicing the cultural hopes of the world; all under the unfortunate maxim of the powerless: there is no justice, get justice however you can get it.iv

———In the eyes of what world ?

That integrated world where justice works correctly (meaning : systematically oppresses the many for the benefit of the chosen) and therefore the submission of the inferior is a badge of propriety and honor for them, because the chosen like to (orally) pay tribute to they willing to sacrifice themselves to maintain the working of a world that's not at all theirs... well... that world is gone. Yes, back in those days, when one of the redskins showed helpful restraint in the face of being raped by Euros, that redskin'd be also praised by old Euro women. Pour encourager les autres.

But in the disintegrated world where the inferior feel themselves more or less equal to the chosen (it doesn't matter that they aren't, nor does it matter they regularly get painfully stomped for their failure to understand their actual position -- all that matters is their failing to understand their actual position, that's the criterion), nobody's in a position to extend one whit of credit, and so there's no benefit that associates with the earlier heroics, there's nobody there in whose eyes "taking it in the ass like a champ" could possibly accrue any credit. It's not surprising the sharperst among the inferior sooner or later figure out "noble" doesn't pay anything, or rather, that there is no "world" in whose "eyes", and start throwing their medals on the mat -- or rather, start only "validating" those events/phenomena/histories where they get the gold medal. Which yes, is directly derealization, and which yes, spells doom for everyone. But what can you do? [↩]Question : what does the author wish to be true ?

Answer : That there is a "we". [↩]Yeah, well, a certain criminal organisation has been building towards this result for decades. Where were you then ? [↩]You said it, brother. [↩]

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Thursday, 25 July, Year 11 d.Tr.