In other schizophrenia-related obituaries, I was saddened to learn that the Schizophrenia Bulletin is phasing itself out. This quarterly journal published by the NIMH since 1969 (ironically, Dr. Holzman was on its advisory board) is unique in combining state-of-the-art review articles on aspects of schizophrenia research and treatment with, in every issue, cover art by a patient with the illness and a first-person account by a person with schizophrenia of the challenges of living with or overcoming aspects of the illness.

The statement from the director of the NIMH explaining the decision to phase out the Bulletin explains that “in this rapidly changing scientific environment it is time to develop communication mechanisms that are equally rapid.” I find this puzzling insofar as the Bulletin is not a vehicle for the latest peer-reviewed and time-sensitive research findings but rather more comprehensive theme-based reviews. Furthermore, it is a conceit to believe one needs to get even the latest research findings as quickly as possible, as opposed to labsorbing them as thoroughly as possible. I do not think it is merely reactionary nostalgia for the way I learned to approach the practice of medicine to lament the obsolescence of the medical journal as a vehicle for medical communication, which is what the authors of this move seems to suggest. When a journal arrives at my doorstep monthly or quarterly, it is a concrete invitation to sit down and get up to date in a way that might not happen with disembodied articles floating out there in the ether. Furthermore, when I read the articles of interest in a journal, I cannot avoid stumbling upon others I would not have suspected would be of interest. This too does not happen as readdily when I read an electronic article. Sad state of affairs…

But then again, readers of FmH will recognize that I have long ranted about the scientific illiteracy of many of my colleagues, so perhaps the medical journal has been obsolete for some time already. Granted, even as a resident I already had a reputation, for which I was both admired and assailed, for keeping up with the literature. I have always distributed articles of significance to my colleagues and students, covertly expecting them to read as well. But most doctors consider themselves “too busy” to keep up with the journals unless they are academics. Unfortunately, that leaves them practicing (in a field where the half-life of knowledge is around — what? — ten years or less) as they did the last time they were up-to-date, which was when they were in their residencies; or updating their knowledge base only by word-of-mouth or with the information provided by the pharmaceutical representatives who visit them. At least in my state, the requirement that a doctor have gotten a certain number of continuing medical education credits in order to renew her/his license is enforced only by the honor system; if you answer “yes” on the renewal application, they believe you. (And if you believe that most doctors who attend medical conferences are there to listen to the lectures, I’ve got a bridge to sell you.)

And let’s not confine this lament merely to the challenge of “keeping up.” How about “getting started”? In my own specialty of psychatry, what proportion of graduating psychiatric residents these days have ever even read any Freud, do you suppose? My guess — less than 10%. (You might argue the irrelevancy of Freudian thinking to modern psychiatric approaches, and I would essentially agree with you; but might not one wish to know one’s lineage, explore the seminal roots of the mysterious field one is in, and reach such a conclusion oneself, perhaps?)

“Here’s how the $144.4 billion for Iraq could have been spent to safeguard Americans.” (New York Timesop-ed)

“A former official in the Nixon, Ford and Reagan administrations and a former British diplomat argue that neo-conservatism is a manifestation of a deeper syndrome that has structural roots in United States history and politics.” (openDemocracy) The core thesis implies that, merely because the Bush administration neo-cons have foundered so badly in orchestrating the invasion of Iraq, we should not assume that their values are finished as a driving force in American foreign policy; indeed, they represent a deep, enduring and recurrent tendency in the American political process. Despite the fact that our Vietnam policy was formulated by the ‘liberal’ Democratic ‘best and brightest’, the authors identify a triad of common features — “the combination of a crusading idealism, an assertion of the universal applicability of American values, and the willingness (indeed eagerness) to use force to back them” — which have in each instance overwhelmed calm and balanced decision-making and allowed special interests to shape the projection of American force without counterbalance. We should take it as a warning sign of recurrent danger of this sort “whenever unchecked special interests within an administration can act on their belief in American exceptionalism, demonise an opponent, and present his position in monolithic terms as a target for destruction”. While the authors’ observation that this pattern transcends partisan ideological differences is a useful one, so is their comment that Republican administrations are more vulnerable to this process because the ‘cosmopolitan globalists’ of the party have given way to ‘America-first populists’ and because of the growing influence of ‘conservative and fundamentalist talk-radio culture.’ I would add that the public’s growing reliance as their primary or sole source of news on broadcast media that inherently do not ask difficult questions of our political leaders makes such hijacking of American policy by jingoist adventurism far easier.

The articulation of this ‘exceptionalist’ ethos, however, should not merely be applied to drawing parallels between Vietnam and Iraq. The proper scale on which to see it operating, I think, is more that of both the Cold War and the War on Terror as a whole, of which Vietnam and Iraq are local manifestations. (While many criticize the invasion of Iraq as a diversion from our proper business of the post-9/11 WoT®, from this perspective the administration’s assertion that it is part and parcel of the larger struggle is truer than they know; it is not Iraq which is ill-advised and poorly formulated, but the WoT® as a whole, since it is driven by the same misguided adventurism.) Those of us who live long enough will likely see the growing competition with China become the overarchng context and preoccupation of US foreign policy, which will manifest the same crusading idealism, projection of force and demonization we have applied to the ‘Communist’ and the ‘Islamic fundamentalist’ demons.(Of course, the authors are unwilling to apply this analysis to the central struggle of the 20th century against Nazi fascism and its allies. As the undisputed modern incarnations of pure evil, it would be difficult to suggest that a similar neo-conservative agenda and its concomitant distortion of the perception of the ‘Kraut’ and ‘Nip’ enemy might have been in play. But might it?)

Sasha Abramsky, writing in The Chronicle of Higher Education, agrees that European loathing for the US is only on the surface about Iraq:

And there’s this:

Ron Reagan may have tried to remain nonpartisan when he spoke at the Democratic Convention (a debatable assertion) but when “…the son of the fortieth president of the United States takes a hard look at the son of the forty-first, (he) does not like what he sees…” (Esquire via Common Dreams)

Ice Cream Sale Goes Sour, Ends in Gunshots

Medical Manufacturer Thinks Breast Implants Ready for Prime Time Advertising

Spanish Thieves Seek to Make Killing with Plundered Haul of Peppers…Literally

The study established no added risk from a flu infection in the second half of pregnancy.

A number of researchers are busy looking at links between viral infection in utero and the development of schizophrenia. For some reason, despite schizophrenia being a fairly common disorder, said to consistently affect approximately 1% of populations across the globe, it has been rarer candidates than the ubiquitous influenze virus that researchers have investigated.

Controversy continues about whether schizophrenia is an inherited or acquired brain disorder, probably because it is both. I think the hypothesis that best fits the observed data is that schizophrenic disease consists of

• a nonfamilial variety in which patients show little or no response to medications, demonstrate fixed deficits and cognitive dysfunction, show suggestions of a seasonal pattern to their birthdates, and show structural brain changes on scanning — this is probably due to a perinatal insult which has disrupted crucial organizing processes of neural tissue in certain brain regions, of which a viral infection is one possible cause
• and a familial variety without changes in brain imaging or neurocognitive functions, and with better medication response.This is the one that involves a “chemical imbalance” in the functioning of various synaptic and neurotransmitter systems, which is exactly the level upon which ‘antipsychotic’ medications act.

As long as two utterly separate diseases are lumped together, significant differences will get washed out of most research studies trying to compare ‘schizophrenics’ with any non-‘schizophrenic’ population.

This bifurcated concept of schizophrenia is of course not original to me, but rather has been put forth by illustrious psychiatric thinkers. Nevertheless, it is astounding to me how thoroughly it is ignored. The bulk of my colleagues persist in speaking of schizophrenic ‘subtypes’ within a unitary disease even though there is little besides historical tradition supporting such a notion.

And while we’re at it, bulk of year’s virus infections pinned to one man. (CNET News)

I suspect this is the last time I am going to post anything about these absurd terror alerts, although I am sure this is not the last time Ridge will dance this jig between now and the election inauguration day. Like others before it, the timing of this alert is too opportune a diversion from the Democratic limelight to be a coincidence. ‘The lady doth protest too much’ with insistent assertions of how credible the threat assessment is. And, as I commented at the time of Ridge’s last contortion about the ‘credible’ al Qaeda threat to ‘disrupt the democratic process’ sometime between then and the election, there is no purpose for these dramatic announcements except to keep the terror issue on everyone’s mind. Since this pitiful president has nothing with which to lay claim to the American voters but his self-professed toughness-on-terrorism (literally the only area in which the pollsters indicate he commands higher ratings than Kerry), and since he and his handlers are sufficiently contemptuous of the American electorate as to be utterly unconcerned about the level of angst they sow in their quest to steal the White House again, expect this pitiful charade to continue fulltilt. It’s all about commodity brand recognition, and once enough has been invested in a branding and marketing strategy, it doesn’t change. I am getting quite a kick out of listening to the ‘person-on-the-street’ interviews with New Yorkers reacting to the ‘threat’. While the BBC commentator to whom I listened characterized their replies as ‘stoical’, what I heard was plain unmitigated perspicacious cynicism.

Addendum: Of course I wrote the above before the news broke that the administration neglected to tell us that it was more than four years ago that al Qaeda cased these buildings. Q.E.D.

Pundits are saying that this is another intelligence failure in the mold of those to which the 9/11 commission report pointed. Let’s be clear that neither in the current instance or in the lead-up to the war was it so much a question of faulty threat assessment by our intelligence analysts as of the disingenuous use of threat data for political purposes by the Bush Cabal. It was clear from its inception that the 9/11 commission would be a whitewash because it examined the generation of threat assessment without a mandate to explore executive branch misuse of the data. The whitewash continues.

In a reverent nod to Emma Goldman, former Republican John Perry Barlow issues a call to discombobulate the RNC in New York with a smart mob of business-suited post-yippies who stage dance attacks among the staid Republicans and then melt back into the crowd. Positively revolting.

“Either he’s crazy, or we’re selfish.” A reader told me that The New Yorker last week profiled Zell Kravinsky, the Pennsylvania professor of Renaissance literature, real estate entrepreneur and philanthropist embroiled in controversy for donating a kidney to a total stranger… and considering donating his other one as well. I cannot find the New Yorker piece online, but this San Francisco Chronicle article from November is the best of the portraits I found online by googling Kravinsky’s name.

Kravinsky has aroused reactions running the gamut from near-beatification to revulsion. When he proposed to donate a kidney to a stranger, with the sole stipulation being that it be to someone poor and black (“No one should have two houses when people were homeless and no one should have two kidneys while others struggled to live without one”), the transplant surgeon had him examined by a psychiatrist “to ensure that he really wanted to do this”, having never encountered a living donor willing to give an organ to an unrelated individual. Kravinsky literally sneaked out of his house to go to the hospital for the procedure, and at the time of the article he and his wife, (also a psychiatrist) who was reportedly angered that his action would prevent one of his children from receiving his kidney if needed (which Kravinsky considers an implausible scenario and an outlandish objection), were estranged. No less a celebrity than Pat Boone, who makes a cause celebre of organ donation, is publicly exhorting Kravisky’s wife to reconcile with this ‘hero’. Others too consider him to be “turning his back on his …young family to fill a personal need” and one columnist called him a “selfish SOB”. Kravinsky appears to answer such objections with homilies (“They say charity begins in the home. I don’t know why it ends at home.”) and a humility that does appear abit labored. Reading about him, one finds oneself less desirous of being in his presence than, say, Albert Schweitzer, who when I was young was the archetypical object of endless consideration of whether someone could be truly altruistic without deriving an egoistic satisfaction from it (or, if it is unavoidable, whether such pride would be in the sinful category).

Kravisky says that, in deference to his family’s objections, he will probably not donate his remaining kidney, having once expressed a hope (again with that somewhat forced modesty) that his death would allow someone who might make an even greater contribution to live. He is looking into donating other organs while he continues to live, which left me with a Buddhist-flavored image of the piece-by-piece dismantling of the self and shedding of the extraneous, melded with the Christian ascetic conceit of the mortification of the flesh. According to the journalist, he seeks to give more and more as a means to a “perfectly moral life” in which he ‘loves everyone’ and is ‘totally good’ and ‘totally self-sacrificing’, which I hope is a caricature of something the writer does not really understand. I look forward to reading the New Yorker piece, which will hopefully have greater psychological depth. (I found myself wihsing I had been the psychiatrist asked to examine him to render an opinion as to his competency to consent to the kidney donation, and grateful I was not the psychiatrist called upon around his hypothetical consent for the second procedure…) Lord help Kravinsky if it is not a caricature; he has much work to do to find an avenue to true humility if so, but the practices of abnegation he is pursuing may be well-suited to getting him there. I wish him well… [thanks, adam]

I’m back. We made a hasty escape from Boston to avoid the DNC craziness. Some backcountry canoeing in northern Maine was just the ticket. Sorry not to have kept up with posting from our campsites!

I’m back. We made a hasty escape from Boston to avoid the DNC craziness. Some backcountry canoeing in northern Maine was just the ticket. Sorry not to have kept up with posting from our campsites!