Do you know someone who would like to vote their values in choosing a presidential candidate but is unsure who best represents them? Send them here. First, you clarify the relative importance of various issues by distributing points among them. Then you specify where you stand on the issues by taking a short quiz. The site will tell you how congruent to your priorities and viewpoints those of a given candidate are. There are quotes and video links typifying each candidate’s position on each issue. You can slice and dice it any way you like, by candidate across issues or by issue across candidates.

The last post to which more than one comment was entered was this, more than two weeks ago. And that was only two comments. You must go back several days further for any more of a conversation in response to one of my posts.

The vulnerable died more often than the hale and hearty. we learn. What in the world is the least bit surprising about that? (Yahoo! News)

I often think of New Year’s resolutions as frontal assaults on one’s stuck points or failings. That may be why they rarely work and people generally do not stick to their resolutions. Better to approach things obliquely when you are stuck. Brian Eno and Peter Schmidt’s oracular Oblique Strategies cards have long been a powerful way to do so, and can lead to some pretty powerful resolutions. You can get a new oblique aphorism every time you reload this page.

Kottke discusses why the Patriots should lose the Superbowl, to avoid becoming boring and to embody the ennobling tragic flaw. I am not much of a football fan but, living in Boston this season, I have to play one. And I have been saying essentially the same thing kottke says. As the season has progressed I have become fond of tweaking the noses of the ‘real’ football fans I find myself among with scurrilous comments about how the games are not worth watching because the outcome has not really been in question.

I was pointed to this article by kottke, who comments that, if he ever thought he was a multitasker, he was disabused of the notion after he had a child. My wife said the same thing after our son was born. Even going out to ‘kid-friendly’ social occasions was no fun for her, because of the stress associated with dividing her attention as called for when you care about paying attention to your child. That sounds like what is being described above. On the other hand, I was never distressed in those and similar situations. Clearly, some parents can socialize without dividing their attention… by ignoring their child’s interruptions of ‘adult conversation.’ But I never felt that was my story. Whenever the neuroscientists describe generalize about how ‘people’ do such and such a task, I always append the word ‘typically’. There is a spectrum of ability and dysfunction. Some people are better multitaskers than others. As I am sitting here writing that sentence, I am simultaneously thinking that it is not earthshattering news; indeed, it is probably a truism.

There is probably nothing special about the capacity of multitasking to “wear down our system through biochemical friction.” Readers of FmH will know I refer from time to time to the emerging understanding that stress hormones mediate actual tissue damage in the CNS, whatever the source of the stress. If multitasking is stressful or depressing to you, the demand to do it will wear you down. If you are more successful at it and not as stressed out, it will not wear you down, or not as much.

Certainly, in a modern world in which multitasking demands impinge on us more, vulnerabilities which exist in the population will be brought out. A new sort of selective pressure is being brought to bear on mental fitness. But I think the more significant finding of the research described above is the conclusion that multitasking demands we concentrate on the act of concentration rather than the content of the task, i.e. shifting activity from the hippocampus (which places significance on experiences and facilitates their storage in memory) to the striatum. But wait a minute. Is it necessarily a dire outcome if we do more things by rote in a world which enforces certain rote routines on us? It seems to me the key to successful multitasking is being strategic in picking which tasks you multitask at. It is simple — multitask at the rote tasks. But this is no new insight and it did not take functional MRI to tell us — there are certain tasks you must do with heart and attention and others you can do by rote, and you must take care to choose wisely. A simple example — someone can always tell, talking to me on the phone, if I have a computer screen open in front of me and am dividing my attention between reading and talking. It takes some care not to let the onscreen material be compelling and steal my attention at the moment I should be giving my heart to the person to whom I am talking. I have to look away from the screen or close my eyes.

One of the absurdities of the current romance with the reductionist concept of attention deficit disorder is that the control of attention is a complex multifaceted process with many parameters and many ways to be deficient. We have to sustain our attention, focus it, avoid distractions, shift flexibly on demand but not shift too much. We have to restore our attentional focus after falling victim to distraction. We have to modulate the depth and breadth of our attention. We need the ability for unfocused mindfulness. Each of these aspects of the attentional process is mediated by different neural circuitry.

Being better or worse at multitasking — dividing our attention — is only one of the ways to be better or worse at control of attention. For example, much of what passes for skill at sharing simultaneous attention among multiple tasks may really be skill at timeslicing, rapidly shifting. Or prioritizing the relative importance of foreground and background attention. Or balancing the focus and the unfocus.

Another factor in the stress imposed by multitasking may be not the challenge to neurocognitive control processes but to our self-presentation and self-integration. There are subtle or not-so-subtle influences to bring different personas to different tasks, especially when we interact remotely across electronic media. People have vastly different capacities to inhabit, balance and shift among different facets of their personality. At one extreme are those chameleonic individuals who reshape themselves in response to the demands of whatever context in which they find themselves; at the opposite extreme, those people who seem ‘themselves’ consistently across all contexts. The modulation and control of persona is, analogously, as complex and diverse as that of attention. The presentation of self in everyday life, to use Goffman’s term (1959), can either be comfortable or impose tremendous stress on the performer.

But is it really ‘wiring problems’ which underlie such disorders?

Related? Misreading the Mind

Jonah Lehrer, author of Proust Was a Neuroscientist, argues against neuroreductionism. How can we get beyond the fact that modern neuroscience is in the process of throwing out the only reality that we know, the ghost in the machine of the self? (Los Angeles Times op-ed)

[Warning: this piece strays, by the end, quite far from mystery…]

There is new case law that says so. A novelist living in Devon has just won a large settlement award for a claim that, brain-damaged by toxic fumes, she became unable to finish a ‘serious’ novel and instead turned to writing crime fiction. This happens just as the barriers between ‘literary’ and ‘populist’ fiction appear to be breaking down. I came upon this Guardian article because I have a standing Google alert set up for new references to Ian Rankin, Scottish writer of police procedurals who is mentioned in the lede of the essay and whose work I enjoy as much as any ‘serious’ fiction I read. If the major distinction is the relatively greater emphasis on plot, then perhaps I do not read any serious literature at all any more, as I look for a thumpin’ good story in most of the literature I read.

Many psychiatrists and therapists are aficionados of mysteries. I have considered several explanations for that. For one thing, mystery writers are in the habit of looking unflinchingly iinto the dark recesses of the soul, as do mental health professionals. When I was in training, one of my supervisors, Les Havens, a brilliant and iconoclastic psychiatrist on whose every word I hung as if it was the gospel, once told me that John Le Carré was one of the most insightful analysts of character who had ever written, and I’ve devoured Le Carré ever since.

But, for another thing, after a day at the office many a therapist tires of thinking only about character and thirsts for something with a storyline. This is especially true of stories that have a satisfying outcome, which I sometimes feel we do not see that often in my line of work. Patients with major mental illnesses often remain static, the things that do not work about their lives unchanging, with few resolutions and only minor improvements despite considerable and repetitive struggle. When one works with the severely mentally ill, it seems to me on many days that it is about helping them and their loved ones in bearing what cannot change rather than changing what cannot be borne. But, ah, a story with tension, a climax, and resolution….

For most psychiatrists, science fiction does not have an appeal comparable to mysteries, but I have been an aficionado of that genre as well. (Few psychiatrist are as geeky as I have become, I suspect…) I have a Google alert set for Neal Stephenson as well as Rankin. Stephenson, incidentally, might consider himself as much a genre-bender as Rankin. Can one really say, with his Baroque Cycle, that he is still writing science fiction? For that matter, can one say that of William Gibson’s recent work? I have always paid attention to the ways in which social context causes, or contributes to, my patients’ psychiatric distress. Speculative fiction often turns on the extrapolation of social trends to extreme and/or surprising conclusions. That, more than ‘hard’ science fiction revolving merely around scientific or technological extrapolation, has always appealed to me, although it is a truism to say that technological trends are major shapers of social trends.

As for my geekiness, my involvement with computing, I find the appeal to a mental health professional clear and I have been surprised it is not more broadly shared by my colleagues. When I sit down at my computer desk, I can make a machine do whatever I want it to do in a manner that never happens in interacting with other human beings during my workday. And, if things don’t turn out as I expect with the machine, it is entirely my fault and my approach can be corrected or perfected to gain the expected outcome, my mistake immediately clear. There are alot of “aha!” moments; the sense of mastery is immediate and very satisfying. This is very unlike psychotherapeutic work, which depends on the complex dance of interacting with the subjectivity of another (the I-Thou relationship, as distinct from the I-It relationship, to use Martin Buber’s terminology) and where, I might argue, mastery is never a word one would use except in a cocky sense.

This appeal of mechanistic success, which I get out of ordering a computer around, may be what drives some psychiatrists to psychopharmacology, in the illusion that it is more definitive and that results come more rapidly than any of the other more murky facets of mental health work. But, I would argue, the satisfaction from mechanistic psychopharmacology in isolation is usually ill-founded and transient, and people are mistaken if they think pushing pills is treating people with mental illnesses. One of the best, least mechanistic, psychopharmacologists I knew fulfilled himself in his off-hours with sculptural metal welding, and another with wooden boat building. Hmmm. Maybe more mental health folks ought to take up a technological pursuit, so that they do not have to be so mechanistic with their psychiatric patients.

What we know and what we remember are both clearly part of the memory system but a new study demonstrates they are mediated differently neuropsychologically. (Cognitive Daily)

Thanks to Walker for pointing me toward this essay by Sarah Boxer, which purports to explain blogs and blogging to New York Review of Books readers (as if most of them were unfamiliar with the medium, which I doubt). I don’t know who Boxer is, but her cred for this piece seems to be based on the fact that she was given a “dreadful idea for a book: create an anthology of blogs” two years ago. Could this have been her first serious acquaintanceship with the weblogging world? From this piece, it appears so. And a rather undiscriminating acquaintanceship it turns out to have become.

She agonizes over whether there is a distinctive blogging style of writing (duh); trumpets the assertion that the medium is different from journalism (a conceit the weblogging world got finished discussing several years ago); and seems to have a difficult time with the essential nature of hyperlinking and the fact that the experience of reading a weblog does not stay within the boundaries of the page as she claims is the case with other reading experiences. I don’t know about her, but my mind travels widely and freely, hyperlinks or not, when I read a book or a newspaper article as well. In fact, sometimes I have worried that the hyperlinking medium constrains and channels extensibility too much, rather than facilitating it.

She also makes much of the red herring (or is it straw man?) issue that many of the references she finds in weblog entries are elliptical. She complains that she feels left out because the weblog writers she’s been reading assume their readers are in the know, that you cannot read them successfully if you are not in the inner circle. With this concern she reveals her failure to grasp the central populist revolution of webcentric communication, the ability to remain viable even with incredibly balkanized audiences. (She also complains that bloggers seem to rely on the fact that their readers can get background on references with which they are unfamiliar by googling!) I have often concluded that the only people who read FmH when in profound disagreement with, or ignorance of, my values or premises are those who enjoy being contentious or compelled to demonstrate their ignorance. For better or worse, a thoughtful essay about the weblogging medium would continue to grapple with whether this balkanization and atomization is good for intellectual life at all. Although clearly new media have added potential to human communication, readers of FmH know that I have been troubled about the indubitable breakdown of discourse between people who disagree throughout our society. One needs to struggle with the ways in which this is being shaped by our changing media of communication, including but not restricted to weblogging and the net as a whole. But this is not where Boxer is going at all.Her concerns would make sense to me if she came right out and confirmed that she is discomforted by new media and yearns nostalgically to salve her anomie by returning to the days before the web added possibilities to written communication at all. But this woman was given a book contract to write about blogging!

One of Boxer’s core observation seems to be more insightful, although it is far from original to her:

Because she is essentially unfamiliar with the weblogging world either longitudinally or in breadth, she takes every generalization for the rule. Of course, if she reads indiscriminately, she will come upon a preponderance of vapid bloggers concerned with getting noticed and little else. Most serious consumers of the medium (and I would hasten to include my FmH reades in that category) stick with the relatively smaller proportion of sites which say something to them. And that is really no different than any other medium of human interaction. Do we dismiss literature, film, journalism, music, the visual arts, or what have you because of the distasteful attention-seekers that occupy a proportion of their space? We either stay shallow and worship in the cult of celebrity, or get beyond it to find some more enduring value in the medium.

Because she takes the part for the whole, she can get away with assertions like this:

This ignores the webloggers of integrity who make it clear exactly who they are and express transparently the values they inhabit in their life. Writers or artists can hide behind a medium or express themselves through it, and, again, the audience of any particular weblog self-selects. By their choices, readers get the weblog content they deserve. Boxer’s conclusions from her reading choices suggest that, yes, she has gotten exactly what she deserves. She thinks she’s characterizing the weblogging world, but what she writes really has much more to say about herself. Consider:

A certain proportion of what I read in the NYRB impresses and inspires me. I have no patience for another proportion of its content, because of its tortured logic and the irrelevance of its erudition or pseudoprofundity. This is the rare NYRB piece utterly dismissible for its illogic, its lack of erudition and its failure to aspire to even the pseudo– level of profundity.

One can only hope…

Surely someone has had a genuine midlife crisis?? “Why do we have to label a common reaction of the male species to one of life’s challenges — the boredom of the routine — as a crisis? True, men are generally more novelty-seeking than women, but they certainly can decide what they do with their impulses.” (International Herald Tribune)

Why Can’t Environmentalism Be Colorblind? (Orion)

Robert M. Sapolsky: “Anyone who says peace is not part of human nature knows too little about primates, including ourselves.” (Greater Good)

“The entire surface of the planet is inevitably going to be a human artifact.” (Science Musings)

Burning biofuels may be worse than coal and oil, say experts: “Scientists point to cost in biodiversity and farmland…” (Guardian.UK)

A philosopher reviews Christopher Lane’s Shyness. It is provocative but it fails, he says, in its attempt to make a case against social phobia as a diagnostic construct and to impeach the current system of psychiatric diagnosis embodied in the DSM (Diagnostic and Statistical Manual). (Metapsychology Online Reviews)

An expert on robots takes today’s advances in computer software and processing speeds to its inevitable conclusion.

This is just another example of correlation not being causation. A certain number of correlations will occur by chance. I am more interested in another sort of nominative determinism — anecdotal cases of people’s names being suited to their roles in life. This was popularized by New Scientist in its back pages. The best case of this I ever ran across personally was when I went to a psychiatric conference concerning violence, whose three keynote speakers were Schouten, Swearingen and Blood. Honest.

“Sometimes the sky itself is the best show in town.” (Astronomy Picture of the Day)

2007 Atlanta Photojournalism Seminar Contest Winners

Could Congress possibly be as gullible again?

‘The U.S. has dropped $10 billion into Pakistani dictator Pervez Musharraf’s lap — much of it in cash. Allegedly, that’s to fight the jihadists in his country and across his border. But,

Terrible title but important issue: “Arrogant doctors criticize their patients who go online to research ailments. But they’re wrong. The best health sites are a boon to patients and doctors alike.

…

A 2004 study showed that almost two-thirds of patients would like to have Internet information provided to them by their doctor. In contrast, a 2001 study of doctors showed that barely half of them encouraged their patients to go online (although the trend has been increasing over time), and 80 percent actually warned them against doing so.

In one regard, this is simply bad business. Pew tells us that patients either fire doctors unwilling to help them with the Web or keep going online without telling them. More important, when patients do venture online themselves, they can sink into a swamp of outdated medical studies, confront a lot of misinformation, and risk creating a rift in the doctor-patient relationship.” (Salon) I’m not sure arrogance exactly captures it. Certainly, there are insufferably arrogant MDs, but I am not sure they are those most threatened by their patient’s use of Google. Insecurity is more to teh point. The old model of the medical profession as an esoteric priesthood guarding secret knowledge should have long since given way to a collaborative model empowering patients, but many physicians do not realize it.

“Women voters rallied en masse for her — but she has run as a stereotypical male and represents the same old cowardly Clintonian politics.” Frances Kissling is a 2007-2008 Fellow at the Radcliffe Institute for Advanced Study at Harvard University and the former president of Catholics for a Free Choice. (Salon)

The Financial Times‘ ‘Undercover Economist’ on the psychoeconomics of ordering behavior in restaurants. The bottom line is that the rest of the people around the table strive not to duplciate an order someone else at the table has already chosen; and that the person who orders frist is happiest with their meal.

How Wrong Were The Polls?

Does current lethal injection procedure equal cruel and unusual punishment?

The current method of execution by lethal injection involves three phases. First the prisoner is put to sleep with a powerful barbiturate, then the muscles are paralyzed with pancuronium, and finally the heart is stopped with an infusion of potassium chloride. Opponents argue that if the procedure is botched the victim may be essentially awake and aware, but paralyzed and unable to signify that they are suffering because paralyzed. Under the influence of pancuronium, people can feel as if they are suffocating. The potassium chloride injection can be excruciating, making them feel that their body is on fire. The success of such a complex three-step procedure depends upon its proper execution by medically trained personnel, and opponents argue that there are substantial possibilities for error in the formulation, dosage or administration of the agents. For example, if the intravenous needle misses a vein, the medication will be infused under the skin instead and not circulate through the system. Because no medical personnel are in the death chamber during the procedure, the assurances that it will be done properly cannot be offered.

Veterinarians have long since given up on a similar three-drug procedure for such reasons. When animals large or small are euthanized, they are merely “put to sleep” with massive barbiturate dosages. For those opponents of the current method of execution by lethal injection who are not opponents of execution overall, the adoption of the veterinary one-agent method would meet many of the pending legal challenges to lethal injection. Moving to this procedure has thus been proposed in several states, but none have moved on the proposals. Expressed reluctance is about being an outlyer and first adopter of an untested methodology.

However, I think the real reluctance to abandoning the three-substance method of lethal injection is all about how unpleasant it is to watch a dying body twitch and convulse if it is not paralyzed first. Proponents concede it would be very difficult for those who witness executions otherwise. In essence, we are protecting observers from the inherent barbarity of humans putting other humans to death with a veneer of civility achieved through the use of pancuronium. Absurdly, as long as it is not like “putting down” an animal, as long as it appears peaceful and undistressing, we as members of society can console ourselves that we are not complicit with “cruel and unusual punishment”.

Some of the most bloodthirsty, vengeful proponents of the death penalty have it right in a sense, arguing that it is absurd to be so concerned about the suffering of someone you are putting to death in another few moments. At least this constitutes a recognition of the inherent barbarity, which the rest of the advocates of execution are comfortably able to ignore.

The James Randi Educational Foundation (JREF)‘s offer of a million dollars to anyone who can demonstrate psychic powers under rigorously controlled observation has gone unclaimed for a decade. Now, they have announced that they will withdraw the prize offer in two years, I guess feeling as if twelve years would have been enough for soemone to come up with something credible. So hurry up and get your demonstration developed!

Does current lethal injection procedure equal cruel and unusual punishment?

The current method of execution by lethal injection involves three phases. First the prisoner is put to sleep with a powerful barbiturate, then the muscles are paralyzed with pancuronium, and finally the heart is stopped with an infusion of potassium chloride. Opponents argue that if the procedure is botched the victim may be essentially awake and aware, but paralyzed and unable to signify that they are suffering because paralyzed. Under the influence of pancuronium, people can feel as if they are suffocating. The potassium chloride injection can be excruciating, making them feel that their body is on fire. The success of such a complex three-step procedure depends upon its proper execution by medically trained personnel, and opponents argue that there are substantial possibilities for error in the formulation, dosage or administration of the agents. For example, if the intravenous needle misses a vein, the medication will be infused under the skin instead and not circulate through the system. Because no medical personnel are in the death chamber during the procedure, the assurances that it will be done properly cannot be offered.

Veterinarians have long since given up on a similar three-drug procedure for such reasons. When animals large or small are euthanized, they are merely “put to sleep” with massive barbiturate dosages. For those opponents of the current method of execution by lethal injection who are not opponents of execution overall, the adoption of the veterinary one-agent method would meet many of the pending legal challenges to lethal injection. Moving to this procedure has thus been proposed in several states, but none have moved on the proposals. Expressed reluctance is about being an outlyer and first adopter of an untested methodology.

However, I think the real reluctance to abandoning the three-substance method of lethal injection is all about how unpleasant it is to watch a dying body twitch and convulse if it is not paralyzed first. Proponents concede it would be very difficult for those who witness executions otherwise. In essence, we are protecting observers from the inherent barbarity of humans putting other humans to death with a veneer of civility achieved through the use of pancuronium. Absurdly, as long as it is not like “putting down” an animal, as long as it appears peaceful and undistressing, we as members of society can console ourselves that we are not complicit with “cruel and unusual punishment”.

Some of the most bloodthirsty, vengeful proponents of the death penalty have it right in a sense, arguing that it is absurd to be so concerned about the suffering of someone you are putting to death in another few moments. At least this constitutes a recognition of the inherent barbarity, which the rest of the advocates of execution are comfortably able to ignore.

Top 49 entries.

My practice group and I have a policy of taking no free samples (indeed, not accepting visits from pharmaceutical representatives). From time to time I have toyed with the idea of receiving samples and creating a stockpile expressly for the indigent, but it still serves the interests of Big Pharma, facilitating the creation of a new customer they hope will remain a captive audience when their physician can no longer provide the medication for free. And, because samples are of the latest greatest medications, they are also the most expensive. We do a service for our patients when we resist the hype about the newest drugs, which are usually no better than old standby agents available generically or at least priced much more reasonably. This is true regardless of the patient’s prescription drug insurance or their ability to afford expensive medications.

Your responsibility as a patient is to question your prescriber’s reasoning in prescribing the latest and greatest rather than an old standby. S/he ought to be able to explain convincingly why the newer (more expensive) medication is worth the extra cost; otherwise, tell them the responsible thing to do would be to prescribe the medication that is less profitable for the manufacturer.

From (//STATiC). I don’t know by whose criteria these are “best”, but there are some incredible, arresting and disturbing images here.

Replication of a famous Stanley Milgrim experiment in social psychology, which turned out to be far harder for the investigators than the subjects. (New York Times )

Notable Deaths of 2007 (New York Times)

Thanks to Boing Boing, a mashup of the Billboard top 25 songs of 2007, to stream or download. (DJ Earworm) I love mashups; the essence of artistic bricolage. In this case, I wish the artist had had better material to work with in the first place, but considering that it is not half-bad.

“The Trackstick II is the perfect fit for personal GPS tracking. Bring it on vacation to keep a satellite scrapbook of all your travels and record your explorations. You can carry it along on all your regular outings from home to get a better sense of your daily surroundings through Google™ Earth’s cohesive 3D maps of your community. With Trackstick II™ a computer screen can guide your family and friends on a virtual tour of your vacation. Take it fishing and mark the catch spots to discover feeding patterns over time. Find a good camping spot and leave it to Trackstick to remember where it is and the path you took to get there. It’s a fun and immersive way to show others where you’ve been. You’ll even enjoy seeing the normal routes of your day breathe new life as you view them like never before with Google™ Earth’s 3D model of the planet.”

It is worth noting that the other hot topic in post-stimulants, modafinil, is also thought to work through the orexin system.

As FmH readers will recognize, I have long considered the War on Terror to be a brand name, which I have signified by referring to it as ‘WoT®’. I guess the brand is just not selling in the UK anymore. I predict the US s well will rebrand its antiterrorism efforts aunder the next, Democratic, administration.

Journal of parapolitics, intelligence and State Research: “Lobster was first published in 1983. It investigates state espionage, government conspiracies, the abuse of governmental power, and the influence of the intelligence and security agencies on contemporary history and politics.

If you generally accept the government line, that there is a ‘national interest’, and believe what you read in the newspapers, then Lobster is probably not for you.” Originating in the UK, Lobster, requires a paid subscription, but there are a number of free articles to whet your appetite at the site.

Rummaging in the Governments attic makes available “materials unavailable elsewhere”, obtained via the Freedom of Information Act.

And Get My FBI File “helps you generate the letters you need to send to the FBI to get a copy of your own FBI file. We can help you get your files from other “three-letter agencies” (CIA, NSA, DIA, …) too. It’s quick, it’s easy, and best of all, it’s free!”

I was assked to write an “Ask the Doctor” newspaper column in my community in response to a reader question about whether there really is such a thing as “Winter Blues.” Here is my first draft of a response. What do you think?

For millennia, humans have reacted with discomfort to the waning of the light and the shortening of the days as we slide into winter each year. It is no accident that many, if not most, cultures have a celebration of rebirth and affirmation of hope around the winter solstice. When we lived closer to nature, there was arguably nothing wrong with ramping down, reducing activity and conserving energy and resources to get through the cold dark nights, to which one writer has referred as “winterizing the soul”. Even if not an annual event for most people, the “winter blues” are common – and distressing. Going to ground, slowing down the pace and enjoying quietude can cause tensions in a modern non-agrarian society that expects activity, outwardness and productivity with no regard to seasonal rhythms. Beyond the biological factors, of course, the wintertime may be hard for other, strictly emotional reasons. Many people have a difficult time around the holidays, which are supposed to be so warm and congenial for us all but often are anything but.

Beyond just feeling down, however, an estimated 15 million Americans experience a full-blown medical syndrome called seasonal affective disorder (SAD) during the colder, shorter days of winter. Most SAD sufferers experience normal mental health through much of the year but experience wintertime symptoms including depression, social withdrawal, excessive sleeping, overeating and weight gain, difficulty with motivation and energy and problems taking care of themselves and those for whom they are responsible . SAD may be severe enough to require psychiatric hospitalization. Women tend to report the condition far more than men, reflecting either hormonal issues or men’s greater reluctance to admit to feeling down.

Seasonal mood variations are believed to be biologically related to decreased light exposure. They vary with the latitude, with higher incidence in the Scandinavian countries and Arctic regions, and also with the typical degree of cloud cover in an area’s climate. Many sufferers can extinguish their symptoms with lifestyle measures such as increased exercise and outdoor activity, especially on sunny days. Light therapy, with specially designed lights many times brighter than normal indoor lighting, is perhaps the most effective specific treatment. Many patients, however, stop the treatment because of the inconvenience, since they must sit close to the light with their eyes open for 30-60 minutes at a consistent time of day each day. Benefits are often apparent only after several weeks. Many antidepressants have also been shown to be beneficial in serious SAD symptoms.

The vulnerability to SAD may be at least partly genetic, and it may be genetically related to manic depressive illness (bipolar disorder), as it tends to cluster in the same families. In fact, some psychiatrists consider SAD (as well as postpartum and perimenstrual mood disorders in women) to be a form of bipolar disorder, which may lead to treatment with lithium or other mood stabilizers.

Stephen Zunes is the Foreign Policy In Focus Middle East editor. He is a professor of politics at the University of San Francisco and the author of Tinderbox: U.S. Middle East Policy and the Roots of Terrorism (Common Courage Press, 2003).

Everyone knows that mentally ill patients who meet certain criteria can be committed involuntarily to psychiatric hospitals. But is outpatient commitment an idea with a future?

Make this a New Year’s resolution?

Helping Her Children Transcend the Intense, Unpredictable, and Volatile Relationship: This book, by Christine Ann Lawson, prompted my thinking when it appeared on another behavioral health practitioner‘s best-of-2007 list. In my own career, grappling with the borderline concept has been a crucial and controversial struggle. I am convinced that the borderline personality structure is a pervasive condition of our time and a hidden cause of much suffering. Ironically, there is a taboo more powerful than nearly any other against discussing it openly in mental health fields. This is because diagnosing someone with the disorder has come to be seen as pejorative and clinically useless. One esteemed American psychiatrist gave a talk to new trainees that was all the rage on the grand rounds circuits for awhile, titled something like “The Beginning of Wisdom: Stop Diagnosing Your Patients as Borderline.” I emphatically disagree, and give the name to the thing whenever I see it, often met with embarrassed silence from colleagues. I will not say they are always merely politically correct and wrong to be uncomfortable, but that is often the case.

A recurrent theme here in FmH, it is true, is the damage that incorrect diagnosis can cause, but let us not throw the baby out with the bathwater. The reason to be apprehensive when diagnosing someone with this seemingly pejorative term is that it is often done in a knee-jerk fashion, based only on our feeling averse or hateful toward a patient who paralyzes us with their neediness, offends us with their manipulativeness, and stings us with their rage. All of these are attributes of the borderline, and in the craft of mental health we must use ourselves as a diagnostic instrument and our reactions to people as evidence about them… but only if we are clear about what it is that they bring to an interaction and what it is that we bring. If we diagnose only on the basis of our gut-level reactions to a patient, we are always vulnerable to the possibility that our slips are showing — that we have revealed only our prejudices and foibles as human beings rather than using our best interpersonal skills as clinicians. We do the latter when we remember to diagnose and formulate our patients in a responsible and systematic way, employing but also transcending our gut-reactions.

Here are diagnostic criteria for the boderline personality disorder, from the ‘bible’ of psychiatric diagnostics, the DSM-IV of the American Psychiatric Association:

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

(1) frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

(2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

(3) identity disturbance: markedly and persistently unstable self-image of sense of self

(4) impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

(5) recurrent suicidal behaviors, gestures, or threats, or self-mutilating behavior

(6) affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)

(7) chronic feelings of emptiness

(8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

(9) transient, stress-related paranoid ideation or severe dissociative symptoms

So why is the borderline concept important? Patients only come to our attention, and get diagnosed with the disorder, when their pathology is dramatically disturbing to themselves or those around them (usually when criterion 5, self-destructiveness, manifests itself). Modern psychiatric diagnostics are descriptive; they depend on observation of outward manifestations and behaviors, i.e. symptoms. There is a deeper, classical tradition in psychology and psychiatry of formulation, i.e. using the outward manifestations to understand a person’s inward dynamics, the forces that make them do business with the world as they do, the construction of their selves. The diagnostic criteria are only the outward manifestations of a core, damaged, way of being and interacting.

I am convinced that many are walking around with damaged selves in the manner the borderline concept gets at, and that that damage is intimately related to the conditions of modern life which facilitate exploitative, unempathic relationships between people — the erosion of personal freedom, the refinement of authoritarian control by the political and corporate forces dominating us, the atomization of family and community, the loss of contact with our personal and cultural heritages as well as our connection with the natural world and our biological selves, the lost arts of forgiveness and apology in modern life. I am convinced that the borderline way of being is at the root of the self-perpetuating cycle through which damage is done to children by narcissistic childrearing; that children raised that way, in turn, raise their own children in a similar way. This is a central means of understanding and explaining the pervasive and inexorable way in which the victim becomes the perpetrator and the crippling of the capacity for mutuality and empathy in modern relationships. The borderline construction of the self, conceptualized in this broader way, is in many ways at the root of modern violence. The brilliant but largely neglected psychological writer, Alice Miller, campaigned against the damage done by broken childrearing practices in a series of books several decades ago, epitomizing our understanding of these processes. Crucially, she recognized our failure to address these issues as a core betrayal of our children. Similarly, I recognize the political correctness that makes us reluctant to use the borderline concept a core betrayal of our patients.

There are additional reasons the borderline personality disorder diagnosis has been seen as inappropriate and politically incorrect. First, it is particularly susceptible to what we call “medical student syndrome”, in which an inexperienced or fledgling clinician reading a list of diagnostic criteria for a condition easily sees the disorder in themselves or those near and dear to them. Subjectivity needs to be tempered with sophistication to make this call responsibly and accurately. Indeed, the core narcissism of our society damages all our selves, so that there is something there to recognize. But it is complicated to understand the implications and subtleties of the borderline formulation.

Also, the borderline notion as commonly employed is gender-biased, rarely applied to men. It is important to recognize that the effects of narcissistic damage in raising boys manifests differently but no less profoundly. Formulating rather than diagnosing (understanding the inward construction of the self rather than how many descriptive criteria a patient meets) can help us to help our male patients as well.

Taking the effort to help my patients understand the borderline concept would in fact be little more than pejorative if it merely condemned them to going through life with a damaged self. Modern psychiatric medicine, focused almost exclusively on biological factors and quick fixes through pharmacology, offers temporary symptom amelioration at best to someone who is living with the implications of a borderline personality structure. I am not going to make this essay a treatise on borderline treatment, but suffice it to say that many of us who still understand the value of psychodynamic formulation and of healing patients through entering into longer-term instrumental relationships with them, talking with them, know that, with a concerted, informed and careful treatment approach, the borderline state is remediable. It is clear that there is decreasing support for this effort both from within the current paradigm of mental health care and, certainly, from the insurance carriers who manage care delivery through bestowing and withholding reimbursement in accordance with unfair and ill-informed notions of what is worth paying for. To my way of thinking, it is centrally important to my patients to help them to understand and forgive what was done to them and empower them to govern their own behavior differently. And centrally important to empower the current generation of therapists and social critics to continue to subvert the dominant paradigm.